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The Mini-Cog, Clock Drawing Test, and the Mini-Mental State Examination in a German Memory Clinic: specificity of separation dementia from depression

Published online by Cambridge University Press:  20 August 2012

Monika Milian ,
Anna-Maria Leiherr ,
Guido Straten ,
Stephan Müller ,
Thomas Leyhe  and
Gerhard W. Eschweiler
Monika Milian*
Affiliation:
Department of Psychiatry and Psychotherapy, University of Tuebingen, Tuebingen, Germany Department of Neurosurgery, University of Tuebingen, Tuebingen, Germany
Anna-Maria Leiherr
Affiliation:
Department of Psychiatry and Psychotherapy, University of Tuebingen, Tuebingen, Germany
Guido Straten
Affiliation:
Department of Psychiatry and Psychotherapy, University of Tuebingen, Tuebingen, Germany
Stephan Müller
Affiliation:
Department of Psychiatry and Psychotherapy, University of Tuebingen, Tuebingen, Germany
Thomas Leyhe
Affiliation:
Department of Psychiatry and Psychotherapy, University of Tuebingen, Tuebingen, Germany Geriatric Center at the University Hospital of Tuebingen, Tuebingen, Germany
Gerhard W. Eschweiler
Affiliation:
Department of Psychiatry and Psychotherapy, University of Tuebingen, Tuebingen, Germany Geriatric Center at the University Hospital of Tuebingen, Tuebingen, Germany
*
Correspondence should be addressed to: Dr. Monika Milian, Department of Neurosurgery, University of Tuebingen, Hoppe-Seyler-Strasse 3, 72076 Tuebingen, Germany. Phone: +49-(0)7071-29 81993; Fax: +49-(0)7071-29 4438. Email: monika.milian@med.uni-tuebingen.de.
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Abstract

Background: The aim of this study was to assess the specificities of the Mini-Cog, the Clock Drawing Test (CDT), and the Mini-Mental State Examination (MMSE) against depression and healthy controls in a German Memory Clinic. Furthermore, we analyzed the specificities of all three screening instruments in dependence of actual depression severity.

Methods: Data from 142 depressed elderly, 438 dementia patients, and 64 healthy controls were retrospectively analyzed. The CDT and an extraction of the three-item recall of the MMSE were used to constitute the Mini-Cog algorithm. Depression severity was rated by either the Beck Depression Inventory (BDI) or the Geriatric Depression Scale (GDS) depending on the age of the patients.

Results: The Mini-Cog achieved a specificity of 79.6% against depressed elderly and 100.0% against healthy subjects (p < 0.001). Similarly, the specificities of the CDT (83.8%) and MMSE (92.3% at a cut-off ≤24 and 90.8% at ≤25, respectively) against healthy subjects were significantly higher than the specificities against depressed patients (each p < 0.05). Concerning the depressed patients, the MMSE demonstrated significant higher specificity than the Mini-Cog and the CDT, but also showed the lowest sensitivity for the detection of dementia. Surprisingly, the depression severity had no effect on the specificity of the Mini-Cog and the CDT, only the MMSE was susceptible for the depression severity.

Conclusion: Although the MMSE showed higher specificities, the weighting between the sensitivities and specificities in all tests prove again the Mini-Cog as a short, valid, and sensitive screening tool.

Keywords

dementiaAlzheimer's diseasedepressionMini-Cogmemory clinic

Information

Type
Research Article
Information
International Psychogeriatrics , Volume 25 , Issue 1 , January 2013 , pp. 96 - 104
Copyright
Copyright © International Psychogeriatric Association 2012

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References

American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), 4th edn. Washington, DC: American Psychiatric Association.Google Scholar
Beck, A. T., Ward, C. H., Mendelson, M., Mock, J. and Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561–571.CrossRefGoogle ScholarPubMed
Blazer, D. G. (2002). Depression in Late Life, 3rd edn. St. Louis, MO: Mosby Year Book.Google ScholarPubMed
Borson, S.et al. (1999). The Clock Drawing Test: utility for dementia detection in multiethnic elders. Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 54, M534–M540.CrossRefGoogle ScholarPubMed
Borson, S., Scanlan, J., Brush, M., Vitaliano, P. and Dokmak, A. (2000). The Mini-Cog: a cognitive ‘vital signs’ measure for dementia screening in multi-lingual elderly. International Journal of Geriatric Psychiatry, 15, 1021–1027.3.0.CO;2-6>CrossRefGoogle ScholarPubMed
Borson, S., Scanlan, J. M., Chen, P. and Ganguli, M. (2003). The Mini-Cog as a screen for dementia: validation in a population-based sample. Journal of the American Geriatrics Society, 51, 1451–1454.CrossRefGoogle Scholar
Borson, S., Scanlan, J. M., Watanabe, J., Tu, S. P. and Lessig, M. (2005). Simplifying detection of cognitive impairment: comparison of the Mini-Cog and Mini-Mental State Examination in a multiethnic sample. Journal of the American Geriatrics Society, 53, 871–874.CrossRefGoogle Scholar
Cacho, J.et al. (2005). Improvement pattern in the Clock Drawing Test in early Alzheimer's disease. European Neurology, 53, 140–145.CrossRefGoogle ScholarPubMed
Colombo, M., Vaccaro, R., Vitali, S. F., Malnati, M. and Guaita, A. (2009). Clock drawing interpretation scale (CDIS) and neuro-psychological functions in older adults with mild and moderate cognitive impairments. Archives of Gerontology and Geriatrics, 49 (Suppl. 1), 39–48.CrossRefGoogle ScholarPubMed
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). Mini-mental state. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.CrossRefGoogle Scholar
Fossati, P., Amar, G., Raoux, N., Ergis, A. M. and Allilaire, J. F. (1999). Executive functioning and verbal memory in young patients with unipolar depression and schizophrenia. Psychiatry Research, 89, 171–187.CrossRefGoogle ScholarPubMed
Gruber, N. P., Varner, R. V., Chen, Y. W. and Lesser, J. M. (1997). A comparison of the Clock Drawing Test and the Pfeiffer Short Portable Mental Status Questionnaire in a geropsychiatry clinic. International Journal of Geriatric Psychiatry, 12, 526–532.3.0.CO;2-V>CrossRefGoogle Scholar
Harvey, P. O.et al. (2004). Executive functions and updating of the contents of working memory in unipolar depression. Journal of Psychiatric Research, 38, 567–576.CrossRefGoogle ScholarPubMed
Kampf-Sherf, O.et al. (2004). Neuropsychological functioning in major depression and responsiveness to selective serotonin reuptake inhibitors antidepressants. Journal of Affective Disorders, 82, 453–459.Google ScholarPubMed
Kiosses, D. N., Klimstra, S., Murphy, C. and Alexopoulos, G. S. (2001). Executive dysfunction and disability in elderly patients with major depression. American Journal of Geriatric Psychiatry, 9, 269–274.CrossRefGoogle ScholarPubMed
Kirby, M., Denihan, A., Bruce, I., Coakley, D. and Lawlor, B. A. (2001). The Clock Drawing Test in primary care: sensitivity in dementia detection and specificity against normal and depressed elderly. International Journal of Geriatric Psychiatry, 16, 935–940.CrossRefGoogle ScholarPubMed
Landrø, N. I., Stiles, T. C. and Sletvold, H. (2001). Neuropsychological function in nonpsychotic unipolar major depression. Neuropsychiatry, Neuropsychology, and Behavioral Neurology, 14, 233–240.Google ScholarPubMed
Lee, H. and Lawlor, B. A. (1995). State-dependent nature of the clock drawing task in geriatric depression. Journal of the American Geriatrics Society, 43, 796–798.CrossRefGoogle ScholarPubMed
Lessig, M. C., Scanlan, J. M., Nazemi, H. and Borson, S. (2008). Time that tells: critical clock-drawing errors for dementia screening. International Psychogeriatrics, 20, 459–470.CrossRefGoogle ScholarPubMed
Leyhe, T., Saur, R., Eschweiler, G. W. and Milian, M. (2009). Clock test deficits are associated with semantic memory impairment in Alzheimer disease. Journal of Geriatric Psychiatry and Neurology, 22, 235–245.CrossRefGoogle ScholarPubMed
Libon, D. J., Swenson, R., Barnoski, E. and Sands, L. T. (1993). Clock drawing as an assessment tool in dementia. Archives of Clinical Neuropsychology, 8, 405–416.CrossRefGoogle ScholarPubMed
McCarten, J. R., Anderson, P., Kuskowski, M. A., McPherson, S. E. and Borson, S. (2011). Screening for cognitive impairment in an elderly veteran population: acceptability and results using different versions of the Mini-Cog. Journal of the American Geriatrics Society, 59, 309–313.CrossRefGoogle Scholar
McKhann, G., Drachman, D., Folstein, M., Katzman, R., Price, D. and Stadlan, E. M. (1984). Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology, 34, 939–944.CrossRefGoogle ScholarPubMed
Milian, M., Leiherr, A. M., Straten, G., Müller, S., Leyhe, T. and Eschweiler, G. W. (2012). The Mini-Cog versus the Mini-Mental State Examination and the Clock Drawing Test in daily clinical practice: screening value in a German Memory Clinic. International Psychogeriatrics, 24, 766–774.CrossRefGoogle Scholar
Morris, J. C.et al. (1989). The Consortium to Establish a Registry for Alzheimer's Disease (CERAD). Part I. Clinical and neuropsychological assessment of Alzheimer's disease. Neurology, 39, 1159–1165.Google Scholar
Murphy, F. C., Michael, A., Robbins, T. W. and Sahakian, B. J. (2003). Neuropsychological impairment in patients with major depressive disorder: the effects of feedback on task performance. Psychological Medicine, 33, 455–467.CrossRefGoogle ScholarPubMed
Naismith, S. L., Longley, W. A., Scott, E. M. and Hickie, I. B. (2007). Disability in major depression related to self-rated and objectively-measured cognitive deficits: a preliminary study. BMC Psychiatry, 7, 32–38.CrossRefGoogle ScholarPubMed
Neu, P., Bajbouj, M., Schilling, A., Godemann, F., Berman, R. M. and Schlattmann, P. (2005). Cognitive function over the treatment course of depression in middle-aged patients: correlation with brain MRI signal hyperintensities. Journal of Psychiatric Research, 39, 129–135.CrossRefGoogle ScholarPubMed
Rohling, M. L., Green, P., Allen, L. M. 3rd and Iverson, G. L. (2002). Depressive symptoms and neurocognitive test scores in patients passing symptom validity tests. Archives of Clinical Neuropsychology, 17, 205–222.CrossRefGoogle ScholarPubMed
Rouleau, I., Salmon, D. P. and Butters, N. (1996). Longitudinal analysis of clock drawing in Alzheimer's disease patients. Brain and Cognition, 31, 17–34.CrossRefGoogle ScholarPubMed
Royall, D. R., Cordes, J. A. and Polk, M. (1998). CLOX: an executive clock drawing task. Journal of Neurology, Neurosurgery, and Psychiatry, 64, 588–594.CrossRefGoogle ScholarPubMed
Scanlan, J. and Borson, S. (2001). The Mini-Cog: receiver operating characteristics with expert and naive raters. International Journal of Geriatric Psychiatry, 16, 216–222.3.0.CO;2-B>CrossRefGoogle ScholarPubMed
Schatzberg, A. F. (2002). Major depression: causes or effects? The American Journal of Psychiatry, 159, 1077–1079.CrossRefGoogle ScholarPubMed
Sheikh, J. I. and Yesavage, J. A. (1986). Geriatric Depression Scale (GDS). Recent evidence and development of a shorter version. In Brink, T. L. (ed.), Clinical Gerontology: A Guide to Assessment and Intervention (pp. 165–173). New York: The Haworth Press Inc.Google Scholar
Shenal, B. V., Harrison, D. W. and Demaree, H. A. (2003). The neuropsychology of depression: a literature review and preliminary model. Neuropsychology Review, 13, 33–42.CrossRefGoogle ScholarPubMed
Shulman, K. I. and Gold, D. P. (1993). Clock-drawing and dementia in the community: a longitudinal study. International Journal of Geriatric Psychiatry, 8, 487–496.CrossRefGoogle Scholar
Tangalos, E. G.et al. (1996). The Mini-Mental State Examination in general medical practice: clinical utility and acceptance. Mayo Clinic Proceedings, 71, 829–837.CrossRefGoogle ScholarPubMed
Taylor, W. D., Wagner, H. R. and Steffens, D. C. (2002). Greater depression severity associated with less improvement in depression-associated cognitive deficits in older subjects. American Journal of Geriatric Psychiatry, 10, 632–635.CrossRefGoogle ScholarPubMed
Tuokko, H., Hadjistavropoulus, T., Miller, J. A. and Beattie, B. L. (1992). The Clock Test: a sensitive measure to differentiate normal elderly from those with Alzheimer disease. Journal of the American Geriatrics Society, 40, 579–584.CrossRefGoogle ScholarPubMed
van Reekum, R., Simard, M., Clarke, D., Conn, D., Cohen, T. and Wong, J. (2000). The role of depression severity in the cognitive functioning of elderly subjects with central nervous system disease. Journal of Psychiatry & Neuroscience, 25, 262–268.Google ScholarPubMed
Woo, B. K., Rice, V. A., Legendre, S. A., Salmon, D. P., Jeste, D. V. and Sewell, D. D. (2004). The Clock Drawing Test as a measure of executive dysfunction in elderly depressed patients. Journal of Geriatric Psychiatry and Neurology, 17, 190–194.CrossRefGoogle ScholarPubMed
World Health Organization (1992). Tenth Revision of the International Classification of Diseases. Chapter 5 (F): Mental and Behavioural Disorders (Including Disorders of Psychological Development). Geneva: Clinical Descriptions and Diagnostic Guidelines.Google Scholar
Yesavage, J. A.et al. (1983). Development and validation of a geriatric depression screening scale: a preliminary report. Journal of Psychiatric Research, 17, 37–49.CrossRefGoogle Scholar