Watson Y I, Arfken C L, Birge S J
Program on Aging, Jewish Hospital, St. Louis, MO 63110.
J Am Geriatr Soc. 1993 Nov;41(11):1235-40. doi: 10.1111/j.1532-5415.1993.tb07308.x.
To develop a simple, readily administered and scored screening test for dementia utilizing the clock-drawing task.
Retrospective analysis of clock-drawing errors and prospective validations.
Hospital-based outpatient geriatric assessment clinic, rehabilitation service, apartment building for older adults, and long-term care facility.
Convenience sample of patients attending the geriatric assessment clinic, patients on the rehabilitation service, or residents of the above sites.
Sensitivity and specificity of a clock-scoring system in identifying patients with dementia and the comparison of this system with the Short Blessed Test (SBT) in the diagnosis of dementia and in the prospective validation of the test.
Of the 10 clock-drawing errors evaluated, placement of digits in a pre-drawn circle had the greatest sensitivity and specificity in distinguishing patients with irreversible dementia from patients with other disorders who did not meet NINCDS-ADRDA criteria for probable dementia. The derived scoring system had a sensitivity of 87% and a specificity of 82%, compared with a sensitivity of 82% and a specificity of 88% for the SBT in identifying dementia. Test-retest reliability for the distinction between demented and non-demented was 82%, with a Kappa of 0.63 for the clock completion, and 82%, with a Kappa of 0.62 for the SBT. Inter-rater reliability for clock completion was 0.90 to 0.93.
A simple, completely objective scoring system for a clock completion test has been developed which involves only the number of digits placed in the fourth quadrant of a pre-drawn circle. This readily administered test is as effective in screening for dementia as the longer six-item SBT.
利用画钟任务开发一种简单、易于实施和评分的痴呆筛查测试。
对画钟错误进行回顾性分析并进行前瞻性验证。
医院门诊老年评估诊所、康复服务机构、老年人公寓楼和长期护理机构。
老年评估诊所的患者、康复服务机构的患者或上述场所的居民的便利样本。
画钟评分系统在识别痴呆患者方面的敏感性和特异性，以及该系统与简易精神状态检查表（SBT）在痴呆诊断和测试前瞻性验证方面的比较。
在评估的10项画钟错误中，在预先画好的圆圈中放置数字在区分不可逆性痴呆患者与未符合NINCDS-ADRDA可能痴呆标准的其他疾病患者方面具有最高的敏感性和特异性。所推导的评分系统的敏感性为87%，特异性为82%，而SBT在识别痴呆方面的敏感性为82%，特异性为88%。痴呆与非痴呆之间区分的重测信度为82%，画钟完成情况的Kappa值为0.63，SBT的重测信度为82%，Kappa值为0.62。画钟完成情况的评分者间信度为0.90至0.93。
已开发出一种简单、完全客观的画钟完成测试评分系统，该系统仅涉及在预先画好的圆圈第四象限中放置的数字数量。这种易于实施的测试在痴呆筛查方面与较长的六项SBT一样有效。
