Aging Clinical and Experimental Research

, Volume 30, Issue 7, pp 775–781 | Cite as

A comparison of six clock-drawing test scoring methods in a nursing home

  • Linhui Chen
  • Shanhu Xu
  • Xiaoqing Jin
  • Xingjiao Lu
  • Lu Liu
  • Yue Lou
  • Yanwen Wang
  • Yaguo Li
  • Yu Jin
Original Article



Clock-drawing test (CDT) is widely used but lack of a suitable scoring method.


To compare the validity of six common CDT scoring methods and to find out the best one.


The drawing CDT was administered in a Chinese nursing-home inhabitants living on the mainland including 110 dementia, 118 MCI (mild cognitive impairment), and 133 random normal. We calculated the sensitivity and specificity of six scoring methods and applied the receiver-operating characteristic (ROC) curve statistic, including determining the area under the curve (AUC).


(1) All six CDT scoring methods had a value of sensitivity higher than 80% and a specificity of 60% except Jouk and Tuokko. Freund got the highest sensitivity (92.73%) of that five for the testing of dementia and high sensitivity (82.20%) for MCI with an acceptable specificity (70.68%). (2) The AUC (area under the ROC curve) of all six CDT methods was over 0.8 for dementia, and for MCI, only Jouk and Tuokko were lower than 0.8. Mendez had the largest AUC of 0.872 for MCI, which closely followed by Freund with 0.859. (3) Freund predicted dementia best but had no significant difference (p > 0.05); it only had significant difference with Jouk and Tuokko (p < 0.001) and the method in MoCA (p < 0.05) for both MCI and cognitive impairment.


Our study suggests that Freund scoring method could be the best one among the six evaluated scoring methods within our setting.


Clock-drawing test Scoring method Chinese nursing home ROC curve 



We would like to thank all individuals involved in this study.

Compliance with ethical standards

Informed consent

Informed consent was obtained from all individual participants included in the study.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


This study was supported by the grants from International Science & Technology Cooperation Program of China (2014DFT30100), Zhejiang Science and Technology Project (2014C33242) and Zhejiang Health Department Project (2015KYA003).


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Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  • Linhui Chen
    • 1
  • Shanhu Xu
    • 1
  • Xiaoqing Jin
    • 1
  • Xingjiao Lu
    • 1
  • Lu Liu
    • 1
  • Yue Lou
    • 1
  • Yanwen Wang
    • 1
  • Yaguo Li
    • 1
  • Yu Jin
    • 1
  1. 1.Department of NeurologyZhejiang HospitalHangzhouChina

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