{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T19:34:26Z","timestamp":1787686466593,"version":"build-2784847793"},"reference-count":82,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2023,9,13]],"date-time":"2023-09-13T00:00:00Z","timestamp":1694563200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Alzheimer\u2019s Disease"],"published-print":{"date-parts":[[2023,10,10]]},"abstract":"<jats:sec specific-use=\"heading-level-1\">\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Clock Drawing Test (CDT) is a commonly used screening tool for cognitive disorders, known for its ease of administration and scoring. Despite frequent use by clinicians, CDT is criticized for its poor predictive value in mild cases of impairment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec specific-use=\"heading-level-1\">\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To evaluate CDT as a screening tool for early stage of cognitive impairment in biomarker-verified Alzheimer\u2019s disease (AD) and depressive disorder (DD).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec specific-use=\"heading-level-1\">\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We analyzed CDT of 172 patients with verified AD, 70 patients with DD, in whom neurodegenerative disorder was excluded using cerebrospinal fluid biomarkers, and 58 healthy older adults. CDT was scored using the semi-quantitative (Shulman) and itemized criteria (adapted from Mendez).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec specific-use=\"heading-level-1\">\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Logistic regression showed that for both DD and AD patients with high Mini-Mental State Examination (MMSE) scores (27 and above) the significant predicting variable is uneven number spacing. As MMSE deteriorates (24-26 points), an additional error of setting clock hands is predictive of the disease. In the low MMSE condition, CDT showed an acceptable discrimination for AD (AUC itemized 0.740, Shulman 0.741) and DD (AUC itemized 0.827, Shulman 0.739) using both scoring methods. In the high MMSE condition, discrimination rates were acceptable using itemized scoring but poor using Shulman scoring for both AD (AUC itemized 0.707, Shulman 0.677) and DD (AUC itemized 0.755, Shulman 0.667) groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec specific-use=\"heading-level-1\">\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Ideally, modern diagnostic process should take place before the cognitive performance drops beneath the healthy range. This makes CDT of little use when screening patients with very mild cognitive deficits.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3233\/jad-230110","type":"journal-article","created":{"date-parts":[[2023,9,15]],"date-time":"2023-09-15T11:18:24Z","timestamp":1694776704000},"page":"1597-1608","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":8,"title":["Clock Drawing Test: Types of Errors and Accuracy in Early Cognitive Screening"],"prefix":"10.1177","volume":"95","author":[{"given":"Karolina","family":"Sejunaite","sequence":"first","affiliation":[{"name":"Ulm University","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederic","family":"Gaucher","sequence":"additional","affiliation":[{"name":"Ulm University","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Lanza","sequence":"additional","affiliation":[{"name":"Ulm University","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias W.","family":"Riepe","sequence":"additional","affiliation":[{"name":"Ulm University","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2023,9,13]]},"reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.1002\/gps.930010209"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0278-2626(03)00170-2"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.1017\/S003329170000310X"},{"key":"e_1_3_5_5_2","first-page":"601","article-title":"Der Allee-Zeichentest: Vorl\u00e4ufige Mitteilung einer Methode zur Erfassung von Raumabbildungsanomalien bei psychisch Kranken [The tree-lined avenue drawing test. Preliminary report on a method to diagnose space drawing abnormalities in mental patients]","volume":"23","author":"Rennert H","year":"1971","unstructured":"RennertH (1971) Der Allee-Zeichentest: Vorl\u00e4ufige Mitteilung einer Methode zur Erfassung von Raumabbildungsanomalien bei psychisch Kranken [The tree-lined avenue drawing test. Preliminary report on a method to diagnose space drawing abnormalities in mental patients]. Psychiatr Neurol Med Psychol 23, 601\u2013609.","journal-title":"Psychiatr Neurol Med Psychol"},{"key":"e_1_3_5_6_2","doi-asserted-by":"publisher","DOI":"10.1002\/1099-1166(200006)15:6<548::AID-GPS242>3.0.CO;2-U"},{"key":"e_1_3_5_7_2","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1099-1166(199706)12:6<619::AID-GPS554>3.0.CO;2-H"},{"key":"e_1_3_5_8_2","first-page":"69","article-title":"Clock-drawing: An assessment technique in dementia","volume":"13","author":"Dastor DP","year":"1991","unstructured":"DastorDP, SchwartzG, KurzmanD (1991) Clock-drawing: An assessment technique in dementia. J Clin Exp Gerontol 13, 69\u201385.","journal-title":"J Clin Exp Gerontol"},{"key":"e_1_3_5_9_2","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1099-1166(199705)12:5<526::AID-GPS535>3.0.CO;2-V"},{"key":"e_1_3_5_10_2","doi-asserted-by":"publisher","DOI":"10.1093\/geronb\/53B.6.P353"},{"key":"e_1_3_5_11_2","doi-asserted-by":"publisher","DOI":"10.1093\/arclin\/8.5.405"},{"key":"e_1_3_5_12_2","doi-asserted-by":"publisher","DOI":"10.2190\/5A0F-936P-VG8N-0F5R"},{"key":"e_1_3_5_13_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.1992.tb01796.x"},{"key":"e_1_3_5_14_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.1989.tb02233.x"},{"key":"e_1_3_5_15_2","first-page":"22","article-title":"An examination of a proposed scoring procedure for the clock drawing test: Reliability and predictive validity of the clock scoring system (CSS)","volume":"10","author":"Todd ME","year":"1995","unstructured":"ToddME, DammersPM, AdamsSG, ToddHM, MorrisonM (1995) An examination of a proposed scoring procedure for the clock drawing test: Reliability and predictive validity of the clock scoring system (CSS). Am J Alzheimers Dis Other Demen 10, 22\u201326.","journal-title":"Am J Alzheimers Dis Other Demen"},{"key":"e_1_3_5_16_2","doi-asserted-by":"publisher","DOI":"10.1002\/gps.747"},{"key":"e_1_3_5_17_2","doi-asserted-by":"publisher","DOI":"10.1002\/gps.352"},{"key":"e_1_3_5_18_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.59.6.898"},{"key":"e_1_3_5_19_2","doi-asserted-by":"publisher","DOI":"10.1017\/S1041610209990676"},{"key":"e_1_3_5_20_2","doi-asserted-by":"publisher","DOI":"10.3233\/JAD-191191"},{"key":"e_1_3_5_21_2","doi-asserted-by":"publisher","DOI":"10.1590\/1980-57642016dn11-010003"},{"key":"e_1_3_5_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/0278-2626(92)90112-Y"},{"key":"e_1_3_5_23_2","doi-asserted-by":"publisher","DOI":"10.1093\/arclin\/11.6.529"},{"key":"e_1_3_5_24_2","doi-asserted-by":"publisher","DOI":"10.1177\/0891988709335798"},{"key":"e_1_3_5_25_2","doi-asserted-by":"publisher","DOI":"10.1177\/0891988711402349"},{"key":"e_1_3_5_26_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.1992.tb02106.x"},{"key":"e_1_3_5_27_2","doi-asserted-by":"publisher","DOI":"10.1080\/13803390701336411"},{"key":"e_1_3_5_28_2","doi-asserted-by":"publisher","DOI":"10.1017\/S1041610207006035"},{"key":"e_1_3_5_29_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.1989.tb02234.x"},{"key":"e_1_3_5_30_2","doi-asserted-by":"publisher","DOI":"10.1002\/gps.930080606"},{"key":"e_1_3_5_31_2","doi-asserted-by":"publisher","DOI":"10.1016\/0022-3956(75)90026-6"},{"key":"e_1_3_5_32_2","doi-asserted-by":"publisher","DOI":"10.1017\/S1041610204000419"},{"key":"e_1_3_5_33_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1440-1819.2001.00894.x"},{"key":"e_1_3_5_34_2","doi-asserted-by":"publisher","DOI":"10.1017\/S104161021200141X"},{"key":"e_1_3_5_35_2","first-page":"e11613","article-title":"Similarities between depression and neurodegenerative diseases: Pathophysiology, challenges in diagnosis and treatment options","volume":"12","author":"Hussain M","year":"2020","unstructured":"HussainM, KumarP, KhanS, GordonDK, KhanS (2020) Similarities between depression and neurodegenerative diseases: Pathophysiology, challenges in diagnosis and treatment options. Cureus 12, e11613.","journal-title":"Cureus"},{"key":"e_1_3_5_36_2","doi-asserted-by":"crossref","unstructured":"HodgesJR (2000) Memory in the dementias. In The Oxford Handbook of Memory Tulving I Craik FIM eds. Oxford University Press: New York 441\u2013459.","DOI":"10.1093\/oso\/9780195122657.003.0028"},{"key":"e_1_3_5_37_2","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.162.4.691"},{"key":"e_1_3_5_38_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jagp.2014.02.006"},{"key":"e_1_3_5_39_2","doi-asserted-by":"publisher","DOI":"10.1093\/braincomms\/fcaa206"},{"key":"e_1_3_5_40_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0231111"},{"key":"e_1_3_5_41_2","doi-asserted-by":"publisher","DOI":"10.1097\/JGP.0b013e3181e89a5b"},{"key":"e_1_3_5_42_2","first-page":"689","article-title":"Brain structure and function related to depression in Alzheimer\u2019s disease: Contributions from neuroimaging research","volume":"45","author":"Brommelhoff JA","year":"2015","unstructured":"BrommelhoffJA, SultzerDL (2015) Brain structure and function related to depression in Alzheimer\u2019s disease: Contributions from neuroimaging research. Int Psychogeriatr 45, 689\u2013703.","journal-title":"Int Psychogeriatr"},{"key":"e_1_3_5_43_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2013.281053"},{"key":"e_1_3_5_44_2","unstructured":"NiemannH SturmW Th\u00f6ne-OttoAIT WillmesK (2008) CVLT California Verbal Learning Test. German adaptation. Manual Pearson Assessment Frankfurt."},{"key":"e_1_3_5_45_2","unstructured":"H\u00e4rtingC MarkowitschHJ NeufeldH CalabreseP DeisingerK KesslerJ (2000) Wechsler Ged\u00e4chtnis Test - Revidierte Fassung: Deutsche Adaptation der revidierten Fassung der Wechsler-Memory-Scale Huber G\u00f6ttingen."},{"key":"e_1_3_5_46_2","unstructured":"ReitanRM WolfstonD (1985) The Halstead-Reitan NeuropsychologicalTest Battery: Theory and Clinical Interpretation Neuropsychology Press Tucson AZ."},{"key":"e_1_3_5_47_2","unstructured":"AschenbrennerS TuchaO LangeKW (2000) RWT: Regensburger Wortfl\u00fcssigkeits-Test Hogrefe Verlag G\u00f6ttingen."},{"key":"e_1_3_5_48_2","unstructured":"World Health Organization (WHO) (1993) The ICD-10 classification of mental and behavioural disorders World Health Organization."},{"key":"e_1_3_5_49_2","doi-asserted-by":"publisher","DOI":"10.1177\/089198879100400310"},{"key":"e_1_3_5_50_2","doi-asserted-by":"publisher","DOI":"10.1111\/ggi.12550"},{"key":"e_1_3_5_51_2","unstructured":"HosmerDWJr. LemeshowS SturdivantRX (2013) Applied logistic regression 398 John Wiley & Sons."},{"key":"e_1_3_5_52_2","doi-asserted-by":"publisher","DOI":"10.1126\/science.1116251"},{"key":"e_1_3_5_53_2","doi-asserted-by":"publisher","DOI":"10.1037\/0894-4105.22.5.553"},{"key":"e_1_3_5_54_2","doi-asserted-by":"crossref","unstructured":"HodgesJR (2013) Distributed cognitive functions. In Cognitive Assessment for Clinicians Hodges JR ed. 2nd Edition Oxford University Press 1\u201328.","DOI":"10.1093\/med\/9780192629760.003.0001"},{"key":"e_1_3_5_55_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jns.2019.04.019"},{"key":"e_1_3_5_56_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.40.3_Part_1.439"},{"key":"e_1_3_5_57_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cortex.2015.08.004"},{"key":"e_1_3_5_58_2","doi-asserted-by":"publisher","DOI":"10.1176\/appi.neuropsych.12070180"},{"key":"e_1_3_5_59_2","doi-asserted-by":"publisher","DOI":"10.55782\/ane-2013-1939"},{"key":"e_1_3_5_60_2","doi-asserted-by":"publisher","DOI":"10.1177\/0891988715598228"},{"key":"e_1_3_5_61_2","doi-asserted-by":"publisher","DOI":"10.1177\/0891988709332941"},{"key":"e_1_3_5_62_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0010-9452(08)70404-0"},{"key":"e_1_3_5_63_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuropsychologia.2004.12.005"},{"key":"e_1_3_5_64_2","doi-asserted-by":"publisher","DOI":"10.1159\/000082352"},{"key":"e_1_3_5_65_2","doi-asserted-by":"publisher","DOI":"10.3233\/JAD-210456"},{"key":"e_1_3_5_66_2","doi-asserted-by":"publisher","DOI":"10.2190\/5QA5-PHUN-1Q9F-C0PB"},{"key":"e_1_3_5_67_2","doi-asserted-by":"publisher","DOI":"10.1002\/gps.445"},{"key":"e_1_3_5_68_2","doi-asserted-by":"publisher","DOI":"10.1177\/0891988704269820"},{"key":"e_1_3_5_69_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2004.52313.x"},{"key":"e_1_3_5_70_2","doi-asserted-by":"publisher","DOI":"10.1177\/0891988715588833"},{"key":"e_1_3_5_71_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11065-011-9171-0"},{"key":"e_1_3_5_72_2","unstructured":"DavisR PenneyD PittmanD LibonD SwensonR KaplanE (2010) The Digital Clock Drawing Test (dCDT)-III: Clinician reliability for a new quantitative system. 39th Annual Meeting of the International Neuropsychological Society Boston MA."},{"key":"e_1_3_5_73_2","unstructured":"PenneyD DavisR LibonD LamarM PriceC SwensonR (2011) The Digital Clock Drawing Test (dCDT)-II: A new computerized quantitative system. 40th Annual Meeting of the International Neuropsychological Society Boston MA."},{"key":"e_1_3_5_74_2","doi-asserted-by":"publisher","DOI":"10.3233\/JAD-191089"},{"key":"e_1_3_5_75_2","doi-asserted-by":"publisher","DOI":"10.1111\/aas.13756"},{"key":"e_1_3_5_76_2","first-page":"5657","article-title":"Phenotyping cognitive impairment using graphomotor and latency features in digital clock drawing test","volume":"2020","author":"Davoudi A","year":"2020","unstructured":"DavoudiA, DionC, AminiS, LibonDJ, TighePJ, PriceCC, RashidiP (2020) Phenotyping cognitive impairment using graphomotor and latency features in digital clock drawing test. Annu Int Conf IEEE Eng Med Biol Soc 2020, 5657\u20135660.","journal-title":"Annu Int Conf IEEE Eng Med Biol Soc"},{"key":"e_1_3_5_77_2","doi-asserted-by":"publisher","DOI":"10.3233\/JPD-202399"},{"key":"e_1_3_5_78_2","doi-asserted-by":"publisher","DOI":"10.2196\/27407"},{"key":"e_1_3_5_79_2","doi-asserted-by":"crossref","unstructured":"DavisR LibonDJ AuR PitmanD PenneyDL (2014) THink: Inferring Cognitive Status from Subtle Behaviors AAAI Conference on Artificial Intelligence. In Proceedings of the AAAI Conference on Artificial Intelligence pp. 2898-2905.","DOI":"10.1609\/aaai.v28i2.19017"},{"key":"e_1_3_5_80_2","doi-asserted-by":"publisher","DOI":"10.3233\/JAD-170444"},{"key":"e_1_3_5_81_2","doi-asserted-by":"publisher","DOI":"10.1017\/S1355617720000144"},{"key":"e_1_3_5_82_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-020-74710-9"},{"key":"e_1_3_5_83_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10994-015-5529-5"}],"container-title":["Journal of Alzheimer\u2019s Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.3233\/JAD-230110","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.3233\/JAD-230110","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.3233\/JAD-230110","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T10:08:29Z","timestamp":1777370909000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.3233\/JAD-230110"}},"subtitle":[],"editor":[{"given":"Carlo","family":"Abbate","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2023,9,13]]},"references-count":82,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2023,10,10]]}},"alternative-id":["10.3233\/JAD-230110"],"URL":"https:\/\/doi.org\/10.3233\/jad-230110","relation":{},"ISSN":["1387-2877","1875-8908"],"issn-type":[{"value":"1387-2877","type":"print"},{"value":"1875-8908","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,9,13]]}}}