Clinical utility of a novel digitized clock drawing task
Chowdhry, Saba Akhtar
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OBJECTIVE: The goal of this research was to examine the clinical utility of the digital Clock in the Box (dCIB), a novel digitized cognitive screening test. This was accomplished by (1) creating cutoff scores for the dCIB, (2) evaluating performance on the dCIB relative to established cognitive screening and standardized neuropsychological measures, and (3) determining the efficacy of the dCIB to screen for subtle cognitive deficits associated with poor vascular health. Metabolic Syndrome (MetS; clinical syndrome of three or more cardiovascular risk factors) is a rising health epidemic associated with an increased risk for cerebrovascular disease and vascular dementia. Early detection of subtle deficits associated with MetS may assist in regulation of disease progression and prevention of future vascular dementia. METHODS: A community-based sample of adults with no self-reported history of cognitive impairment was recruited for a cross-sectional study in which they completed a metabolic assessment, blood draw, and a brief neuropsychological battery consisting of the dCIB, the Mini-Mental State Exam (MMSE), and measures of executive function, memory, and attention. For part of the analysis, participants were separated into MetS (n=21) and non-MetS (n=42) groups based on current diagnostic criteria for MetS. RESULTS: Participants (N=63) were older (62.49 ± 9.16 years), educated (16.46 ± 2.76 years), and diverse with 44.4% female (n=28) and 28.6% non-White (n=18). Receiver operating characteristic (ROC) analysis and Youden’s J statistic determined the optimal cutoff value for the dCIB as 5.5 (dCIB score ≤ 6 indicating suspected impairment; dCIB score ≤ 5 indicating probable impairment). Performance on the dCIB (6.32 ± 2.32) was significantly correlated with the MMSE (28.19 ± 2.06); (Pearson’s r = 0.437, p = 0.000). The dCIB had better sensitivity (72.7%) but poorer specificity (65.4%) compared to the MMSE (sensitivity 45.5%; specificity 94.2%). Using regression modeling, the dCIB significantly predicted performance on measures of executive function, memory, and attention. In a sample stratified by vascular risk, the dCIB successfully differentiated MetS (5.33 ± 2.75) and non-MetS (6.81 ± 1.93) groups, with lower dCIB scores in the MetS group relative to the non-MetS group (F = 8.975, p = 0.004). CONCLUSION: The dCIB is a novel digitized clock drawing task designed to screen for cognitive impairment. Clinical utility for the dCIB was established by determining its test validity and demonstrating its sensitivity to detect subtle cognitive deficits in a sample with vascular risk. Because the dCIB is simple to administer and brief to complete, it may be an ideal option for routine cognitive screening in primary care settings.
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