{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T14:44:51Z","timestamp":1791816291587,"version":"4.3.4"},"reference-count":52,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T00:00:00Z","timestamp":1791417600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["KAKENHI\/ JP18K03105, JP23K02966, and JP23K10352"],"award-info":[{"award-number":["KAKENHI\/ JP18K03105, JP23K02966, and JP23K10352"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Alzheimer\u2019s Disease"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The Clock Drawing Test (CDT) is widely used for cognitive screening but lacks unified scoring standards and neuroanatomical validation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>We examined the neuroanatomical correlates and incremental validity beyond conventional CDT scoring of CDT-14, a psychometrically refined 14-item system with three subfactors (Circle, Numbering, and Hand), using voxel-based morphometry (VBM).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed 985 participants from a heterogeneous memory-clinic cohort. Whole-brain VBM compared CDT-14 total and subfactor scores with three conventional scoring systems. Models adjusted for age, sex, education level, and total intracranial volume. Incremental validity was assessed after controlling for a principal-component-derived conventional composite score, with sensitivity analyses adjusting for white matter lesion volume (WMLV).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>CDT-14 was associated with gray matter volume (GMV) in distributed clock-drawing regions, including the right anterior hippocampus, parahippocampal gyrus, bilateral precuneus, and prefrontal regions. Primary incremental analyses identified additional associations in bilateral ventral temporal, right occipito-temporal, and dorsal anterior cingulate regions after accounting for conventional CDT performance. These associations were attenuated after WMLV adjustment, and no clusters survived FWE correction in the WMLV-adjusted incremental model. Subfactor analyses suggested partially distinct but overlapping patterns involving frontostriatal and cingulate regions for Circle, thalamic and limbic-related regions for Numbering, and hippocampal, parietal, and occipital regions for Hand.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>CDT-14 showed cross-sectional GMV associations beyond conventional scoring in primary analyses. However, the incremental associations were not robust to WMLV adjustment at the FWE-corrected threshold and should be interpreted cautiously. Longitudinal, biomarker-informed, and externally validated studies are needed to establish predictive validity, disease specificity, and clinical utility.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/13872877261493066","type":"journal-article","created":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T10:57:03Z","timestamp":1791457023000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Neuroanatomical correlates of the CDT-14: A voxel-based morphometry study exploring incremental information beyond conventional clock drawing scores"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6345-382X","authenticated-orcid":false,"given":"Yoichi","family":"Sawada","sequence":"first","affiliation":[{"name":"Okayama Prefectural University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2324-1144","authenticated-orcid":false,"given":"Toru","family":"Satoh","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery, Neurology, and Psychiatry, Ryofukai Satoh Neurosurgical Hospital, Fukuyama, Hiroshima, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideaki","family":"Saba","sequence":"additional","affiliation":[{"name":"Section of Higher Brain Function, Department of Rehabilitation, Ryofukai Satoh Neurosurgical Hospital, Fukuyama, Hiroshima, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshiki","family":"Kato","sequence":"additional","affiliation":[{"name":"Section of Higher Brain Function, Department of Rehabilitation, Ryofukai Satoh Neurosurgical Hospital, Fukuyama, Hiroshima, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomoko","family":"Kuwada","sequence":"additional","affiliation":[{"name":"Section of Higher Brain Function, Department of Rehabilitation, Ryofukai Satoh Neurosurgical Hospital, Fukuyama, Hiroshima, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sayoko","family":"Shima","sequence":"additional","affiliation":[{"name":"Section of Higher Brain Function, Department of Rehabilitation, Ryofukai Satoh Neurosurgical Hospital, Fukuyama, Hiroshima, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kana","family":"Murakami","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery, Neurology, and Psychiatry, Ryofukai Satoh Neurosurgical Hospital, Fukuyama, Hiroshima, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megumi","family":"Sasaki","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery, Neurology, and Psychiatry, Ryofukai Satoh Neurosurgical Hospital, Fukuyama, Hiroshima, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yudai","family":"Abe","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery, Neurology, and Psychiatry, Ryofukai Satoh Neurosurgical Hospital, Fukuyama, Hiroshima, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaori","family":"Harano","sequence":"additional","affiliation":[{"name":"Department of Human Welfare, Faculty of Human Relations, Otsuma Women's University, Tama, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,10,8]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)30367-6"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1001\/archneur.56.3.303"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1590\/S1807-59322009001000006"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13195-019-0474-3"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1017\/S1355617722000662"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1002\/gps.930010209"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1177\/0891988711402349"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1176\/appi.neuropsych.12070180"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1590\/1980-57642016dn11-010003"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1002\/gps.4731"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/0278-2626(92)90112-Y"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.1989.tb02233.x"},{"key":"e_1_3_3_14_2","volume-title":"Clock Drawing: a neuropsychological analysis","author":"Freedman M","year":"1994","unstructured":"Freedman M, Leach L, Kaplan E, et al. 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