Global Journal of Medical Research, A: Neurology & Nervous System, Volume 23 Issue 3

management strategies (Vanderploeg, 2014). For instance, neuropsychological assessment plays a crucial role in clinical practice, particularly for conditions like dementia (Prado et al., 2019). These assessments have the potential to enhance the precision of diagnosis and facilitate the continual observation of illness progress. However, it is often noticed in clinical practise, specifically in the field of autoimmune illnesses, that there is a tendency to give higher priority to somatic symptoms, sensorimotor difficulties, and laboratory test results, while unintentionally overlooking cognitive deficits. By acknowledging the significance of cognitive assessments and integrating them into regular clinical practice, healthcare professionals can augment the thorough evaluation of patients, which results in enhanced early detection, suitable treatment, and improved overall patient well-being, that involve mental health. Diseases like Multiple Sclerosis (MS) and Systemic Lupus Erythematosus (SLE) can be associated with cognitive decline. A significant percentage of patients with these conditions around 40- 60% may experience impairments in cognitive functions such as memory, attention, and processing speed (Macías Islas & Ciampi, 2019; Mendelsohn et al., 2021). Regarding dementia, it is more commonly associated with older age and memory loss. The risk of developing dementia does increase with age, with most cases being diagnosed in individuals over the age of 65 (Brayne & Miller, 2017). However, it's important to note that some forms of dementia, such as early-onset Alzheimer's disease, can affect individuals as young as their 40s (Masellis et al., 2013). Besides this, there is often a challenge in distinguishing between mild cognitive impairment (MCI) and the spectrum of dementia (Knopman & Petersen, 2014). MCI refers to a stage where cognitive changes are present but do not meet the criteria for a diagnosis of dementia (Vega & Newhouse, 2014). There is no clear-cut between MCI and dementia, and it requires a comprehensive evaluation to make an accurate diagnosis (Lu et al., 2022). The discussed diseases have significant and complex molecular pathways and processes that differ and yet are similar to their clinical expression. On the other hand, neuroinflammation is the first negative observed effect in MS, then the results are myelin loss and axonal injury, whereas SLE leads to inflammation and affects the brain processes, both contributing to neurodegeneration (Mandel et al., 2004). Dementia, including Alzheimer's disease, is characterized by the presence of amyloid-beta plaques and tau protein tangles. However, the pathophysiology of SLE and MS is uncommonly associated with these molecules (Stancu et al., 2019). Additionally, small vessel disease and the reduced cerebral blood flow are significant contributors to MCI, Dementia with vascular involvement (Cai et al., 2015). These factors have as conswquence the vascular changes, which are not a requisite feature of systemic lupus erythematosus (SLE) or multiple sclerosis (MS), however, in many cases, the symptoms are presented respectively, but it depends on many factors for the appearance of vascular changes on MS and SLE (Jácome Sánchez et al., 2018). Therefore, the pathophysiological along with cognitive examination can help to recognize such brain dysfunctions, targeting each type to the situation and the brain region. This type of examination can interpret issues related to cognitive processes and functions of the brain, such as attention, memory, and problem-solving, to identify any abnormalities or disruptions that may be indicative of neurological or autoimmune conditions. II. CLOX: A n E xecutive C lock-drawing T ask- the T ool D escription The CLOX drawing assessment meets all the criteria of a remarkable neuropsychological tool, as it enables the researchers, to quickly and easily, control a wide range of cognitive functions, including comprehension, design, visual memory, spatial abilities, motor organization, and executive function, involving individuals' knowledge, abstract thinking, inhibition of attraction to sensory stimuli, concentration, and tolerance to frustration (Royall et al., 1998). The CLOX's structure is divided into two parts, The purpose of dividing the CLOX task into two sections is to differentiate between the executive control aspects of drawing a clock and the basic ability to draw a clock. Typically, the first portion of the CLOX task requires individuals to draw a clock face from memory while following specific time-setting instructions. This section evaluates the ability to draw a timepiece and visuospatial skills. The second section of the CLOX exercise focuses on the executive control aspects of drawing a clock. It entails supplying individuals with specific instructions and requirements, such as setting the time to a specific hour or adding particular elements to the clock face. This section evaluates the candidate's ability to follow directions, plan, organize, and carry out tasks in a goal-directed manner. By dividing the task into two parts, researchers and clinicians can distinguish between individuals with deficits in fundamental clock- drawing skills and those with deficits in executive functions related to clock drawing. This separation can provide valuable insights into the cognitive processes involved in clock drawing and assist in identifying specific areas of difficulty in individuals with cognitive impairments or neurological disorders. this helps to be better recognized the performance between the executive control of the clock drawing and the clock drawing itself. Moreover, the first part (CLOX1) assesses executive functioning, and the second part (CLOX2) the visuospatial and visuoconstructive capacities (Royall et al., 1998). The individual takes instructions to draw a 58 Year 2023 Global Journal of Medical Research Volume XXIII Issue III Version I ( D ) A © 2023 Global Journals Reliability and Validity Evaluation of the ‘’CLOX: An Executive Clock Drawing Task’’ in a Greek Population with Neurological and Autoimmune Diseases