Cognitive Assessment Has Never Been Faster! The Clock Drawing Test as a Screening Test for Cognitive Impairment in MS Clinical Practice

INTRODUCTION: Cognitive changes are commonly seen in patients with multiple sclerosis (MS), which is a chronic autoimmune, demyelinating disease. The Clock Drawing Test (CDT) is an easy to use and highly reliable cognitive assessment tool that evaluates planning, visuospatial abilities, and abstract thinking. In this study, the CDT was scored with the Shulman, Manos-Wu, and Watson methods, which are the most frequently used scoring methods, and the correlation was examined between clinical evaluation tests.
METHODS: A total of 109 participants with a diagnosis of MS were included in the study. Participants were followed longitudinally, three times in total, at intervals of 3-6 months. Clinical tests and the CDT (scored with the Shulman, Manos-Wu, and Watson methods) were applied to the participants. The relationships between the CDT, the clinical evaluations, and the demographic data were analyzed by Pearson’s correlation analysis. Differences between the participants’ first and follow-up clinical tests and the CDT scores were assessed by repeated-measures analysis of variance.
RESULTS: Significant moderate to strong correlations were detected between the CDT score and the Expanded Disability Status Scale, the Nine Hole Peg Test, the 25-Foot Walk Test, education, age, and disease duration. No significant differences were observed between the baseline and follow-up CDT or the clinical evaluation test scores.
DISCUSSION AND CONCLUSION: The CDT scored by three different methods was moderate to strongly correlated with clinical tests frequently used to assess motor symptoms. This finding suggests that the CDT is a useful cognitive evaluation tool that is closely related to general clinical evaluation tests.