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The Efficiency of Four Clock-Drawing Conditions for Differentiating Mild Dementia from Geriatric Depression

Abstract

The purpose of this study was to examine the efficiency of four clock-drawing conditions (the free-drawn condition, the pre-drawn condition, the examiner clock condition and the copy condition) for differentiating mild dementia patients from geriatric depressed patients and normal elderly persons. The Clock Drawing Test(CDT), including four clock-drawing conditions, was administered to 25 patients with mild dementia, 25 patients with geriatric depression and 25 normal elderly persons, and all of whom were matched according to age, gender and the education level. The cut-off scores, efficiencies, sensitivities, specificities, positive likelihood ratio(+LR), negative likelihood ratio(-LR), and the Area Under Curve(AUC) for the four clock-drawing conditions were calculated. Additionally, the relative diagnostic efficiencies of the four clock-drawing conditions, with using z test on the AUC, were compared for differentiating mild dementia patients from geriatric depressed patients and normal elderly persons. With the exception of the examiner clock condition, the other clock-drawing conditions well discriminated the mild dementia patients from the geriatric depressed patients or the normal elderly persons. All conditions were not able to discriminate the geriatric depressed patients from the normal elderly persons. The pre-drawn condition was the most efficient for differentiating the mild dementia patients from the geriatric depressed patients or the normal elderly persons. The examiner clock condition showed the worst efficiencies for all the differentiations. Additionally, there were no significant differences among the relative diagnostic efficiencies of the free-drawn condition, the pre-drawn condition, and the copy condition. The relative diagnostic efficiencies of the examiner clock condition were the lowest. These results suggest the diagnostic utility of using the free-drawn condition and the pre-drawn condition for differentiating mild dementia patients. It should be noted that the low specificity of the copy condition may have influenced its diagnostic utility. Finally, the limitations of this study as well as ideas and suggestions for future research are discussed.

keywords
mild dementia, geriatric depression, clock-drawing conditions, differential efficiency, 경도 치매, 노인성 우울, 시계 그리기 조건, 변별효율성, mild dementia, geriatric depression, clock-drawing conditions, differential efficiency

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