There are significant benefits to the Clock-Drawing Test when compared to receiving a traditional medical diagnosis. Speed – The test only takes a few minutes to administer and interpret. Simplicity – You don’t need training to ask someone to draw a clock and determine whether it’s correct or not.
What is the Clock Drawing Test in nursing?
The Clock Drawing Test (CDT) is a nonverbal screening tool in which the patient is asked to draw a clock. Placement of the numbers around the circle requires visual-spatial, numerical sequencing, and planning abilities.47 The patient is then asked to draw the hands on the clock to indicate “ten minutes past 11 o’clock.”
How are clock-drawing tests administered?
As noted above, there is also variability in how clock-drawing tests are administered. Some tests provide a predrawn circle and different time-settings. Most formal tests first instruct the patient to draw a clock (i.e., draw-to-command) and then copy a clock (i.e., copy-to-command).
How do you test for dementia with a clock?
Someone who may have dementia is asked to draw a clock showing the time as “10 minutes past 11.” Sometimes the subject is provided a pre-drawn circle and asked to fill in the numbers and hands. Other times, the tester will not provide the circle, nor say the words “number” or “hands,” to avoid giving hints.
How to draw a clock for a doctor's appointment?
It only requires a pencil and a piece of paper with a pre-drawn circle on it. The doctor will first ask the person to draw the numbers on the face of the clock. Next, the person will be asked to draw the hands to show a specific time.
What is the purpose of the clock-drawing test?
The clock-drawing test is used for screening for cognitive impairment and dementia and as a measure of spatial dysfunction and neglect. It was originally used to assess visuo-constructive abilities but we know that abnormal clock drawing occurs in other cognitive impairments.
What does it mean if you fail the clock test?
There can be elaborate scoring methods, assigning points based on positioning of numbers and hands, but simple pass/fail scoring has been shown as effective. If the clock is drawn correctly, that's a pass; if there are mistakes, the person drawing has failed.
How accurate is the clock test for dementia?
Previous studies of objective clock drawing test rating systems identified Alzheimer's disease with overall diagnostic accuracy ranging from 59% to 85%. However, such diagnostic accuracy has not been found in mild cognitive impairment cohorts with sensitivities ranging from 17% to 92%.
What test makes you draw a clock?
The Clock Drawing Test (CDT) is a nonverbal screening tool in which the patient is asked to draw a clock. Placement of the numbers around the circle requires visual-spatial, numerical sequencing, and planning abilities.
How do dementia patients draw a clock?
0:231:36Clock drawing test dementia - YouTubeYouTubeStart of suggested clipEnd of suggested clipTest you should draw a clock face on a piece of white paper and make sure that the clock face isMoreTest you should draw a clock face on a piece of white paper and make sure that the clock face is fairly large so I'd like you to draw the hands of the clock to be ten past eleven. And number the clock
What are the first signs of early onset dementia?
Early symptoms of dementiamemory problems, particularly remembering recent events.increasing confusion.reduced concentration.personality or behaviour changes.apathy and withdrawal or depression.loss of ability to do everyday tasks.
How accurate is the clock-drawing test?
Fifteen of these studies were included for meta-analysis according to each scoring system. The pooled sensitivity and specificity of the clock drawing test using the Shulman system were 82% and 75.7% respectively. In the Sunderland system, these were 72.6% and 87.9% respectively.
Is the clock test accurate?
In conclusion, studies which tested the accuracy of the CDT in dementia screening have shown that the CDT may be scored reliably with a variety of scales and that it accurately discriminates cognitively unimpaired patients from patients showing early cognitive decline.
What is the cognitive assessment of clock drawing?
The Clock-Drawing Test (CDT) is a simple and effective cognitive test used to assess executive function and visual-spatial function. It is a reliable screening tool for cognitive dysfunction, particularly for dementia. However, it lacks sensitivity for the diagnosis of early or mild dementia.
What questions do they ask in a dementia test?
The MMSE includes questions that measure:Sense of date and time.Sense of location.Ability to remember a short list of common objects and later, repeat it back.Attention and ability to do basic math, like counting backward from 100 by increments of 7.Ability to name a couple of common objects.More items...
How do you stop dementia from progressing?
This means you can help reduce your risk of dementia by:eating a healthy, balanced diet.maintaining a healthy weight.exercising regularly.keeping alcohol within recommended limits.stopping smoking.keeping your blood pressure at a healthy level.
Can you test yourself for dementia?
A new test you can take at home may help detect early symptoms of the disease. The test, known as SAGE, can be taken online or downloaded and completed at your doctor's office. The exam poses a series of questions involving identification of objects, math problems, and thinking tasks.
Why is a clock drawing test good?
Why Early Diagnosis is Best. The Clock-Drawing Test does not turn you into a clinician, able to expertly assess whether a loved one has Alzheimer’s disease. It does, however, help show whether a doctor’s appointment and further testing are necessary. This is why it’s a good idea if you have concerns.
What is needed to draw a clock?
Drawing a clock sounds basic and simple, but consider what’s required: – Verbal understanding. – Spatial knowledge. – Visual memory. – Abstract thinking. First, a person has to hear the instruction and then turn those words into the correct action. It takes thinking ability to turn “Draw a clock” into the act itself.
What is a CDT test?
The Alzheimer’s Clock-Drawing Test (CDT) is a fast, simple way of spotting warning signs for Alzheimer’s disease and other related dementias that can be administered by non-professionals in the comfort of one’s home. While a true diagnosis of Alzheimer’s or dementia obviously requires more than a few minutes of drawing with a pencil and paper, ...
Why does my clock not look like a clock?
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. Spatial Errors.
How big is a clock for Alzheimer's?
Patients with Parkinson’s disease dementia and Huntington’s disease, a rarer dementia that can develop in a person’s 30s and 40s, are prone to draw a smaller clock (less than two inches), while people with Alzheimer’s disease tend to draw bigger (more than 10 inches) clocks.
Why do we use CDT?
While a true diagnosis of Alzheimer’s or dementia obviously requires more than a few minutes of drawing with a pencil and paper, the CDT is useful for identifying issues in thinking ability that might indicate the presence of these illnesses.
Why do we ask for 10 minutes after 11?
The reason it’s a good idea to ask for “10 minutes after 11,” is because the mind has some work to do . Someone whose brain doesn’t correctly process information might draw hands pointing to the 10 and the 11. It takes a little more effort to know that the “10 after” means drawing an arrow toward the 2.
What is a Clock Drawing Test?
The Clock Drawing Test (CDT) is a nonverbal screening tool in which the patient is asked to draw a clock. Placement of the numbers around the circle requires visual-spatial, numerical sequencing, and planning abilities.47 The patient is then asked to draw the hands on the clock to indicate “ten minutes past 11 o’clock.” The test also assesses long-term attention, memory, auditory processing, motor programming, and frustration tolerance. 18,58 There are multiple approaches to scoring the CDT. 58 Advantages of this test include an absence of language and cultural biases. Riegel and colleagues 18 concluded that the CDT was better than the MMSE at detecting cognitive impairment in patients with heart failure. This may be because of the instability and subtle nature of cognitive impairment in patients with heart failure, in contrast to patients with dementia.
What is the MMSE?
The MMSE is a brief quantitative measure of cognitive status in adults. It can be used to screen for cognitive impairment and to aid in estimating its severity. It is composed of tests of orientation, registration, calculation, recall, language, and visual-spatial skills.
What is a CDT test?
The clock drawing test (CDT) is a rapidly administered test that is appropriate for primary care practices. Although there are multiple versions of this test, in general, they all ask the patient to draw the face of a clock and then to draw the hands to indicate a particular time. This single test may be sensitive to dementia because it involves many cognitive areas that can be affected by dementia, including executive function, visuospatial abilities, motor programming, and attention and concentration. Many of our patients have difficulty with analog watches in the early stages of a dementing illness (we often address this problem by suggesting they wear a digital watch).
How long does it take to administer the GPCOG?
The GPCOG is a paper or online tool that can be given directly to the patient or to the patient’s informant. It takes 4 minutes to administer. It includes both recall items (stated name/address and the date) and the clock drawing test. Each correct answer scores one point for a total possible score of 9.
What is delirium syndrome?
Delirium is a geriatric syndrome that should be considered with any change in mental status and cognition. The hallmarks of delirium are acute onset, fluctuating course, impaired attention, and cognitive changes. It can be mistaken for dementia, depression, or another psychiatric problem.
What is the first stage of a clock?
In the first stage (CLOX1) the tested person is instructed to “Draw me a clock that says 1:45. Set the hands and numbers on the face so that a child could read them.”. In the second stage (CLOX2) the tested person is instructed to copy a clock that was drawn by the test administrator.
Why is delirium so common in cancer patients?
The onset of delirium in any cancer patient is important, as multiple causes that are more common in cancer, including brain metastasis or metabolic issues like hyponatremia or hypercalcemia, can predispose the already at-risk individual to develop delirium.
What is perseveration in clock drawing?
Perseveration is defined as the continuation or recurrence of activity without an appropriate stimulus. In clock-drawing, this can be due to perseveration of hands (e.g., presence of more than two hands, reflecting a failure to terminate the ongoing set of tracing the hands) or perseveration of numbers (e.g., abnormal prolongation of numbers, such as writing beyond 12 or inappropriate recurrence of the same numbers). 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.
What is the DLPFC in MCI?
In the MCI group, DL PFC 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.
What is stimulus bound error?
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. Usually, the instructions are to set the time at “10 after 11.” In one error, the hands are set for “10 ‘til 11” instead of “10 after 11.” The patient fails to re-code the “10” in “10 after 11” as a “2” in order to set the minute hand. The patient is “attracted” to the strong stimulus source (i.e., “10”) rather than the appropriate response that involves a more complex operation (i.e., setting the minute hand at “2”). In the second type of stimulus-bound error, the “1” is written near the “11” or between “10 and 11” on the clock. 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. Several studies have reported stimulus-bound errors to be more common in AD than in HD, Parkinson’s disease (PD), or frontotemporal dementia. 1, 14, 15 However, contrary results have also been reported, with stimulus-bound errors more common in PD with dementia than in AD. 16 One possible way to reconcile these findings is that frontostriatal circuits may be greatly impaired by the time PD progresses to dementia, resulting in executive-functioning deficits.
What is the role of clock drawing in dementia?
Thus, there is much still to be learned. Although more research is needed to better understand the functional neuroanatomy of clock-drawing, it is clear that multiple brain regions, in cortical and subcortical areas, and the circuits that connect them, play a role. 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. 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 a clock drawing test?
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. For example, recent studies have reported the use of a clock-drawing test for diagnosing and grading the severity of hepatic encephalopathy, predicting rehabilitation outcomes after traumatic brain injury (TBI), and assessing functional status in veterans with deployment-related mild TBI. 10 – 12 At least 13 scoring systems have been introduced over the years. Shulman’s review, concluding that clock-drawing tests are complementary to the Mini-Mental State Exam (MMSE) and provide a significant advance in the early detection of dementia and monitoring cognitive change, also noted that a simple scoring system with emphasis on the qualitative aspects of clock-drawing should maximize its utility. 5 Documenting the type of clock-drawing errors can contribute to the clinical evaluation of patients with suspected neuropsychiatric disorders and syndromes, both in the initial and subsequent assessments. It also has great educational value for patients’ families and in teaching trainees, as it provides an easily understood demonstration of subtle cognitive deficits sometimes challenging to identify in a routine bedside exam. The focus of this review is to present the major qualitative clock-drawing errors and the evidence linking performance with neuroanatomy. The wide variability in how clock-drawing tests are administered and scored is beyond the scope of this review. 5
What is impaired clock drawing?
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. 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 conceptual deficit?
Conceptual deficits are defined as a loss or impairment in accessing knowledge of the attributes, features, and meaning of a clock. This category encompasses a wide variety of errors. 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). Misrepresentation of the clock suggests the unavailability of a correct graphic representation of a clock. Misrepresentation of the time (e.g., hands absent, hands inadequately represented, the time written on the clock) suggests a deficit in the knowledge of the feature that confers most of the meaning of a clock, which is to communicate time.
How The Test Is Done
- The clock-drawing test can be given by a doctor or other qualified professional. It only requires a pencil and a piece of paper with a pre-drawn circle on it. The doctor will first ask the person to draw the numbers on the face of the clock. Next, the person will be asked to draw the hands to s…
Test Scoring
- There are as many as 15 different ways to score the clock-drawing test. Some methods are complex and will award as many as 10, 15, or 20 points based on whether or not the sequence of numbers, the placement of numbers, and the placement of the hands are correct.4 Errors such as missing numbers, missing hands, repeated numbers, the wrong sequence of numbers, or the inc…
Benefits and Limitations
- The early detection of dementia is important as there are medications that may help slow the progression of Alzheimer's disease. To this end, the clock-drawing test offers benefits in that: 1. It is quick and simple. The test can be completed in a few minutes and only requires a pencil and paper. 2. It is easy to administer. The test doesn't require much training if a simple scoring meth…
Summary
- The clock-drawing test is a quick way to screen for early dementia, including Alzheimer's disease. It involves drawing a clock on a piece of paper with numbers, clock hands, and a specific time. The inability to do so is a strong indication of mental decline. Even so, the clock-drawing test cannot tell which type of dementia is involved or if the loss of cognition is due to some other co…
A Word from Verywell
- If you suspect a loved one has signs of Alzheimer’s or other types of dementia, it's important to seek a diagnosis from a qualified physician. This may include your primary care doctor, a doctor trained in brain disorders (neurologist), or a doctor trained to treat older adults (geriatrician) These doctors are qualified to diagnose dementia but can also rule out other reversible causes …