Brian J. Mainland

Clock Drawing Test

The clock drawing test (CDT) has long been recognized as a useful component for the screening of cognitive disorders. It provides a user-friendly visual representation of cognitive functioning that is simple and rapidly administered, making it appealing to clinicians and patients alike. The ease of use and wide range of cognitive abilities required to complete the CDT successfully have made this test an increasingly popular cognitive screening measure in both research and clinical settings. This chapter summarizes and compares the numerous CDT scoring methods that have been described in the literature. Also, psychometric properties are presented for the CDT when used for cognitive screening in a variety of neurologic conditions, including Alzheimer’s disease, Parkinson’s disease, Huntington’s disease, vascular disease, schizophrenia, stroke, and traumatic brain injury. Cultural, ethnic, and educational considerations for the CDT are also discussed.

The Manifestation of Anxiety Disorders after Traumatic Brain Injury: A Review

The development of anxiety disorders after a traumatic brain injury (TBI) is a strong predictor of social, personal, and work dysfunction; nevertheless, the emergence of anxiety has been largely unexplored and poorly understood in the context of TBI. This article provides an overview of the limited published research to date on anxiety disorders that are known to develop after TBI, including post-traumatic stress disorder, generalized anxiety disorder, obsessive-compulsive disorder, panic disorder, specific phobia, and social anxiety disorder. This review also examines diagnostic criteria, the epidemiology of each disorder, and the factors that influence the expression of these conditions, including injury-related and psychosocial variables. Putative neural correlates will be reviewed where known. A discussion of current treatment options and avenues for further research are explored.

The Times They Are a-Changin’ Clock Drawing and Prediction of Dementia

Identification of individuals who will eventually develop dementia is critical for early intervention, treatment, and care planning. The clock drawing test (CDT) is a widely used cognitive screening tool that has been well accepted among clinicians and patients for its ease of use and short administration time. This review explores the value of the CDT for predicting the later development of dementia in cognitively intact older adults and patients with mild cognitive impairment (MCI). Additionally, we reviewed studies that examined the ability of the CDT to monitor declines in cognitive functioning over time. A PubMed literature search for articles that included a longitudinal analysis of the CDT was conducted. The search included articles published up to June 2013 and manual cross-referencing of bibliographies. Relevant studies were categorized, summarized, and critiqued. The consensus from the studies reviewed suggests that the CDT is a useful measure of cognitive decline over time. Conceptual clock drawing errors (eg, misrepresentation of time) detected this decline most effectively. In addition, the CDT appears to differentiate at baseline between cognitively intact older adults who will develop dementia up to 2 years postbaseline. Finally, the CDT has been found to differentiate between patients with MCI who will progress to dementia up to 6 years postbaseline. The CDT appears useful for the longitudinal assessment of cognitive impairment and together with other validated measures may be helpful for predicting conversion to dementia. Cost-effective and practical ways of predicting risk of dementia will become increasingly critical as we develop disease-modifying treatments.

Interpersonal problems and impacts: Further evidence for the role of interpersonal functioning in treatment outcome in major depressive disorder

INTRODUCTION Empirical research has converged to support the concurrent association between social difficulties and psychiatric symptoms; yet, longitudinal associations between interpersonal problems and treatment outcome require clarification. The current investigation evaluated the influence of interpersonal problems assessed prior to treatment on interpersonal impacts assessed during treatment as well as on treatment outcome in outpatients with major depressive disorder (MDD). METHOD 125 participants with a primary diagnosis of MDD were randomized to receive cognitive behavioural therapy or interpersonal therapy. Participants completed the Beck Depression Inventory-II, Hamilton Depression Rating Scale, and Inventory of Interpersonal Problems Circumplex before and after treatment. Therapists completed the Impact Message Inventory during and after treatment. RESULTS Interpersonal distress improved over the course of treatment; all other interpersonal changes were non-significant when distress was taken into account. Pre-treatment rigidity and agentic problems predicted less reduction in depressive symptoms, whereas agentic and communal impacts upon therapists during treatment predicted greater symptom change. Overall interpersonal distress was only indirectly associated with treatment response later in treatment, through its association with agentic style. Results did not differ across therapy type, and were replicated across self-report and interviewer-rated measures of depression severity. LIMITATIONS Limitations include the brief duration of treatment, lack of medication arm, and potentially restricted generalizability of patients in a randomized control trial to those in routine practice. CONCLUSIONS Interpersonal style demonstrated a trait-like stability over treatment, and appears to fluctuate due to co-occurring distress. Yet, specific interpersonal styles were negative prognostic indicators, even within therapy specifically targeting interpersonal functioning.

Can clock drawing differentiate Alzheimer's disease from other dementias?

BACKGROUND Studies have shown the clock-drawing test (CDT) to be a useful screening test that differentiates between normal, elderly populations, and those diagnosed with dementia. However, the results of studies which have looked at the utility of the CDT to help differentiate Alzheimers disease (AD) from other dementias have been conflicting. The purpose of this study was to explore the utility of the CDT in discriminating between patients with AD and other types of dementia. METHODS A review was conducted using MEDLINE, PsycINFO, and Embase. Search terms included clock drawing or CLOX and dementia or Parkinsons Disease or AD or dementia with Lewy bodies (DLB) or vascular dementia (VaD). RESULTS Twenty studies were included. In most of the studies, no significant differences were found in quantitative CDT scores between AD and VaD, DLB, and Parkinsons disease dementia (PDD) patients. However, frontotemporal dementia (FTD) patients consistently scored higher on the CDT than AD patients. Qualitative analyses of errors differentiated AD from other types of dementia. CONCLUSIONS Overall, the CDT score may be useful in distinguishing between AD and FTD patients, but shows limited value in differentiating between AD and VaD, DLB, and PDD. Qualitative analysis of the type of CDT errors may be a useful adjunct in the differential diagnosis of the types of dementias.

Can Clock Drawing Differentiate Alzheimer’s Disease From Other Dementias?

Objective Studies have shown the Clock Drawing Test (CDT) to be useful as a screening test between normal, elderly populations and those diagnosed with dementia. However, the results of studies which have looked at the utility of the CDT to help differentiate Alzheimers dementia (AD) and other dementias have been conflicting. The purpose of this study was to explore the utility of the CDT in discriminating between patients with AD and other dementias. Method A review was conducted using MEDLINE, PsycINFO and Embase. Search terms included clock drawing or CLOX and dementia or Parkinsons Disease or Alzheimers Disease or Dementia with Lewy Bodies (DLB) or Vascular Dementia (VaD) or Semantic Dementia. Results 20 studies were selected. In most of the studies included, no significant differences were found in CDT scores between AD and VaD, DLB, and Parkinsons disease dementia (PDD) patients. Frontotemporal dementia (FTD) patients consistently scored higher in the CDT than AD patients. Qualitative analyses of the type of errors seem to suggest a difference between AD and the other types of dementias. Conclusions Overall, the CDT score may be useful in distinguishing between AD and FTD patients, but shows limited value in differentiating between AD and VaD, DLB and PDD. Qualitative analysis of the type of CDT errors may be a useful adjunct in the differential diagnosis of the types of dementias.

Cognitive Fluctuations and Cognitive Test Performance Among Institutionalized Persons With Dementia

Objective: To examine the nature and frequency of cognitive fluctuations (CFs) among institutionalized persons with dementia. Method: A clinical interview and a medical chart review were conducted, and 55 patients were assigned a specific dementia diagnosis. The Severe Impairment Battery (SIB) was administered to assess cognitive function, and the Dementia Cognitive Fluctuation Scale (DCFS) was administered to each patient’s primary nurse to determine the presence and severity of CFs. Results: A simple linear regression model was conducted with DCFS as the predictor variable and SIB total score as the dependent variable. The overall model was significant, suggesting that score on the DCFS significantly predicted SIB total score. Additionally, greater severity of CFs predicted poorer performance in the areas of orientation, language, and praxis. Conclusions: Results suggest that CFs exert a clinically significant influence over patients’ cognitive abilities and should be considered as a source of excess disability.

Outcomes of Cognitive Fluctuations in Dementia Patients

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