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Cultural influence on clock drawing test: A systematic review

Published online by Cambridge University Press:  25 November 2022

Giorgia Maestri ,
Alessia Nicotra ,
Simone Pomati ,
Marco Canevelli ,
Leonardo Pantoni  and
Ilaria Cova Open the ORCID record for Ilaria Cova [Opens in a new window]
Giorgia Maestri
Affiliation:
Neurology Unit, Luigi Sacco University Hospital, Milan, Italy
Alessia Nicotra
Affiliation:
Neurology Unit, Luigi Sacco University Hospital, Milan, Italy
Simone Pomati
Affiliation:
Neurology Unit, Luigi Sacco University Hospital, Milan, Italy
Marco Canevelli
Affiliation:
Department of Human Neuroscience, Sapienza University, Rome, Italy
Leonardo Pantoni
Affiliation:
Stroke and Dementia Lab, “Luigi Sacco” Department of Biomedical and Clinical Sciences, University of Milan, Milano, Italy
Ilaria Cova*
Affiliation:
Neurology Unit, Luigi Sacco University Hospital, Milan, Italy
*
Corresponding author: Ilaria Cova, email: ilaria.cova@unimi.it
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Abstract

Objective:

Dementia among migrants is an emerging phenomenon worldwide and the development of neuropsychological tests sensitive to cultural differences is increasingly regarded as a priority. The Clock Drawing Test (CDT) is one of the most used screening tools for the detection of cognitive decline. Nevertheless, there is still a debate about its adoption as a cross-cultural assessment.

Methods:

To identify cultural variables influencing performance at CDT, we performed a systematic review of literature on three databases of all studies considering the role of at least one of the following: (1) language; (2) education; (3) literacy; (4) acculturation; and (5) ethnicity.

Results:

We extrapolated 160 analyses from 105 studies. Overall, an influence of cultural determinants on performance at CDT was found in 127 analyses (79.4%). Regarding specific cultural factors, 22 analyses investigated the effect of ethnicity on CDT scores, reporting conflicting results. Only two scoring systems turned out to be sufficiently accurate in a multicultural population. Language influenced performance in only 1 out of 8 analyses. A higher level of education positively influenced test performance in 118 out of 154 analyses (76.6%), and a better quality of education in 1 analysis out of 2. A negative influence of illiteracy on CDT performance emerged in 9 out of 10 analyses. Acculturation affected performances at CDT in 1 out of 2 studies.

Conclusions:

Based on the present findings, caution is needed when using CDT in a multicultural context, even if it requires limited linguistic competence.

Keywords

cross-culturalneuropsychologycognitive screeningcognitive impairmentethnicityexecutive functions
Type
Research Article
Information
Journal of the International Neuropsychological Society , Volume 29 , Issue 7 , August 2023 , pp. 704 - 714
Copyright
Copyright © INS. Published by Cambridge University Press, 2022

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Table S1

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Appendix

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