|
|
J Neurol Neurosurg Psychiatry. 1998 May; 64(5): 588–594. | PMCID: PMC2170069 |
CLOX: an executive clock drawing task D. Royall, J. Cordes, and M. Polk Department of Psychiatry, University of Texas, Health Science Center at San Antonio, 78284-7792, USA. Email: royall/at/uthscsa.edu OBJECTIVE—To describe a clock drawing task (CLOX)
designed to elicit executive impairment and discriminate it from
non-executive constructional failure.
SUBJECTS—90 elderly subjects were studied (45 elderly and well persons from the independent living apartments of a
continuing care retirement community and 45 patients with probable
Alzheimer's disease). The clock drawing performance of elderly
patients was compared with that of 62 young adult controls.
METHODS—Subjects received the CLOX, an executive
test (EXIT25), and the mini mental state examination (MMSE). The CLOX
is divided into an unprompted task that is sensitive to executive
control (CLOX1) and a copied version that is not (CLOX2). Between rater reliability (27 subjects) was high for both subtests.
RESULTS—In elderly subjects, CLOX subscores
correlated strongly with cognitive severity (CLOX1:
r=−0.83 v the EXIT25; CLOX2:
r=0.85 v the MMSE). EXIT25 and MMSE scores
predicted CLOX1 scores independently of age or education
(F(4,82)=50.7, p<0.001;
R2=0.71). The EXIT25 accounted for 68% of
CLOX1 variance. Only the MMSE significantly contributed to CLOX2 scores
(F(4,72)= 57.2,p<0.001;
R2=0.74). CLOX subscales discriminated between
patients with Alzheimer's disease and elderly controls (83.1% of
cases correctly classified; Wilkes' lambda=0.48, p<0.001), and
between Alzheimer's disease subgroups with and without constructional
impairment (91.9% of cases correctly classified; Wilkes' lambda=0.31,
p<0.001).
CONCLUSIONS—The CLOX is an internally consistent
measure that is easy to administer and displays good inter-rater
reliability. It is strongly associated with cognitive test scores. The
pattern of CLOX failures may discriminate clinical dementia subgroups.
The Full Text of this article is available as a PDF (184K). These references are in PubMed. This may not be the complete list of references from this article. - Manos PJ, Wu R. The ten point clock test: a quick screen and grading method for cognitive impairment in medical and surgical patients. Int J Psychiatry Med. 1994;24(3):229–244. [PubMed]
- Mendez MF, Ala T, Underwood KL. Development of scoring criteria for the clock drawing task in Alzheimer's disease. J Am Geriatr Soc. 1992 Nov;40(11):1095–1099. [PubMed]
- Watson YI, Arfken CL, Birge SJ. Clock completion: an objective screening test for dementia. J Am Geriatr Soc. 1993 Nov;41(11):1235–1240. [PubMed]
- Wolf-Klein GP, Silverstone FA, Levy AP, Brod MS. Screening for Alzheimer's disease by clock drawing. J Am Geriatr Soc. 1989 Aug;37(8):730–734. [PubMed]
- Tuokko H, Hadjistavropoulos T, Miller JA, Beattie BL. The Clock Test: a sensitive measure to differentiate normal elderly from those with Alzheimer disease. J Am Geriatr Soc. 1992 Jun;40(6):579–584. [PubMed]
- Kirk A, Kertesz A. On drawing impairment in Alzheimer's disease. Arch Neurol. 1991 Jan;48(1):73–77. [PubMed]
- PIERCY M, SMYTH VO. Right hemisphere dominance for certain non verbal intellectual skills. Brain. 1962 Dec;85:775–790. [PubMed]
- Lee H, Lawlor BA. State-dependent nature of the clock drawing task in geriatric depression. J Am Geriatr Soc. 1995 Jul;43(7):796–798. [PubMed]
- Royall DR, Polk M. Dementias that present with and without posterior cortical features: an important clinical distinction. J Am Geriatr Soc. 1998 Jan;46(1):98–105. [PubMed]
- Rouleau I, Salmon DP, Butters N, Kennedy C, McGuire K. Quantitative and qualitative analyses of clock drawings in Alzheimer's and Huntington's disease. Brain Cogn. 1992 Jan;18(1):70–87. [PubMed]
- Royall DR, Mahurin R. Qualitative assessment of dementia. J Am Geriatr Soc. 1994 Jul;42(7):798–799. [PubMed]
- Royall DR. Precis of executive dyscontrol as a cause of problem behavior in dementia. Exp Aging Res. 1994 Apr–Jun;20(2):73–94. [PubMed]
- Royall DR. Comments on the executive control of clock-drawing. J Am Geriatr Soc. 1996 Feb;44(2):218–219. [PubMed]
- McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology. 1984 Jul;34(7):939–944. [PubMed]
- Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975 Nov;12(3):189–198. [PubMed]
- Royall DR, Mahurin RK, Gray KF. Bedside assessment of executive cognitive impairment: the executive interview. J Am Geriatr Soc. 1992 Dec;40(12):1221–1226. [PubMed]
- Nelson A, Fogel BS, Faust D. Bedside cognitive screening instruments. A critical assessment. J Nerv Ment Dis. 1986 Feb;174(2):73–83. [PubMed]
- Celsis P, Agniel A, Puel M, Le Tinnier A, Viallard G, Démonet JF, Rascol A, Marc-Vergnes JP. Lateral asymmetries in primary degenerative dementia of the Alzheimer type. A correlative study of cognitive, haemodynamic and EEG data, in relation with severity, age of onset and sex. Cortex. 1990 Dec;26(4):585–596. [PubMed]
- Motomura N, Seo T. Lateral hemispheric asymmetries in senile dementia of Alzheimer's type (SDAT) assessed by I-123 IMP SPECT imaging: a preliminary report. Int J Neurosci. 1992 Mar;63(1-2):1–3. [PubMed]
- Ober BA, Jagust WJ, Koss E, Delis DC, Friedland RP. Visuoconstructive performance and regional cerebral glucose metabolism in Alzheimer's disease. J Clin Exp Neuropsychol. 1991 Sep;13(5):752–772. [PubMed]
- Huntzinger JA, Rosse RB, Schwartz BL, Ross LA, Deutsch SI. Clock drawing in the screening assessment of cognitive impairment in an ambulatory care setting: a preliminary report. Gen Hosp Psychiatry. 1992 Mar;14(2):142–144. [PubMed]
- Ainslie NK, Murden RA. Effect of education on the clock-drawing dementia screen in non-demented elderly persons. J Am Geriatr Soc. 1993 Mar;41(3):249–252. [PubMed]
- Axelrod BN, Goldman RS, Henry RR. Sensitivity of the Mini-Mental State Examination to frontal lobe dysfunction in normal aging. J Clin Psychol. 1992 Jan;48(1):68–71. [PubMed]
- Coffey CE, Wilkinson WE, Parashos IA, Soady SA, Sullivan RJ, Patterson LJ, Figiel GS, Webb MC, Spritzer CE, Djang WT. Quantitative cerebral anatomy of the aging human brain: a cross-sectional study using magnetic resonance imaging. Neurology. 1992 Mar;42(3 Pt 1):527–536. [PubMed]
- Kuhl DE, Metter EJ, Riege WH, Hawkins RA. The effect of normal aging on patterns of local cerebral glucose utilization. Ann Neurol. 1984;15 Suppl:S133–S137. [PubMed]
- Haxby JV, Grady CL, Koss E, Horwitz B, Heston L, Schapiro M, Friedland RP, Rapoport SI. Longitudinal study of cerebral metabolic asymmetries and associated neuropsychological patterns in early dementia of the Alzheimer type. Arch Neurol. 1990 Jul;47(7):753–760. [PubMed]
- Grady CL, Haxby JV, Schapiro MB, Gonzalez-Aviles A, Kumar A, Ball MJ, Heston L, Rapoport SI. Subgroups in dementia of the Alzheimer type identified using positron emission tomography. J Neuropsychiatry Clin Neurosci. 1990 Fall;2(4):373–384. [PubMed]
- Sawada H, Udaka F, Kameyama M, Seriu N, Nishinaka K, Shindou K, Kodama M, Nishitani N, Okumiya K. SPECT findings in Parkinson's disease associated with dementia. J Neurol Neurosurg Psychiatry. 1992 Oct;55(10):960–963. [PubMed]
|
This article has been