Psychometric properties, pragmatic screening cut-offs, and feasibility of two Clock Drawing Test formats in older psychiatric outpatients: Associations with MMSE and HDS-R.

内容摘要

To compare the psychometric properties, pragmatic screening cut-offs, and feasibility of two Clock Drawing Test (CDT) formats in older psychiatric outpatients. We retrospectively analyzed 447 outpatients aged &#x2265;65 years who completed the Mini-Mental State Examination (MMSE), the Hasegawa Dementia Scale-Revised (HDS-R), and two CDT formats scored using the Freedman method: a free-drawn clock (CDT1) and an examiner-provided clock face (CDT2). Pearson correlations, forced-entry multiple regression models, exploratory factor analyses, and receiver operating characteristic (ROC) analyses were used. Possible cognitive impairment was operationally defined as MMSE&#x2009;&#x2264;&#x2009;23 and/or HDS-R&#x2009;&#x2264;&#x2009;20. Administration time was summarized in a convenience subsample (n&#x2009;=&#x2009;20). Mean (SD) age was 80.20 (5.15) years, and mean education was 11.74 (2.36) years. CDT totals correlated positively with MMSE and HDS-R totals (r&#x2009;=&#x2009;0.47-0.58, all p&#x2009;<&#x2009;0.01). Education, functional disability, CDT1, and CDT2 predicted MMSE total, while age additionally predicted HDS-R total. Both CDT formats showed interpretable two-factor structures with good internal consistency (Cronbach's &#x3b1; 0.82-0.90). ROC analyses identified the same pragmatic cut-off (10/11) for both formats (CDT1 area under the curve [AUC] 0.72, 95% CI 0.67-0.77; CDT2 AUC 0.71, 95% CI 0.66-0.76). Mean CDT administration time was 2.13&#x2009;min. Both CDT formats showed clinically useful psychometric properties and similar pragmatic cut-offs in older psychiatric outpatients. CDT1 favored sensitivity, and CDT2 favored specificity at the same threshold. The CDT was highly feasible in routine practice, requiring approximately 2&#x2009;min to administer.