Método com algoritmo específico para pontuação do teste do desenho do
                  relógio em idosos cognitivamente normais

Mendes-Santos, Liana Chaves; Mograbi, Daniel; Spenciere, Bárbara; Charchat-Fichman, Helenice

doi:10.1590/1980-57642015DN92000007

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Original Articles • Dement. neuropsychol. 9 (2) • Apr-Jun 2015 • https://doi.org/10.1590/1980-57642015DN92000007 linkcopiar

Método com algoritmo específico para pontuação do teste do desenho do relógio em idosos cognitivamente normais

Autoria SCIMAGO INSTITUTIONS RANKINGS

O Teste do Desenho do Relógio (TDR) é uma barata e rápida medida de função cognitiva, de fácil aplicação, especialmente em idosos. Este instrumento é uma ferramenta clínica muito conhecida, amplamente utilizada no rastreamento de transtornos cognitivos e demência. O TDR pode ser aplicado de diferentes formas e a sua pontuação também varia.

OBJETIVO: Os objetivos deste estudo foram analisar o desempenho dos idosos no TDR e avaliar a confiabilidade inter-examinadores do TDR pontuado por um método com algoritmo específico, adaptado a partir dos critérios estabelecidos por Sunderland et al. (1989).

MÉTODOS: Analisamos o TDR de 100 idosos cognitivamente saudáveis com 60 anos de idade ou mais. O TDR ("desenho livre") e o Mini-Exame do Estado Mental (MEEM) foram administrados em todos os participantes. Seis avaliadores independentes pontuaram 30 TDR para avaliar a confiabilidade inter-examinadores.

RESULTADOS E CONCLUSÃO: A pontuação 5 do algoritmo proposto ("Os números em ordem inversa ou concentrados") equivalente a 5 pontos na escala original de Sunderland foi a mais frequente (53,5%). O método com algoritmo específico do TDR utilizado teve alta confiabilidade entre avaliadores (p<0,01), e a média da pontuação variou entre 5,06 e 5,96. A alta frequência de 5 pontos na pontuação geral pode sugerir a necessidade da elaboração de critérios de avaliação mais sutis, que sejam sensíveis às diferenças entre indícios de comprometimento nas habilidades visuoconstrutivas e executivas durante o envelhecimento.

Teste do Desenho do Relógio; confiabilidade inter-examinadores; idosos; neuropsicologia

You should mark with an “X” all the items present in the clock drawn
(a)	Presence of circle.	(j)	Presence of hour hand.
(b)	Presence of 12 numbers.	(k)	Presence of minute hand.
(c)	Numbers entered in the internal limit of the clock.	(l)	Minute hand proportionally larger than the hour hand.
(d)	Number in the correct ascending order.	(m)	One of the hands between 2 and 3.
(e)	Numbers in correct spatial position.	(n)	One of the hands on exactly 9.
(f)	Can you draw a straight vertical line between 12 and 6.	(o)	Wrong use of hands (digital or circling the numbers).
(g)	Can you draw a straight horizontal line between 3 and 9.	(p)	Some evidence of having understood that it is a clock.
(h)	Numbers not concentrated in one part of the clock.	(q)	Did not try or did not represent a clock.
(i)	Presence of two pointers.
Follow the algorithm for the score, but consider these three points initially
1. If the item “o” is checked, the score is 6 points.
2. If the item “p” is checked, the score is 2 points.
3. If the item “q” is checked, the score is 1 point.
The score will be 10-6 if the clock and the numbers are drawn correctly
10	Correct time (no “X” in the items: “o”, “p”, “q”).
9	Very mild disorder of hands (absence of “X” in at least one item: “l”, “m” or “n”).
8	Mild disorder of hands (absence of “X” in at least 2 items: “l”, “m”, “n”).
7	Severe disorder of hands (absence of “X” in the items: “l”, “m”, “n”).
6	Wrong use of hands (presence of “X” in item “o”).
The score will be 5-1 if the drawing of the clock and the numbers are incorrect
5	Numbers in reverse order or concentrated (no “X” in the items: “d” or “h”).
4	Numbers missing and located outside the boundary of the clock (no “X” in items: “b” and “c”).
3	Absence of hands (no “X” in the items: “i”, “j”, “k”).
2	Only some evidence of having understood that it is a clock (presence of “X” in item p).
1	Not tried or did not represent a clock (presence of “X” item in q).

Sociodemographic characteristics		Mean	SD*	Minimum value	Maximum value
Age		72.6	5.9	60	84
Years of education		9.8	4.2	3	24
Instruments and scales	MMSE (Memory Figures Test)	25.2	3.3	18	30
	Incidental Memory	25.4	1.1	2	8
	Immediate Memory 1	7.9	1.3	4	10
	Immediate Memory 2	8.6	1.1	5	10
	5 Minutes - Delayed Memory	7.7	1.5	4	10
	Recognition	9.9	0.3	8	10
Verbal Fluency		15	4.8	5	27
Lawton’s Scale		20.1	1.4	18	21
GDS		1.9	2.1	0	8

N	Mean	Median	Standard deviation	Minimum score	Maximum score
100	5.22	5	2.02	2	10

Examiners	Mean	SD
1	5.06	2.24
2	5.66	2.57
3	5.96	2.74
4	5.73	2.55
5	5.23	1.95
6	5.6	2.71

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Academia Brasileira de Neurologia, Departamento de Neurologia Cognitiva e Envelhecimento R. Vergueiro, 1353 sl.1404 - Ed. Top Towers Offices, Torre Norte, São Paulo, SP, Brazil, CEP 04101-000, Tel.: +55 11 5084-9463 | +55 11 5083-3876 - São Paulo - SP - Brazil
E-mail: revistadementia@abneuro.org.br | demneuropsy@uol.com.br

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SD: standard deviation.

10-6	Drawing of clock face with circle and numbers is generally intact.
10	Hands are in correct position.
9	Slight errors in placement of hands.
8	More noticeable errors in placement of hour and minute hands.
7	Placement of hands is significantly off course.
6	Inappropriate use of clock hands (i.e., use of digital display or circling of numbers despite repeated instructions).
5-1	Drawing of a clock face with circle and numbers is not intact.
5	Crowding of numbers at one end of the clock or reversal of numbers. Hands may still be present in some fashion.
4	Further distortion of number sequence. Integrity of clock face is now gone (i.e., numbers missing or placed at outside of the boundaries of the clock face).
3	Numbers and clock face no longer obviously connected in drawing. Hands are not present.
2	Drawing reveals some evidence of instructions being received but only a vague representation of a clock.
1	Either no attempt or an uninterpretable effort is made.