Executive clock drawing correlates with performance-based functional status in people with combat-related mild traumatic brain injury and comorbid posttraumatic stress disorder

Department of Psychiatry, San Antonio Military Medical Center, Lackland Air Force Base, TX, USA.
The Journal of Rehabilitation Research and Development (Impact Factor: 1.43). 01/2010; 47(9):841-50. DOI: 10.1682/JRRD.2009.10.0162
Source: PubMed


Executive Clock Drawing Tasks (CLOX parts 1 and 2) can predict functional impairment. This study determined the correlation between CLOX and other psychometric screening instruments with the Structured Assessment of Independent Living Skills (SAILS)-defined performance-based functional status in people with combat-related mild traumatic brain injury (TBI) and comorbid posttraumatic stress disorder (PTSD). We hypothesized that CLOX would correlate significantly with functional performance. This prospective, cross-sectional study design determined the correlation between a structured neuropsychological battery and functional status assessment. We calculated Pearson correlation coefficients between neuropsychological instruments and functional status scores. We entered neuropsychological measures correlating p < 0.1 with functional status into a linear regression model to determine independent contributions. Fifteen Operation Iraqi Freedom veterans participated. Only CLOX1 correlated significantly with functional competency and efficiency. Only mean CLOX1 scores were significantly lower in those scoring below the median for SAILS competency and in those scoring above the median for SAILS efficiency. CLOX1 contributed significant variance to functional status independent of mood or anxiety symptoms and was not affected by age or time since injury. Executive dysfunction per the brief, easily administered CLOX1 is sensitive to functional status following combat-related mild TBI, independent of PTSD anxiety with or without depression.

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    ABSTRACT: The Clock Drawing Test (CDT) has long been recognized as a useful component for the screening of cognitive disorders. It provides a user-friendly visual representation of cognitive functioning that is simple and rapidly administered, making it appealing to clinicians and patients alike. The ease of use and wide range of cognitive abilities required to successfully complete the CDT has made this test an increasingly popular cognitive screening measure in both research and clinical settings. This chapter summarizes and compares the numerous CDT scoring methods that have been described in the literature. Also, psychometric properties are presented for the CDT when used for cognitive screening in a variety of neurologic conditions, including: Alzheimer’s disease, Parkinson’s disease, Huntington’s disease, vascular disease, schizophrenia, stroke and traumatic brain injury. Cultural, ethnic and educational considerations for the CDT are also discussed.
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