{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T11:40:51Z","timestamp":1765539651089,"version":"3.48.0"},"reference-count":35,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T00:00:00Z","timestamp":1765497600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"hospital foundation SKWOSZ"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Geriatrics"],"abstract":"<jats:p>Objective: The non-verbal nature of the Clock Drawing Test (CDT) suggests it is a suitable cognitive screening instrument for populations with lower educational levels and\/or language barriers. This study evaluates whether the CDT is a valid screening instrument for low-educated patients and includes a qualitative analysis of CDT errors. Method: A total of 503 participants were included, divided into four groups (dementia, MCI, no cognitive impairment, and other diagnosis), based on a clinical diagnosis by a geriatrician. Educational levels were categorized into four groups: no education and low, middle, and high education. CDT scores were assessed using the seven-point scoring system (Freedman), and two cutoff points were evaluated. Results: Results showed that in all education categories, the dementia group scored significantly lower on the CDT compared to the non-dementia group. The difference was smallest in participants with no education. Two cut-off points were assessed: &lt;4 and &lt;3. A cut-off of &lt;4 showed better sensitivity versus &lt;3, particularly for low-educated groups. A cut-off of &lt;3 provided better specificity versus &lt;4. Error analysis showed that errors made by low-educated participants without dementia were similar to those of patients with dementia. Conclusions: These findings show that the CDT (both total score and qualitative error analysis) has limited value in dementia case-finding in low-educated groups. The CDT is recommended primarily for middle- and high-educated groups.<\/jats:p>","DOI":"10.3390\/geriatrics10060164","type":"journal-article","created":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T11:13:33Z","timestamp":1765538013000},"page":"164","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Clock Drawing Test: A Valid Screening Instrument for Dementia Detection in Low-Educated Patients?"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2239-6486","authenticated-orcid":false,"given":"Janique","family":"Boots-van der Heiden","sequence":"first","affiliation":[{"name":"Department of Geriatrics, OLVG Hospital, 1061 AE Amsterdam, The Netherlands"},{"name":"Department of Palliative Care, Isala Hospital, 8025 AB Zwolle, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jos","family":"van Campen","sequence":"additional","affiliation":[{"name":"Department of Geriatrics, OLVG Hospital, 1061 AE Amsterdam, The Netherlands"},{"name":"Department of Geriatrics, Maasstad Hospital, 3079 DZ Rotterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tessa","family":"Kooistra","sequence":"additional","affiliation":[{"name":"Department of Geriatrics, Alrijne Hospital, 2353 GA Leiderdorp, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Irene","family":"van de Vorst","sequence":"additional","affiliation":[{"name":"Independent Researcher, 1061 AE Amsterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6876-0469","authenticated-orcid":false,"given":"Miriam","family":"Goudsmit","sequence":"additional","affiliation":[{"name":"Department of Psychiatry & Medical Psychology, OLVG Hospital, 1061 AE Amsterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,12]]},"reference":[{"key":"ref_1","unstructured":"Prince, M.J., Wimo, A., Guerchet, M., Ali, G., Wu, Y., and Prina, M.A. (2025, July 01). 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