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Detecting cognitive impairment in individuals at risk for cardiovascular disease: the “Clock‐in‐the‐Box” screening test
Author(s) -
Grande Laura J.,
Rudolph James L.,
Milberg William P.,
Barber Colleen E.,
McGlinchey Regina E.
Publication year - 2011
Publication title -
international journal of geriatric psychiatry
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.28
H-Index - 129
eISSN - 1099-1166
pISSN - 0885-6230
DOI - 10.1002/gps.2635
Subject(s) - verbal learning , verbal fluency test , cohort , california verbal learning test , population , medicine , boston naming test , recall , psychology , cognitive decline , neuropsychology , audiology , gerontology , cognition , dementia , disease , psychiatry , cognitive psychology , environmental health
Objective The purpose of this study was to evaluate the performance on the Clock‐in‐the‐Box (CIB), a screening measure for cognitive function, relative to neuropsychological testing in an older population with cardiovascular risk. Methods A prospective cohort of older patients (>50 years) with cardiovascular risk was recruited to perform the CIB and complete a brief neuropsychological battery consisting of Trailmaking tests, the Hopkins Verbal Learning Test (HVLT), and fluency tasks. Performance on the CIB was scored according to standard criteria (range 0–8, 0–worst). The performance on the total CIB, working memory subscale (CIB–WM), and planning/organization (COB–PO) was compared to neuropsychological measures. Results The cohort ( n = 127) was older (age 67 ± 7 years) and diverse with 33% female ( n = 42) and 42% non‐white race ( n = 53). Cardiac risk factors were prevalent: hypertension (83%), hyperlipidemia (74%), overweight (84%), diabetes (48%), prior cardiac disease (39%), and smoking (11%). The CIB (mean 6.5 ± 1.3) took 84 ± 21 s on average to complete and had good inter‐rater reliability ( κ = 0.809, p < 0.01). The CIB–WM subscale was significantly correlated with performance on Trailmaking B and HVLT learning, recall, and recognition. The CIB–PO subscale was significantly associated with semantic and phonemic fluency, Trailmaking B, and HVLT learning and recall. In regression modeling, CIB–WM significantly predicted performance on HVLT learning, recall, and retention. CIB–PO subscale predicted performance on Trailmaking B, HVLT learning, and HVLT recall. Conclusions The CIB is a brief cognitive screening instrument with good reliability and predictive validity in a CV risk population. The CIB–WM and CIB–PO subscales could provide utility for clinicians. Published in 2010 by John Wiley & Sons, Ltd.