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. 2022 Sep-Oct;20(5):452-459.
doi: 10.1370/afm.2855.

Clock-Drawing Test as a Screening Tool for Cognitive Impairment Associated With Fecal Immunochemical Test Collection Errors

Jeanette M Daly  1 , Yinghui Xu  2 , Seth D Crockett  3 , Megan E Schmidt  2 , Peter Kim  4 , Barcey T Levy  2   5   6
Affiliations

Clock-Drawing Test as a Screening Tool for Cognitive Impairment Associated With Fecal Immunochemical Test Collection Errors

Jeanette M Daly et al. Ann Fam Med. 2022 Sep-Oct.

Abstract

Purpose: The purposes of this study were to determine if (1) certain demographic characteristics (potential predictors) of participants, and (2) clock-drawing test results (as a screening test for cognitive impairment) were associated with fecal immunochemical test (FIT) sample collection errors.

Methods: Patients scheduled for an upcoming colonoscopy were asked to collect stool samples using 5 different FITs. Patients completed a questionnaire that included the clock-drawing test. Errors included mistakes or omissions in recording the stool collection date and errors in stool collection. Each clock drawing was scored by 2 reviewers using 2 established methods.

Results: Of the 1,448 participants with a clock drawing, 63% were female with a mean age of 63 years. In this population there were 83% White, 6% Black, and 24% Hispanic persons. Cognitive impairment was found in 292 patients by the Mendes-Santos method. Kappa coefficient for the 2 clock-drawing scores was 0.79 (P <.001). The multivariable generalized linear mixed model for FIT collection errors indicated being female (adjusted odds ratio [AOR], 1.64; 95% CI, 1.09-2.48), having an 8th grade or less education (AOR, 3.40; 95% CI, 1.87-6.18), and having an abnormal Mendes-Santos method clock score (AOR, 1.65; 95% CI, 1.08-2.54) were associated with significantly more errors.

Conclusion: Among the participants who do not have dementia, FIT collection errors were made not only by those who had abnormal clock drawing, but also, by those with normal clock drawings. Subjects being female, having 8th grade education or less, and having an abnormal clock drawing scored by Mendes-Santos's method were associated with FIT collection errors.

Trial registration: ClinicalTrials.gov NCT03264898.

Keywords: clock drawing test; cognitive impairment; colorectal cancer; fecal immunochemical test; occult blood.

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Figures

Figure 1.
Figure 1.
Examples of abnormal clock drawings.
See this image and copyright information in PMC

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