Classifying Non-Dementia and Alzheimer's Disease/Vascular Dementia Patients Using Kinematic, Time-Based, and Visuospatial Parameters: The Digital Clock Drawing Test

Topic: Risk, prevention and care in population studies

Background Advantages of digital clock drawing metrics for dementia subtype classification needs examination. Objective To assess how well kinematic, time-based, and visuospatial features extracted from the digital Clock Drawing Test (dCDT) can classify a combined group of Alzheimer's disease/Vascular Dementia patients versus healthy controls (HC), and classify dementia patients with Alzheimer's disease (AD) versus vascular dementia (VaD). Methods Healthy, community-dwelling control participants (n = 175), patients diagnosed clinically with Alzheimer's disease (n = 29), and vascular dementia (n = 27) completed the dCDT to command and copy clock drawing conditions. Thirty-seven dCDT command and 37 copy dCDT features were extracted and used with Random Forest classification models. Results When HC participants were compared to participants with dementia, optimal area under the curve was achieved using models that combined both command and copy dCDT features (AUC = 91.52%). Similarly, when AD versus VaD participants were compared, optimal area under the curve was, achieved with models that combined both command and copy features (AUC = 76.94%). Subsequent follow-up analyses of a corpus of 10 variables of interest determined using a Gini Index found that groups could be dissociated based on kinematic, time-based, and visuospatial features. Conclusion The dCDT is able to operationally define graphomotor output that cannot be measured using traditional paper and pencil test administration in older health controls and participants with dementia. These data suggest that kinematic, time-based, and visuospatial behavior obtained using the dCDT may provide additional neurocognitive biomarkers that may be able to identify and tract dementia syndromes.

Key findings

• Objective To assess how well kinematic, time-based, and visuospatial features extracted from the digital Clock Drawing Test (dCDT) can classify a combined group of Alzheimer's disease/Vascular Dementia patients versus healthy controls (HC), and classify dementia patients with Alzheimer's disease (AD) versus vascular dementia (VaD).
• Results When HC participants were compared to participants with dementia, optimal area under the curve was achieved using models that combined both command and copy dCDT features (AUC = 91.52%).
• Similarly, when AD versus VaD participants were compared, optimal area under the curve was, achieved with models that combined both command and copy features (AUC = 76.94%).
• These data suggest that kinematic, time-based, and visuospatial behavior obtained using the dCDT may provide additional neurocognitive biomarkers that may be able to identify and tract dementia syndromes.

Why it matters

Features from the digital Clock Drawing Test classified Alzheimer's disease and vascular dementia patients versus healthy controls with an area under the curve of 91.52%, and distinguished Alzheimer's disease from vascular dementia with 76.94%. This supports using the test to help classify dementia subtypes, but it does not test any treatment, cure or prevention.

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Study details

• Participants175
• Effect sizeAUC = 91.52; AUC = 76.94
• Evidence strengthLow

Read the original

• DOI: 10.3233/jad-201129
• PubMed: 34219737
• Original source →
• Free full text: PubMed Central →

Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).

@article{davoudi2021-34219737,
  author  = {Davoudi, A. and Dion, C. and Amini, S. and Tighe, P. J. and Price, C. C. and Libon, D. J. and Rashidi, P.},
  title   = {{Classifying Non-Dementia and Alzheimer's Disease/Vascular Dementia Patients Using Kinematic, Time-Based, and Visuospatial Parameters: The Digital Clock Drawing Test}},
  journal = {Journal of Alzheimer's disease : JAD},
  year    = {2021},
  doi     = {10.3233/jad-201129},
  pmid    = {34219737},
  url     = {https://doi.org/10.3233/jad-201129}
}

Studies this one cites

Referenced by this study and also in the alzhub library, so you can read them here.

• “Mini-mental state” Journal of Psychiatric Research · 1975-11-01 · usefulness score 55/100 · Cognitive tests and assessment
• Diagnostic value of digital clock drawing test in comparison with CERAD neuropsychological battery total score for discrimination of patients in the early course of Alzheimer's disease from healthy individuals Scientific reports · 2019-03-05 · usefulness score 54/100 · Digital health tools
• Comparative accuracies of two common screening instruments for classification of Alzheimer's disease, mild cognitive impairment, and healthy aging Alzheimer's & dementia : the journal of the Alzheimer's Association · 2012-12-21 · usefulness score 53/100 · Getting a diagnosis
• CLOX: an executive clock drawing task Journal of neurology, neurosurgery, and psychiatry · 1998-05-01 · usefulness score 51/100 · Cognitive tests and assessment
• Subcortical vascular dementia: integrating neuropsychological and neuroradiologic data Neurology · 2005-08-01 · usefulness score 48/100 · Brain scans and imaging
• Age and Graphomotor Decision Making Assessed with the Digital Clock Drawing Test: The Framingham Heart Study Journal of Alzheimer's disease : JAD · 2017-01-01 · usefulness score 43/100 · Digital health tools
• Diagnostic and Statistical Manual of Mental Disorders 2013-05-22 · usefulness score 16/100 · Getting a diagnosis

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