C-22 Examining the Factor Structure of the Clock-In-the-Box in Older Adults

• Published in: Archives of clinical neuropsychology Vol. 34; no. 6; p. 1051
• Main Authors: Sabbah-Talasazan, L, D'Orio, V, Grande, L
• Format: Journal Article
• Language: English
• Published: 28.08.2019
• ISSN: 1873-5843; 1873-5843
• DOI: 10.1093/arclin/acz034.184

Abstract Objective To investigate the factor structure of the Clock-In-the-Box (CIB), a cognitive screening measure, and compare it to the original CIB subscores (Working Memory and Planning/Organization) that were created based on clinical observations. The new factor structure was used to determine the predictive validity of the CIB subscores, in predicting cognitive diagnosis in an older veteran population. Methods Neuropsychological evaluations conducted at VA Boston Healthcare System were reviewed. Exploratory factor analysis (EFA) and logistic regression were employed to determine the predictive validity of the new CIB subscores compared to the original subscores. Results The cohort had a mean age of 69.77 years (SD = 10.12), 97% male and mainly white (84.9%). EFA revealed a best fit two-factor model, explaining 60% of the variance (Factor 1 - 46% and, Factor 2 - 14% of the variance). Factor 1 reflected conceptual items (i.e., numbers, resembles clock) while Factor 2 reflected planning/organizational items (i.e., hand length, number spacing). Factors were moderately correlated (r = .456). Logistic regression revealed the original and new subscores were equivalent in predicting cognitive impairment when controlling for age and education; correctly classified 82% of the cases. When controlling for age and education, only Factor 2 remained predictive of impairment. Conclusions Analysis of specific task items resulted in subscores that differ from those initially generated based on clinical experience, with both providing clinically useful information. The CIB is a brief instrument with good predictive validity of cognitive impairment and clinically useful as a first line screening to inform the need for further assessment.