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Cognitive Screening in Community-Dwelling Elders: Performance on the Clock-in-the-Box - 19/08/11

Doi : 10.1016/j.amjmed.2011.02.023 
Jennifer G. Chester a, Laura J. Grande, PhD b, g, William P. Milberg, PhD c, g, Regina E. McGlinchey, PhD c, g, Lewis A. Lipsitz, MD d, e, g, James L. Rudolph, MD, SM c, f, g,
a Albert Einstein College of Medicine, Bronx, NY 
b Department of Psychology, VA Boston Healthcare System, Boston, Mass 
c Geriatric Research, Education, and Clinical Center, VA Boston Healthcare System, Boston, Mass 
d Institute for Aging Research, Hebrew SeniorLife, Boston, Mass 
e Beth Israel Deaconess Medical Center, Boston, Mass 
f Division of Aging, Brigham and Women's Hospital, Boston, Mass 
g Harvard Medical School, Boston, Mass 

Requests for reprints should be addressed to James L. Rudolph, VABHS, GRECC, 150 S. Huntington Ave, Boston, MA 02130

Abstract

Background

The Clock-in-the-Box is a rapid (2-minute) cognitive screening tool. The purpose of this study was to compare the Clock-in-the-Box with the Mini-Mental State Exam and neuropsychologic tests; to determine Clock-in-the-Box score normative values by age and education group; and to determine if the Clock-in-the-Box score is associated with measures of physical function.

Methods

Community-dwelling older participants in the Boston area were recruited for a prospective, longitudinal study in which they completed a variety of cognitive and functional assessments.

Results

At baseline, participants (n=798; mean age [± standard deviation]=78.2 [±5.5] years; 14 [±3] mean years of education) completed in-home assessments of cognition (Clock-in-the-Box and Mini-Mental State Exam), measures of independent function (Activities of Daily Living and Instrumental Activities of Daily Living), and measures of physical function (Short Physical Performance Battery). The mean Mini-Mental State Exam score was 27.1 (±1.6; range 0-30 [0 worst]), and the mean Clock-in-the-Box score was 6.2 (±1.6; range 0-8 [0 worst]). Performance on the Clock-in-the-Box was correlated (Spearman) with the Mini-Mental State Exam (r=0.49, P<.001) and neuropsychologic measures (r=0.37-0.50; P<.001). Higher Clock-in-the-Box score was significantly associated with no difficulty in Activities of Daily Living (χ2 = 39.6, P<.001) and Instrumental Activities of Daily Living (χ2 = 35.5, P<.001). In addition, higher Clock-in-the-Box scores were associated with higher scores on the Short Physical Performance Battery (F=5.4, P<.001).

Conclusion

The Clock-in-the-Box is a brief cognitive screening test that is correlated with the Mini-Mental State Exam, neuropsychologic tests, and measures of independent and physical function in community-dwelling older adults.

El texto completo de este artículo está disponible en PDF.

Keywords : Aged, Cognition, Dementia, Function, Neuropsychologic testing, Screening


Esquema


 Funding: JGC was funded by an Einstein Research Fellowship. JLR is funded by a Veterans Affairs Rehabilitation Career Development Award. Additional support provided by the American Federation for Aging Research, the Boston MSTAR, and National Institutes of Health Grants AG-038027-01 AG-023480, AG-08812, and AG-029861. The data for this project were collected by the Hebrew SeniorLife/Harvard Research Nursing Home-Maintenance Of Balance, Independent Living, Intellect, and Zest in the Elderly (MOBILIZE) Boston Project (AG004390). The MOBILIZE Boston Study is funded by National Institutes of Health/National Institute on Aging under Grant P01AG004390.
 Conflict of Interest: None of the authors have any conflicts of interest associated with the work presented in this manuscript. The Clock-in-the-Box was developed by Dr Grande with contributions from Drs Milberg and McGlinchey. All were Veterans Affairs employees at time.
 Authorship: All authors had access to the data and played a role in writing this manuscript. Study design: LAL, LJG, WPM, REM, JLR; acquisition of data: LAL, LJG, JGC; data analysis and interpretation: JGC, LJG, WPM, REM, LAL, JLR; preparation of manuscript: JGC, LJG, WPM, REM, LAL, JLR.


© 2011  Publicado por Elsevier Masson SAS.
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Vol 124 - N° 7

P. 662-669 - juillet 2011 Regresar al número
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