The use of the Clock Drawing Test in bipolar disorder
                    with or without dementia of Alzheimer’s type

Aprahamian, Ivan; Radanovic, Marcia; Nunes, Paula Villela; Ladeira, Rodolfo Braga; Forlenza, Orestes Vicente

doi:10.1590/0004-282X20140153

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Sumário

Articles • Arq. Neuro-Psiquiatr. 72 (12) • Dec 2014 • https://doi.org/10.1590/0004-282X20140153 copy

The use of the Clock Drawing Test in bipolar disorder with or without dementia of Alzheimer’s type

O uso do Teste do Desenho do Relógio em pacientes com transtorno bipolar com e sem demência do tipo Alzheimer

Authorship SCIMAGO INSTITUTIONS RANKINGS

There is limited data regarding the cognitive profile from screening tests of older adults with bipolar disorder (BD) with dementia.

Objective

To investigate the Clock Drawing Test (CDT) among older adults with BD with and without Alzheimer’s disease (AD).

Method

209 older adults (79 with BD without dementia and 70 controls; 60 with AD, being 27 with BD) were included to evaluate the performance of three CDT scoring scales, beyond the Mini-Mental State Examination (MMSE) and verbal fluency (VFT).

Results

Patients with BD without dementia presented with lower scores in MMSE, VF and one CDT scoring scale than controls. Patients with BD and AD presented with lower scores in VF and CDT scoring scales than patients with only AD. All CDT scales presented similar sensitivity and specificity for BD and non-BD groups.

Conclusion

Elderly subjects with BD showed greater impairment in CDT in both groups of normal cognition and AD.

Clock Drawing Test; Alzheimer’s disease; bipolar disorder

	BD (n=79)	non-BD (n=70)	p*
Age (years)	67.1 (4.0)	68.1 (5.2)	0.142
Female gender (n)	50	60	0.002**
Education (years)	9.1 (4.6)	9.9 (5.0)	0.349
CAMCOG	91.2 (6.5)	92.0 (9.0)	0.146
MMSE	27.1 (2.2)	27.9 (2.3)	0.003
VFT animals	14.9 (4.4)	18.0 (5.5)	0.001
CDT Shulman	3.7 (1.0)	3.8 (0.8)	0.367
CDT Sunderland	8.1 (2.1)	8.7 (1.9)	0.107
CDT Mendez	17.3 (3.9)	18.2 (3.2)	0.037

	BD (n=27)	non-BD (n=33)	p*
Age (years)	71.3 (6.4)	73.9 (5.5)	0.113
Female gender (n)	23	25	0.364**
Education (years)	4.9 (3.4)	5.6 (4.4)	0.662
CAMCOG	65.2 (14.2)	63.0 (12.3)	0.284
MMSE	20.3 (3.7)	18.7 (4.1)	0.117
VFT animals	7.8 (3.0)	10.8 (4.4)	0.015
CDT Shulman	1.7 (1.4)	2.7 (1.6)	0.016
CDT Sunderland	4.0 (2.6)	5.33 (2.5)	0.032
CDT Mendez	7.4 (7.4)	11.5 (6.8)	0.024

	AUC	95%CI AUC	Cut-off scores	Sens. / Spec.	p
CAMCOG	0.963	0.906-0.990	81	90.1 / 85.7	<0.001
MMSE	0.972	0.918-0.994	24	93.9 / 91.2	<0.001
VFT animals	0.841	0.752-0.908	14	74.2 / 75.3*	<0.001
CDT Shulman	0.802	0.712-0.874	3	84.8 / 71.4	<0.001
CDT Sunderland	0.848	0.764-0.911	7	78.9 / 74.2	<0.001
CDT Mendez	0.832	0.746-0.898	18	81.8 / 72.8	<0.001

	AUC	95%CI AUC	Cut-off scores	Sens. / Spec.	p
CAMCOG	0.974	0.923-0.995	82	92.6 / 94.9	<0.001
MMSE	0.952	0.892-0.984	23	88.9 / 93.7	<0.001
VFT animals	0.912	0.841-0.958	11	88.9 / 82.3	<0.001
CDT Shulman	0.864	0.784-0.923	3	92.6 / 62.0	<0.001
CDT Sunderland	0.880	0.802-0.935	6	81.5 / 72.2	<0.001
CDT Mendez	0.872	0.793-0.929	15	81.5 / 81.0	<0.001

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[1] Correspondence: Ivan Aprahamian; Rua Dr. Ovidio Pires de Campos, 785 / 3° andar; 05403-010 São Paulo SP, Brasil; E-mail: aprahamian@usp.br