Sunderland used a patient's ability to draw a clock as a method to detect and grade dementia. This can be useful in clinical settings where specialized neuropsychological testing is not available. The authors are from the National Institute of Neurological Disorders and Stroke at NIH.
Method:
(1) The patient is given a piece of clean paper and a pen or pencil.
(2) The patient is instructed to draw a clock showing the hours, then to draw the hands to indicate 2:45.
|
Ability to Follow Instructions and Draw a Clock |
Score |
|
either no attempt or an uninterpretable effort is made |
1 |
|
drawing reveals some evidence of instructions being received, but only a vague representation of a clock |
2 |
|
numbers and clock face no longer obviously connected in the drawing. Hands are not present |
3 |
|
distortion of number sequence. Integrity of clock face is now gone (numbers may be missing, placed outside of boundaries of clock face, etc.) |
4 |
|
crowding of numbers at one end of the clock, or a reversal of the numbers. Hands may be present in some fashion. |
5 |
|
inappropriate use of clock hands (use a digital display, circle numbers despite repeated instructions) |
6 |
|
placement of hands is significantly off course |
7 |
|
noticeable errors in the placement of hours and minute hands |
8 |
|
slight errors in the placement of the hands |
9 |
|
hands are in correct position to indicate "2:45" |
10 |
Interpretation:
• A score from 1 to 5 reflects an inability to draw a clock face with numbers.
• A score from 6 to 10 reflects that the ability to draw the clock face with numbers is intact.
• A low score correlates with dementia.
|
Score |
Interpretation |
|
10 |
normal |
|
8 or 9 |
probably normal; may have mild dementia |
|
6 or 7 |
indeterminate (either normal or demented) |
|
5 |
probably demented; a few normal |
|
1 to 4 |
demented |
from Figure 2, page 728
where:
• Modifications of the score may ask that the patient indicate a different time.
Performance:
• The test was found to be simple and reliable. Inter-rater reliability was high (r = 0.86 with p < 0.001).
• Scores from the test correlate with global measures of dementia.
Specialty: Neurology
