The most commonly utilized system of qualitative clock-drawing errors was described by Rouleau.1 He categorized five types of errors in addition to size of the clock (Figure 1): 1) graphic difficulties; 2) stimulus-bound response; 3) conceptual deficit; 4) spatial and/or planning deficit; and 5) perseveration. 1 point for the two hands of the clock. The clock-drawing test has these advantages: One other very helpful aspect of this test, as published in the Canadian Medical Journal Association, is that it can detect problems in executive functioning even when someone scores well on the MMSE, a common screening tool. 3) Draw hand pointing to a given time. However, a study published in the Danish Medical Journal outlines research that compared five of the most common ways to score the test. Nicholas R. Metrus, MD, is a board-certified neurologist and neuro-oncologist. Spatial Errors. 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 identified correctly (1 point) for full credit. 1 point for the correct time. Instruct the patient to draw the face of a clock, either on a blank sheet of paper, or on a sheet with the clock circle already drawn on the page. Finally, there’s abstract thinking. If there are big gaps, numbers outside the circle, or numbers on only one side of the circle, this is more common in Parkinson’s disease with dementia, Lewy body dementia and vascular dementia, and less common in people with Alzheimer’s. It’s important to remember that no true diagnosis can be made without further tests from a doctor. The patient is given a pen, blank good-sized paper, all the time they need, and the request to “please draw the face of clock, with all the numbers on it, and please make it show the time ‘ten minutes after eleven.’” This is why it’s best to begin with the simple CDT. It also takes planning, or an understanding of the steps involved. For each clock, 2 points awarded for correct placement of each hand (1 point each), and a third point is given for … If the clock is drawn incorrectly (see “Reading the CDT” below), that is not cause for despair. 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. It concluded that the easiest scoring method provided results that were just as accurate as the more complicated scoring methods. It is suggested that one might put themselves out of visual range of the test taker in order to discourage questions. – Verbal understanding While the clock-drawing test is generally quite effective at identifying cognitive concerns, there is not a consensus in the research community that it can consistently identify mild cognitive impairment or help distinguish between different forms of dementia (such as Alzheimer's disease and vascular dementia). Neglect patients may also ignore the contralesional side of their body; for instance, they might only shave, or apply make-up to, the non … If someone with neglect is asked to draw a clock, their drawing might show only the numbers 12 to 6, or all 12 numbers might be on one half of the clock face with the other half distorted or blank. The site is for educational purposes, medical decisions should not be based on its content and its authors assume no liability for errors or omissions. Someone whose illness is caught earlier will manage symptoms better than someone who waits longer to be diagnosed. Furthermore, the clock drawing test is suitable for non-English speaking populations, whereas the MMSE does have … A 78-year-old man is being evaluated in the geriatric clinic. 4) Can you draw two lines to divide the numbers so that the total of the numbers on each side of the lines are both multiples of six? For any error in the number of digits in the last quadrant, assign a score of 4. If the clock doesn’t even look like a clock, like if there are letters or incorrect shapes added, this suggests confusion that is more indicative of Alzheimer’s disease than Huntington’s, Parkinson’s, vascular dementia or frontotemporal dementia. Indicate the top of the page. Sign up for our Alzheimer’s and Dementia Newsletter and get your free recipe guide today. What Memory and Thinking Tests Do Doctors Use to Evaluate Dementia? 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