Vol. 15 nº 4 - Oct/Nov/Dec de 2021
Original Article Páginas: 480 a 484

Clock drawing test: comparison between the Pfizer and the Shulman systems

Authors Daniela Bertol Graeff1; Jéssica Maldaner Lui1; Nathália Dal Prá Zucco1; Ana Luisa Sant'Anna Alves1; Cassiano Mateus Forcelini1; Bernadete Maria Dalmolin1


keywords: cognitive decline, screening, clock drawing test, correlation.

Cognitive decline can be screened by the clock drawing test (CDT), which has several versions.
OBJECTIVE: This survey aimed to analyze the correlation between two simple methods for scoring the CDT.
METHODS: This cross-sectional study was nested in the Elo-Creati cohort from Passo Fundo, Brazil and comprised 404 subjects. Two raters underwent previous training and scored the subjects' CDT according to both the Pfizer and Shulman systems. The inter-observer and intra-observer concordance within each method was analyzed with the Spearman's rank correlation coefficient, as well as the concordance of the scores between the two methods. Age and scholarity were also correlated with the scores.
RESULTS: Most of the participants were women (93.8%) and Caucasian (84.6%), with a mean age of 66.9 (±7.8) years and a scholarity of 10.9 years (±5.6). There was significant inter-observer (Pfizer: r=0.739, p£0.001; Shulman: r=0.727, p£0.001) and intra-observer correlation (Pfizer: rater 1, r=0.628, p≤0.001; rater 2, r=0.821, p≤0.001; Shulman: rater 1, r=0.843, p≤0.001; rater 2: r=0.819; p≤0.001). Intra-observer correlation was also observed comparing Pfizer and Shulman methods (rater 1: r=0.744; p≤0.001; rater 2: r=0.702; p≤0.001). There was weak correlation of the scores with scholarity (Pfizer: r=0.283, p£0.001; Shulman: r=0.244, p£0.001) and age (Pfizer: r=-0.174, p£0.001; Shulman: r=-0.170, p£0.001). More participants were classified with decreased cognition through the Pfizer system (rater 1: 44.3 vs. 26.5%; rater 2: 42.1 vs. 16.3%; p≤0.001).
CONCLUSIONS: For this population, our results suggest that the Pfizer system of scoring CDT is more suitable for screening cognitive decline.


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