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Original Article
Dementia and Neurocognitive Disorders 2008: 7: 2: 39-46

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시계 그리기의 임상 활용 예비 연구: 알츠하이머병과 피질하혈관치매에서의 비교
김보연∙김현정*∙백민재*∙김상윤*,†
서울가정법원, 분당서울대학교병원 뇌신경센터*

서울대학교 의과대학 신경과학교실†
Preliminary Study for Expanding the Clinical Utility of Clock Drawing Test: Alzheimer’s Disease vs. Subcortical Vascular Dementia
Bo-Yeon Kim, M.D., Hyun Jung Kim, M.D.*, Min Jae Baek, M.D.*, SangYun Kim, M.D.*,†
Seoul Family Court, Seoul;
Clinical Neuroscience Center*, Seoul National University Bun-dang Hospital, Seongnam;
Department of Neurology†, Seoul National University College of Medicine , Seoul, Korea
Background: This study examines the differences in the types of errors made on the clock drawing test (CDT) by patients with Alzheimer’s disease (AD) or subcortical vascular dementia (SVaD). Methods: The CDT scores of 27 patients with AD, 27 patients with SVaD and 27 healthy elderly subjects were analyzed using 26 scoring items. We also investigated which scoring items were more useful in differentiating between the control and dementia groups and between the AD and SVaD groups. Results: Qualitative analysis revealed that 5 of the 26 items (‘closed’, ‘bilateral symmetry’, ‘no same numbers’, ‘all numbers in the circle’, and ‘absence of unnecessary mark and word’) were not useful in differentiating between the control and dementia groups. The control and AD groups differed on items related to hands, but almost all of the items could be used to differentiate between the control and SVaD groups. The SVaD group differed from the control group on nearly every item. Qualitative analysis revealed differences in the types of errors on the CDT between AD and SVaD, such as ‘difficulty of drawing’ and ‘spatial-planning deficit’, which could make it possible to differentiate between these two groups, but only in the early stages of these diseases. Moreover, the CDT was more useful in the diagnosis of SVaD than AD. Conclusions: The CDT is a very useful cognitive screening tool. However, it should be interpreted on the basis of error type and education level. Knowledge about the basic mechanism behind each error type can make the CDT a more reliable screening tool.
Key Words: Clock drawing test, Alzheimer’s disease, Sub-vascular dementia