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Increased Diagnostic Accuracy of Digital vs. Conventional Clock Drawing Test for Discrimination of Patients in the Early Course of Alzheimer's Disease from Cognitively Healthy Individuals
Müller S, Preische O, Heymann P, Elbing U, Laske C.. Frontiers in aging neuroscience, 2017-04-11
Topic: Amyloid, tau and blood-test diagnosis
The conventional Clock Drawing Test (cCDT) is a rapid and inexpensive screening tool for detection of moderate and severe dementia. However, its usage is limited due to poor diagnostic accuracy especially in patients with mild cognitive impairment (MCI). The diagnostic value of a newly developed digital Clock Drawing Test (dCDT) was evaluated and compared with the cCDT in 20 patients with early dementia due to AD (eDAT), 30 patients with amnestic MCI (aMCI) and 20 cognitively healthy controls (HCs). Parameters assessed by dCDT were time while transitioning the stylus from one stroke to the next above the surface (i.e., time-in-air), time the stylus produced a visible stroke (i.e., time-on-surface) and total-time during clock drawing. Receiver-operating characteristic (ROC) curves were calculated and logistic regression analyses have been conducted for statistical analysis. Using dCDT, time-in-air was significantly increased in eDAT (70965.8 ms) compared to aMCI (54073.7 ms; p = 0.027) and HC (32315.6 ms; p p = 0.003), even in the aMCI group with normal cCDT score (54141.8 ms; p < 0.001). Time-in-air using dCDT allowed discrimination of patients with aMCI from HCs with a sensitivity of 81.3% and a specificity of 72.2% while cCDT scoring revealed a sensitivity of 62.5% and a specificity of 83.3%. Most interestingly, time-in-air allowed even discrimination of aMCI patients with normal cCDT scores (80% from all aMCI patients) from HCs with a clinically relevant sensitivity of 80.8% and a specificity of 77.8%. A combination of dCDT variables and cCDT scores did not improve the discrimination of patients with aMCI from HC. In conclusion, assessment of time-in-air using dCDT yielded a higher diagnostic accuracy for discrimination of aMCI patients from HCs than the use of cCDT even in those aMCI patients with normal cCDT scores. Modern digitizing devices offer the opportunity to measure subtle changes of visuo-constructive demands and executive functions that may be used as a fast and easy to perform screening instrument for the early detection of cognitive impairment in primary care.
Key findings
- The diagnostic value of a newly developed digital Clock Drawing Test (dCDT) was evaluated and compared with the cCDT in 20 patients with early dementia due to AD (eDAT), 30 patients with amnestic MCI (aMCI) and 20 cognitively healthy controls (HCs).
- Using dCDT, time-in-air was significantly increased in eDAT (70965.8 ms) compared to aMCI (54073.7 ms; p = 0.027) and HC (32315.6 ms; p p = 0.003), even in the aMCI group with normal cCDT score (54141.8 ms; p < 0.001).
- Time-in-air using dCDT allowed discrimination of patients with aMCI from HCs with a sensitivity of 81.3% and a specificity of 72.2% while cCDT scoring revealed a sensitivity of 62.5% and a specificity of 83.3%.
- In conclusion, assessment of time-in-air using dCDT yielded a higher diagnostic accuracy for discrimination of aMCI patients from HCs than the use of cCDT even in those aMCI patients with normal cCDT scores.
Why it matters
A digital version of the Clock Drawing Test measured the time the pen was in the air and distinguished people with amnestic mild cognitive impairment from healthy controls with 81.3% sensitivity and 72.2% specificity, compared with 62.5% and 83.3% for the conventional test. This is a small study of 70 people and concerns diagnosis only, not treating, curing or preventing Alzheimer's disease.
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Study details
- Participants20
- Effect size81.3%; 72.2%; 62.5%
- Evidence strengthLow
How this study scored 51/100
Published in a peer-reviewed journal. Scored zero for study design and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Frontiers in aging neuroscience) |
| Journal's citation record | 2 / 4 | Frontiers in Aging Neuroscience: journal h-index 174 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 2 / 5 | 2017 — within 10 year(s) of the newest study here |
| Sample size | 1 / 4 | 20 participants |
| Effect reported | 2 / 3 | Effect reported as a number, without an interval or test |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 4 / 7 | Cited 72 times (OpenAlex, 2026-10-10) |
| Citations per year | 2 / 5 | 6.5 citations a year over 11 year(s) since 2017 |
| Impact for its field and year | 3 / 6 | Cited 5.0× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 2 / 6 | Cited by 8 other studies in this library |
| Still being cited | 2 / 4 | Cited 21 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 3 / 4 | Last-listed author Christoph Laske: h-index 58 (OpenAlex, whole career) |
| Institution's track record | 1 / 3 | University of Tübingen: institution h-index 940 (OpenAlex) |
| Multi-centre collaboration | 2 / 3 | OpenAlex lists 4 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 28443019) |
| Free to read | 2 / 2 | Free to read |
| Total | 51 / 100 | — |
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Read the original
- DOI: 10.3389/fnagi.2017.00101
- PubMed: 28443019
- Original source →
- Free full text: Frontiers in Aging Neuroscience →
Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
APA 7th
Müller, S., Preische, O., Heymann, P., Elbing, U., & Laske, C. (2017). Increased Diagnostic Accuracy of Digital vs. Conventional Clock Drawing Test for Discrimination of Patients in the Early Course of Alzheimer's Disease from Cognitively Healthy Individuals. Frontiers in aging neuroscience. https://doi.org/10.3389/fnagi.2017.00101
Vancouver
Müller S, Preische O, Heymann P, Elbing U, Laske C. Increased Diagnostic Accuracy of Digital vs. Conventional Clock Drawing Test for Discrimination of Patients in the Early Course of Alzheimer's Disease from Cognitively Healthy Individuals. Frontiers in aging neuroscience. 2017. doi:10.3389/fnagi.2017.00101. PMID: 28443019.
BibTeX
@article{muller2017-28443019,
author = {Müller, S. and Preische, O. and Heymann, P. and Elbing, U. and Laske, C.},
title = {{Increased Diagnostic Accuracy of Digital vs. Conventional Clock Drawing Test for Discrimination of Patients in the Early Course of Alzheimer's Disease from Cognitively Healthy Individuals}},
journal = {Frontiers in aging neuroscience},
year = {2017},
doi = {10.3389/fnagi.2017.00101},
pmid = {28443019},
url = {https://doi.org/10.3389/fnagi.2017.00101}
}
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