الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Mild cognitive impairment is a condition that progresses to dementia overtime in many cases. Early detection and management with correction of modifiable risk factors is the only way to reduce the burden of dementia. Hence, using proper screening tools for mild cognitive impairment are warranted. The Montreal Cognitive Assessment (MoCA) test was validated in many languages for diagnosis of MCI. Although MoCA is a more accurate diagnostic tool; MMSE is more widely used, and both are affected by age and education.
Clock Drawing Test is the second most widely used screening test for grading cognitive problems after MMSE. It is well accepted by patients and can be easily and quickly applied and scored. It is a useful for dementia screening in primary care settings.
The aim of the study was to compare the utility and applicability of different CDT scoring systems for screening for MCI among a group of Egyptian elderly and to determine the diagnostic performance of CDT with and without MMSE and MoCA in MCI assessment in those people.
This study was a case-control study that included 106 elderly subjects both males and females ≥ 60 years classified according to their MoCA score into MCI and non-MCI groups. They were recruited from the outpatients’ Geriatric clinics at El-Mansoura University Hospital and the Geriatric memory clinic at Geriatric Ain shams University hospital between April 2021 and August 2023. All attendants were examined using the Arabic version of both MoCA test and MMSE. MoCA test was applied as the gold standard test to categorize patients into MCI and normal cognition groups as follows: those with score < 26 and ≥ 21 were categorized as having MCI, those with scores ≥ 26 were categorized as having normal cognition. CDT tests were performed and revised Petersen`s criteria. All tests were done on the same setting. Exclusion criteria included: Patients with history of dementia (MoCA score less than 21), aphasia, depression, or psychosis, patients with functional disability hindering writing and drawing, patients with visual and hearing impairment enough to interfere with the assessment, patients with neurological disorders affecting comprehension, and movement, individuals who had less than 4 years of education.
The present study had shown that MCI was more frequent in females.
The study showed that CDT had high diagnostic performance in differentiating MCI from controls. CDT3 with cut-off at ≤2.0 had the highest sensitivity (96.2%) and negative predictive value (95.0%), meanwhile the CDT10 score had the highest diagnostic accuracy (85.8%) and Youden’s index (71.7%) with cut-off at ≤7. The ideal cut-off for diagnosing MCI by CDT5, CDT8, MMSE were ≤3, ≤7, ≤29 respectively. CDT using different scoring systems and CDT time have better performance than MMSE. Revised Petersen criteria had high Specificity (96.2%) and Positive predictive value (94.7%) but low sensitivity (67.9%). So we suggest that it can be applied for confirmation of MCI cases and not as a screening.
Our results also demonstrated that all CDTs scored using the different scoring systems yielded satisfactory correlations with some MoCA domains in the MCI and the group with normal cognition.
Visuospatial had significant positive correlations with CDT3, CDT5, CDT8 & CDT10. Attention had significant positive correlations with MMSE as well as significant negative correlation with CDT time. Delayed recall had significant positive correlations with MMSE. Total MoCA score had significant positive correlations with MMSE and CDT3& CDT5 in the MCI group, and with CDT3, CDT5, CDT8 in the group with normal cognition as well as significant negative correlation with CDT time. CDT had significant high diagnostic performance in differentiating MCI from normal, while MMSE had significant lower diagnostic performance.