title: The Clock Drawing Test: performance among elderly with low educational level.
abstract: OBJECTIVE
  To compare the accuracy of four scales, and to determine the inter-rater reliability and the influence of schooling on Clock Drawing Test performance in screening for dementia in elderly with low educational level.
  
  
  METHODS
  
  
  
  METHODS
  Criterion validation, concurrent type.
  
  
  METHODS
  Outpatient unit of Universidade do Estado do Rio de Janeiro Hospital, Brazil.
  
  
  METHODS
  A total of 306 individuals (> or = 65 years) were assessed by a geriatrician and a neuropsychologist using functional and cognitive instruments. The diagnosis of dementia was established by consensus in a meeting between these professionals. Four different researchers blinded as to the cognitive status of the patients scored the Clock Drawing Test using Shulman's, Sunderland's, Manos', and Wolf-Klein's methods; and a fifth researcher assessed Manos' method for an inter-rater reliability study.
  
  
  RESULTS
  The data of 211 individuals (< or = 4 years of schooling) were analyzed. The sensitivity and specificity of the four methods were similar (about 65%). The inter-rater reliability of Manos' method was excellent (ICC = 0.944). The areas under the ROC curves were small (0.657 to 0.681), and the differences between them were not statistically significant.
  
  
  CONCLUSIONS
  The Clock Drawing Test is a reliable but not valid test to screen for dementia in older outpatients with 4 or less years of formal schooling.
authors.affiliation: Internal Medicine Department, Medical Sciences School, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil. roberto.lourenco@globo.com
authors.forename: Roberto Alves
authors.initials: RA
authors.lastname: Lourenço
authors.forename: Sergio Telles
authors.initials: ST
authors.lastname: Ribeiro-Filho
authors.forename: Irene de Freitas Henriques
authors.initials: Ide F
authors.lastname: Moreira
authors.forename: Emylucy Martins Paiva
authors.initials: EM
authors.lastname: Paradela
authors.forename: Aline Sobral de
authors.initials: AS
authors.lastname: Miranda
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D003704:Dementia / Q000175:diagnosis*; D004522:Educational Status; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D015588:Observer Variation; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity