title: Clock drawing test in elderly individuals with different education levels: correlation with clinical dementia rating.
abstract: OBJECTIVE
  The aim of this study was to describe the performance in Clock Drawing Test (CDT) of the elderly individuals assessed in a geriatric clinic, with at least 1 year of schooling, comparing with other groups with higher education and with Clinical Dementia Rating (CDR) levels. The study also aims to correlate the results of CDT and other used diagnostic tests for dementia by CDR levels, providing additional validity evidence to the CDT.
  
  
  METHODS
  Cross-sectional study with 426 elderly individuals, >60 years old and at least 1 year of education. All participants searched for medical assistance at Geriatric and Gerontology Ambulatory of Jundiaí city, in Brazil. The community-dwelling outpatients previously undergone a detailed clinical examination and neuropsychological evaluation: Cambrigde Cognitive Examination (CAMCOG), Mini-Mental State Examination (MMSE), andCDT. To differentiate data from diagnostic groups based on CDR, it Kruskal-Wallis test was used. Pearson statistics were calculated to compare data from CDT and CDR. The statistical analyses were 2-tailed and were considered significant when P < .05.
  
  
  RESULTS
  Regarding CDT, groups with more years of schooling showed similar means in CDR = 0 and CDR = 0.5 and in CDR = 1 and CDR = 2. Shulman and Sunderland scale were high score in groups with more years of education and above of cutoff points in all CDT score. On the contrary, in Mendez scale we did not observed similar means. Otherwise, in the group with less years of schooling greater means differences in the CDT were observed.
  
  
  CONCLUSIONS
  The CDT did not show a strong correlation with MMSE and CAMCOG, both important instruments in Brazilian population to investigate dementia. For elderly individuals with high education levels, the CDT did not seem to be a good test to detect cognitive impairment.
authors.affiliation: Jundiaí Medical School, Jundiaí, Brazil.
authors.forename: Juliana Francisca
authors.initials: JF
authors.lastname: Cecato
authors.forename: Bruna
authors.initials: B
authors.lastname: Fiorese
authors.forename: José Maria
authors.initials: JM
authors.lastname: Montiel
authors.forename: Daniel
authors.initials: D
authors.lastname: Bartholomeu
authors.forename: José Eduardo
authors.initials: JE
authors.lastname: Martinelli
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil; D003072:Cognition Disorders / Q000175:diagnosis* / Q000523:psychology*; D003430:Cross-Sectional Studies; D003704:Dementia / Q000175:diagnosis* / Q000523:psychology*; D004522:Educational Status; D005260:Female; D015577:Geriatric Assessment / Q000379:methods; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests / Q000592:standards*; D015203:Reproducibility of Results; D012720:Severity of Illness Index