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

(MACFIMS), which incorporates the CDT as one of its measures, this study investigated cognitive impairment in MS patients. According to their performance on the CDT, the authors discovered planning and organization deficits in MS patients. These findings have been suggested from similar studies, indicating that cognitive impairment in people with MS can be linked with poor performance on the CDT and general cognitive dysfunction (Achiron, 2003). Zwecker et al. (2018) used the Brief Repeatable Battery of Neuropsychological Tests (BRB-N), clock-drawing test (CDT), and P300 Event-Related Potentials (ERPs) to assess cognitive impairments in MS patients. The key study findings were that 61.5% of 56 early-stage MS patients (less than 3 years) had sub-normal scores on at least two BRB-N or CDT cognition subtests; verbal fluency (88.6%), short- term memory (70.5%), visual-spatial learning (59.1%), CDT (45.5%), and sustained attention (29.5%) were impaired. However, a significant barrier to conducting CLOX tasks has been revealed by studies that have shown patients with MS often exhibit difficulties in performing the CDT due to motor disabilities. These difficulties may manifest as impaired planning and organization, reduced attention to detail, and difficulty conceptualizing and executing the task accurately. These deficits in CDT performance can be interpretative as cognitive impairment and can be used as an indicator of disease-related cognitive dysfunction in MS however, these occur because of spinal cord lesions related to MS (Lynch et al., 2005). D. Systemic Lupus Erythematosus and Clox Tasks There is a lack of studies to determine whether Clox tasks are effective in identifying cognitive impairment caused by systemic lupus erythematosus (SLE). Assessing cognitive impairment in SLE can be intricate due to factors such as the diversity of cognitive deficits, the influence of coexisting medical conditions, and the similarity with other neuropsychiatric symptoms of SLE (Seet et al., 2021). Neuropsychological assessments are commonly utilized to evaluate cognitive impairment in SLE, involving a battery of tests that focus on various cognitive domains (Nowicka-Sauer et al., 2011). However, the utilization of CLOX in SLE appears to be restricted. The validity and utility of the CLOX task in this context lack substantial evidence in the research literature in the knowledge of the authors. While neuropsychological tests that evaluate executive functioning in SLE are the Trail Making Test A and B, Stroop Test, and Wisconsin Card Sorting Test (Hanly et al., 2010). Nonetheless, it is pertinent to highlight some noteworthy research studies. Hanly et.al. , (2006;2009;2010) have conducted many studies to examine cognitive impairment in individuals with SLE by utilizing a comprehensive neuropsychological battery to represent the initial exploration of cognitive-related SLE issues. Although the CLOX task was not explicitly referenced, researchers applied alternative cognitive evaluation measurements that focused on executive functions. According to Kozora et al. (2022) a significant proportion of individuals diagnosed with SLE demonstrate executive dysfunction, which has a discernible impact on their daily functioning. The researchers employed an innovative methodology to examine attentional and executive function in individuals with Systemic Lupus Erythematosus (SLE) using a digital platform. The findings of this study indicate that individuals diagnosed with SLE demonstrated significant improvements in their motor speed and executive functions. Hence, it has been highlighted that individuals diagnosed with SLE may present advantageous outcomes by engaging in cognitive interventions that are custom-designed to address the frontoparietal networks of the brain. It is crucial to note that the studies may involve a broader scope of assessments related to cognitive impairment and executive functioning in SLE, rather than solely concentrating on the CLOX task. However, additional research is required to address the limited amount of existing research on the utilization of the CLOX task in SLE. For this reason, a new research protocol would contribute to a more comprehensive comprehension of the cognitive difficulties experienced by individuals with SLE and facilitate the formulation of focused interventions and treatment strategies. Furthermore, it would be beneficial for future research to investigate alternative cognitive assessment tools that have the potential to capture various dimensions of cognitive functioning within the population affected by SLE. Additionally, given the numerous similarities with other autoimmune disorders like MS, it would be advantageous for researchers to employ specialized neuropsychological tools such as CLOX tasks. This approach would yield more accurate estimations of the results and facilitate meaningful comparisons and contrasts between these findings. E. Aim of this Study The purpose of this study is to validate the neuropsychological tool -CLOX: An Executive Clock- Drawing Task- to the Greek population and recognize its reliability in disease existence. Based on previous studies, the CLOX: an executive clock drawing task has been proven a useful neuropsychological tool for the assessment of executive function impairment. However, to the best of the researchers’ knowledge, no previous protocol has aimed to validate the screening qualities of CLOX: an executive clock drawing and scoring system on the Greek population. Moreover, there has been no prior endeavor to validate the psychometric properties of this instrument on the Greek population diagnosed with Multiple Sclerosis, Systemic Erythematosus Lupus, Dementia spectrum, and MCI. 60 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