Research Reports - Getting clocked: screening for TBI-related cognitive impairment with the clock drawing test

Brain Inj. 2017 Sep 28:1-6. doi: 10.1080/02699052.2017.1376763. [Epub ahead of

Hazan E(1), Zhang J(1), Brenkel M(1), Shulman K(1)(2), Feinstein A(1)(2).

PRIMARY OBJECTIVE: Undetected cognitive impairment resulting from Traumatic Brain
Injuries (TBIs), particularly the 75-95% classified as mild (mTBI), poses a
significant public health challenge as untreated symptoms, can persist and cause
lasting disability. These cognitive deficits are often missed by standard
screening tests, creating a need for alternative cognitive screening tools. The
Clock Drawing Test (CDT), a popular, brief cognitive screening instrument, was
used to evaluate cognition in persons with TBI.
DESIGN: The effectiveness of the CDT was assessed on its own and in tandem with a
validated computerised screening battery, including the Stroop Test, Symbol Digit
Modalities Test (SDMT), and Paced Visual Serial Addition Test 2-second trials
METHODS AND PROCEDURES: The clock drawing component of the Montreal Cognitive
Assessment (MoCA) of 223 subjects attending an outpatient TBI clinic was scored
using two different methods.
MAIN OUTCOMES AND RESULTS: The CDT screened for cognitive impairment most
effectively when scored using the Clock Drawing Interpretation Scale (CDIS).
Cognitive impairment was detected in 19.4% of the elusive cohort of persons with
CONCLUSIONS: The results of this study suggest that the CDT is effective at
screening for cognitive impairment in persons with TBI. The CDT could be a
valuable supplementary tool in TBI clinics as well as an effective cognitive
screening instrument in busy primary care settings. 

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