Clock drawing test-modified and integrated approach (CDT-MIA): Description and preliminary examination of its validity and reliability in dementia patients referred to a specialized psychogeriatric setting

The authors developed a scoring system for clock drawing, based on modification and integration of 3 established scoring methods. The Clock Drawing Test-Modified and Integrated Approach (CDT-MIA) is a 4-step, 20-item instrument, with a maximum score of 33, which emphasizes differential scoring of contour, numbers, hands, and center. It was administered to 139 patients (93 with and 46 without dementia). Dementia patients revealed significantly more impairment on the CDT-MIA total score and hours and hands subscores. Correlations between CDT-MIA and 2 CDTs were high. With receiver operating characteristics (ROC) curves, the area constructed under CDT-MIA curve was large. The best trade-off between sensitivity and specificity for CDT-MIA was the cut-point 23 (91% and 80%, respectively). The internal consistency of CDT-MIA was high, and there was a high degree of interrater reliability. Thus, CDT-MIA was found to be a valid and reliable evaluation instrument for dementia patients in a specialized setting.