Normative References for Graphomotor and Latency Digital Clock Drawing Metrics for Adults Age 55 and Older: Operationalizing the Production of a Normal Appearing Clock

Article type: Research Article

Authors: Davoudi, Anis^{a; 1} | Dion, Catherine^{b; 1} | Formanski, Erin^b | Frank, Brandon E.^b | Amini, Shawna^c | Matusz, Emily F.^d | Wasserman, Victor^e | Penney, Dana^f | Davis, Randall^g | Rashidi, Parisa^a | Tighe, Patrick J.^c | Heilman, Kenneth M.^h | Au, Rhoda^{i; j; k; l} | Libon, David J.^{d; e} | Price, Catherine C.^{b; c; *}

Affiliations: [a] Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA | [b] Clinical and Health Psychology, University of Florida, Gainesville, FL, USA | [c] Department of Anesthesiology, University of Florida, Gainesville, FL, USA | [d] Department of Geriatrics and Gerontology, New Jersey Institute for Successful Aging, School of Osteopathic Medicine, Rowan University, NJ, USA | [e] Department of Psychology, Rowan University, NJ, USA | [f] Department of Neurology, Lahey Clinic Medical Center, Burlington, MA, USA | [g] Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, MA, USA | [h] Department of Neurology, Veterans Affairs Medical Center, University of Florida, Gainesville, FL, USA | [i] Framingham Heart Study, Boston University School of Medicine, Boston, MA, USA | [j] Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, USA | [k] Department of Neurology, Boston University School of Medicine, Boston, MA, USA | [l] Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA

Correspondence: [*] Correspondence to: Catherine Price, PhD, Associate Professor, Clinical and Health Psychology, University of Florida, Gainesville, FL 32610, USA. Tel.: +1 352 273 5929; E-mail: [email protected].

Note: [1] These authors contributed equally to this work.

Abstract: Background:Relative to the abundance of publications on dementia and clock drawing, there is limited literature operationalizing ‘normal’ clock production. Objective:To operationalize subtle behavioral patterns seen in normal digital clock drawing to command and copy conditions. Methods:From two research cohorts of cognitively-well participants age 55 plus who completed digital clock drawing to command and copy conditions (n = 430), we examined variables operationalizing clock face construction, digit placement, clock hand construction, and a variety of time-based, latency measures. Data are stratified by age, education, handedness, and number anchoring. Results:Normative data are provided in supplementary tables. Typical errors reported in clock research with dementia were largely absent. Adults age 55 plus produce symmetric clock faces with one stroke, with minimal overshoot and digit misplacement, and hands with expected hour hand to minute hand ratio. Data suggest digitally acquired graphomotor and latency differences based on handedness, age, education, and anchoring. Conclusion:Data provide useful benchmarks from which to assess digital clock drawing performance in Alzheimer’s disease and related dementias.

Keywords: Older adult, aging, attention, cognition, dementia, digital technology, executive function, laterality, middle aged, neuropsychological tests, reference standards, short-term memory, clock drawing test

DOI: 10.3233/JAD-201249

Journal: Journal of Alzheimer's Disease, vol. 82, no. 1, pp. 59-70, 2021