Clock Drawing Test Scoring Guide
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ScribdTranslationsClock Drawing Test Scoring Guide
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ScribdTranslationsFACULTAD CIENCIA DE LA SALUD
SPEECH THERAPY DEGREE
CLOCK DRAWING TEST (THALMAN, 1996)
Scoring criteria of the Clock Test (J. Cacho and R. García)
CLOCK SPHERE
Punt Results
os
2 Normal drawing. Circular or oval sphere with slight distortions due to trembling.
1 Incomplete or with some significant distortion. Very asymmetric sphere.
0 Absence or totally distorted drawing
Watch hands
Point Results
os
4 The hands are in the correct position and with the appropriate size proportions.
shortest hour.
3.5 The hands in the correct position but both of equal size.
3 Small localization errors of the hands (placing one of the hands in the space
destined for the previous or next number
3 Minute hand shorter than the hour hand, with correct hour marking.
2 Great distortion in the location of the hands (even if they indicate eleven and ten), when the
numbers show significant errors in spatial localization.
2 When the hands do not meet at the center point and mark the correct time.
1 When the hands do not meet at the central point and indicate an incorrect time.
1 Presence of a single hand or a sketch of the two.
0 Absence of hands or perseverance in the drawing of them.
0 Effect in the form of a 'car wheel'.
CLOCK NUMBERS
Points Resultados
4
All the numbers present and in the correct order. Only "small mistakes" in the
spatial location in less than 4 numbers (for example, place the number 8 in the
space of number 9).
3.5
When the 'small errors' in localization occur with 4 or more numbers.
3
All present with significant error in spatial localization (for example, placing the
number 3 in the space of number 6)
3
Number with some disorder of sequence (less than 4 numbers).
2
Omission or addition of any number, but without major distortions in the remaining numbers.
2
Numbers with some disorder of sequence (4 or more numbers).
2
The 12 numbers arranged in counterclockwise (reverse rotation).
2
All the numbers present, but with great spatial distortion (number outside the clock or
drawn in a half-sphere, etc.)
2
Presence of the 12 numbers in a vertical, horizontal, or diagonal line (alignment
numeric).
1
Absence or excess of numbers with great spatial distortion.
1 Numerical alignment with a lack or excess of numbers.
1 Inverse rotation with a lack or excess of numbers.
0
Absence or limited representation of numbers (fewer than 6 numbers drawn).
APPLICATION CRITERIA
It should be applied in two successive phases and in this order:
1. Watch test on command (WTO).
2. Clock test to the copy (TRC).
[Link] condition of the TRO
Each subject has been presented with a completely blank sheet of paper, a pen and
an eraser, and the following instruction has been given: 'I would like you to draw a clock'
round and large on this sheet, placing all your numbers on it and whose hands indicate the
Once and ten. In case I make any mistakes, here you have an eraser so you can.
Rectify it. This test does not have a time limit, so we ask you to take it calmly.
giving him all the attention that is possible.
Each subject has been given the instruction as many times as deemed necessary for them to
I understood her. If after drawing the sphere and the numbers, any were missing, she was asked if
I had already put them all, thus allowing him to correct the drawing if he became aware of his mistakes. If
I did not perceive that there were missing or excess numbers when asking that question, it has been repeated to him.
instruction of the timetable.
After drawing the numbers, they have been reminded that they should place the hands marking
eleven ten. If after some time they did not draw the arrows or if one of them was missing, they were...
asked if his watch was finished. In case of an affirmative answer, they were informed that they were going to move on to
an easier test, then starting to carry out the TR phase 'to the copy'. Otherwise,
They have been granted an additional time period to complete the task.
[Link] condition of the TRC
In this second condition, each subject was presented with a sheet in vertical position, with a clock.
whose format can be seen in the figure.
Each subject has been informed that they were going to undergo an easier test. They have been asked to
They will copy the drawing of the clock that appears at the top of the page as accurately as possible.
They have also been urged to pay maximum attention in order to capture all the details of the drawing.
and be able to copy them. Since there is no time limit in this test, it has been suggested that they
They will carry out calmly and will use the eraser in case of making any mistakes. After
provide the instructions to each study subject and ensure that they understood them,
We have allowed them to start the task.
At the end of this test, the sheet has been removed for later evaluation and scoring. If the clock
it was incomplete, before picking up the sheet he asked if the drawing was finished. If the
If the subject notices the existence of any error, they are allowed to correct it; otherwise, it would be collected.
leaf.
Cut-off points for estimating deterioration
cognitive associated with Alzheimer's dementia
In the TRO condition, we observe that the cutoff point that shows the highest efficacy (93.16) is 6.
with a sensitivity of 92.8% and a specificity of 93.48%.
Therefore, we consider the test positive if the value of the sum of the three scores (sphere,
numbers and hands) "at your service" is less than or equal to 6, and as negative if the sum of the
scores greater than 6.
High scores are used to rule out the disease (especially scores close to
to 8 and to 9).
We observe that the point of greatest effectiveness (82.49), in the application condition 'to the copy' is 8.
that for a sensitivity of 73.11 it produces a specificity of 90.58%. Therefore, we consider the
test as positive if the value of the sum of the three scores (sphere, numbers, and hands) "to the
copy is less than or equal to 8, and as negative if the sum of the scores is greater than 8.
The appearance of reverse rotation or numerical alignment, as well as the persistence of errors in
either of the two experimental conditions (TRO, TRC) must be considered as very
suggestive of cognitive deterioration.
Cut-off score Interpretation
7 ≥ pts. Normal
≤6 points. Cognitive deterioration
References: Cacho J, García-García R, Arcaya J, Vicente JL, Lantada N (1999) A proposal for
Application and scoring of the Clock Drawing Test in Alzheimer's disease. Revisit the Neurologic.
htp://[Link]/abstract/med/10363287
Collaborators: Roberto Rodríguez-Pérez
Martn Hemmings Bernardino Fernández
Model for the application of the clock test to the copy