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Tip Sheet 4 - The Clock Drawing Test (CDT) : Things To Be Aware of Scoring

The Clock Drawing Test (CDT) is used to assess frontal and temporal-parietal functioning and severity of dementia. It involves asking a client to draw a clock face and mark the numbers and hands. Scoring focuses on correct placement of numbers and hands. While quick to administer, the CDT requires awareness of factors like physical and vision impairments, presence of clocks, and educational and cultural differences that could influence performance.

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Pandu Bagus Allam
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271 views2 pages

Tip Sheet 4 - The Clock Drawing Test (CDT) : Things To Be Aware of Scoring

The Clock Drawing Test (CDT) is used to assess frontal and temporal-parietal functioning and severity of dementia. It involves asking a client to draw a clock face and mark the numbers and hands. Scoring focuses on correct placement of numbers and hands. While quick to administer, the CDT requires awareness of factors like physical and vision impairments, presence of clocks, and educational and cultural differences that could influence performance.

Uploaded by

Pandu Bagus Allam
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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Tip Sheet 4 – The Clock

Drawing Test (CDT)

What is the CDT: The Clock Drawing Test


(CDT) is a measure of dementia severity.
There are variations in the administration
of the test including using a pre-drawn
circle and a clock copying task. This tip Consider physical impairment including any
sheet refers to the free drawn test where issues with muscles in the hand/arm or
the client is presented with a blank piece of vision.
paper. Clients are asked to draw a clock face
and mark in the hours and then draw in the Remove/cover any clocks in the room and
hands to indicate a particular time (for be aware if participants have a wrist watch
example quarter to two – see below, ten on during this test.
past eleven, or ten to two. The CDT assesses It is advised to use an interpreter when
frontal and temporo-parietal functioning. assessing people from CALD backgrounds.
Benefits of the CDT: The way a client
draws a clock face can provide an assessor
with insight into the severity of dementia
and it only takes two minutes to administer.
It is also appropriate in multiethnic
populations due to the ‘universal’ nature of
the clock.
The CDT can complement other screening
tests, especially those, which do not include
an item to assess frontal lobe impairment. Scoring
Things to be There are a number of scoring systems used
in the literature but no one scoring system
aware of
shows superior predictive validity.
A valid scoring method in a The main aspects to consider are
multiethnic Australian
population has not been (i) correct spacing with even spaces
demonstrated with the CDT. The one study between numbers and correct
in Australia using a multiethnic sample placement of 12,3,6,and 9, and
demonstrated low specificity using five (ii) correct placement of hands (e.g.10
different scoring methods; between 42%- past 11)
84% of cognitively intact people were
(Brodaty et al, 2002). Much is gained by
incorrectly classified as having dementia.
observation of the task, and scoring is
The CDT could be used to supplement the descriptive.
recommended tools. Educational
attainment can influence this test, so be
aware when interpreting scores.

The Assessment of Older People with dementia and depression of CALD Backgrounds: A review of current practice and the development of
guidelines for Victorian ACAS (undertaken by NARI, 2011). Funds for this project were provided by the Council of Australian governments
(COAG) as part of the COAG initiative to strengthen and improve the Aged Care Assessment Program (ACAP). The ACAP is an initiative of
the Australian Government and is jointly funded by the Australian Government and the Government of Victoria. 1
Another more complicated scoring system
is described if required:
Sunderland et al. 1989 A PRIORI
criteria for evaluating clock drawings.
Cut off score = 5 or less indicates
impairment.
10 - 6 Drawing of clock face with number
and circle generally intact
10 Hands in correct position (i.e. Hours
hand approaching 3 o'clock)
9 Slight errors in placement of hands.
8 More noticeable errors in placement of
hour and minute hands. Further Resources and
7 Placement of hands is significantly off
References
course. Tool reference: Sunderland, T., Hill, J.L.,
6 Inappropriate use of clock hands (i.e. Mellow, A.M., Lawlor, B.A.,
use of digital display or circling Gundersheimer, J., Newhouse, P.A., &
numbers despite repeated Grafman, J.H. (1989). Clock drawing in
instructions). Alzheimer’s disease: a novel measure of
dementia severity. Journal of the
5 - 1 Drawing of clock face with circle and
American Geriatrics Society , 37, 725-
numbers is NOT intact
729.
5 Crowding of numbers at one end of the
clock or reversal of numbers. Hands Brodaty H, Pond D, Kemp NM, et al.
may still be present in some fashion. (2002). The GPCOG: A new screening
test for dementia designed for general
4 Further distortion of number sequence.
Integrity of clock face is now gone (i.e. practice. Journal of the American
numbers missing or placed outside of Geriatrics Society, 50(3), 530-534.
boundaries of the clock face).
3 Numbers and clock face no longer
obviously connected in the clock
drawing. Hands are not present.
2 Drawing reveals some evidence of
instructions being received but only
vague representation of a clock.
1 Either no attempt or an un-
interpretable effort is made.

The Assessment of Older People with dementia and depression of CALD Backgrounds: A review of current practice and the development of
guidelines for Victorian ACAS (undertaken by NARI, 2011). Funds for this project were provided by the Council of Australian governments
(COAG) as part of the COAG initiative to strengthen and improve the Aged Care Assessment Program (ACAP). The ACAP is an initiative of
the Australian Government and is jointly funded by the Australian Government and the Government of Victoria. 2

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