Quantitative and qualitative analyses of clock drawings in Alzheimer's and Huntington's disease

doi:10.1016/0278-2626(92)90112-Y

Brain and Cognition

Volume 18, Issue 1, January 1992, Pages 70-87

https://doi.org/10.1016/0278-2626(92)90112-Y Get rights and content

Abstract

Although visuoconstructive impairment has been reported in both Alzheimer's (DAT) and Huntington's (HD) disease, there is little knowledge concerning how this cognitive deficit differs quantitatively and qualitatively in these two progressive dementias. To address this issue, the present study compared performances on the Clock Drawing Test (CDT: command and copy) of 25 DAT patients, 25 equally demented HD patients, and 25 elderly normal controls (NC). In the command condition, both patient groups were significantly impaired compared to the NC group. Although there was no significant difference between DAT and HD patients' total quantitative scores, a qualitative error analysis revealed a number of dissociations between the two patient groups. Graphic difficulties, very common in HD patients, were virtually absent in DAT patients; in contrast, conceptual errors were almost exclusively seen in DAT patients and were related to the severity of their dementia. Perseveration and “stimulus-bound” responses were also more frequent in DAT patients, and both groups made visuospatial errors. In the copy condition, the DAT, but not the HD, patients evidenced a marked improvement in performance. These results indicate that while both DAT and HD patients have significant visuoconstructive difficulties even in the early stages of their disorders, the specific cognitive processes underlying their quantitative impairments are quite different. It is possible that the DAT patients' conceptual errors are yet another indicator of the deterioration of their semantic knowledge.

References (58)

K.A. Bayles et al.
Confrontation naming and dementia
Brain and Language
(1983)
W.W. Beatty et al.
Retrograde amnesia in patient with Alzheimer's or Huntington's disease
Neurobiology of Aging
(1988)
J. Brandt et al.
The neuropsychology of Huntington's disease
Trends in Neurosciences
(1986)
R.G. Brown et al.
“Subcortical dementia”: The neuropsychological evidence
Neuroscience
(1988)
N. Butters et al.
The effect of verbal mediators on the pictorial memory of brain-damaged patients
Neuropsychologia
(1983)
N. Butters et al.
An assessment of verbal recall, recognition and fluency abilities in patients with Huntington's disease
Cortex
(1986)
E. Granholm et al.
Associative encoding and retrieval in Alzheimer's and Huntington's disease
Brain and Cognition
(1988)
W.C. Heindel et al.
Pictorial priming and cued recall in Alzheimer's and Huntington's disease
Brain and Cognition
(1990)
F.J. Huff et al.
Semantic impairment and anomia in Alzheimer's disease
Brain and Language
(1986)
D. Jacobs et al.
Intrusion errors in the figural memory of patients with Alzheimer's and Huntington's disease
Archives of Clinical Neuropsychology
(1990)

A. Martin et al.

Word production and comprehension in Alzheimer's disease: The breakdown of semantic knowledge

Brain and Language

(1983)

A. Martin et al.

A note on different patterns of impaired and preserved cognitive abilities and their relation to episodic memory deficits in Alzheimer's patients

Brain and Language

(1985)

A.I. Tröster et al.

Differentiating Alzheimer's disease from Huntington's disease with the Wechsler memory scale—Revised

Clinics in Geriatric Medicine

(1989)

J. Ajuriaguerra et al.

A propos de quelques problèmes posés par l'apraxie dans les démences

Encéphale

(1960)

J. Brandt et al.

Differential cognitive impairment in Alzheimer's disease and Huntington's disease

Annals of Neurology

(1988)

M. Brantjes et al.

Qualitative analysis of the drawings of Alzheimer patients

The Clinical Neuropsychologist

(1991)

P. Brouwers et al.

Differential perceptual spatial impairment in Huntington's and Alzheimer's dementia

Archives of Neurology

(1984)

N. Butters et al.

Episodic and semantic memory: A comparison of amnesic and demented patients

Journal of Clinical and Experimental Neuropsychology

(1987)

N. Butters et al.

Dissociation of implicit memory in dementia: Neurological implications

Bulletin of the Psychonomic Society

(1990)

N. Butters et al.

Differentiation of amnesic and demented patients with the Wechsler Memory Scale—Revised

The Clinical Neuropsychologist

(1988)

N. Butters et al.

Processes underlying the memory impairments of demented patients

N. Butters et al.

Episodic, semantic, and procedural memory: Some comparisons of Alzheimer and Huntington disease patients

N. Butters et al.

Comparison of the neuropsychological deficits associated with early and advanced Huntington's disease

Archives of Neurology

(1978)

N. Butters et al.

Memory disorders associated with Huntington's disease: Verbal recall, verbal recognition and procedural memory

Neuropsychologia

(1985)

H. Chertkow et al.

Semantic memory loss in dementia of Alzheimer's type

Brain

(1990)

S. Corkin

Some relationships between global amnesias and the memory impairments in Alzheimer's disease

D.C. Delis et al.

Profiles of demented and amnesic patients on the California Verbal Learning Test: Implication the assessment of memory disorders

Psychological Assessment: A Journal of Consulting and Clinical Psychology

(1991)

P. Fedio et al.

Neuropsychological profile of Huntington's disease: Patients and those at risk

S.E. Folstein et al.

The measurement of abnormal movement: Methods developed for Huntington's disease

Neurobehavioral Toxicology and Teratology

(1983)

Cited by (452)

Longitudinal trajectory effects of different MCI subtypes on general cognitive and daily functions in a population-based cohort of older adults
2024, Journal of Psychiatric Research
To identify different mild cognitive impairment (MCI) phenotypes based on substantial relative impairment in specific cognitive domains and then characterize the complex process of general cognitive and daily functions over time in older adults with these MCI subtypes.
A total of 1020 participants with MCI at baseline from the Alzheimer's Disease Neuroimaging Initiative (ADNI) were recruited. MCI subtypes were obtained based on neuropsychological tests in five cognitive domains: memory (M), visuospatial function (V), language (L), processing speed (P), and executive function (E). General cognitive function and daily function were measured by the Mini-Mental State Examination (MMSE) and the Functional Assessment Questionnaire (FAQ), respectively. Linear mixed models were fitted to curve their trajectories across different MCI subtypes.
Considering visuospatial function, subtypes were MO (memory impaired only), M&V (memory and visuospatial function impaired) and M&nV (memory impaired and visuospatial function non-impaired). Similar subtypes and naming rules were obtained based on language, executive function, and processing speed. Further, depending on the number of relative impaired cognitive domains M&S and M&M were obtained. Participants with MO had the highest prevalence in the sample (53.4 %), followed by M&nV (31.1 %). Participants with M&V had the highest mean age (74.69 years) at baseline and the greatest dementia conversion rate (53.2 %). The MMSE and FAQ score trajectories changed most slowly in participants with MO while fastest in those with M&V. Obvious different trajectories of both MMSE and FAQ scores were observed across different subtypes based on visuospatial function and executive function.
Compared to MO, individuals with multi-dimensional cognitive impairment have worse general cognitive and daily functions, especially for those with M&V.
Gaussian Process-based prediction of memory performance and biomarker status in ageing and Alzheimer's disease—A systematic model evaluation
2023, Medical Image Analysis
Neuroimaging markers based on Magnetic Resonance Imaging (MRI) combined with various other measures (such as genetic covariates, biomarkers, vascular risk factors, neuropsychological tests etc.) might provide useful predictions of clinical outcomes during the progression towards Alzheimer’s disease (AD). The use of multiple features in predictive frameworks for clinical outcomes has become increasingly prevalent in AD research. However, many studies do not focus on systematically and accurately evaluating combinations of multiple input features. Hence, the aim of the present work is to explore and assess optimal combinations of various features for MR-based prediction of (1) cognitive status and (2) biomarker positivity with a multi-kernel learning Gaussian process framework. The explored features and parameters included (A) combinations of brain tissues, modulation, smoothing, and image resolution; (B) incorporating demographics & clinical covariates; (C) the impact of the size of the training data set; (D) the influence of dimensionality reduction and the choice of kernel types. The approach was tested in a large German cohort including 959 subjects from the multicentric longitudinal study of cognitive impairment and dementia (DELCODE). Our evaluation suggests the best prediction of memory performance was obtained for a combination of neuroimaging markers, demographics, genetic information (ApoE4) and CSF biomarkers explaining 57% of outcome variance in out-of-sample predictions. The highest performance for A $β$ 42/40 status classification was achieved for a combination of demographics, ApoE4, and a memory score while usage of structural MRI further improved the classification of individual patient’s pTau status.
Discriminant validity and inter-rater concordance of two scoring systems for the clock test
2023, Revista Espanola de Geriatria y Gerontologia
Comparar la validez discriminante y la fiabilidad interobservador de los 2 métodos de corrección del test del reloj más usados en España.
Se han evaluado 2 colecciones de dibujos del reloj obtenidos en un contexto clínico (116 casos; 56,8% mujeres, edad media 73,1 ± 7,7 años) y en una cohorte de voluntarios (2.039 dibujos de 579 sujetos; 59,5% mujeres, edad media 78,3 ± 3,8 años). Todos los sujetos fueron clasificados como sin deterioro cognitivo (DC⁻) o con deterioro cognitivo (DC⁺) tras una extensa evaluación clínica y neuropsicológica. Evaluadores expertos han valorado estos dibujos de forma independiente y sin conocimiento del diagnóstico con los métodos de Sunderland y Solomon estandarizados en español por Cacho (rango: 0 a 10) y del Ser (rango: 0 a 7), respectivamente. Se ha calculado la validez discriminante de cada método mediante el área bajo la curva ROC (aROC) en las 2 muestras, y la fiabilidad interobservador mediante el coeficiente de correlación intraclase (CCI) y el coeficiente kappa en la muestra clínica que fue valorada por los 2 evaluadores.
No hay diferencias significativas en la validez discriminante de los métodos de Sunderland y Solomon en ninguna de las muestras (clínica: aROC: 0,73 [IC 95%: 0,64-0,81] y 0,77 [IC 95%: 0,69-0,85], respectivamente, p = 0,19; voluntarios: aROC: 0,69 [IC 95%: 0,67-0,71] y 0,72 [IC 95%: 0,69-0,73], respectivamente, p = 0,08). Los puntos de corte ≤ 8 y ≤ 5 clasifican correctamente al 71 y 73% de la muestra clínica y al 82 y 84% de la muestra de voluntarios, respectivamente. Los 2 métodos tienen una buena concordancia en la muestra clínica (Sunderland: CCI: 0,90 [IC 95%: 0,81-0,93]; kappa: 0,76 [IC 95%: 0,70-0,83]; Solomon: 0,92 [IC 95%: 0,88-0,95] y 0,77 [IC 95%: 0,71-0,83], respectivamente), algo mayor en el segundo, aunque las diferencias no son significativas.
La validez discriminante y la fiabilidad interobservador de estos 2 métodos de corrección del test del reloj son similares. El método de Solomon, más breve y sencillo, puede ser más aconsejable en términos pragmáticos.
To compare the discriminant validity and inter-rater reliability of the two scoring systems for the Clock test that are most used in Spain.
Two collections of clock drawings obtained in a clinical context (116 cases; 56.8% women, mean age 73.1 ± 7.7 years) and in a cohort of volunteers (2039 drawings of 579 subjects; 59.5% women, mean age 78.3 ± 3.8 years) have been assessed. All subjects were classified as cognitively normal (CN) or cognitively impaired (CI) after extensive clinical and neuropsychological evaluation. Expert raters have evaluated these drawings independently and without knowledge of the diagnosis using the Sunderland and Solomon systems standardized in Spanish by Cacho (range 0 to 10) and del Ser (range 0 to 7) respectively. The discriminant validity of each method was calculated in the two samples using the area under the ROC curve (aROC), and the inter-rater reliability was calculated in the clinical sample, that was assessed by the two evaluators, using the intraclass correlation coefficient (ICC) and the kappa coefficient.
There are no significant differences in the discriminant validity of the Sunderland and Solomon systems in any of the samples (clinical: aROC 0.73 [CI95%: 0.64-0.81] and 0.77 [CI95%: 0.69-0.85] respectively, P=.19; volunteers: aROC 0.69 [CI95%: 0.67-0.71] and 0.72 [CI95%: 0.69-0.73] respectively, P=.08). The cut-off points ≤8 and ≤5 correctly classify 71% and 73% of the clinical sample and 82% and 84% of the volunteer sample, respectively. Both systems have good agreement in the clinical sample (Sunderland: ICC 0.90 [CI95%: 0.81-0.93], kappa 0.76 [CI95%: 0.70-0.83]; Solomon: 0.92 [CI95%: 0.88-0.95] and 0.77 [CI95%: 0.71-0.83] respectively), somewhat higher in the second, although the differences are not significant.
The discriminant validity and inter-observer reliability of these two Clock Test correction systems are similar. Solomon's method, shorter and simpler, may be more advisable in pragmatic terms.
Examination of eye movements during visual scanning of real-world images in Alzheimer's disease and amnestic mild cognitive impairment
2023, International Journal of Psychophysiology
Available evidence shows that Alzheimer's disease (AD) patients display inefficiencies in visual scanning of their surroundings, directing their attention towards non-relevant aspects of scenes. Not much is known about eye movements during visual scanning in individuals with amnestic mild cognitive impairment (aMCI). Notably, a consensus has yet to be reached on this issue. Furthermore, prior research has indicated the existence of visual attention deficits in individuals diagnosed with AD and aMCI. The objective of this study was to examine the visual scanning patterns of individuals diagnosed with AD, aMCI, and healthy controls (HC) when viewing various scenes. Thirty patients with AD, 32 aMCI, and 32 HC were included in the study. A set of 30 real-life scene images were presented to the participants in the visual scanning task. Participants' eye events were monitored using the EyeLink 1000 Plus in this task. The results indicate a significant reduction in total fixation duration, number of scanned areas, fixation counts, and saccade counts in AD as compared to those with aMCI and HC. The research did not reveal any significant statistical differences in eye parameters between the aMCI and HC groups. This study found abnormalities in visual scanning in AD compared to aMCI and HC. Visual scanning patterns of aMCI patients were not different from HC. Previous studies have specifically shown visual attention difficulties in AD and MCI. Our findings may be related to visual attention difficulties in AD. In addition, this study is the first to examine visual scanning behaviour with real-world images in AD and aMCI.
Increased Parasympathetic Activity as a Fall Risk Factor Beyond Conventional Factors in Institutionalized Older Adults with Mild Cognitive Impairment
2023, Asian Nursing Research
This study aimed to investigate autonomic nervous function during the orthostatic challenge and its relationship with depression and fall, and to elucidate fall-associated factors, including autonomic function, executive function, and depression among institutionalized older adults with mild cognitive impairment (MCI).
This study employed a descriptive cross-sectional design. Fall experiences in the current institutions were researched. Heart rate variability (HRV) during the orthostatic challenge was measured. Executive function was evaluated using the semantic verbal fluency test and clock drawing test. Depression was assessed using the Geriatric Depression Scale.
Of the 115 older adults, 17 (14.8%) experienced falls in the current institution. None of the HRV indices during the orthostatic challenge showed any significant changes except for the standard deviation of normal RR intervals (p = .037) in the institutionalized older adults with MCI. None of the HRV indices was significantly related to the depressive symptoms. Multivariate logistic regression analysis showed that normalized high frequency on lying was independently associated with falls (OR = 1.027, p = .049) after adjusting for other conventional fall risk factors although executive function and depressive symptoms were not significant factors for falls.
Institutionalized older adults with MCI were vulnerable to autonomic nervous modulation, especially to sympathetic modulation, during the orthostatic challenge, which was not associated with depressive symptoms. As increased resting parasympathetic activity seemed to play a key role in association with falls, autonomic nervous function assessment should be considered for fall risk evaluation.
About time: neurocognitive correlates of stimulus-bound and other time setting errors in the Clock Drawing Test
2023, Journal of the International Neuropsychological Society

View all citing articles on Scopus

^☆: This study was supported by funds from the Medical Research Service of the Department of Veterans Affairs, by NIA Grants AG-05131 and AG-08204 to the University of California at San Diego, and by FRSQ (Fonds de la recherche en santé du Québec) Postdoctoral Fellowship to Dr. Rouleau.

View full text

Quantitative and qualitative analyses of clock drawings in Alzheimer's and Huntington's disease☆

Abstract

Brain and Language

Neurobiology of Aging

Trends in Neurosciences

Neuroscience

Neuropsychologia

Cortex

Brain and Cognition

Brain and Cognition

Brain and Language

Archives of Clinical Neuropsychology

Brain and Language

Brain and Language

Clinics in Geriatric Medicine

A propos de quelques problèmes posés par l'apraxie dans les démences

Encéphale

Differential cognitive impairment in Alzheimer's disease and Huntington's disease

Annals of Neurology

Qualitative analysis of the drawings of Alzheimer patients

The Clinical Neuropsychologist

Differential perceptual spatial impairment in Huntington's and Alzheimer's dementia

Archives of Neurology

Episodic and semantic memory: A comparison of amnesic and demented patients

Journal of Clinical and Experimental Neuropsychology

Dissociation of implicit memory in dementia: Neurological implications

Bulletin of the Psychonomic Society

Differentiation of amnesic and demented patients with the Wechsler Memory Scale—Revised

The Clinical Neuropsychologist

Processes underlying the memory impairments of demented patients

Episodic, semantic, and procedural memory: Some comparisons of Alzheimer and Huntington disease patients

Comparison of the neuropsychological deficits associated with early and advanced Huntington's disease

Archives of Neurology

Memory disorders associated with Huntington's disease: Verbal recall, verbal recognition and procedural memory

Neuropsychologia

Semantic memory loss in dementia of Alzheimer's type

Brain

Some relationships between global amnesias and the memory impairments in Alzheimer's disease

Profiles of demented and amnesic patients on the California Verbal Learning Test: Implication the assessment of memory disorders

Psychological Assessment: A Journal of Consulting and Clinical Psychology

Neuropsychological profile of Huntington's disease: Patients and those at risk

The measurement of abnormal movement: Methods developed for Huntington's disease

Neurobehavioral Toxicology and Teratology