Clock face drawing test

Basics of Clock Face Drawing Test

1. CLOCK FACE DRAWING TEST: METHODS & IMPLICATIONS Dr.S.K . Kar Associate Professor of Psychiatry KGMU, Lucknow, U.P

2. Clock face drawing test: Overview Developed in early 1900s for evaluation of soldiers with head injury (particularly to parietal and occipital lobes) Injury to parieto-occipital area: Difficulty in composing images (appropriate number of parts, correct size & orientation):::: CONSTRUCTIONAL APRAXIA Skills required to draw a CLOCK Ability to follow directions Language comprehension Visualize orientation of the object Execute normal movements (coordination) Conceptualization and planning Number sequencing Mc Gee S (2018): Mental Status Examination: Evidence based physical diagnosis; 4 th Edition

3. Neurobiological correlates of clock face drawing test Eknoyan D, Hurley RA, Taber KH. The clock drawing task: common errors and functional neuroanatomy. The Journal of neuropsychiatry and clinical neurosciences. 2012 Jul;24(3):260-5.

4. Clock Face Drawing Test in Dementia Dementia Sensitivity Specificity Abnormal clock drawing test 36-75 72-98 MMSE score ≤23 53-100 71-99 MMSE is affected by the level of education of the patient, but CFDT is not. Mc Gee S (2018): Mental Status Examination: Evidence based physical diagnosis; 4 th Edition

5. Sunderland T, Hill JL, Mellow AM, Lawlor BA, Gundersheimer J, Newhouse PA, et al. Clock drawing in Alzheimer's disease: a novel measure of dementia severity. J Am Geriatr Soc 1989;37:725-9.

6. Watson YI, Arfken CL, Birge SJ. Clock completion: an objective screening test for dementia. J Am Geriatr Soc 1993;41:1235-40

7. Other methods Alzheimer's Disease (AD) Cooperative Study scoring system: The AD Cooperative Study scoring system uses a 5-point scale, with higher numbers indicating better performance. Scoring: One point each is assigned for drawing an approximately circular face, symmetry of number placement, correctness of numbers, presence of two hands, and hands showing correct length or time Wolf-Klein method: In the Wolf-Klein method, subjects are merely asked to “draw a clock” on a preprinted circle. Scoring: Their scoring system has 10 anchor points which pertain only to the spacing of the numbers; time setting is not assessed. Sample anchor points include: 10“normal”; 7 “very inappropriate spacing;” 4 “counter-clockwise rotation;” and 1 “irrelevant figures” Shulman method: One of the oldest scoring systems used was by Shulman et al. They developed a 5-point scale of hierarchical errors with the higher score for a failed attempt to draw a clock. In a subsequent study, this scale was reversed and the maximum points given to a perfect clock Many other methods (Manos and Wu system; Mendez system; Rouleau system; Pfizer Inc., and Eisai Inc. System; Tuokko system etc)

8. Implications Fronto -temporo-parietal functioning Indicator of constructional apraxia Early screening for cognitive impairment (Dementia) Useful in dementias like : AD, VD, FTD Also useful in DELIRIUM, FOCAL CEREBRAL LESIONS, HUNTINGTON’S DISEASE, HEMINEGLECT, MULTIPLE SCLEROSIS, SCHIZOPHRENIA Poor performance may be seen with: Old age, Depression, Low education, Hypertension Advantage: Simple & Quick Little need of resources Can be administered to hearing impaired Easy to document graphically Easy to remember Palsetia D, Rao GP, Tiwari SC, Lodha P, De Sousa A. The Clock Drawing Test versus Mini-mental Status Examination as a Screening Tool for Dementia: A Clinical Comparison. Indian J Psychol Med. 2018;40(1):1–10.

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