Original Study
Understated Cognitive Impairment Assessed with the Clock-Drawing Test in Community-Dwelling Individuals Aged ≥50 Years

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Abstract

Objectives

To estimate the prevalence of understated cognitive impairment by administering the Clock-Drawing Test (CDT) to community-dwelling individuals aged ≥50 years and to investigate the associated clinical phenotype.

Design

A cross-sectional analysis of baseline data on community-dwelling individuals assessed at an outpatient clinic in the Paris region of France.

Setting and Participants

Participants aged ≥50 years (n = 488, median age: 62.1 years) prospectively included in the SUCCessful agEing outpatiEnt's Department survey between 2010 and 2014.

Methods

A multidimensional geriatric assessment, including cognition [7-point CDT, Mini-Mental State Examination (MMSE), the 5-word screening test (5-WT), and the Frontal Assessment Battery (FAB)], gait speed in dual tasks, mood [the Geriatric Depression Scale (GDS)], balance, physical functions (gait speed and handgrip strength), nutrition, bone density, and comorbidities; major cardiovascular risk factors, and Scheltens and Fazekas scores on brain magnetic resonance imaging. Baseline characteristics were analyzed as a function of the CDT score (<7 vs 7), using age-adjusted logistic models.

Results

The prevalence of impairment in the CDT was 23.6%; higher than the values for the MMSE (12.7%), 5-WT (2.3%), and FAB (16.6%). In age-adjusted analyses, a lower educational level (odds ratio [95% confidence interval] = 0.72 [0.58‒0.89]), diabetes (2.57 [1.14‒5.79]), metabolic syndrome (1.93 [1.05‒3.56]), lower gait speed in the cognitive dual task (1.27 [1.05‒1.53]), a poorer Geriatric Depression Scale score (1.86 [1.04‒3.32]), a poorer MMSE score (2.56 [1.35‒4.88]), a poorer FAB score (1.79 [1.01‒3.16]), impaired episodic memory in the 5-WT (4.11 [1.12‒15.02]), and a higher Scheltens score (P = .001) were significantly associated with CDT impairment.

Conclusions and Implications

Understated cognitive impairment is common among young seniors and is associated with factors known to be linked to a higher risk of cognitive decline and dementia. These findings suggest that the CDT may be of value for identifying high-risk individuals who may then benefit from targeted multidomain prevention actions (diet, exercise, cognitive training, and vascular risk factor management).

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.

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  • 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.

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