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Digital Clock Drawing: Differentiating “Thinking” versus “Doing” in Younger and Older Adults with Depression

Published online by Cambridge University Press:  15 September 2014

Jamie Cohen ,
Dana L. Penney ,
Randall Davis ,
David J. Libon ,
Rodney A. Swenson ,
Olusola Ajilore ,
Anand Kumar  and
Melissa Lamar
Jamie Cohen
Affiliation:
Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois
Dana L. Penney
Affiliation:
The Lahey Clinic, Burlington, Massachusetts
Randall Davis
Affiliation:
MIT Computer Science and Artificial Intelligence Laboratory, Cambridge, Massachusetts
David J. Libon
Affiliation:
Department of Neurology, Drexel University, Philadelphia, Pennsylvania
Rodney A. Swenson
Affiliation:
University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota
Olusola Ajilore
Affiliation:
Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois
Anand Kumar
Affiliation:
Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois
Melissa Lamar*
Affiliation:
Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois Graduate Program in Neuroscience, University of Illinois at Chicago, Chicago, Illinois
*
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
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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)

Keywords

Psychomotor slowingClock drawingDigital technologiesAgeMajor depressive disorder
Type
Research Articles
Information
Journal of the International Neuropsychological Society , Volume 20 , Issue 9 , October 2014 , pp. 920 - 928
Copyright
Copyright © The International Neuropsychological Society 2014 

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References

Alexopoulos, G. S. (2011). Pharmacotherapy for late-life depression. The Journal of Clinical Psychiatry, 72(1), e04. doi: 10.4088/JCP.7085tx2cj CrossRefGoogle ScholarPubMed
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), 915–922.CrossRefGoogle ScholarPubMed
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), 1146–1150.Google Scholar
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.CrossRefGoogle ScholarPubMed
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), 395–409.Google Scholar
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), 135–141. doi: S0165032702001076 [pii]CrossRefGoogle ScholarPubMed
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.Google Scholar
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, 1166–1174. doi: 10.1002/gps.3939 Google Scholar
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), 74–84.Google Scholar
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.Google Scholar
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.Google Scholar
Delis, D. C., Kaplan, E., & Kramer, J. H. (2001). Delis-Kaplan executive function system (D-KEFS). San Antonio, TX: Psychological Corporation.Google Scholar
Delis, D. C., & Kramer, J. H. (2000). California Verbal Learning Test: CvLT-II; Adult Version. San Antonio, TX: Psychological Corporation.Google Scholar
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, 189–198.CrossRefGoogle Scholar
Gallo, J. J., & Rabins, P. V. (1999). Depression without sadness: Alternative presentations of depression in late life. American Family Physician, 60(3), 820–826.Google ScholarPubMed
Golden, C. (1978). Stroop colour and word test. North Tonawanda, NY: Psychological Assessments and Services.Google Scholar
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), 35–43.Google Scholar
Hamilton, M. A. (1960). A rating scale for depression. Journal of Neurology, Neurosurgery, and Psychiatry, 23, 56–62.CrossRefGoogle ScholarPubMed
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), 125–132.Google Scholar
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), 822–831.CrossRefGoogle ScholarPubMed
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), 138–145.CrossRefGoogle ScholarPubMed
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), 193–205.CrossRefGoogle ScholarPubMed
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), 405–415.CrossRefGoogle ScholarPubMed
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), 1035–1038.CrossRefGoogle ScholarPubMed
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), 84–90.CrossRefGoogle ScholarPubMed
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), 679–691.Google Scholar
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.Google Scholar
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.Google Scholar
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), 5649–5654.CrossRefGoogle ScholarPubMed
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), 425–435.CrossRefGoogle ScholarPubMed
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), 109–120.Google Scholar
Pier, M. P., Hulstijn, W., & Sabbe, B. G. (2004c). Psychomotor retardation in elderly depressed patients. Journal of Affective Disorders, 81(1), 73–77.CrossRefGoogle ScholarPubMed
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), 893–899.Google Scholar
Pratt, L. A., & Brody, D. J. (2008). Depression in the United States household population, 2005-2006. NCHS Data Brief, (7), 1–8.Google Scholar
Radloff, L. S. (1977). The CES-D Scale: A self-report depression scale for research in the general population. Applied Psychological Measures, 1, 385–401.Google Scholar
Radloff, L. S., & Teri, L. (1986). Use of the Center for Epidemiological Studies Depression Scale with older adults. Clinical Gerontology, 5, 119–136.CrossRefGoogle Scholar
Royall, D. R., Cordes, J. A., & Polk, M. (1998). CLOX: An executive clock drawing task. Journal of Neurology, Neurosurgery, and Psychiatry, 64(5), 588–594.CrossRefGoogle ScholarPubMed
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), 39–44.Google Scholar
Schrijvers, D., Hulstijn, W., & Sabbe, B. G. (2008). Psychomotor symptoms in depression: A diagnostic, pathophysiological and therapeutic tool. Journal of Affective Disorders, 109(1), 1–20.Google Scholar
Sobin, C., & Sackeim, H. A. (1997). Psychomotor symptoms of depression. American Journal of Psychiatry, 154(1), 4–17.Google Scholar
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), 624–629.CrossRefGoogle ScholarPubMed
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), 41–47.Google Scholar
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), 211–215.Google Scholar
Wechsler, D. (1997a). Wechsler Adult Intelligence Scale (WAIS-III). San Antonio, TX: Psychological Corporation.Google Scholar
Wechsler, D. (1997b). Wechsler memory scale (WMS-III). San Antonio, TX: Psychological Corporation.Google Scholar
Wechsler, D. (2001). Wechsler Test of Adult Reading: WTAR. San Antonio, TX: Psychological Corporation.Google Scholar
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), 312–318.CrossRefGoogle ScholarPubMed