Scoring and Interpreting the Clock Drawing Test for Dementia (2023)

The clock-drawing test is a simple tool used to check for signs of dementia, including Alzheimer’s disease. It is often used in combination with other screening tests but can provide valuable clues on its own.

This article explores the aims of the clock-drawing test, how it is done, what the scores mean, and some of the benefits and drawbacks of testing.

Scoring and Interpreting the Clock Drawing Test for Dementia (1)

Aims of the Test

The aim of the clock-drawing test is to see if there is any loss of a person's cognition. In simple terms, cognition is the ability to learn, understand, and reason through experience, thoughts, and senses.

The clock-drawing test is able to detect mental decline as people with dementia often have problems reading traditional clocks. Reading clocks requires you to interpret the placement of the hands on a clock and the time they are meant to represent. This ability is often lost in people with early dementia.

With dementia, many aspects of cognition are affected, including:

  • Executive function: Mental skills involving working memory, flexible thinking, and self-control
  • Visual-spatial ability: The ability to perceive the relationship of objects in space
  • Motor programming: The ability to represent sequence and movement in abstract form
  • Attention and concentration

All of these skills are involved when a person is asked to draw a clock. Any difficulties with the task suggest that a person may have dementia.

Studies suggest that the clock-drawing test can detect early dementia even when other tests, such as mini-mental state exam (MMSE), are normal.

Recap

The clock-drawing test is used to screen for early-stage dementia. This is because one of the first signs of dementia is difficulty understanding what the hands on a clock represent.

What Is Cognitive Impairment?

How the Test Is Done

The clock-drawing test can be given by a doctor or other qualified professional. It only requires a pencil and a piece of paper with a pre-drawn circle on it.

The doctor will first ask the person to draw the numbers on the face of the clock. Next, the person will be asked to draw the hands to show a specific time. Different times can be used, but many doctors choose 10 minutes after 11 as a standard value.

One variation of the test is to provide the person with a blank piece of paper and ask them to draw a clock showing 10 minutes after 11. The word "hands" is not used to avoid giving clues. A total of three drawings is typically used with each drawing done within a specific time limit.

What Are the Different Types of Dementia?

(Video) Episode 7: MiniCog Clock Draw Test

Test Scoring

There are as many as 15 different ways to score the clock-drawing test. Some methods are complex and will award as many as 10, 15, or 20 points based on whether or not the sequence of numbers, the placement of numbers, and the placement of the hands are correct.

Errors such as missing numbers, missing hands, repeated numbers, the wrong sequence of numbers, or the incorrect time can also factor into the interpretation. Even the refusal to draw a clock may be interpreted as a sign of dementia.

This simplest scoring method allots one point if the drawing is correct and zero points if it was not. A 2012 study in the Danish Medical Journal concluded that the simplest method is just as accurate in diagnosing early dementia as complex methods.

For its part, the Alzheimer's Association endorses the simple method of scoring.

Recap

There are many different ways to score a clock-drawing test. The Alzheimer's Association endorses a simple method using a score of 1 for a correct drawing and 0 for an incorrect drawing. A total of three drawings is commonly used.

How Dementia Is Diagnosed

Benefits and Limitations

The early detection of dementia is important as there are medications that may help slow the progression of Alzheimer's disease. To this end, the clock-drawing test offers benefits in that:

  • It is quick and simple. The test can be completed in a few minutes and only requires a pencil and paper.
  • It is easy to administer. The test doesn't require much training if a simple scoring method is used.
  • It can screen for delirium. Delirium, a sudden deterioration of cognition, can also be detected with the test. Causes may include a severe illness, brain infection, or drug reaction rather than mental decline.

At the same time, the clock-drawing test has its drawbacks. Among the limitations:

  • It cannot diagnose the type of dementia. The test can be a strong indication of early dementia, but it cannot tell if Alzheimer's or some other condition is involved. Other tests would be needed.
  • It can be misinterpreted. If the tester is not a trained medical professional, they can mistake conditions like vascular dementia for Alzheimer's and not pursue the appropriate diagnosis.

How

Summary

The clock-drawing test is a quick way to screen for early dementia, including Alzheimer's disease. It involves drawing a clock on a piece of paper with numbers, clock hands, and a specific time. The inability to do so is a strong indication of mental decline.

Even so, the clock-drawing test cannot tell which type of dementia is involved or if the loss of cognition is due to some other condition like a severe illness, brain infection, or drug reaction.

A Word From Verywell

If you suspect a loved one has signs of Alzheimer’s or other types of dementia, it's important to seek a diagnosis from a qualified physician. This may include your primary care doctor,a doctor trained in brain disorders (neurologist), or a doctor trained to treat older adults (geriatrician)

These doctors are qualified to diagnose dementia but can also rule out other reversible causes of dementia, such as hydrocephalus, brain trauma, or even vitamin B-12 deficiency.

How To Choose an Alzheimer's Doctor

(Video) Clock drawing test dementia

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Frequently Asked Questions

  • What conditions besides dementia is the clock drawing test used for?

    The clock drawing test has several other uses, including:

    • Diagnosing hepatic encephalitis
    • Diagnosing delirium in hospitalized patients
    • Evaluating recovery from a traumatic brain injury
  • What is executive functioning?

    Executive functioning refers to the ability to focus, plan, remember, and follow through on instructions and prioritized tasks. It involves working memory, mental flexibility, and self-control. The clock-drawing test can provide clues as to how intact these skills are.

  • What do errors in drawing a clock mean?

    It depends on the error. A small clock (less than 1.5 inches) may indicate problems in the basal ganglia as seen in people with Huntington's disease, while a large clock (bigger than 5 inches) is associated with Alzheimer's disease. People with Alzheimer's also may draw misshapen circles, hands, or numbers, which is less common with Huntington's disease.

8 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

  1. Alzheimer's Association. Cognitive assessment toolkit.

  2. Budson AE, Solomon PR. Chapter 2. Evaluating the patient with memory loss or dementia. In: Memory Loss, Alzheimer's Disease, and Dementia: A Practical Guide for Clinicians (Second Edition). Amsterdam, Netherlands: Elsevier

  3. 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 Jan-Feb;40(1):1–10. doi:10.4103/IJPSYM.IJPSYM_244_17

  4. Mendes-Santos LC, Mograbi D, Spenciere B, Charchat-Fichman H. Specific algorithm method of scoring the clock drawing test applied in cognitively normal elderly. Dement Neuropsychol.2015 Apr-Jun;9(2):128–35. doi:10.1590/1980-57642015DN92000007

  5. Eknoyan D, Hurley RA, Taber KH. The clock drawing task: common errors and functional neuroanatomy.J Neuropsychiatry Clin Neurosci. 2012;24(3):260-5. doi:10.1176/appi.neuropsych.12070180

  6. Korner EZ, Lauritzen L, Nilsson FM, Lolk A, Christensen P. Simple scoring of the clock-drawing test for dementia screening. Dan Med J.2012 Jan;59(1):A4365.

  7. Adamis D, Meagher D, O'Neill D, McCarthy G. The utility of the clock drawing test in detection of delirium in elderly hospitalised patients. Aging Ment Health.2016 Sep;20(9):981-6.doi:10.1080/13607863.2015.1050996

  8. Diamond A. Executive functions. Annu Rev Psychol. 2013;64:35–168. doi:10.1146/annurev-psych-113011-143750

(Video) Automatic Dementia Screening and Scoring by Applying Deep Learning on Clock-drawing Tests

Scoring and Interpreting the Clock Drawing Test for Dementia (2)

By Esther Heerema, MSW
Esther Heerema, MSW, shares practical tips gained from working with hundreds of people whose lives are touched by Alzheimer's disease and other kinds of dementia.

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(Video) Clock Drawing Test CDT Aministration, Scoring and Interpretation

FAQs

How accurate is the clock test for dementia? ›

In the Sunderland system, these were 72.6% and 87.9% respectively. Conclusions: The findings indicate that the accuracy of the clock drawing test using the Shulman system was the most studied and highly sensitive.

How do you score the clock draw test? ›

Clock Drawing Score:

2 points for a normal clock or 0 (zero) points for an abnormal clock drawing. A normal clock must include all numbers (1-12), each only once, in the correct order and direction (clockwise). There must also be two hands present, one pointing to the 11 and one pointing to 2.

What does the clock drawing tell us? ›

The clock-drawing test is used for screening for cognitive impairment and dementia and as a measure of spatial dysfunction and neglect. It was originally used to assess visuo-constructive abilities but we know that abnormal clock drawing occurs in other cognitive impairments.

How are dementia tests scored? ›

The maximum MMSE score is 30 points. A score of 20 to 24 suggests mild dementia, 13 to 20 suggests moderate dementia, and less than 12 indicates severe dementia. On average, the MMSE score of a person with Alzheimer's declines about two to four points each year.

What does it mean if you can't draw a clock face? ›

Summary. The clock-drawing test is a quick way to screen for early dementia, including Alzheimer's disease. It involves drawing a clock on a piece of paper with numbers, clock hands, and a specific time. The inability to do so is a strong indication of mental decline.

How accurate is the clock-drawing test? ›

A study including normal controls, patients with dementia or depression was compared with both tests. In case of an abnormal result in one of the tests when the CDT and the MMSE were used together, 39 out of 41 cases of dementia were identified correctly generating a sensitivity of 95%.

What does a cognitive score of 5 mean? ›

Level 5: Learning New Activity

A score between 5.0 and 5.8 means that cognitive impairment is mild. They can still function well on their own and learn new things.

What does a mini-cog score of 5 mean? ›

A score of 0-2 out of 5 is a positive screen for dementia, 3-5 out of 5 is a negative screen for dementia (Borson et al., 2006), but a cut score of 4-5 out of 5 may increase detection of mild cognitive impairment (McCarten et al., 2012).

Which score range on the mini-cog test indicates a positive screen for dementia? ›

Mini-Cog Score To obtain the mini-cog score, add the recall and CDT scores. 0-2 indicates positive screen for dementia. 3-5 indicates negative screen for dementia.

What is one of the first signs of cognitive decline? ›

Forgetting appointments and dates. Forgetting recent conversations and events. Feeling increasingly overwhelmed by making decisions and plans. Having a hard time understanding directions or instructions.

What medications cause memory loss and forgetfulness? ›

Here are 10 of the top types of offenders.
  • Antianxiety drugs (Benzodiazepines) ...
  • Cholesterol-lowering drugs (Statins) ...
  • Antiseizure drugs. ...
  • Antidepressant drugs (Tricyclic antidepressants) ...
  • Narcotic painkillers. ...
  • Parkinson's drugs (Dopamine agonists) ...
  • Hypertension drugs (Beta-blockers)
9 Feb 2016

Does someone with dementia know they have it? ›

In some cases, the short answer is no, they're not aware they have dementia or Alzheimer's. Cognitive impairment can cause people with Alzheimer's, dementia, stroke, brain tumors, and other types of damage in the brain to believe that there's nothing wrong.

What is a good score on a cognitive test? ›

A score of 50 marks a performance better than or equal to 50% of all candidates. A score of 70 marks a performance better or equal to 98% of all candidates.

What is a normal AMT score? ›

It can also be used following a fall to identify a change in cognitive function. Score 1 point for each correct answer (no half marks) Final score 0–3 is suggestive of severe impairment; 4–7 moderate impairment; 8 and above is suggestive of normal cognitive function.

What is a normal cognitive test score? ›

A score of 26 or over is considered to be normal. In a study, people without cognitive impairment scored an average of 27.4; people with mild cognitive impairment (MCI) scored an average of 22.1; people with Alzheimer's disease scored an average of 16.2.

Why do neurologists have you draw a clock? ›

Neurologists have used clock-drawing and time telling tests extensively. Several factors contribute to the test's popularity, including administration and scoring ease and evaluation of multiple cognitive domains,10,11 such as executive functioning.

Is dementia genetic or hereditary? ›

Many people affected by dementia are concerned that they may inherit or pass on dementia. The majority of dementia is not inherited by children and grandchildren. In rarer types of dementia there may be a strong genetic link, but these are only a tiny proportion of overall cases of dementia.

How quickly can dementia patients deteriorate? ›

There is no way to be sure how quickly a person's dementia will progress. Some people with dementia will need support very soon after their diagnosis. In contrast, others will stay independent for several years.

What does mild cognitive impairment mean? ›

Mild cognitive impairment (MCI) is the stage between the expected cognitive decline of normal aging and the more serious decline of dementia. It's characterized by problems with memory, language, thinking or judgment.

How is vascular dementia diagnosed? ›

MRI s are generally the preferred imaging test because MRI s can provide even more detail than CT scans about strokes, ministrokes and blood vessel abnormalities and is the test of choice for evaluating vascular dementia. Computerized tomography (CT) scan.

What are the 4 levels of cognitive impairment? ›

Cognitive Severity Stages (Normal Aging - Dementia)
  • No Cognitive Impairment (NCI)
  • Subjective Cognitive Impairment (SCI)
  • Mild Cognitive Impairment (MCI)
  • Dementia.

What is a good memory score? ›

The maximum score for the MMSE is 30. A score of 25 or higher is classed as normal. If the score is below 24, the result is usually considered to be abnormal, indicating possible cognitive impairment.

What does a cognitive score of 12 mean? ›

The following ranges may be used to grade severity: 18-25 = mild cognitive impairment, 10-17= moderate cognitive impairment and less than 10= severe cognitive impairment.

How is the mini cog test scored? ›

The Mini-Cog is scored in two parts: 1) 3-item recall, and 2) clock drawing. These are added together for a total score. 3-Item Recall Score: 1 point for each word recalled without cues, for a 3-item recall score of 1, 2, or 3.

What are the 3 words on a memory test? ›

Recall of Three Little Words Helps Quick Diagnosis of Mild Cognitive Impairment. ATLANTA, Nov. 19 -- Mild cognitive impairment can be determined in less than five minutes with a three-word memory test and a clock-drawing task, according to researchers here. The words are apple, penny, and table.

What is determined based on the results of a mini cog exam? ›

The Mini‐Cog would most commonly be used in primary care settings as a screening test to identify individuals who may or may not have identified cognitive complaints or dementia.

Does dementia always show up on a brain scan? ›

Dementia brain scans

Not everyone will need a brain scan, particularly if the tests and assessments show that dementia is a likely diagnosis. These scans may also be used to check for evidence of other possible problems that could explain a person's symptoms, such as a stroke or a brain tumour.

What are normal slums scores? ›

SLUMS scores are interpreted as follows: 27 to 30: Normal in a person with a high school education. 21 to 26: Suggest a mild neurocognitive disorder. 0 to 20: Indicate dementia.

How does a neurologist diagnose dementia? ›

Brain scans.

These tests can identify strokes, tumors, and other problems that can cause dementia. Scans also identify changes in the brain's structure and function. The most common scans are: Computed tomography (CT), which uses X-rays to produce images of the brain and other organs.

What are signs that dementia is getting worse? ›

increasing confusion or poor judgment. greater memory loss, including a loss of events in the more distant past. needing assistance with tasks, such as getting dressed, bathing, and grooming. significant personality and behavior changes, often caused by agitation and unfounded suspicion.

What stage of dementia is anger? ›

The middle stages of dementia are when anger and aggression are most likely to start occurring as symptoms, along with other worrying habits like wandering, hoarding, and compulsive behaviors that may seem unusual.

What are the 4 warning signs of dementia? ›

These resources are available at your local Alzheimer Society office.
  • Sign 1: Memory loss that affects day-to-day abilities. ...
  • Sign 2: Difficulty performing familiar tasks. ...
  • Sign 3: Problems with language. ...
  • Sign 4: Disorientation to time and place. ...
  • Sign 5: Impaired judgement. ...
  • Sign 6: Problems with abstract thinking.

What is the most common cause of death in dementia patients? ›

One of the most common causes of death for people with dementia is pneumonia caused by an infection. A person in the later stages of dementia may have symptoms that suggest that they are close to death, but can sometimes live with these symptoms for many months.

What is the new drug for dementia? ›

Developed by Eisai, a pharmaceutical company in Tokyo, and biotechnology firm Biogen in Cambridge, Massachusetts, lecanemab is a monoclonal antibody designed to clear clumps of protein from the brain that many think are a root cause of Alzheimer's disease.

What prescription drugs are linked to dementia? ›

Some anticholinergic drugs linked to dementia risk include:
  • Amitriptyline (Elavil)
  • Aripiprazole (Abilify)
  • Benztropine (Cogentin)
  • Biperiden (Akineton)
  • Brompheniramine (Dimaphen DM)
  • Carbamazepine (Tegretol)
  • Chlorpheniramine (ChlorTrimeton)
  • Chlorpromazine (Thorazine)
16 Jun 2022

Do people with dementia sleep a lot? ›

It is quite common for a person with dementia, especially in the later stages, to spend a lot of their time sleeping – both during the day and night. This can sometimes be distressing for the person's family and friends, as they may worry that something is wrong.

Should you tell dementia patients the truth? ›

Honesty isn't always the best policy when it comes to someone with Alzheimer's or dementia. That's because their brain may experience a different version of reality. Dementia damages the brain and causes progressive decline in the ability to understand and process information.

What stage of dementia is forgetting family members? ›

Stage 6. In stage 6 of dementia, a person may start forgetting the names of close loved ones and have little memory of recent events. Communication is severely disabled and delusions, compulsions, anxiety, and agitation may occur.

What stage of dementia is losing track of time? ›

Stage 7: Late-Stage Dementia

This final category of dementia includes one stage. Stage 7, very severe cognitive decline lasts an average of 2.5 years. A person in this stage usually has no ability to speak or communicate and requires assistance with most activities, including walking.

Why do neurologists have you draw a clock? ›

Neurologists have used clock-drawing and time telling tests extensively. Several factors contribute to the test's popularity, including administration and scoring ease and evaluation of multiple cognitive domains,10,11 such as executive functioning.

What is one of the first signs of cognitive decline? ›

Forgetting appointments and dates. Forgetting recent conversations and events. Feeling increasingly overwhelmed by making decisions and plans. Having a hard time understanding directions or instructions.

What is the standard dementia test? ›

Mini-Mental Status Examination (MMSE)

The MMSE is the most common test for the screening of dementia. It assesses skills such as reading, writing, orientation and short-term memory.

What is the most common cause of death in dementia patients? ›

One of the most common causes of death for people with dementia is pneumonia caused by an infection. A person in the later stages of dementia may have symptoms that suggest that they are close to death, but can sometimes live with these symptoms for many months.

What are signs that dementia is getting worse? ›

increasing confusion or poor judgment. greater memory loss, including a loss of events in the more distant past. needing assistance with tasks, such as getting dressed, bathing, and grooming. significant personality and behavior changes, often caused by agitation and unfounded suspicion.

What stage of dementia is not bathing? ›

Dementia stage 5: moderately severe cognitive decline

At this point, a person may no longer be able to carry out normal activities of daily living (ADLs), such as dressing or bathing, without some caregiver assistance.

Does someone with dementia know they have it? ›

In some cases, the short answer is no, they're not aware they have dementia or Alzheimer's. Cognitive impairment can cause people with Alzheimer's, dementia, stroke, brain tumors, and other types of damage in the brain to believe that there's nothing wrong.

What is the difference between Alzheimer's and dementia? ›

While dementia is a general term, Alzheimer's disease is a specific brain disease. It is marked by symptoms of dementia that gradually get worse over time. Alzheimer's disease first affects the part of the brain associated with learning, so early symptoms often include changes in memory, thinking and reasoning skills.

What causes loss of cognitive function? ›

While age is the primary risk factor for cognitive impairment, other risk factors include family history, education level, brain injury, exposure to pesticides or toxins, physical inactivity, and chronic conditions such as Parkinson's disease, heart disease and stroke, and diabetes.

What stage of dementia is anger? ›

The middle stages of dementia are when anger and aggression are most likely to start occurring as symptoms, along with other worrying habits like wandering, hoarding, and compulsive behaviors that may seem unusual.

What causes dementia patients to suddenly get worse? ›

other long-term health problems – dementia tends to progress more quickly if the person is living with other conditions, such as heart disease, diabetes or high blood pressure, particularly if these are not well-managed.

What are the 4 warning signs of dementia? ›

These resources are available at your local Alzheimer Society office.
  • Sign 1: Memory loss that affects day-to-day abilities. ...
  • Sign 2: Difficulty performing familiar tasks. ...
  • Sign 3: Problems with language. ...
  • Sign 4: Disorientation to time and place. ...
  • Sign 5: Impaired judgement. ...
  • Sign 6: Problems with abstract thinking.

What is a good score on a cognitive test? ›

A score of 50 marks a performance better than or equal to 50% of all candidates. A score of 70 marks a performance better or equal to 98% of all candidates.

What is the 5 minute test for early dementia? ›

The five-minute cognitive test (FCT) was designed to capture deficits in five domains of cognitive abilities, including episodic memory, language fluency, time orientation, visuospatial function, and executive function.

What are the dementia test questions? ›

The MMSE includes questions that measure:
  • Sense of date and time.
  • Sense of location.
  • Ability to remember a short list of common objects and later, repeat it back.
  • Attention and ability to do basic math, like counting backward from 100 by increments of 7.
  • Ability to name a couple of common objects.

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