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Turkish Journal of Neurology Indexed By

Validity, reliability and Turkish norm scores of the clock drawing test for two different scoring systems [Turk J Neurol]
Turk J Neurol. Ahead of Print: TJN-26504

Validity, reliability and Turkish norm scores of the clock drawing test for two different scoring systems

Derya Durusu Emek Savaş1, Deniz Yerlikaya2, Görsev G. Yener3
1Department of Psychology, Faculty of Letters, Dokuz Eylul University, Izmir, Turkey
2Department of Neurosciences, Institute of Health Sciences, Dokuz Eylul University, Izmir, Turkey
3Department of Neurology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey

Objective: The Clock Drawing Test (CDT) version with the pre-drawn circle has been widely used in research and clinical practice without standardized Turkish norms. The present study aims to standardize CDT scores according to the most frequently used scoring methods in the literature (Manos and Wu and Shulman) and to estimate the validity and reliability of both methods.
Materials and Methods: The norm determination phase of the study was performed with 244 healthy individuals in the age range of 50-92 years. The effects of age, education and gender on the CDT scores were examined and normative data stratified by age and education were derived. Test-retest reliability, inter-rater reliability, concurrent validity and criterion validity of the two scoring methods were tested. Criterion validity was assessed by ROC curve method to examine the extent to which the CDT scores can distinguish among healthy individuals, mild cognitive impairment (MCI) patients and Alzheimer’s disease (AD) patients.
Results: In Manos and Wu method, age and education had significant effects on CDT scores of healthy individuals; however, in Shulman method only education effect was found. Both methods had high test-retest reliability (Manos and Wu,.81; Shulman,.72) and inter-rater reliability (Manos and Wu,.98; Shulman,.96) and showed high correlations with each other and with other cognitive screening tests. Area under the ROC curve had high values only in discriminating between healthy individuals and AD, and healthy individuals and MCI.
Conclusion: In the present study, detailed normative data for individuals aged 50 and older were established. Level of age and education should be taken in account when interpreting CDT scores. Both scoring methods provided similar results in terms of high test-retest and inter-rater reliability, as well as high concurrent and criterion validity.

Keywords: Clock drawing test, Normative data, Validity-Reliability, Alzheimer’s disease, Mild cognitive impairment

Corresponding Author: Derya Durusu Emek Savaş, Türkiye

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