Comparison of a clock drawing test in elderly schizophrenia and Alzheimer's disease patients: a preliminary study.

The objective of this study was to compare between the quantitative and qualitative aspects of a clock drawing test in elderly schizophrenic and Alzheimer's disease (AD) patients. Three independent raters performed a retrospective analysis of the clock drawing item from the Cambridge Cognitive Examination (CAMCOG), in long-term open wards of a public psychiatric hospital and an outpatient psychogeriatric clinic. The study group comprised 21 elderly schizophrenic patients ('graduates') and 21 AD patients matched for gender and education, and cognitive impairment confirmed by a Folstein mini-mental state examination (MMSE) score of 18-23. The Clock Drawing Interpretation Scale (CDIS) was the measure used. Schizophrenic patients were significantly younger than AD patients (63.5 versus 81.3 years, p<0.0001), however, similar concerning gender, education, MMSE and CAMCOG scores. CDIS scores were not correlated with age in eight group. Inter-rater reliability was high (range 0.84-0.97). No significant differences between patient groups were found in mean CDIS total scores. A CDIS specific item analysis revealed that schizophrenic patients were significantly less impaired than AD patients on three out of 20 items: Number 7 (most symbols are aligned in a clockwise or a rightward direction). Number 8 (all symbols are totally within a closure figure), and Number 13 (numbers do not go beyond 12). Although schizophrenic patients and AD patients had similar total scores on the clock drawing test, they differed on specific test items related to spatial/planning deficit and preservation.

Agreement between spouses and children in descriptions of personality change in Alzheimer's disease.

The purpose of the present study was to evaluate the agreement among spouses and children in their describing the current and past personality of patients with Alzheimer's disease (AD) and to determine the relations between their descriptions and selected demographic and clinical variables. The subjects were 22 dementia out-patients who fulfilled the DSM-III-R criteria for uncomplicated dementia of the Alzheimer's type and the NINCDS-ADRDA criteria for AD. Spouses and children of these patients were separately administered Brooks and McKinlay's personality inventory consisting of 18 pairs of adjectives that characterize the extremes of a behavioral dimension, and were asked to judge where the subject's demeanor fell on a five-point scale, varying from +2 to -2, in which zero was regarded as neutral. Spouses and children reported marked changes in most measured behavioral dimensions following the onset of AD. Spouses identified significant changes on 14/18 items and children on 13/18 items. Spouses and children agreed on practically all items concerning personality attributes before the onset of illness, and on 16/18 items after it. Changes in personality were not correlated with the studied demographic characteristics of patients, spouses and children, nor with the cognitive deficits and illness duration of the patients.

Clock drawing test in elderly schizophrenia patients.

OBJECTIVE: Clock drawing has been studies in Alzheimer's disease but not in elderly schizophrenics. We examined clock drawing ability in elderly schizophrenia patients and sought possible correlations with demographic, clinical and cognitive variables. DESIGN: Retrospective analysis of the clock drawing item from the Cambridge Cognitive Examination (CAMCOG) presented to three independent raters. SETTING: Long-stay 'open' departments of a public psychiatric hospital in Israel. PATIENTS: Thirty-one physically well psychiatric inpatients suffering from schizophrenia (DSM-III-R, APA), between ages 60 and 76 years. MEASURES: The Clock Drawing Interpretation Scale (CDIS). RESULTS: The mean CDIS score was 14.4 (out of 20), and 61-84% of patients scored beneath the normal range (> 18). Interrater reliability was high (0.91-0.96). A moderate but significant correlation was found between CDIS and duration of illness as well as total scores on the Manchester Scale, the CAMCOG and the Mini-Mental State Examination, but not with the other variables studies. CONCLUSIONS: Clock drawing skills of a significant portion of long-term institutionalized elderly schizophrenics are impaired. When this test is used as a screening device for Alzheimer's disease in these patients, the results should be interpreted cautiously. Clock drawing abilities in these patients seem to be related to cognitive and non-cognitive (psychiatric state) factors, as well as to illness duration.