알츠하이머병과 기억성 경도인지장애에서 시계 그리기 검사의 양적 분석 및 오류 유형 분석

Quantitative and Qualitative Analyses of Clock Drawings in Patients with Alzheimer' Disease and Amnestic Mild Cognitive Impairment

  • 류선영 (가톨릭대학교 대전성모병원 신경과학교실) ;
  • 이상봉 (가톨릭대학교 대전성모병원 신경과학교실) ;
  • 김태우 (가톨릭대학교 대전성모병원 신경과학교실) ;
  • 송인욱 (가톨릭대학교 인천성모병원 신경과학교실) ;
  • 오은영 (가톨릭대학교 대전성모병원 신경과학교실) ;
  • 최혜영 (충남대학교 일반대학원 응용심리학과 임상심리)
  • Ryu, Seon-Young (Department of Neurology, Daejeon St. Mary’ Hospital, The Catholic University of Korea) ;
  • Lee, Sang-Bong (Department of Neurology, Daejeon St. Mary’ Hospital, The Catholic University of Korea) ;
  • Kim, Tae-Woo (Department of Neurology, Daejeon St. Mary’ Hospital, The Catholic University of Korea) ;
  • Song, In-Uk (Department of Neurology, Incheon St. Mary’ Hospital, The Catholic University of Korea) ;
  • Oh, Eun-Young (Department of Neurology, Daejeon St. Mary’ Hospital, The Catholic University of Korea) ;
  • Choi, Hye-Yeoung (Clinical Psychology, Graduate School, Chungnam National University)
  • 발행 : 2010.06.30

초록

Background: The Clock Drawing Test (CDT) has been widely used as the neuropsychological instrument to assess the cognitive function in patients with dementia. Amnestic mild cognitive impairment (aMCI) among the subtypes of MCI has a high risk of progression to Alzheimer' disease (AD). To date, there have been few studies examining the CDT in MCI, in particular compared with AD. The purpose of this study was to compare the performance of CDT in patients with AD and aMCI. Methods: Thirty-four patients with AD and 35 patients with aMCI were participated in this study. The score of CDT was analyzed by three different methods (modified Shulman, Rouleau, and Freedman) and qualitative analyses of CDT were also performed. Results: The results of CDT showed significantly lower performances in the AD group than in the aMCI group according to the three different scoring methods. Qualitative analyses revealed that the 'onceptual deficit'error was useful in differentiating between the AD and aMCI groups (p<0.001). Conclusions: The patients with AD had significantly lower performances in CDT than that of the aMCI group. These results suggest that the quantatitive and qualitative analysis of the CDT can help differentiate the patients with AD from the patients with aMCI.

키워드

참고문헌

  1. Kelly BJ, Peterson RC. Alzheimer's disease and mild cognitive impairment. Neurol Clin 2007; 25: 577-609. https://doi.org/10.1016/j.ncl.2007.03.008
  2. Petersen RC, Smith GE, Waring SC, Ivnik RJ, Tangalos EG, Kokmen E. Mild cognitive impairment: clinical characterization and outcome. Arch Neurol 1999; 56: 303-8. https://doi.org/10.1001/archneur.56.3.303
  3. Petersen RC. Mild cognitive impairment as a diagnostic entity. J Intern Med 2004; 256: 183-94. https://doi.org/10.1111/j.1365-2796.2004.01388.x
  4. Winblad B, Palmer K, Kivipelto M, Jelic V, Fratiglioni L, Wahlund LO, et al. Mild cognitive impairment: beyond controversies, towards a consensus-report of the International Working Group on Mild Cognitive Impairment. J Intern Med 2004; 256: 240-6. https://doi.org/10.1111/j.1365-2796.2004.01380.x
  5. Gauthier S, Reisberg B, Zaudig M, Petersen RC, Ritchie K, Broich K. Mild cognitive impairment. Lancet 2006; 367: 1262-70. https://doi.org/10.1016/S0140-6736(06)68542-5
  6. Shulman KI. Clock-drawing: is it the ideal cognitive screening test? Int J Geriatr Psychiatry 2000; 5: 548-61.
  7. Rouleau I, Salmon DP, Butters N. Longitudinal analysis of clock drawing in Alzheimer's disease patients. Brain Cogn 1996; 31: 17-34. https://doi.org/10.1006/brcg.1996.0022
  8. Lee H, Swanwick GRJ, Coen RF, Lawlor BA. Use of the clock drawing task in the diagnosis of mild and very mild Alzheimer's disease. Int Psychogeriatr 1996; 8: 469-76. https://doi.org/10.1017/S1041610296002827
  9. Sunderland T, Hill JL, Mellow AM, Lawlor BA, Gundersheimer J, Newhouse PA, et al. Clock drawing in Alzheimer's disease. A novel measure of dementia severity. J Am Geriatr Soc 1989; 37: 725-9. https://doi.org/10.1111/j.1532-5415.1989.tb02233.x
  10. Wolf-Klein GP, Silverstone FA, Levy AP, Brod MS. Screening for Alzheimer's disease by clock drawing. 1989; 37: 730-4. https://doi.org/10.1111/j.1532-5415.1989.tb02234.x
  11. Yamamoto S, Mogi N, Umegaki H, Suzuki Y, Ando F, Shimokata H, et al. The clock drawing test as a valid screening method for mild cognitive impairment. Dementia Geriatr Cogn Disord 2004; 18: 172-9. https://doi.org/10.1159/000079198
  12. Manos PJ. Ten-point clock test sensitivity for Alzheimer's disease in patients with MMSE scores greater than 23. Int J Geriat Psychiatry 1999; 14: 454-8. https://doi.org/10.1002/(SICI)1099-1166(199906)14:6<454::AID-GPS951>3.0.CO;2-N
  13. Pinto E, Peters R. Literature review of the clock drawing test as a tool for cognitive screening. Dement Geriatr Cogn Disord 2009; 27: 201-13. https://doi.org/10.1159/000203344
  14. Heo JI, Son CN, Kook SH. The efficiency of the clock drawing test as a screening test for detecting dementia. Korean J Clin Psychol 2001; 20: 519-33
  15. Kim BY, Kim HJ, Baek MJ, Kim SY. Preliminary study for expanding the clinical utility of clock drawing test: Alzheimer's disease vs. subcortical vascular dementia. Dementia and Neurocognitive Disorders 2008; 7: 39-46.
  16. Lee AY, Kim JS, Choi BH, Sohn EH. Characteristics of clock drawing test (CDT) errors by the dementia type: quantitative and qualitative analyses. Arch Gerontol Geriatr 2009; 48: 58-60. https://doi.org/10.1016/j.archger.2007.10.003
  17. Lee KS, Kim EA, Hong CH, Lee DW, Oh BH, Cheong HK. Clock drawing test in mild cognitive impairment: quantitative analysis of four scoring methods and qualitative analysis. Dement Geriatr Cogn Disord 2008; 26: 483-9. https://doi.org/10.1159/000167879
  18. Shulman K, Gold D, Cohen C. Clock drawing and dementia in the community: a longitudinal study. Int J Geriatr Psychiatry 1993; 8: 487-96. https://doi.org/10.1002/gps.930080606
  19. Rouleau I, Salmon DP, Butters N, Kennedy C, McGuire K. Quantitative and qualitative analyses of clock drawings in Alzheimer's and Huntington's disease. Brain Cogn 1992; 18: 70-87. https://doi.org/10.1016/0278-2626(92)90112-Y
  20. Freedman M, Leach L, Kaplan E, Winocur G, Shulman KI, Delis DC. Clock drawing: a neuropsychological analysis. New York: Oxford University Press; 1994.
  21. Shulman KI, Shedletsky R, Silver IL. The challenge of time: clock-drawing and cognitive function in the elderly. Int J Geriatr Psychiatry 1986; 1: 135-40. https://doi.org/10.1002/gps.930010209
  22. McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer's disease: report of the NINCDSADRDA work group under the auspices of department of health and human services task force on Alzheimer's disease. Neurology 1984; 34: 939-44. https://doi.org/10.1212/WNL.34.7.939
  23. Petersen RC, Doody R, Kurz A, Mohs RC, Morris JC, Rabins PV, et al. Current concepts in mild cognitive impairment. Arch Neurol 2001; 58: 1985-92. https://doi.org/10.1001/archneur.58.12.1985
  24. Kang YW, Na DL. Seoul neuropsychological screening battery. Incheon: Human Brain Research & Consulting Co.; 2003.
  25. Choi SH, Na DL, Lee BH, Hahm DS, Jeong JH, Yoon SJ, et al. Estimating the validity of the Korean version of expanded Clinical Dementia Rating (CDR) scale. J Korean Neurol Assoc 2001; 19: 585-91.
  26. Reisberg B, Ferris SH, de Leon MJ, Crook T. Global Deterioration Scale (GDS). Psychopharmacol Bull 1988; 24: 661-3.
  27. Kang YW, Na DL, Hahn SH. A validity study on the Korean Mini-Mental State Examination (K-MMSE) in dementia patients. J Korean Neurol Assoc 1997; 15: 300-8.
  28. Kang SJ, Choi SH, Lee BH, Kwon JC, Na DL, Han SH. The reliability and validity of the Korean Instrumental Activities of Daily Living (K-IADL). J Korean Neurol Assoc 2002; 20: 8-14.
  29. Wade DT, Collin C. The Barthel ADL index: a standard measure of physical disability? Int Disabil Stud 1998; 10: 64-7.
  30. Choi SH, Na DL, Oh KM, Park BJ. A Short form of the Samsung Dementia Questionnaire (S-SDQ): development and cross-validation. J Korean Neurol Assoc 1999; 17: 253-8.
  31. Hachinski VC, Lassen NA, Marshall J. Multi-infarct dementia-a cause of mental deterioration in the elderly. Lancet 1974; 2: 207-9.
  32. Cahn DA, Salmon DP, Monsch AU, Butters N, Wiederholt WC, Corey-Bloom J, et al. Screening for dementia of the Alzheimer type in the community: the utility of the clock drawing test. Arch Clin Neuropsychol 1996; 11: 529-39. https://doi.org/10.1093/arclin/11.6.529
  33. Kitabayashi, Y, Ueda H, Narumoto J, Nakamura K, Kita H, Fukui K. Qualitative drawings in Alzheimer's disease and vascular dementia. Psychiatry Clin Neurosci 2001; 55: 485-91. https://doi.org/10.1046/j.1440-1819.2001.00894.x