Clock Drawing Test Performance in Rural Vietnam: Reliability and Concurrent Validity Relative to the Mini-Mental State Examination in a Community-Based Sample.

@article{yazawa2026clock,
  title = {{Clock Drawing Test Performance in Rural Vietnam: Reliability and Concurrent Validity Relative to the Mini-Mental State Examination in a Community-Based Sample.}},
  author = {Aki Yazawa and Thuy Thi Phuong Pham and Chau Que Nguyen and Aoi Ito and Danh Cong Phan and Masahiko Hachiya and Thanh Tien Hoang and Hung Thai Do and Tetsuya Mizoue and Yosuke Inoue},
  journal = {Geriatrics \& gerontology international},
  year = {2026},
  month = nov,
  doi = {10.1111/ggi.70876},
  url = {https://europepmc.org/article/MED/42974696},
  note = {CC BY},
}

TY  - JOUR
TI  - Clock Drawing Test Performance in Rural Vietnam: Reliability and Concurrent Validity Relative to the Mini-Mental State Examination in a Community-Based Sample.
AU  - Aki Yazawa
AU  - Thuy Thi Phuong Pham
AU  - Chau Que Nguyen
AU  - Aoi Ito
AU  - Danh Cong Phan
AU  - Masahiko Hachiya
AU  - Thanh Tien Hoang
AU  - Hung Thai Do
AU  - Tetsuya Mizoue
AU  - Yosuke Inoue
PY  - 2026
DA  - 2026/11/01
JO  - Geriatrics & gerontology international
DO  - 10.1111/ggi.70876
UR  - https://europepmc.org/article/MED/42974696
AB  - Aim  Some cognitive screening tools can be difficult to administer in population-based epidemiological studies because they are time-consuming and rely on familiarity with formal testing. The Clock Drawing Test (CDT) is a brief, pragmatic tool requiring minimal verbal instruction, but its performance in low- and middle-income countries remains unclear. We examined the reliability and performance characteristics of the CDT and its concurrent validity relative to the Mini-Mental State Examination (MMSE) performance in rural Vietnam.Methods  Data came from 1073 adults aged 55-65 years participating in the second wave (2023) of the Khánh Hòa Cardiovascular Study. The CDT was scored using the 6-point Shulman method (lower scores indicate better performance). Inter-rater reliability was assessed using intraclass correlation coefficients (ICC). Construct validity was examined via Spearman's correlations with MMSE scores. Known-groups validity was tested across education levels. Concurrent validity relative to MMSE performance was evaluated by examining the discriminatory performance of the CDT using ROC analysis, sensitivity, specificity, predictive values, and agreement between CDT- and MMSE-based classifications using Cohen's κ.Results  Inter-rater reliability between two raters was good (single-measure ICC = 0.79), and CDT scores correlated negatively with MMSE (ρ = -0.30, p < 0.001). CDT performance varied by education (p < 0.001). ROC analysis showed modest discriminatory accuracy (AUC = 0.68); a cutoff ≥ 3 yielded sensitivity 67% and specificity 62%, with limited agreement between CDT and MMSE classifications (κ = 0.13).Conclusions  In rural Vietnam, the CDT demonstrated acceptable reliability and modest concurrent validity relative to MMSE performance. Agreement between CDT- and MMSE-based classifications was limited, suggesting that the two measures should not be considered interchangeable. Although a high negative predictive value was observed in this community-based sample, its implications for cognitive screening remain uncertain. Further validation against clinical diagnostic outcomes and in higher-risk populations is warranted.
SN  - 1444-1586
SN  - 1447-0594
ER  -