Clock test

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There are various versions of the Clock test which involves asking a patient to draw an analogue clock face. In the classic perceptual defects associated with visual neglect after a stroke a quadrantic or hemianopic field defect may be manifest, with identical deficits in the drawing with severe visual extinction. The test has been popularised as an outpatient test for cognitive disability[1] as it tests for apraxias common in moderate to severe Alzheimer's disease that some report are not easy to identify with the mini mental state examination. The quadrant from 9 to 12 is the most likely to be misdrawn in dementia associated apraxia. This has been added to some standard American driving license assessments[2][3] but it has actually been shown to be non-discriminatory with respect to ability to dementia in multi-cultural populations[4] and may not add to the information from the MMSE[5] to identify which drivers need more validated assessment of driving skills.

To illustrate that perceptual pathways can be involved in an abnormal test: This patient actually had an infective encephalopathy and had a marked improvement in performance after treatment

References

  1. ↑ Schramm U, Berger G, Müller R, Kratzsch T, Peters J, Frölich L. Psychometric properties of Clock Drawing Test and MMSE or Short Performance Test (SKT) in dementia screening in a memory clinic population. International journal of geriatric psychiatry 2002;17(3):254-60.
  2. ↑ Oswanski MF, Sharma OP, Raj SS, Vassar LA, Woods KL, Sargent WM, et al. Evaluation of two assessment tools in predicting driving ability of senior drivers. American journal of physical medicine & rehabilitation / Association of Academic Psychiatrists 2007;86(3):190-9. (Direct link – subscription may be required.)
  3. ↑ Freund B, Gravenstein S, Ferris R, Burke BL, Shaheen E. Drawing clocks and driving cars. Journal of general internal medicine : official journal of the Society for Research and Education in Primary Care Internal Medicine 2005;20(3):240-4. (Direct link – subscription may be required.)
  4. ↑ Storey JE, Rowland JT, Basic D, Conforti DA. Accuracy of the clock drawing test for detecting dementia in a multicultural sample of elderly Australian patients. International psychogeriatrics / IPA 2002;14(3):259-71.
  5. ↑ Diegelman NM, Gilbertson AD, Moore JL, Banou E, Meager MR. Validity of the Clock Drawing Test in predicting reports of driving problems in the elderly. BMC geriatrics 2004;4:10.(Epub) (Direct link – subscription may be required.)
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