Objective: To examine the utility of DCTclock, for assessing subtle cognitive impairments in early Parkinson’s disease (PD).

Background: The identification of cognitive decline is crucial for ensuring independence in daily living. Standardized cognitive tests often provide crude information on cognitive impairments. Digital technology has the ability to deliver more granulated measures which can improve sensitivity of detecting early cognitive decline in people with PD. We used the DCTclock test, a digitizing pen that captures the pen position at a rate of 75Hz and analyzes the entire drawing process to measure cognitive processing and motor performance of the clock drawing tasks.

Method: Participants underwent a thorough neurological and medical examination, followed by a neuropsychological exam, including the Montreal Cognitive Assessment (MoCA), Color Trails Test (CTT) and DCTclock. Participants were instructed to draw a clock with the hands pointing at ten past eleven, and then asked to copy a clock showing the same time. Outcome measures included performance time, motor (e.g. pen stroke speed) and cognitive components (e.g. information processing speed) presented as standardized scores, as well as an overall score for performance on the test (range from 0 to 100). Descriptive analysis was performed to compare the DCTclock with the MOCA, CTT scores.

Results: 128 patients with PD (64% males mean age:65.8±9.8, H&Y I-II, mean disease duration 3.6±3.1 years, UPDRS-III 20.5±10.4 and mean years of education 15.5±2.5) participated in this study. The median MoCA score was 24 with 64% showing cognitive decline (MoCA <26). Mean CTT scores were 66.58±28.08s and 140.50±63.72s for CTT1 and CTT2 respectively, with only 50% classified as impaired. DCTclock mean score was 42.4±25.03 (1.9-94.7) with 88% classified as impaired. DCTclock information processing identified 93.6% of participants classified as having cognitive decline by the MoCA and 89.5% of those with impaired CTT scores with specificity of 53.6% and 77.3% respectively. DCTclock was impaired in 20% of patients with normal MoCA scores.

Conclusion: Using digital technology DCTclock can provide additional sensitive information relating to specific cognitive domains and potentially identify additional subtle cognitive decline compared to standard measures in early stages of PD.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/the-utility-of-dctclock-the-digital-clock-drawing-test-for-unmasking-early-cognitive-decline-in-parkinsons-disease/