title: Validation of the Freund Clock Drawing Test as a screening tool to detect cognitive dysfunction in elderly cancer patients undergoing comprehensive geriatric assessment.
abstract: OBJECTIVE
  We aimed to validate the Freund Clock Drawing Test (CDT), with its predefined cutoff score of ≤4, as a screening tool to detect elderly cancer patients in need of a more in-depth cognitive evaluation within a comprehensive geriatric assessment (CGA).
  
  
  METHODS
  Patients aged 70 years or older with a histologically confirmed diagnosis of cancer were evaluated with a full CGA, including CDT and Folstein Mini Mental State Examination (MMSE) as gold standard. Validation of the Freund CDT was defined in terms of diagnostic accuracy of the test through receiver operating characteristics (ROC)-analysis. To accept the Freund CDT as a screening tool, we estimated that the area under the ROC curve (AUC) had to differ significantly from 0.70 with an AUC of at least 0.85.
  
  
  RESULTS
  Two hundred elderly cancer patients with a mean age of 79.0 years were included. Four patients were excluded from the analyses because of invalid results. Potential cognitive impairment (MMSE ≤23) was observed in 27.0% of patients. Based on of the AUC ± SE, the Freund CDT showed excellent diagnostic performance (0.95 ± 0.17). Furthermore, it provided excellent sensitivity (94.3%) and high specificity (87.4%).
  
  
  CONCLUSIONS
  Our results indicate that the Freund CDT can be used as an initial screening tool to detect elderly cancer patients in need of a more in-depth cognitive assessment within CGA, instead of the MMSE.
authors.affiliation: Department of Medical Oncology, General Hospital Groeninge, Kortrijk, Belgium; Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium.
authors.forename: Michelle
authors.initials: M
authors.lastname: Lycke
authors.forename: Lore
authors.initials: L
authors.lastname: Ketelaars
authors.forename: Tom
authors.initials: T
authors.lastname: Boterberg
authors.forename: Lies
authors.initials: L
authors.lastname: Pottel
authors.forename: Hans
authors.initials: H
authors.lastname: Pottel
authors.forename: Philippe
authors.initials: P
authors.lastname: Vergauwe
authors.forename: Laurence
authors.initials: L
authors.lastname: Goethals
authors.forename: Koen
authors.initials: K
authors.lastname: Van Eygen
authors.forename: Patrick
authors.initials: P
authors.lastname: Werbrouck
authors.forename: David
authors.initials: D
authors.lastname: Debruyne
authors.forename: Sofie
authors.initials: S
authors.lastname: Derijcke
authors.forename: Marleen
authors.initials: M
authors.lastname: Borms
authors.forename: Véronique
authors.initials: V
authors.lastname: Ghekiere
authors.forename: Hans
authors.initials: H
authors.lastname: Wildiers
authors.forename: Philip R
authors.initials: PR
authors.lastname: Debruyne
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000175:diagnosis* / Q000523:psychology; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000295:instrumentation*; D009369:Neoplasms / Q000150:complications / Q000523:psychology*; D009483:Neuropsychological Tests; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
keywords: Cancer; Clock Drawing Test; Comprehensive Geriatric Assessment; Elderly; Oncology