Skip to main content
SpringerLink
Log in

Performance at the clock drawing test of individuals affected by Parkinson’s disease and healthy subjects: a retrospective study

  • Original Article
  • Published:
Neurological Sciences Aims and scope Submit manuscript

Abstract

Clock drawing test (CDT) is a screening tool used in neuropsychological assessment for evaluating comprehensively multiple cognitive functions. Aberrant performance at CDT was observed in Parkinson’s disease, due to impaired executive functioning as well as visuospatial difficulties. However, previous studies suffered from different limitations, such as reduced sample size as well as no comparison with healthy individuals. This retrospective study aimed to verify CDT accuracy in discriminating between 240 patients with idiopathic Parkinson’s disease and 205 healthy subjects. We verified CDT accuracy in discriminating patients when classified according to their global cognitive functioning measured through the Mini-Mental State Examination and the Frontal Assessment Battery. Our results showed that affected individuals reported a worse performance in CDT than healthy controls. Instead, no difference was found between patients when categorized according to their performance at the Mini-Mental State Examination or Frontal Assessment Battery. We confirmed that patients with Parkinson’s disease reported low performance at the CDT. We encouraged the use of CDT for early detection of possible cognitive difficulties in Parkinson’s disease for clinical and research purposes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Agrell B, Dehlin O (1998) The clock-drawing test. Age Ageing 27:399–403. https://doi.org/10.1093/ageing/afs149

    Article  Google Scholar 

  2. Freedman M, Leach L, Kaplan E (1994) Clock drawing: a neuropsychological analysis. OUP, USA

    Google Scholar 

  3. Camargo CHF, Tolentino EDS, Bronzini A, Ladeira MA, Lima R, Schultz-Pereira GL, Young-Blood MR (2016) Comparison of the use of screening tools for evaluating cognitive impairment in patients with Parkinson’s disease. Dement Neuropsychol 10:344–350. https://doi.org/10.1590/s1980-5764-2016dn1004015

    Article  PubMed  PubMed Central  Google Scholar 

  4. Shulman KI (2000) Clock-drawing: is it the ideal cognitive screening test? Int J Geriatr Psychiatry 15:548–561

    Article  CAS  PubMed  Google Scholar 

  5. Borson SOO, Brush M, Gil E et al (1999) The clock drawing test: utility for dementia detection in multiethnic elders. J Gerontol A Biol Sci Med 54:M534–M540

    Article  CAS  Google Scholar 

  6. Folstein MF, Folstein SE, McHugh PR (1975) “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12(3):189–198. https://doi.org/10.1016/0022-3956(75)90026-6

    Article  CAS  PubMed  Google Scholar 

  7. Yamamoto S, Mogi N, Umegaki H, Suzuki Y, Ando F, Shimokata H, Iguchi A (2004) The clock drawing test as a valid screening method for mild cognitive impairment. Dement Geriatr Cogn Disord 18(2):172–179. https://doi.org/10.1159/000079198

    Article  PubMed  Google Scholar 

  8. Allone C, Lo Buono V, Corallo F, Bonanno L, Palmeri R, di Lorenzo G, Marra A, Bramanti P, Marino S (2018) Cognitive impairment in Parkinson’s disease, Alzheimer’s dementia, and vascular dementia: the role of the clock-drawing test. Psychogeriatrics 18(2):123–131

    Article  PubMed  Google Scholar 

  9. Pinto E, Peters R (2009) Literature review of the clock drawing test as a tool for cognitive screening. Dement Geriatr Cogn Disord 27(3):201–213. https://doi.org/10.1159/000203344

    Article  PubMed  Google Scholar 

  10. Zgaljardic DJ, Borod JC, Foldi NS, Mattis P (2003) A review of the cognitive and behavioral sequelae of Parkinson’s disease: relationship to frontostriatal circuitry. Cogn Behav Neurol 16:193–210

    Article  PubMed  Google Scholar 

  11. Emre M, Aarsland D, Brown R et al (2007) Clinical diagnostic criteria for dementia associated with Parkinson’s disease. J Mov Disord 22(12):1689–1707. https://doi.org/10.1002/mds.21507

    Article  Google Scholar 

  12. Caballol N, Martí MJ, Tolosa E (2007) Cognitive dysfunction and dementia in Parkinson disease. J Mov Disord 22(S17):S358–S366. https://doi.org/10.1002/mds.21677

    Article  Google Scholar 

  13. Stella F, Gobbi LT, Gobbi S, Oliani MM, Tanaka K, Pieruccini-Faria F (2007) Early impairment of cognitive functions in Parkinson’s disease. Arq Neuropsiquiatr 65(2B):406–410. https://doi.org/10.1590/S0004-282X2007000300008

    Article  PubMed  Google Scholar 

  14. Saur R, Maier C, Milian M, Riedel E, Berg D, Liepelt-Scarfone I, Leyhe T (2012) Clock test deficits related to the global cognitive state in Alzheimer’s and Parkinson’s disease. Dement Geriatr Cogn Disord 33(1):59–72. https://doi.org/10.1159/000336598

    Article  CAS  PubMed  Google Scholar 

  15. Duro D, Tábuas-Pereira M, Freitas S, Santiago B, Botelho MA, Santana I (2018) Validity and clinical utility of different clock drawing test scoring systems in multiple forms of dementia. J Geriatr Psychiatry Neurol 31(3):114–122. https://doi.org/10.1177/0891988718774432

    Article  PubMed  Google Scholar 

  16. Dubois B, Slachevsky A, Litvan I, Pillon B (2000) The FAB: a frontal assessment battery at bedside. Neurology 55(11):1621–1626. https://doi.org/10.1212/WNL.55.11.1621

    Article  CAS  PubMed  Google Scholar 

  17. Hughes AJ, Daniel SE, Kilford L, Lees AJ (1992) Accuracy of clinical diagnosis of idiopathic Parkinson’s disease. A clinico-pathological study of 100 cases. J. Neurol. Neurosurg. Psychiatry 55:181–184. https://doi.org/10.1136/jnnp.55.3.181

    Article  CAS  Google Scholar 

  18. Mondini S, Mapelli D, Vestri A, Bisiacchi P (2003) Esame neuropsicologico breve [brief neuropsychological exam]. Raffaello Cortina Editore, Milano

    Google Scholar 

  19. Magni E, Binetti G, Bianchetti A, Rozzini R, Trabucchi M (1996) Mini-Mental State Examination: a normative study in Italian elderly population. Eur J Neurol 3(3):198–202. https://doi.org/10.1111/j.1468-1331.1996.tb00423.x

    Article  CAS  PubMed  Google Scholar 

  20. Appollonio I, Leone M, Isella V et al (2005) The Frontal Assessment Battery (FAB): normative values in an Italian population sample. Neurol Sci 26(2):108–116. https://doi.org/10.1007/s10072-005-0443-4

    Article  CAS  PubMed  Google Scholar 

  21. Youden WJ (1950) Index for rating diagnostic tests. Cancer 3:32–35. https://doi.org/10.1002/1097-0142(1950)3:1<32::AID-CNCR2820030106>3.0.CO;2-3

    Article  CAS  PubMed  Google Scholar 

  22. Hanley JA, McNeil BJ (1983) A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology 148(3):839–843. https://doi.org/10.1148/radiology.148.3.6878708

    Article  CAS  PubMed  Google Scholar 

  23. Cohen OS, Vakil E, Tanne D, Molshatzki N, Nitsan Z, Hassin-Baer S (2012) The frontal assessment battery as a tool for evaluation of frontal lobe dysfunction in patients with Parkinson disease. J Geriatr Psychiatry Neurol 25(2):71–77. https://doi.org/10.1177/0891988712445087

    Article  PubMed  Google Scholar 

  24. Bugalho P, Vale J (2011) Brief cognitive assessment in the early stages of Parkinson disease. Cogn Behav Neurol 24(4):169–173. https://doi.org/10.1097/WNN.0b013e3182350a1f

    Article  PubMed  Google Scholar 

  25. Paviour DC, Winterburn D, Simmonds S, Burgess G, Wilkinson L, Fox NC, Lees AJ, Jahanshahi M (2005) Can the frontal assessment battery (FAB) differentiate bradykinetic rigid syndromes? Relation of the FAB to formal neuropsychological testing. Neurocase 11(4):274–282. https://doi.org/10.1080/13554790590962933

    Article  CAS  PubMed  Google Scholar 

  26. Nasreddine ZS, Phillips NA, Bédirian V, Charbonneau S, Whitehead V, Collin I, Cummings JL, Chertkow H (2005) The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc 53(4):695–699. https://doi.org/10.1111/j.1532-5415.2005.53221.x

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Neurology and Neurorehabilitation, IRCCS, Istituto Auxologico Italiano, Ospedale San Giuseppe, Via Cadorna, 90 28824, Piancavallo, VCO, Italy

    Federica Scarpina, Lorenzo Priano & Alessandro Mauro

  2. Istituto Auxologico Italiano IRCCS, Psychology Research Laboratory, Ospedale San Giuseppe, Piancavallo, VCO, Italy

    Clara Paschino

  3. “Rita Levi Montalcini” Department of Neuroscience, University of Turin, Turin, Italy

    Lorenzo Priano & Alessandro Mauro

Authors
  1. Federica Scarpina
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Clara Paschino
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lorenzo Priano
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Alessandro Mauro
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

FS and AM contributed to the study conception and design. LP performed patients’ clinical assessment. Material preparation and data collection were performed by FS and CP. Data analyses were performed by FS. The first draft of the manuscript was written by FS and CP; and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Federica Scarpina.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Scarpina, F., Paschino, C., Priano, L. et al. Performance at the clock drawing test of individuals affected by Parkinson’s disease and healthy subjects: a retrospective study. Neurol Sci 41, 843–849 (2020). https://doi.org/10.1007/s10072-019-04167-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10072-019-04167-w

Keywords

Search

Navigation