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    Clock Drawing Task Instructions

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    fabyana_irina
    Clock drawing is a complex task that requires different abilities in addition to constructional skills. It is useful as a screening tool to differentiate normal elderly from individuals with cognitive impairment. A low score indicates the need for further evaluation.

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    Clock Drawing Task Instructions

    Uploaded by

    fabyana_irina
    767 views2 pages
    Clock drawing is a complex task that requires different abilities in addition to constructional skills. It is useful as a screening tool to differentiate normal elderly from individuals with cognitive impairment. A low score indicates the need for further evaluation.

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    Clock drawing is a complex task that requires different abilities in addition to constructional skills. It is useful as a screening tool to differentiate normal elderly from individuals with cognitive impairment. A low score indicates the need for further evaluation.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    767 views2 pages

    Clock Drawing Task Instructions

    Uploaded by

    fabyana_irina
    Clock drawing is a complex task that requires different abilities in addition to constructional skills. It is useful as a screening tool to differentiate normal elderly from individuals with cognitive impairment. A low score indicates the need for further evaluation.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    Clock Drawing Task

    Freehand clock drawing is a complex task that requires different abilities in addition to constructional skills.1,2 It has been shown to be a sensitive measure of constructional apraxia,2 but also may reflect general deficits in the conception of time.1 This task is particularly useful as a screening tool to differentiate normal elderly from individuals with cognitive impairment, and in particular with Alzheimers disease, which accounts for the majority of all dementias.3 It is important to note that performance on this brief screening test does not establish criteria for dementia. However, it can be useful in determining whether further cognitive evaluationssuch as the Mini-Mental State Examination (MMSE)are necessary.4

    Instructions
    Ask the person to draw the face of a clock, putting the numbers in the correct positions. After he/she has drawn a circle and placed the numbers in position, ask him/her to draw in the hands indicating ten minutes after eleven or twenty minutes after eight.

    Scoring
    Although various methods for scoring the Clock Drawing Task have been described,1,2,4 a 04 point method4 is presented here, which is brief, sensitive, and easy to apply 4: Draws closed circle: Places numbers in correct positions: Includes all 12 correct numbers: Places hands in correct positions: Score 1 point Score 1 point Score 1 point Score 1 point

    Interpretation
    Certain errors, such as grossly distorted contour or extraneous markings, are rarely produced by cognitively intact persons.4 Clinical judgment must be applied, but a low score indicates the need for further evaluation. It is important to note that any cut-off score is subjective and arbitrary, and classification errors may occur. However, it is unlikely that a cognitively impaired person will draw a perfectly drawn clock. When in doubt, multiple sources of evidence should be examined.4

    Examples of Clock Drawing

    A
    CDT=4 MMSE=30

    B
    CDT=2 MMSE=20

    C
    CDT=2 MMSE=19

    D
    CDT=1 MMSE=14

    E
    CDT=2 MMSE=19

    Figure: Examples of clock drawing by a normal elderly control (A) and patients with dementia (B-E). For these examples, patients were instructed to draw in the hands at twenty minutes after eight. Respective CDT and MMSE scores are shown below each drawing.4*

    Next Steps
    Performance on this brief screening test does not establish criteria for dementia, but can be useful in determining whether further cognitive evaluations are necessary.4 If performance on clock drawing is impaired, a complete diagnostic evaluation for dementia (eg, DSM-IV 5 criteria) should be considered6 Evaluation should include a standardized cognitive assessment such as the Mini-Mental State Examination (MMSE)6
    TM

    *Figure adapted with permission from Nolan KA, Mohs RC. Screening for dementia in family practice. In: Richter RW, Blass JP, eds. Alzheimers Disease: A Guide to Practical Management, Part II. St Louis, Mo: Mosby-Year Book, Inc; 1994:81-95.

    References: 1. Tuokko H, Hadjistavropoulos T, Miller JA, Beattie BL. The Clock Test: a sensitive measure to differentiate normal elderly from those with Alzheimer disease. J Am Geriatr Soc. 1992;40:579-584. 2. Mendez MF, Ala T, Underwood KL. Development of scoring criteria for the Clock Drawing Task in Alzheimers disease. J Am Geriatr Soc. 1992;40:1095-1099. 3. Morris JC. Differential diagnosis of Alzheimers disease. In: Friedland RP, ed. Clinics in Geriatric Medicine: Alzheimers Disease Update. Philadelphia, Pa: WB Saunders Company; 1994:257-276. 4. Data on file. Pfizer Inc, New York, NY. 5. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV ). 4th ed. Washington, DC: American Psychiatric Association; 1994:142-143. 6. Folstein MF, Folstein SE, McHugh PR. Mini-Mental State: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189-198.

    AR273579 2006 Eisai Inc. and Pfizer Inc. All rights reserved. Printed in USA/April 2006

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