The completely normal clock means that a number of functions are intact and suggests that the patient may be able to continue independently.Ī grossly abnormal clock is an indicator of potential problems warranting further investigation or resource allocation (Royall DR, 1996). The executive function required for clock-drawing involves control functions shared by independent living skills. Orientation, conceptualization of time (Lam LWC, 1998)Įxecutive function (Estaban-Santillan C, 1998).Īuditory comprehension, motor programming, numerical knowledge, semantic instruction, inhibition of distracting stimuli, concentration and frustration tolerance (Shulman KI, 2000) Visuo-spatial abilities (Nagahama Y, 2005). Successful completion of the task requires The strength and weakness of the clock-drawing test lies in the number of cognitive, motor and perceptual functions required simultaneously for successful completion. The CDT can be effectively administered to resistant and non-compliant older persons, (Freund B, 2005) In Alzheimer's disease the CDT has been used to :ĭifferentiate Alzheimers Disease from cerebral vascular disease (Heinik J, 2002)ĭetermine the degree to which executive function decline affects gait (Sheridan PL, 2003) Thinning of the posterior cingulate and right middle frontal gyrus (Ahn HJ, 2011)Ĭorrelation with fronto-lobar dysfunction (Moretti R, 2002) Ischemic vascular dementia (Libon DJ, 1996)Ĭorrelation with gray matter volumes in the bilateral superior temporal regions (Heinik J, 2000) Specific brain dysfunctions have been associated with specific CDT abnormalities : Prediction of functional outcome in hip fracture patients (Adunsky A, 2002) Predictiion of post-operative delirium (Fisher BW, 1995) Screen for executive control dysfunction in sub-cortical strokes or vascular pathology, as in hypertension or diabetes (Munshi M, 2006), and hypothyroidismy (Royall DR, 1998) Symbol Digits Modalities test (Mendez MF, 1992)Įstablish problems with executive functions indicating the need for a formal driving evaluation (Freund B, 2005). Rey-Osterreith Comp[lex Figure (Osterreith P, 1994) The CDT can used to supplement information obtained from other tests such as :ħ Minute Neurocognitive Screening Battery (Solomon PR, 1998) The difference in the length of the hands must be obvious at a glance.ġ0 suggests that cognitive impairment (CI) is unlikely. One point each is given for an obvious short hand pointing at the 11 and an obvious long hand pointing to the 2. One point each is given for the numbers 1, 2, 4, 5, 7, 8, 10, and 11 if at least half the area of the number is in the proper octant of the circle relative to the number 12. The scoring template shows the clock circle, already divided in to eighths.Ī scoring template, drawn on a see-through sheet of plastic, is placed over the patient's drawing.Īlternatively, a scoring template drawn on paper, is placed under the patient's drawing so that the scoring template clock shows through the patient's drawing paper above it. If the 12 is missing, its position is assumed to be counterclockwise from the 1 at a distance equal to that between the 1 and 2.Īny straight edge may be used to divide the clock into eighths. The clock is divided into eighths, beginning with a line through the number 12 and the center of the circle. The choice of a scoring system ultimately depends on the specific needs and goals of the clinician or researcher. Indicate that the circle represents the face of a clock and ask the patient to put in the numbers so that it looks like a clock.Īsk the patient to add arms so that the clock indicates the time "ten minutes after eleven." Provide patient with a piece of paper with a pre-drawn circle of approximately 10 cm in diameter. The CDK can be effectively administered to resistant and non-compliant older persons, (Freund B, 2005) The clock drawing test (CDT) has been proposed as a quick screening test for cognitive dysfunction secondary to dementia, delirium, or a range of neurological and psychiatric illnesses (Cucinotta D, 2004).
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