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시계 그리기 검사(Clock Drawing Test: CDT)는 치매 선별검사로, 임상 장면에서 많이 사용되는 신경심리검사 중 하나이다. 본 연구에서는 기억성 경도인지장애(amnestic Mild Cognitive Impairment, aMCI)와 임상치매평가척도(Clinical Dementia Rating scale: CDR)에 따라 CDR 0.5로 분류된 알츠하이머병 치매(Alzheimer's disease, AD), 그리고 CDR 1로 분류된 AD 환자를 대상으로 시계 그리기 검사(CDT)의 수행을 양적 및 질적 오류 분석을 통해 비교하고자 하였다. 서울 소재 한 종합병원 신경과를 방문한 환자 중 aMCI 환자 97명, AD-CDR 0.5 환자 37명, AD-CDR 1 환자 50명을 대상으로 CDT와 종합적인 신경심리평가가 시행되었다. 연구 결과, CDT의 양적 점수는 유의한 차이가 있었으나 사후분석에서 aMCI와 AD-CDR 0.5 간의 유의한 차이는 보이지 않았다. 그러나 질적 오류 분석에서, <개념적 결함> 오류 중 <잘못된 표상: 시계>, <공간과 계획 결함> 오류 중 <불특정형태 오류>, 그리고 <그리기 어려움: 중도>에서 aMCI와 AD-CDR 0.5 간의 유의한 차이를 확인할 수 있었다. 다른 신경심리평가와 CDT의 상관관계를 분석한 결과, 한국판 보스톤 이름 대기 검사, 레이 복합 도형 검사: 모사, 언어적/시각적 기억 과제 및 전두엽/집행기능 과제들과 유의한 상관관계를 보였다. 따라서 본 연구 결과는 CDT 수행의 양적 점수만으로는 AD 초기 인지 변화를 살펴보는데 제한이 있으나 질적 오류 특성이 AD 초기 인지 변화를 살펴보는데 유용할 것이라는 점과 CDT를 수행하는데 의미적 지식, 시공간 구성 능력 및 집행기능이 영향을 미친다는 점을 시사한다.
The clock drawing test (CDT) has been consistently used as part of neuropsychological assessment, specifically as a screening tool for dementia. This study compared the quantitative and qualitative performance on the CDT among patients with amnestic mild cognitive impairment (aMCI), very mild Alzheimer's disease (AD) with a clinical dementia rating (CDR) of 0.5, and mild AD with a CDR of 1. Ninety-seven subjects with aMCI, 37 subjects with AD-CDR 0.5, and 50 subjects with AD-CDR 1, who visited the Memory Disorders Clinic in the Department of Neurology at the general hospital located in Seoul, underwent CDT and standardized neuropsychological battery tests. Although significant differences were found in the total quantitative scores among the three patient groups, there were no significant differences between aMCI and AD-CDR 0.5 patients. However, the qualitative error analysis revealed differences between the two groups in several areas: misrepresentation of clock (conceptual deficit error), deficit in spatial layout of numbers without any specific pattern (spatial disorganization), and moderate graphic difficulty. In correlational analysis between the CDT and other neuropsychological measures, the CDT was significantly correlated with the Korean-Boston Naming Test, Rey-Osterrieth Complex Figure copying test, verbal/visual memory tests, and frontal/executive function tests. Therefore, the findings of this study suggested that the characteristics of qualitative errors in the CDT can help identify cognitive changes in the early stage of AD; however, the quantitative scores of the CDT revealed limited information about these changes. Additionally, our results indicated that performance in the CDT was associated with semantic knowledge, visuospatial function, and executive function
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