Relation between the clock drawing test (CDT) and structural changes of brain in dementia
Introduction
CDT has been regarded as a simple and useful screening tool for determining cognitive functioning in neurodegenerative disorders (Libon et al., 1996, Richardson and Glass, 2002, Cahn-Weiner et al., 2003, Lin et al., 2003). The diverse cognitive skills that are needed for the CDT operate in the different brain regions; these skills are verbal understanding, memory, spatially coded knowledge, abstract thinking, planning and visuo-constructive functions. The CDT also reflects deficits in the executive function, which are often overlooked by routine cognitive evaluations (Kitabayashi et al., 2001, Ino et al., 2003). However, little is known about the relation between the CDT and such structural cerebral changes as WMH or CA in dementia patients.
We expect that performance on the CDT may be influenced by frontal-subcortical circuits that have a role for the executive function. The purpose of the present study is to identify structural cerebral changes that might contribute to the results of the CDT taken by patients diagnosed with dementia.
Section snippets
Participants
Eighty-four patients who were diagnosed with dementia were enrolled for this retrospective study. They attended the outpatient memory clinic of the Neurology Department at Chungnam University Hospital from January 2005 to April 2006 due to their cognitive impairment. Brain magnetic resonance imaging (MRI), laboratory studies and cognitive assessments, including the CDT, were given to all patients. Alzheimer's disease (AD), (n = 41) was diagnosed by the National Institute of Neurological and
Sample characteristics
Table 1 shows the baseline characteristics of the study population. The mean age of the total sample was 69.4 years (range: 42–82 years). The mean scores of the MMSE and 3MS tests were 21.6 and 67.2, respectively.
Neuropsychological tests
The results obtained by the methods of Wolf-Klein et al. (1989) and of Manos and Wu (1994) had positive correlations with the MMSE/3MS tests. In contrast, the methods of Watson et al. (1993) and of Shulman et al. (1993) gave negative correlations with the MMSE/3MS tests. Performance on
Discussion
In terms of the neuropsychological aspects, performance on the CDT showed a significant relation with the overall level of cognition and the executive function. This is consistent with the results of prior studies that proved that the CDT was sensitive to executive control, regardless of the underlying disease (Libon et al., 1996, Royall et al., 1998, Royall et al., 1999). Although one study has reported low CDT scores for patients with normal MMSE scores (Juby et al., 2002), the overall
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