Journal of the American Medical Directors Association
Original StudyUnderstated Cognitive Impairment Assessed with the Clock-Drawing Test in Community-Dwelling Individuals Aged ≥50 Years
Section snippets
Study Population
We analyzed baseline data from the SUCCEED survey18 of community-dwellers aged ≥50 years, free of dementia and cognitive complaints, and consecutively assessed at an outpatient clinic in a 3000-bed university hospital in the greater Paris area of France. Individuals underwent a multidimensional geriatric assessment (including evaluations of cognition, mood, balance, mobility, muscle strength, nutrition, comorbidities, and bone density) and brain magnetic resonance imaging (MRI). For this
Results
A total of 488 participants were included in the analysis; the median (range) age was 62.1 (50‒87) years, 20.9% had obtained a university degree, and the most prevalent cardiovascular risk factors were dyslipidemia (in 34% of the participants) and hypertension (30.7%) (Table 1). Approximately 68% of the participants were prefrail and 5.5% were frail, according to the physical frailty phenotype. Almost one-quarter of the participants (n = 115) had a CDT score of <7, yielding a prevalence of
Discussion
In a population of asymptomatic middle-aged and older community-dwellers (median age: 62 years), the prevalence of understated cognitive impairment was 23.6%. In age-adjusted analyses, the factors significantly associated with impaired CDT performance were a lower educational level, diabetes, MetS, depressive symptoms, a lower gait speed in the cognitive dual task, poorer performance in the MMSE, 5-WT, and FAB tests, and a higher Scheltens score. In our study population, the CDT score was not
Conclusions and Implications
Almost one-quarter of asymptomatic middle-aged and older community-dwellers had understated cognitive impairment (as assessed by the CDT). The clinical phenotype associated with CDT impairment included cardiovascular risk factors, depressive symptoms, a lower educational level, worse cognitive performance in dual tasks and in memory or executive tasks, and a higher degree of hippocampal atrophy. These factors (some of which are modifiable) are known to be related to a higher risk of cognitive
Acknowledgments
The authors thank David Fraser (Biotech Communication SARL, Ploudalmézeau, France) for editorial assistance.
References (46)
- et al.
Defeating Alzheimer’s disease and other dementias: A priority for European science and society
Lancet Neurol
(2016) - et al.
Longitudinal association between diabetes and cognitive decline: The National Health and Aging Trends Study
Arch Gerontol Geriatr
(2017) - et al.
Cognitive function in individuals with physical frailty but without dementia or cognitive complaints: Results from the I-Lan Longitudinal Aging Study
J Am Med Dir Assoc
(2015) - et al.
Frailty criteria and cognitive performance are related: Data from the FIBRA study in Ermelino Matarazzo, São Paulo, Brazil
J Nutr Health Aging
(2012) - et al.
Cognitive performance across 3 frailty phenotypes: Toledo Study for Healthy Aging
J Am Med Dir Assoc
(2017) - et al.
Handgrip strength predicts longitudinal changes in clock drawing test performance. An observational study in a sample of older non-demented adults
J Nutr Health Aging
(2017) - et al.
Identification of five frailty profiles in community-dwelling individuals aged 50-75: A latent class analysis of the SUCCEED survey data
Maturitas
(2019) - et al.
A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): A randomised controlled trial
The Lancet
(2015) - et al.
Clock drawing performance in cognitively normal elderly
Arch Clin Neuropsychol Off J Natl Acad Neuropsychol
(2008) - et al.
The metabolic syndrome predicts longitudinal changes in clock drawing test performance in older nondemented hypertensive individuals
Am J Geriatr Psychiatry
(2016)
Research criteria for the diagnosis of Alzheimer’s disease: Revising the NINCDS-ADRDA criteria
Lancet Neurol
Mild cognitive impairment: A concept in evolution
J Intern Med
Cognitive test performance in relation to health and function in 12 European countries: The SHARE Study
Can Geriatr J
White matter lesions: Prevalence and clinical phenotype in asymptomatic individuals aged ≥50 years
Dement Geriatr Cogn Disord
Clock-drawing: Is it the ideal cognitive screening test?
Int J Geriatr Psychiatry
Literature Review of the clock drawing test as a tool for cognitive screening
Dement Geriatr Cogn Disord
Metabolic parameters and cognitive function in a cohort of older diabetic patients
Aging Clin Exp Res
Impaired cognitive executive dysfunction in adult treated hypertensives with a confirmed diagnosis of poorly controlled blood pressure
Int J Med Sci
Motor phenotype of decline in cognitive performance among community-dwellers without dementia: Population-based study and meta-analysis
PLoS One
The relationship between executive function and falls and gait abnormalities in older adults: A systematic review
Dement Geriatr Cogn Disord
Combination of the clock drawing test with the physical phenotype of frailty for the prediction of mortality and other adverse outcomes in older community dwellers without dementia
Gerontology
Strategies for dementia prevention: Latest evidence and implications
Ther Adv Chronic Dis
Screening for undernutrition in geriatric practice: Developing the short-form mini-nutritional assessment (MNA-SF)
J Gerontol A Biol Sci Med Sci
Cited by (0)
J.P.D. and S.B.G. contributed equally to the study.
This research did not receive any funding from agencies in the public, commercial, or not-for-profit sectors.
The authors declare no conflicts of interest.