Arch Clin Neuropsychol 1996; 11:529–539Crossref, Medline, Google Scholar, 18 Rouleau I, Salmon DP, Butters N: Longitudinal analysis of clock drawing in Alzheimer’s disease patients. … Spatial/planning deficits have been found to be more common in AD than in frontotemporal dementia or schizophrenia.14,24 This is likely due to greater parietal lobe involvement in AD. Impaired clock-drawing can provide a signal of cognitive impairment that guides the clinician to better understanding of the patient and the context of the presenting symptoms. Illustrations of the left and right hemispheres, summarizing the major functions of the cortical regions. 27, No.

She suggested that if our patient is easily distracted, that eliminating one sensory system may help them stay on task. The authors of this study noted that these findings are consistent with impaired visuospatial processing in the first group, and impaired language processing in the second. I lightly edited it by providing the circle for the pre-drawn condition and renaming the tests to be consistent with her presentation and for clarity. There is greater emphasis on comparing errors due to stimulus-bound responses, conceptual deficit, spatial and/or planning difficulties, or perseveration. What do you think about using three versions of the CDT? Outdoors, I love hiking and rock-climbing. How the Clock-Drawing Test Screens for Dementia, Ⓒ 2020 About, Inc. (Dotdash) — All rights reserved. What Is a Neurological and Cognitive Exam? In this version, you’d give your patient three clocks already drawn and ask them to add the hands to represent three separate times. It is important to note that many publications do not include all six qualitative errors. The Trail Making Test and Its Use as a Screening Tool for Dementia, How the GPCOG Screening Tool Is Used to Screen for Dementia. Recall and place numbers in the correct location and orientation. Create or retrieve a motor plan to draw the clock. : Cognitive test performance and brain pathology. The patient is asked to draw a clock face with all the numbers and hands and then to state the time as drawn. This simplest scoring method consists of giving one point if the task was completed correctly and zero points if the clock was not completed correctly. More spatial/planning deficits are present in PD with dementia, Diffuse Lewy Body (DLB) disease, or vascular dementia than AD.13,25 These findings are likely due to the subcortical involvement in these conditions. There are as many as 15 different ways to score this test. Osford, UK, Williams & Wilkins, 1972, pp vii–51Google Scholar, 9 Goodglass H, Kaplan E: The Assessment of Aphasia and Related Disorders, 2nd Edition. The hands may be absent or pointed toward “10” and/or “11.” This second type of stimulus-bound error can also be rated as a conceptual error. The clock-drawing test. My plan is to start assessment with the free-drawn CDT and if there are any errors to move on to the other two versions to provide additional information. 4.5 out of 5 stars (114) 114 reviews $ 7.00. See the following papers for an excellent review of the assessment, scoring, and functional neuroanatomy of clock-drawing: Eknoyan, D (2012). Result should be a well-planned and organized clock face. Arch Gerontol Geriatr 2009; 48:58–60Crossref, Medline, Google Scholar, 17 Cahn DA, Salmon DP, Monsch AU, et al. Views: 1754 Images: 36 Downloads: 39 Likes: 2. clock; test; alarm clock; dementia; wall; round; tattoo; performance; time; doctor; Like JPG. The clinician can also use clock-drawing as a means of monitoring cognitive changes and providing a teaching tool for family and students. What Is the Allen Cognitive Level Screen? : Comparison of a clock-drawing test in elderly schizophrenia and Alzheimer’s disease patients: a preliminary study. It can often be one helpful component of a full assessment when a dementia diagnosis (or other cognitive impairment) is being considered. It is important to note that many publications do not include all six qualitative errors. Clock‐drawing: is it the ideal cognitive screening test?. 1, Topics in Geriatric Rehabilitation, Vol. The clock drawing test in primary care: sensitivity in dementia detection and specificity against normal and depressed elderly. Conceptual deficits in clock-drawing can be due to a drawing that does not look like a clock (i.e., misrepresentation of the clock) or drawing with hands that do not communicate a time (i.e., misrepresentation of time). A stimulus-bound response is “the tendency of the drawing to be dominated or guided by a single stimulus, most often related to the time-setting instructions.” An example is pointing the hands to the 10 and the 11 when asked to set the time for 10 after 11. Brain Cogn 1992; 18:70–87Crossref, Medline, Google Scholar, 2 Ino T, Asada T, Ito J, et al. Also, as noted above, it appears to have the ability to detect problems with executive functioning that other tests may miss. Graphical errors include wavy lines, distorted clock face, numbers that are difficult to read, or hands that don’t meet.

Placement of the numbers around the circle requires visual-spatial, numerical sequencing, and planning abilities. An fMRI study in normal, healthy individuals performing a task that required drawing clock hands to indicate time found activations in both frontal and parietal regions (Figure 2).2 A study in patients with MCI, using resting-state fMRI to assess functional connectivity of dorsolateral prefrontal cortex (DLPFC), reported that connectivity to multiple brain regions (e.g., inferior parietal lobule, superior frontal gyrus, medial frontal gyrus, putamen) was reduced, but only the reduction in connectivity between left DLPFC and left thalamus correlated with performance impairment on the clock-drawing task (Figure 3).3 A study using voxel-based relaxometry to identify structural injury found that the clock-drawing task was more sensitive than several other commonly-used tests (e.g., MMSE, Trailmaking test Part A, Trailmaking test Part B) to the presence of small areas of brain injury, but that the injuries were to a wide variety of cortical (insula, temporal, frontal, posterior parietal) and subcortical (corpus callosum, caudate) locations.26 Another study found that white-matter abnormalities in the periventricular region were more strongly associated with impaired performance than were white-matter abnormalities in other areas, implicating fronto-subcortical connections.27 Several studies have utilized positron emission tomography (PET) and single photon emission computed tomography (SPECT) to examine the relationship between localized reductions in cerebral blood flow or cerebral metabolic rate and impaired performance on the clock-drawing task in various disorders. : Parieto-frontal networks for clock-drawing revealed with fMRI. 1, 22 October 2019 | Clinical Drug Investigation, Vol. Int J Geriatr Psychiatry 2000; 15:638–643Crossref, Medline, Google Scholar, 25 Cahn-Weiner DA, Williams K, Grace J, et al. Does the Clock Drawing Test have focal neuroanatomical correlates? Cogn Behav Neurol 2003; 16:85–92Crossref, Medline, Google Scholar, 26 Serber SL, Kumar R, Woo MA, et al. In the MCI group, DLPFC had reduced connectivity with multiple cortical (inferior parietal lobule, superior and medial frontal gyri) and subcortical (putamen, thalamus) areas, indicating changes in both the fronto-parietal and fronto-striatal-thalamic circuits.

“Draw the face of the clock, put in all the numbers, and set the time to 10 after 11.”, “I’d like you to draw a large circle and fill it in with numbers like on the face of a clock. Relationships between constructional and visuospatial abilities in normal subjects and in focal brain-damaged patients. This site uses Akismet to reduce spam. Download Michelle’s assessment materials (or PDF version). Executive functioning can be impaired before any memory problems are evident, and identifying this early allows early treatment. Clock-drawing is a simple and effective test to include in the neuropsychiatric assessment of patients.4 Reviews of the research literature support its use as a reliable screening tool for cognitive dysfunction, particularly for dementia.5,6 Although in use since the 1960s, it was made popular in 1983, when Goodglass and Kaplan incorporated it into the Boston Aphasia Battery.7–9 Although the majority of studies utilize the clock-drawing test to assess cognition in the context of screening for dementia, other conditions have also been evaluated. 16, Wilderness & Environmental Medicine, Vol. You would ask your patient to add all the numbers of the clock and set it to your desired time. However, a study published in the Danish Medical Journal outlines research that compared five of the most common ways to score the test. They can work to rule out other potentially reversible causes of dementia, such as vitamin B12 deficiency and normal pressure hydrocephalus, as well as determine an accurate diagnosis and treatment plan. The number 12 must appear on top (3 points), there must be 12 numbers present (1 point), there must be two distinguishable hands (1 point), and the time must be … (1998). Journal of the American Geriatrics Society, 50(3), 530-534. The diagnosis and prognosis for recovery. Perseveration errors are more common in AD than in normal subjects or in patients with schizophrenia.17,24 Perseveration clock-drawing errors are likely due to impairment of executive function in the prefrontal area of the frontal lobe, which is found in many dementia disorders. FIGURE 2. : Qualitative analyses of clock-drawings in Alzheimer’s disease and vascular dementia. Clock-drawing is a widely used bedside test of constructional ability, but it has never been systematically studied or standardized.

10, International Psychogeriatrics, Vol. 47 The patient is then asked to draw the hands on the clock to indicate “ten minutes past 11 o’clock.” For instance, we may decide to work on attention, impulse-control, self-monitoring, abstract thinking, or judgment.

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