Modeling Cognitive Status through Automatic Scoring of a Digital Version of the Clock Drawing Test

The Clock Drawing Test is used as a cognitive assessment tool in geriatrics to detect signs of dementia or to model the progress of stroke recovery. The result is scored manually by a trained professional. We implement the Mendez scoring scheme and create a hierarchy of error categories that model the test characteristics of the clock drawing test, based on a set of impaired clock examples provided by a geriatrics clinic. Using a digital pen we recorded 120 clock samples for evaluating the automatic scoring system, with a total of 2400 error samples distributed over the 20 error classes of the Mendez scoring scheme. Error classes are scored automatically using a handwriting and gesture recognition framework. Results show that we provide a clinically relevant cognitive model for each subject. In addition, we heavily reduce the time spent on manual scoring. We compare manual scoring results with results produced by our automated system.

[1]  M. McHugh Interrater reliability: the kappa statistic , 2012, Biochemia medica.

[2]  Daniel Sonntag,et al.  Multimodal Speech-based Dialogue for the Mini-Mental State Examination , 2019, CHI Extended Abstracts.

[3]  D. Libon,et al.  Clock drawing as an assessment tool for dementia. , 1993, Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists.

[4]  Daniel Sonntag,et al.  Interactive Cognitive Assessment Tools: A Case Study on Digital Pens for the Clinical Assessment of Dementia , 2018, ArXiv.

[5]  K. Shulman,et al.  Clock‐drawing and dementia in the community: A longitudinal study , 1993 .

[6]  Fang Chen,et al.  Cognitive Load Measurement with Pen Orientation and Pressure , 2011 .

[7]  H. Charchat-Fichman,et al.  Scoring systems for the Clock Drawing Test: A historical review , 2017, Dementia & neuropsychologia.

[8]  Isabelle Rouleau,et al.  Quantitative and qualitative analyses of clock drawings in Alzheimer's and Huntington's disease , 1992, Brain and Cognition.

[9]  Andrew M. Tyrrell,et al.  Automated scoring of a neuropsychological test: the Rey Osterrieth complex figure , 2000, Proceedings of the 26th Euromicro Conference. EUROMICRO 2000. Informatics: Inventing the Future.

[10]  Marcos Faúndez-Zanuy,et al.  Analysis of in-air movement in handwriting: A novel marker for Parkinson's disease , 2014, Comput. Methods Programs Biomed..

[11]  D. Royall,et al.  CLOX: an executive clock drawing task , 1998, Journal of neurology, neurosurgery, and psychiatry.

[12]  H. Tuokko,et al.  A comparison of alternative approaches to the scoring of clock drawing. , 2000, Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists.

[13]  Daniel Sonntag,et al.  Interakt - A Multimodal Multisensory Interactive Cognitive Assessment Tool , 2017, ArXiv.

[14]  S. Birge,et al.  Clock Completion: An Objective Screening Test for Dementia , 1993, Journal of the American Geriatrics Society.

[15]  Elisabete Pinto,et al.  Literature Review of the Clock Drawing Test as a Tool for Cognitive Screening , 2009, Dementia and Geriatric Cognitive Disorders.

[16]  Kun Yu,et al.  Cognitive Load Evaluation with Pen Orientation and Pressure , 2011 .

[17]  Magdolna Pákáski,et al.  Is there any difference between the findings of Clock Drawing Tests if the clocks show different times? , 2014, Journal of Alzheimer's disease : JAD.

[18]  D. Marson,et al.  The Severe Mini-Mental State Examination: A New Neuropsychologic Instrument for the Bedside Assessment of Severely Impaired Patients With Alzheimer Disease , 2000, Alzheimer disease and associated disorders.

[19]  G. Rao,et al.  The Clock Drawing Test versus Mini-mental Status Examination as a Screening Tool for Dementia: A Clinical Comparison , 2018, Indian journal of psychological medicine.

[20]  Arno Villringer,et al.  Clock Drawing Test – screening utility for mild cognitive impairment according to different scoring systems: results of the Leipzig Longitudinal Study of the Aged (LEILA 75+) , 2011, International Psychogeriatrics.

[21]  Éric Anquetil,et al.  HBF49 feature set: A first unified baseline for online symbol recognition , 2013, Pattern Recognit..

[22]  Daniel Sonntag,et al.  Integrating Digital Pens in Breast Imaging for Instant Knowledge Acquisition , 2014, AI Mag..

[23]  P J Manos,et al.  The Ten Point Clock Test: A Quick Screen and Grading Method for Cognitive Impairment in Medical and Surgical Patients , 1994, International journal of psychiatry in medicine.

[24]  Daniel Sonntag,et al.  Towards a Multimodal Multisensory Cognitive Assessment Framework , 2018, 2018 IEEE 31st International Symposium on Computer-Based Medical Systems (CBMS).

[25]  S. Folstein,et al.  "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. , 1975, Journal of psychiatric research.

[26]  Antonio Krüger,et al.  The Handbook of Multimodal-Multisensor Interfaces: Foundations, User Modeling, and Common Modality Combinations - Volume 1 , 2017, The Handbook of Multimodal-Multisensor Interfaces, Volume 1.

[27]  Johan Wagemans,et al.  Diagnosing the Periphery: Using the Rey–Osterrieth Complex Figure Drawing Test to Characterize Peripheral Visual Function , 2017, i-Perception.

[28]  Daniel Sonntag,et al.  A categorisation and implementation of digital pen features for behaviour characterisation , 2018, ArXiv.

[29]  Ivan Silver,et al.  The challenge of time: Clock‐drawing and cognitive function in the elderly , 1986 .

[30]  M. Mendez,et al.  Development of Scoring Criteria for the Clock Drawing Task in Alzheimer's Disease , 1992, Journal of the American Geriatrics Society.

[31]  Dean Rubine,et al.  Specifying gestures by example , 1991, SIGGRAPH.