Daily exposure to digital displays may affect the clock-drawing test: from psychometrics to serendipity
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ORIGINAL ARTICLE
Daily exposure to digital displays may affect the clock-drawing test: from psychometrics to serendipity Ciro Rosario Ilardi 1
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& Elisabetta Garofalo & Sergio Chieffi & Nadia Gamboz & Marco La Marra & Alessandro Iavarone
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Received: 27 February 2020 / Accepted: 30 May 2020 # Fondazione Società Italiana di Neurologia 2020
Abstract Background The clock-drawing test (CDT) is a neuropsychological screening tool largely used to explore cognitive functioning. It requires participants to draw an analog clock face. Many studies have reported a good correlation between the CDT and the Mini-Mental State Examination (MMSE). The CDT has also showed a variable specificity. There are, however, some inconsistencies concerning the effect of sociodemographic variables (sex, age, education) on clock-drawing abilities. The present study aimed at examining these issues in a sample of middle-aged/young-old healthy adults. Method Participants (n = 97) performed the MMSE and CDT. Clock drawings were assessed by five formal scoring systems (Wolf-Klein, Watson, Freedman, Manos, Shulman). In addition, three naïve raters provided a dichotomous judgment (normal vs. abnormal) for each clock. Results Sociodemographic variables did not affect CDT performance. Unlike earlier studies, CDT scores did not correlate with MMSE. Moreover, test specificity was appropriate only for Freedman’s, Shulman’s, and Wolf-Klein’s methods. Interestingly, some participants drew clocks with numbers as they appear in digital clocks. By re-running the statistical analyses after removing these atypical clocks, four out of the five formal scores showed a significant correlation with MMSE; furthermore, CDT specificity slightly increased for all scoring systems including naïve ratings. Conclusions CDT is not affected by sociodemographic variables. The finding of some clocks with digitally represented numbers suggests the need to align neuropsychological assessments with demands from an increasing digitalized environment. Moreover, the occurrence of high false-positives and possible digital contaminations suggest great caution in interpreting the clinical significance of CDT. Keywords Clock-Drawing Test . Mini-Mental State Examination . Neuropsychology . Cognitive screening . Digital display
Introduction The clock-drawing test (CDT) is a well-known neuropsychological screening tool widely used in outpatient settings.
* Ciro Rosario Ilardi [email protected] 1
Department of Psychology, University of Campania “Luigi Vanvitelli”, Caserta, Italy
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Neurological Unit, CTO Hospital, AORN “Ospedali dei Colli”, Naples, Italy
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Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
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Laboratory of Experimental Psychology, Suor Orsola Benincasa University, Naples, Italy
Although the CDT has been traditionally employed for studying attentional deficits in patients with hemispatial neglect [1], it is currently considered an effective task for a quick assessment of general cognitive functioni
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