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

clock that says 1:45 with the thought it is easy even a child could read this clock. This process is conducted on the empty page of the CLOX form, with no further instructions. The researcher repeats the instructions until they are totally understood, when the individual starts drawing no further details or aid can be given by the researcher. The researcher observes all the drawing procedures to score the 'CLOX1' (there is full detail for the scoring on the front page of the form). Then, follows the drawing procedures of 'CLOX2'. Initially, the researcher must perform the clock drawing while the individual observes the detailed process of drawing e.g. placing the 12, 6, 3, and 9 first. Then, the individual has to draw the CLOX2, and the researcher scores it accordingly (Royall et al., 1998) (please see Appendix 3) A. Dementia and Clox Tasks CLOX task has been extensively examined and used as an evaluative tool for cognitive dysfunction, particularly in the context of dementia, including Alzheimer's dis-ease (AD) (Kim et al., 2018; Rakusa et al., 2018). Royall et al., (1998; 1999) as the creators of CLOX: an executive clock drawing task, conducted many studies. One study examined the application of the CLOX task as a means of discriminating between persons afflicted with Alzheimer's disease and those affected by alternative types of dementia. The study's findings indicate that certain errors made during the CLOX task drawing exercise can effectively differentiate between Alzheimer's disease and non-Alzheimer's dementia, underscoring its diagnostic efficacy (Royall et al., 1999). Many studies have examined the longitudinal variations in the clox drawing tests performance of Alzheimer's disease patients (Lee et al., 2011). Deteriorating performance on the CLOX2 over time was associated with a progressive decline in cognitive function and the progression of Alzheimer's disease, according to the neuroimages and neuroanatomical findings (Shon et al., 2013). Similarly, it has been examined the performance of individuals with mild cognitive impairment (MCI), Alzheimer's disease, and healthy controls on the CLOX task, revealed an additional significant finding. They discovered that the CLOX2 component was particularly sensitive in distinguishing between MCI and Alzheimer's disease, indicating its diagnostic potential. These studies demonstrate the usefulness of the CLOX task for assessing executive functioning and cognitive impairment in patients with dementia spectrum disorders. They emphasize its diagnostic utility, longitudinal tracking abilities, and potential to distinguish between various forms of dementia (Huang et al., 2021). It is essential to note, that the specific results and implications of these studies may vary, and additional research is needed to continue the investigation of the CLOX task in dementia assessment. The multidimensional findings of brain mechanisms related to dementia and factors like biomarkers and brain segmentation are still under investigation. B. Mild Cognitive Impairment and Clox Tasks The CLOX task has been identified as a useful tool for distinguishing between individuals with Mild Cognitive Impairment (MCI) and those experiencing normal cognitive aging. Research has indicated that individuals diagnosed with mild cognitive impairment (MCI) exhibit inferior performance on the CLOX task in comparison to individuals without cognitive impairment, which suggests the presence of initial executive dysfunction (Kim et al., 2018; Rakusa et al., 2018). The CLOX task has shown promising results as a predictor of progression from mild cognitive impairment (MCI) to dementia (Kim et al., 2018). An adequate number of researches conducted over an extended period of time have demonstrated the correlation between suboptimal results on the CLOX task and a heightened susceptibility to the onset of dementia, including AD, among individuals diagnosed with mild cognitive impairment and cognitive complaints (Forti et al., 2010; McGuinness et al., 2015). The CLOX task has been determined to possess sensitivity in identifying cognitive alterations over a period in persons diagnosed with MCI. The deterioration of performance on the CLOX task may serve as an indicator of additional cognitive decline and advancement toward the onset of dementia (Forti et al., 2010). The integration of this test with other cognitive assessments can yield a more helpful appraisal of cognitive dysfunction. Prof. Royall and his colleagues conducted research using the CLOX task to distinguish between individuals with MCI and healthy controls, as discussed previously. Although the findings were solid Royall et al. (2000) continued the research on this topic by employing neuropsychological batteries containing both cognitive and functional status measures in order to diagnose dementia more accurately relative to expert clinicians. Indicating that the use of Clox tasks in conjunction with tools such as the MMSE and IADL can enhance diagnostic performance and increase the likelihood of identifying MCI and dementia accurately (Royall et al., 2015). Similarly, Babins et.al ., (2008) investigated the predictive value of the CLOX task for the progression of mild cognitive impairment to dementia. During follow-up evaluations, individuals with MCI who performed inadequately on the CLOX task at baseline were more likely to progress to dementia, including Alzheimer's disease. C. Multiple Sclerosis and Clox tasks The relevance of the CLOX task in assessing executive functioning in individuals with Multiple Sclerosis has not been extensively examined, while many studies have used plenty of neuro psychometric tools (Rogers & Panegyres, 2007). For instance, Benedict et al. (2006) have used the Minimal Assessment of Cognitive Function in Multiple Sclerosis 59 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