A comparison of five clock scoring methods using ROC (receiver operating characteristic) curve analysis

International Journal of Geriatric Psychiatry
J E StoreyD A Conforti

Abstract

To compare the accuracy of five clock scoring methods for detecting dementia in English-speaking patients. A prospective cohort study. A general geriatric outpatient clinic in southwest Sydney, Australia. A total of 127 consecutive new referrals to the clinic, of mean age 78.2 years. The clock drawing test was conducted at the beginning of each clinic appointment by a blinded observer. Each patient was then assessed by a geriatrician, who collected demographic data, administered the modified Barthel index, the geriatric depression scale, and the Folstein Mini-Mental State Examination, and categorised each patient as demented or not demented, according to DSM-4 criteria. Each clock was scored according to the methods of Mendez, Shulman, Sunderland, Watson and Wolf-Klein, and evaluated for reliability, and predictive accuracy, using receiver operating characteristic (ROC) curve analysis. The area under the ROC curve was largest for the Shulman (0.79, 95% CI 0.70-0.85) and Mendez (0.78, 95% CI 0.70-0.85) methods. Both predicted dementia more accurately than the Sunderland (area = 0.71) and Watson (area = 0.65) methods (p < 0.05). The inter-rater (0.81-0.93) and intra-rater (0.87-0.96) correlation coefficients were high for all fiv...Continue Reading

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