A population based study on the intra and inter-rater reliability of the clock drawing test in Brazil: the Bambuí Health and Ageing Study.

Full Abstract

BACKGROUND:
Reliability should be considered when selecting a scoring system since it influences validity. CDT reliability has rarely been assessed in population based studies and in developing countries. The aim of the present study was to determine intra and inter-rater reliabilities of the CDT scored by the Shulman (2000) method, in elderly with very low formal educational level from Brazil.

METHODS:
CDTs performed by a random sample of 202 subjects of a population-based cohort of elderly were scored on two occasions by the same rater and by two independent raters. Reliability was measured using the kappa statistic, weighted kappa and the intraclass correlation coefficient. Data were stratified according to gender, age and schooling level.

RESULTS:
Intra and inter-rater reliabilities were excellent when CDTs were classified as 'normal' (scores 4 or 5) or 'abnormal' (scores 0 to 3) (kappa = 0.99 and 0.94, respectively) and were in the good to excellent range when scored from 0 to 5 (kappa = 0.88 and 0.74, respectively). Difficulties in distinguishing between scores 4 and 5, and a low proportion of score 1 tests were found.

CONCLUSIONS:
The CDT scored by the Shulman (2000) method appears to have good to excellent reliability in an elderly population with very low formal educational level. However, difficulties in distinguishing between scores 4 and 5, and a low proportion of score 1 tests suggest these scores may not be totally adequate for this population. Further studies are necessary to determine the consistency of our results in similar populations.Copyright 2003 John Wiley & Sons, Ltd.

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Author information

Author/s: Fuzikawa, Cíntia (C); Lima-Costa, Maria Fernanda (MF); Uchoa, Elizabeth (E); Barreto, Sandhi Maria (SM); Shulman, Ken (K); Bambuí Health and Ageing Study;

Affiliation: Public Health and Ageing Research Group (PHARG), Federal University of Minas Gerais Medical School and Oswaldo Cruz Foundation, René Rachou Research Institute, Belo Horizonte, Brazil. cintia(-atsign-)task.com.br

Journal and publication information

Publication Type: Journal Article; Research Support, Non-U.S. Gov't

Journal: International journal of geriatric psychiatry (Int J Geriatr Psychiatry), published in England. (Language: eng)

Reference: 2003-May; vol 18 (issue 5) : pp 450-6

Dates: Created 2003/05/26; Completed 2003/06/13; Revised 2006/11/15;

PMID: 12766923, status: MEDLINE (last retrieval date: 12/26/2008)

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Humans
Male
Middle Aged
Neuropsychological Tests - standards
Observer Variation
Pattern Recognition, Visual - physiology
Predictive Value of Tests
Sensitivity and Specificity

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