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Digital Clock Drawing: Differentiating “ThinkingversusDoing” in Younger and Older Adults with Depression

  • Jamie Cohen (a1), Dana L. Penney (a2), Randall Davis (a3), David J. Libon (a4), Rodney A. Swenson (a5), Olusola Ajilore (a1), Anand Kumar (a1) and Melissa Lamar (a1) (a6)...
Abstract
Abstract

Psychomotor slowing has been documented in depression. The digital Clock Drawing Test (dCDT) provides: (i) a novel technique to assess both cognitive and motor aspects of psychomotor speed within the same task and (ii) the potential to uncover subtleties of behavior not previously detected with non-digitized modes of data collection. Using digitized pen technology in 106 participants grouped by Age (younger/older) and Affect (euthymic/unmedicated depressed), we recorded cognitive and motor output by capturing how the clock is drawn rather than focusing on the final product. We divided time to completion (TTC) for Command and Copy conditions of the dCDT into metrics of percent of drawing (%Ink) versus non-drawing (%Think) time. We also obtained composite Z-scores of cognition, including attention/information processing (AIP), to explore associations of %Ink and %Think times to cognitive and motor performance. Despite equivalent TTC, %Ink and %Think Command times (Copy n.s.) were significant (AgeXAffect interaction: p=.03)—younger depressed spent a smaller proportion of time drawing relative to thinking compared to the older depressed group. Command %Think time negatively correlated with AIP in the older depressed group (r=−.46; p=.02). Copy %Think time negatively correlated with AIP in the younger depressed (r=−.47; p=.03) and older euthymic groups (r=−.51; p=.01). The dCDT differentiated aspects of psychomotor slowing in depression regardless of age, while dCDT/cognitive associates for younger adults with depression mimicked patterns of older euthymics. (JINS, 2014, 20, 1–9)

Copyright
Corresponding author
Correspondence and reprint requests to: Melissa Lamar, University of Illinois at Chicago, 1601 West Taylor Street (MC912), Chicago, IL, 60612. E-mail: mlamar@psych.uic.edu
References
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Alexopoulos G. S. (2011). Pharmacotherapy for late-life depression. The Journal of Clinical Psychiatry, 72(1), e04. doi: 10.4088/JCP.7085tx2cj
Alexopoulos G. S., Meyers B. S., Young R. C., Campbell S., Silbersweig D., & Charlson M. (1997). “Vascular depression” hypothesis. Archives of General Psychiatry, 54(10), 915922.
Bodner T., Delazer M., Kemmler G., Gurka P., Marksteiner J., & Fleischhacker W. W. (2004). Clock drawing, clock reading, clock setting, and judgment of clock faces in elderly people with dementia and depression. Journal of the American Geriatrics Society, 52(7), 11461150.
Butters M. A., Whyte E. M., Nebes R. D., Begley A. E., Dew M. A., Mulsant B. H., … Becker J. T. (2004). The nature and determinants of neuropsychological functioning in late-life depression. Archives of General Psychiatry, 61(6), 587.
Buyukdura J. S., McClintock S. M., & Croarkin P. E. (2011). Psychomotor retardation in depression: Biological underpinnings, measurement, and treatment. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 35(2), 395409.
Caligiuri M. P., Gentili V., Eberson S., Kelsoe J., Rapaport M., & Gillin J. C. (2003). A quantitative neuromotor predictor of antidepressant non-response in patients with major depression. Journal of Affective Disorders, 77(2), 135141. doi: S0165032702001076 [pii]
Carew T. G., Lamar M., Cloud B. S., Grossman M., & Libon D. J. (1997). Impairment in category fluency in ischemic vascular dementia. Neuropsychology, 11(3), 400.
Charlton R. A., Lamar M., Ajilore O., & Kumar A. (2013). Preliminary analysis of ag of illness onset effects on symptom profiles in major depressive disorder. International Journal of Geriatric Psychiatry, 28, 11661174. doi: 10.1002/gps.3939
Cosentino S., Jefferson A., Chute D. L., Kaplan E., & Libon D. J. (2004). Clock drawing errors in dementia: Neuropsychological and neuroanatomical considerations. Cognitive and Behavioral Neurology, 17(2), 7484.
Cunningham H., Penney D., Davis R., Tanner J. J., Nguyen P. T., Schwab N., … Price C. C. (2012). Clock drawing in PD: What makes the clock drawing test tick? Paper presented at the The International Neuropsychological Society, Montreal, Canada.
Davis R., Penney D. L., Pittman D., Libon D. J., Swenson R., & Kaplan E. (2010). The Digital Clock Drawing Test (dCDT) I: Development of a new computerized quantitative system. Paper presented at the The International Neuropsychological Society, Montreal, Canada.
Delis D. C., Kaplan E., & Kramer J. H. (2001). Delis-Kaplan executive function system (D-KEFS). San Antonio, TX: Psychological Corporation.
Delis D. C., & Kramer J. H. (2000). California Verbal Learning Test: CvLT-II; Adult Version. San Antonio, TX: Psychological Corporation.
Folstein M. R., Folstein S. E., & McHugh P. R. (1974). Mini-mental state: A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189198.
Gallo J. J., & Rabins P. V. (1999). Depression without sadness: Alternative presentations of depression in late life. American Family Physician, 60(3), 820826.
Golden C. (1978). Stroop colour and word test. North Tonawanda, NY: Psychological Assessments and Services.
Grant M. M., Thase M. E., & Sweeney J. A. (2001). Cognitive disturbance in outpatient depressed younger adults: Evidence of modest impairment. Biological Psychiatry, 50(1), 3543.
Hamilton M. A. (1960). A rating scale for depression. Journal of Neurology, Neurosurgery, and Psychiatry, 23, 5662.
Hoffstaedter F., Sarlon J., Grefkes C., & Eickhoff S. B. (2012). Internally vs. externally triggered movements in patients with major depression. Behavioural Brain Research, 228(1), 125132.
Jungwirth S., Zehetmayer S., Hinterberger M., Kudrnovsky-Moser S., Weissgram S., Tragl K. H., & Fischer P. (2011). The influence of depression on processing speed and executive function in nondemented subjects aged 75. Journal of the International Neuropsychological Society, 17(5), 822831.
Koster E. H., De Lissnyder E., Derakshan N., & De Raedt R. (2011). Understanding depressive rumination from a cognitive science perspective: The impaired disengagement hypothesis. Clinical Psychology Review, 31(1), 138145.
Libon D. J., Malamut B. L., Swenson R., Sands L. P., & Cloud B. S. (1996). Further analyses of clock drawings among demented and nondemented older subjects. Archives of Clinical Neuropsychology, 11(3), 193205.
Libon D. J., Swenson R. A., Barnoski E. J., & Sands L. P. (1993). Clock drawing as an assessment tool for dementia. Archives of Clinical Neuropsychology, 8(5), 405415.
Little J. T., Reynolds C. F. III, Dew M. A., Frank E., Begley A. E., Miller M. D., … Kupfer D. J. (1998). How common is resistance to treatment in recurrent, nonpsychotic geriatric depression? American Journal of Psychiatry, 155(8), 10351038.
Lohr J. B., May T., & Caligiuri M. P. (2012). Quantitative assessment of motor abnormalities in untreated patients with major depressive disorder. Journal of Affective Disorders, 146(1), 8490.
Nebes R. D., Butters M. A., Mulsant B. H., Pollock B. G., Zmuda M. D., Houck P. R., & Reynolds C. F. (2000). Decreased working memory and processing speed mediate cognitive impairment in geriatric depression. Psychological Medicine, 30(3), 679691.
Penney D. L., Davis R., Libon D. J., Lamar M., Price C. C., Swenson R., … Kaplan E. (2010). The Digital Clock Drawing Test (dCDT) - II: A new computerized quantitative system. Paper presented at the The International Neuropsychological Society, Montreal, Canada.
Penney D. L., Libon D. J., Lamar M., Swenson R., Price C. C., Weninger C., … Davis R. (2010). The Digital Clock Drawing Test (dCDT) - III: Clinician reliability for a new quantitative system. Paper presented at the The International Neuropsychological Society, Montreal, Canada.
Petrides M., Alivisatos B., & Frey S. (2002). Differential activation of the human orbital, mid-ventrolateral, and mid-dorsolateral prefrontal cortex during the processing of visual stimuli. Proceedings of the National Academy of Sciences of the United States of America, 99(8), 56495654.
Pier M. P., Hulstijn W., & Sabbe B. G. (2004a). Differential patterns of psychomotor functioning in unmedicated melancholic and nonmelancholic depressed patients. Journal of Psychiatric Research, 38(4), 425435.
Pier M. P., Hulstijn W., & Sabbe B. G. (2004b). No psychomotor slowing in fine motor tasks in dysthymia. Journal of Affective Disorders, 83(2–3), 109120.
Pier M. P., Hulstijn W., & Sabbe B. G. (2004c). Psychomotor retardation in elderly depressed patients. Journal of Affective Disorders, 81(1), 7377.
Pimontel M. A., Culang-Reinlieb M. E., Morimoto S. S., & Sneed J. R. (2012). Executive dysfunction and treatment response in late‐life depression. International Journal of Geriatric Psychiatry, 27(9), 893899.
Pratt L. A., & Brody D. J. (2008). Depression in the United States household population, 2005-2006. NCHS Data Brief, (7), 18.
Radloff L. S. (1977). The CES-D Scale: A self-report depression scale for research in the general population. Applied Psychological Measures, 1, 385401.
Radloff L. S., & Teri L. (1986). Use of the Center for Epidemiological Studies Depression Scale with older adults. Clinical Gerontology, 5, 119136.
Royall D. R., Cordes J. A., & Polk M. (1998). CLOX: An executive clock drawing task. Journal of Neurology, Neurosurgery, and Psychiatry, 64(5), 588594.
Sabbe B., Hulstijn W., van Hoof J., Tuynman-Qua H. G., & Zitman F. (1999). Retardation in depression: Assessment by means of simple motor tasks. Journal of Affective Disorders, 55(1), 3944.
Schrijvers D., Hulstijn W., & Sabbe B. G. (2008). Psychomotor symptoms in depression: A diagnostic, pathophysiological and therapeutic tool. Journal of Affective Disorders, 109(1), 120.
Sobin C., & Sackeim H. A. (1997). Psychomotor symptoms of depression. American Journal of Psychiatry, 154(1), 417.
Spitzer R. L., Williams J. B. W., Gibbon M., & First M. B. (1992). The Structured Clinical Interview for DSM-III-R (SCID) I: History, rationale, and description. Archives of General Psychiatry, 49(8), 624629.
Stordal K. I., Lundervold A. J., Egeland J., Mykletun A., Asbjørnsen A., Landrø N. I., … Lund A. (2004). Impairment across executive functions in recurrent major depression. Nordic Journal of Psychiatry, 58(1), 4147.
Tucha O., Aschenbrenner S., Eichhammer P., Putzhammer A., Sartor H., Klein H. E., & Lange K. W. (2002). The impact of tricyclic antidepressants and selective serotonin re-uptake inhibitors on handwriting movements of patients with depression. Psychopharmacology (Berl), 159(2), 211215.
Wechsler D. (1997a). Wechsler Adult Intelligence Scale (WAIS-III). San Antonio, TX: Psychological Corporation.
Wechsler D. (1997b). Wechsler memory scale (WMS-III). San Antonio, TX: Psychological Corporation.
Wechsler D. (2001). Wechsler Test of Adult Reading: WTAR. San Antonio, TX: Psychological Corporation.
Wolf P. A., D’Agostino R. B., Belanger A. J., & Kannel W. B. (1991). Probability of stroke: A risk profile from the Framingham Study. Stroke, 22(3), 312318.
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Journal of the International Neuropsychological Society
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