Dementia & Alzheimer’s Disease
There are a variety of ways doctors can test cognitive function in a person with dementia.
Often, a patient or a family member has picked up on clues that there is a problem with cognition.
However, are there ways to formally and objectively assess this?
The answer is, yes there are a host of cognitive tests for dementia that range from simple bedside tests that take a few minutes to perform to in-depth neuropsychiatric testing that can take a few hours.
While imaging of the brain can provide insights into brain structure and some types of brain imaging can even show metabolic and blood flow function, cognitive tests directly observe performance in certain domains and remain essential in the diagnosis of dementia.
In this article, we will describe what these tests are and how they affect the diagnosis and testing for dementia.
How The Test Is Done
The clock-drawing test can be given by a doctor or other qualified professional. It only requires a pencil and a piece of paper with a pre-drawn circle on it.
The doctor will first ask the person to draw the numbers on the face of the clock. Next, the person will be asked to draw the hands to show a specific time. Different times can be used, but many doctors choose 10 minutes after 11 as a standard value.
One variation of the test is to provide the person with a blank piece of paper and ask them to draw a clock showing 10 minutes after 11. The word “hands” is not used to avoid giving clues. A total of three drawings is typically used with each drawing done within a specific time limit.
What Does Research Say About The Clock Test
Compared to the Mini-Mental State Examination , the clock drawing test is thought to have less educational bias and is better able to detect cognitive decline due to Alzheimers disease and other dementias. The MMSE is known to have some issues with the educational level of the individuals taking the test , as well as not being as sensitive to milder cognitive changes and is primarily sensitive to detecting Alzheimers than other dementias. The clock drawing test has also been advocated over the MMSE as an office screening test for dementia in community clinics and in acute hospital settings. It requires less time to administer and to score. Furthermore, the clock drawing test is suitable for non-English speaking populations, whereas the MMSE does have some language bias.
A 2010 study from researchers at the Alzheimers Disease Center at Boston University School of Medicine looked at interrater reliability and diagnostic accuracy of the Clock Drawing Test. They found it had excellent interrater reliability, sensitivity , and specificity for predicting a consensus diagnosis and excellent interrater reliability and sensitivity for differentiating participants with mild Alzheimers Disease from the control participants. The researchers found that while the clock drawing test may be a good screening instrument for Alzheimers disease although it is not recommended to use as a stand-alone screening, it may not be a sensitive instrument for screening mild cognitive impairment.
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Alternative Forms Of The Cdt
The Clock Drawing Test-Modified and Integrated Approach is a 4-step, 20-item instrument, with a maximum score of 33. The CDT-MIA emphasizes differential scoring of contour, numbers, hands, and center. It integrates 3 existing CDTs:
- Freedman et als free-drawn clock on some item definitions
- Scoring techniques adapted from Paganini-Hill, Clark, Henderson, & Birge
- Some items borrowed from Royall, Cordes, & Polk executive CLOX
The CDT-MIA was found to be reliable and valid in individuals with dementia, however this measure has not been validated in the strokeAlso called a brain attack and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a schemic stroke, or the formation of a blood clot in a vessel supplying blood to the brain. More population .
What Is Dementia And What Causes It
Dementia is a syndrome that causes a person to develop difficulty and problems with their memory or their ability to think. Unlike the normal changes that happen in a persons memory and thinking over time, dementia affects someones ability to function in their daily life activities and their normal routine .There are different causes of dementia. These causes are typically underlying neurological conditions . One common cause of dementia is Alzheimers disease. Other causes include diseases that impact brain blood vessels. For example, strokes may cause what is commonly termed Vascular Dementia. Some causes include Lewy Body Disease and Parkinsons disease.
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Digital Clock Drawing Test
The clock drawing test has been used for several decades as a simple and effective means of diagnosing disruptions to spatial orientation and dementias. Scientists at the Pattern Recognition Lab at the Department of Computer Science at FAU fed AI neural networks with data from 2500 tests to teach them how to assess these results independently. The research findings have been published in the journal Scientific Reports. The same group also plan to launch open source software that could make diagnosing dementia much easier for medical and neuropsychological specialists.
How Long Do Dementia Patients Live After Diagnosis
Dementia symptoms typically progress slowly. People with dementia will progress from mild to severe dementia at varying speeds and may be diagnosed earlier or later in life. Some people with dementia may live for up to 20 years after their diagnosis, though according to the Alzheimer’s Association research shows that the average person lives for four to eight years after a diagnosis of dementia. It’s important to point out that the diagnosis of dementia is often missed, delayed, or diagnosed when the illness is moderate or advanced. The impact of that variable may not be accurately reflected in the research regarding the years of life post-diagnosis.
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At What Age Can You Test Someone For The Signs Of Dementia
There is no one particular age that someone must meet before they can be assessed for signs of dementia, although dementia is more common in people over 65. Early-onset dementia can begin in people who are in their 30s, 40s, and 50s. Diagnosing dementia in its early stages is important as early treatment can slow the progression of symptoms and help to maintain mental functions.
How Accurate Is It
This quiz is NOT a diagnostic tool. Mental health disorders can only be diagnosed by licensed healthcare professionals.
Psycom believes assessments can be a valuable first step toward getting treatment. All too often people stop short of seeking help out of fear their concerns arent legitimate or severe enough to warrant professional intervention.
If you think you or someone you care about may be experiencing symptoms of dementia or any other mental health condition, Psycom.net strongly recommends that you seek help from a mental health professional in order to receive a proper diagnosis and support. For those in crisis, we have compiled a list of resources where you may be able to find additional help at: https://www.psycom.net/get-help-mental-health.
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What Causes Dementia To Progress So Quickly
Dementia symptoms are typically mild at first and progress over time to moderate and then severe, over several years. The speed as which dementia progresses varies between individuals, but some factors can cause dementia to progress more quickly. These include the persons age, the type of dementia, and other long term health problems. Dementia tends to progress more slowly in people over 65 compared to younger people below 65.
Performance On The Clock Drawing Task In Patients With Amci Edat And Healthy Individuals
Overall, cCDT performance differed significantly between the groups = 31.525 p< 0.001 Table 1). cCDT scores were significantly higher in patients with eDAT compared to MCI and HC as well as in patients with aMCI compared to healthy individuals .
Analyzing the digitized variables during clock drawing, we found a significant difference in time-in-air = 15.230 p< 0.001 Table 1). Transitioning the drawing hand from one stroke to the next requires significantly less time in the HC group compared to patients with aMCI and eDAT . Additionally, time-in-air in the aMCI group was significantly shorter compared to patients with eDAT .
Although a stable trend was observable time-on-surface just failed to differ between the groups on the predetermined significance level = 3.008 p = 0.056 Table 1).
Finally, we found significant differences in total-time = 10.518 p< 0.001 Table 1). HC individuals required significantly less time to complete clock drawing compared to the aMCI and the eDAT group . However, patients with aMCI and eDAT did not differ significantly .
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Get A Professional Assessment
If you suspect a loved one may be showing signs of Alzheimers or another dementia, it’s important to seek an assessment by a qualified clinician.
They can work to rule out other potentially reversible causes of dementia, such as vitamin B12 deficiency and normal pressure hydrocephalus, as well as determine an accurate diagnosis and treatment plan.
Its Purpose Is To Evaluate The Cognitive Deterioration Of Patients And Diagnose Possible Neurological And Psychiatric Disorders
Bmo Show. Dementia clock test results a normal score for the test is four or five points. Accuracy the 7ms has been shown to be very effective at identifying multiple types of dementia such as alzheimer s vascular lewy body dementia frontotemporal dementia and decreased cognitive functioning related to diabetes. The alzheimer s clock drawing test cdt is a fast simple way of spotting warning signs for alzheimer s disease and other related dementias that can be administered by non professionals in the comfort of one s home.
This effective tool is widely used by medical practitioners alongside other thorough screening tests to reveal one s cognitive abilities. The clock drawing test is a test of cognitive functioning that measures visual constructional abilities and executive functions e g planning organization. The properly administered test requires abstraction.
The clock drawing test is a frequently used test where the person is asked to draw a clock and set the hands of the clock at a certain time. It is often used in combination with other more thorough screening tests but even when used by itself it can provide helpful insight into a person s cognitive ability. The test is not sensitive to early dementia.
The clock drawing test should be a very simple test to somebody with normal cognitive abilities but if a person has memory difficulties then it may become apparent that there is a problem. Anything less than four points should be a concern.
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Advocating For Your Aging Parent
I learned another lesson about advocating for Mom that day. I knew something was not right, but the doctor had only 10 minutes to decide if Mom needed additional assessments. We werent leaving that appointment until the doctor SAW what we saw AND agreed to evaluate further. I needed to STAY ON TASK for Moms benefit. Moms goal was to satisfy her daughter by going to the visit and bluff her way through it my goal was to get her properly evaluated. We already had one parent with a diagnosis of dementia. I was pretty certain now I had two and I was right.
We had our evaluation and it confirmed the elephant in the room. Sometimes I really. Hate. Being. Right. Did having a legitimate diagnosis change anything? In some ways no, but Christy and I needed a diagnosis to be able to advocate for mom legally. This is why we make them have these dreadful evaluations. There are no medications or treatments that change the course of dementia. But having an ICD code that documents a diagnosis of dementia allowed Christy and I to utilize our power of attorneys and AD for each parent at critical times in their care.
We are here to help you start the conversation Send us your concerns and we will do our best to walk with you.
Pros & Cons Of The Mini
Pros: 1. Easy to use. The only thing you need is the test and a couple writing instruments.2. Quick to administer. The Mini-Cog should not take more than three to five minutes.3. Basic. Other tests, like the MMSE, have been found to require a certain level of education, while the Mini-Cog can be taken by anyone.4. Useful in identifying mild cognitive impairment . People in the earliest stages of dementia are harder to find, but the Mini-Cog has been shown to identify them.
Cons: 1. Not always accurate. The Mini-Cog has been shown in studies to correctly identify dementia about three-quarters of the time.2. The Mini-Cog does not identify the stage or extent of a persons dementia.3. People with sight issues have difficulty with the clock drawing.
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What Is The Mini
The Mini-Cog is a tool for seeing whether someone shows signs of dementia. It tests cognition, or thinking ability, in a way that has been scientifically demonstrated to help determine if someone might be in the early stages of Alzheimers disease or a related dementia. The test is incredibly brief, only taking about three minutes, and easy to administer at home.
Importantly, the Mini-Cog does not replace a doctors diagnosis. Instead, it should be considered as a nudge toward speaking with healthcare professionals about whether an actual, in-depth diagnosis should be sought by someone having issues with memory and/or concentration. The Mini-Cog is a simple way to decide whether you need to bring these issues up with a doctor.
The Mini-Cog includes two elements: three-word recall test and the Clock Drawing Test.
1. Three-Word RecallThe test begins with the administrator reading three unrelated words aloud, in a strong voice to ensure theyre clearly heard. Examples would be banana, sunrise, chair, or daughter, heaven, mountain. Then the test-taker is asked to draw a clock . After completing the drawing, the test-taker is asked to repeat the three words that were spoken at the beginning of the test.
Compared to the SAGE
Compared to the MMSE
Compared to the MoCA
What Diagnosis Falls Under Alzheimer’s Disease
Alzheimers disease is a diagnosis in itself. When it is noticeable clinically and identified early on, the formal diagnosis may be Mild Cognitive Impairment due to Alzheimers disease which may later develop into a diagnosis of dementia due to Alzheimers disease.
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Screening Value Of The Clock Drawing Task In Patients With Amci Edat And Healthy Individuals
When the traditional scoring system of the cCDT was used to discriminate between the aMCI group and healthy individuals, the best cut-off was a score of 1.5 revealing an accuracy of 70.0% with sensitivity of 62.5% and specificity of 83.3% . With an accuracy of 87.1% in discriminating the eDAT group and HCs a score of 2.5 on the cCDT had a sensitivity of 90.5% and a specificity of 83.3% .
Figure 1. Receiver-operating characteristic curve analysis for discriminating patients with amnestic mild cognitive impairment from healthy control individuals using time-in-air, time-on-surface, total-time, or conventional clock drawing test scores.
Figure 2. ROC curve analysis for discriminating patients with early dementia due to Alzheimers disease from HC individuals using time-in-air, time-on-surface, total-time, or cCDT scores.
Table 3. Diagnostic value of time-in-air, time-on-surface, total-time and cCDT scoring in differentiating patients with aMCI or eDAT from HC individuals HC.
An accuracy of 78.0% was found when time-in-air was used to discriminate between the aMCI group and healthy individuals at 35588 ms with sensitivity of 81.3% and specificity of 72.2% . Between the eDAT group and HCs a cut-off of 39869 ms on the time-in-air score revealed an accuracy of 87.2% with a sensitivity of 85.7% and a specificity of 88.9% .
As time-on-surface failed to differ between the groups significantly this variable was excluded from further discrimination analysis.
Dementia Tests You Can Do At Home
There is no one correct way that you can test for conditions like Alzheimers or other forms of dementia without taking a medical test that a doctor can give. But you can do an easy memory test at home. The test may help give you an indication that something may be wrong with your, or somebody elses memory. It helps differentiate between normal everyday forgetfulness that we sometimes get and something more serious.
We take a look at two ways that you can a do at home dementia test
Word Association Tests
Simple word tests can be used to help detect memory problems a person may have.
Our brain saves and stores all the words we learn during our lives in our memories which then allows us to recollect what a word means without thinking about it.
A person who is having difficulty remembering words or confusing their words could have a problem that is associated with their memory. Word association tests such as the one below seem to work well in detecting memory problems.
- Ask the individual taking the test to name all the animals they can think of in one minute.
- Ask the individual to name all the types of fruit they can remember in one minute.
Test Results Research has found that a healthy individuals scoring should between 20 to 25 words in the time given whereas a person who may have memory problems usually scores between 10 15
The Clock Drawing Test. Do at Home Dementia Test.
Dementia Clock Test Results
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