Age-related cognitive impairments, including Alzheimer's disease, are among the most common diseases in the United States. Prevention through delay is currently considered the best way to tackle Alzheimer's disease and related disorders (ADRD). Early detection is crucial, as screening individuals with Mild Cognitive Impairment (MCI) may delay its progression and prevent it from developing. This research investigates the role of technologies for senior citizens with potential MCI at-risk factors and for medical practitioners, such as neurologists or neuropsychologists, to make data-driven clinical decisions.

The Clock Drawing Test, in which the patient is asked to draw a clock showing a certain time, is one of the easiest and most frequently used instruments for dementia screening. Current practice requires medical practitioners to administer and assess each individual paper-and-pencil test. It requires tedious effort and is prone to errors and inconsistent scoring among different clinicians. To address these difficulties, previous work by this research group has resulted in a computer-based version of the Clock Drawing Test that records a patient's freehand drawing on a tablet computer, then analyzes the drawing for evidence of cognitive imparment.

The current project is extending the computer-based system to acquire additional data associated with the Clock Drawing Test. This data includes timing of drawing and pausing phases, and pressure applied during drawing. The data can be used in evaluating drawings under several different scoring critera that can be chosen by the clinician. Through analysis of data and focus group discussions, the clinical utility of the new features are being evaluated with a goal of further improvement.

Project Report

HOME-BASED ASSESSMENT TOOL FOR DEMENTIA SCREENING With baby boomers approaching the age of 65 and new cases of Alzheimer’s disease expected to increase by 50 percent by the year 2030, Georgia Tech researchers have created a tool that allows adults to screen themselves for early signs of dementia. The home-based computer software is patterned after the paper-and-pencil Clock Drawing Test, one of health care’s most commonly used screening exams for cognitive impairment. "Technology allows us to check our weight, blood-sugar levels and blood pressure, but not our own cognitive abilities," said project leader Prof. Ellen Yi-Luen Do. "Our ClockMe System helps older adults identify early signs of impairment, while allowing clinicians to quickly analyze the test results and gain valuable insight into the patient’s thought processes." Georgia Tech’s ClockMe system eliminates the paper trail and computerizes the test into two main components: the ClockReader Application and the ClockAnalyzer Application. Click here to see a video demo. ClockReader is the actual test and is taken with a stylus and computer or tablet. The participant is given a specific time and instructed to draw a clock with numbers and the correct minute and hour hands. Once completed, the sketch is emailed to a clinician, who uses the ClockAnalyzer Application to score the test. The software checks for 13 traits. They include correct placement of numbers and hands without extra markings. People with cognitive impairment frequently draw clocks with missing or extra numbers. Digits are sometimes drawn outside of the clock. The time is often incorrect. In addition to scoring automatically and consistently, ClockAnalyzer records the duration of the test and the time between each stroke. The software also replays the drawing in real-time, allowing a clinician to watch the drawing being created to observe any behavior abnormality. "The traditional paper-and-pencil test is usually overseen by a technician and later scored by a clinician, who scores the test based only on the finished drawing," said Do, a professor in Georgia Tech’s Colleges of Computing and Architecture. "By looking at the sketch, the scorer is not able to decipher whether the person struggled to remember certain numbers while drawing the clock. The ClockMe system’s timing software highlights those delays." And, because they’re saved electronically, the drawings can be used to easily compare a person’s cognitive ability progress or regression over time. Do’s research found that traditional tests are often filed in a folder and are rarely used for future comparison. The ClockMe system was initially tested at the Emory Alzheimer’s Disease Research Center in Atlanta, where it’s currently being used in addition to the traditional paper-and-pencil test. Despite a lack of computer literacy, all of the elderly patients who used the software during the study said they had no problems with the pen-based, computer technology. "For this reason, as well as the ability to send the drawings directly to clinicians for convenient scoring, we envision ClockMe as a viable tool for home-based screening," said Do. "America’s health care costs are expected to soar as baby boomers become senior citizens. If a screening tool can be used at home, unnecessary trips to clinics can be eliminated and medical expenses can be saved." Do and her colleagues are hoping to commercialize the project in the future. Their research was published in September’s Journal of Ambient Intelligence and Smart Environments. This project is supported by the National Science Foundation (NSF) (Award Number SHB-1117665). The content is solely the responsibility of the principal investigators and does not necessarily represent the official views of the NSF. ========================================================== Note: An ClockAnalyzer Application supports the medical practitioner’s decision-making by automatically scoring the criteria, as well as by visualizing graphs from the existing data. The application has (1) the Drawing Output area, (2) the Analysis area, and (3) the Monitoring panel. Two different drawing outputs are provided: static drawing and active animated drawing. When a patient’s file is opened, one would see the static clock drawing from the CDT. The static drawing becomes an animation when the "Arrow" button on the bottom of the window is clicked and a video playback is initiated. The "Clean" button resets the animation to its initial state. Fig. 1. The User Interface of the ClockAnalyzer: Scoring Tab The Analysis area lies in the top right side of the UI and includes three different tabs: Scoring, Graph, and Monitoring. Each tab shows different information. The Scoring Tab shows two types of data: Scores and Sequences. The CDT results are evaluated by Freedman et al.’s 13-point CDT criteria. If a patient’s CDT drawing applies each criterion, the green-color check is shown. The Sequences show how a user constructs a clock with a specific sequence. The timestamps of each stroke for each number can help clinicians inspect the patient’s drawing strategies.

National Science Foundation (NSF)
Division of Information and Intelligent Systems (IIS)
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Michael Foster
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Georgia Tech Research Corporation
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