Clock Drawing Test for Cognitive Assessment
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ScribdTranslationsClock Drawing Test for Cognitive Assessment
Translated by
ScribdTranslationsCLOCK DRAWING TEST (CDT)
It is a screening test to examine cognitive decline, although it is also used to
follow the evolution of confusional syndromes. Several authors have
developed different criteria for implementation and scoring.
It is a simple test that assesses overall cognitive functioning, mainly the
constructive apraxia, motor execution, attention, comprehension, and knowledge
numeric, by the command to draw a clock (a circle, the 12 hours of the clock) and mark
a specific time (11:10).
Scoring criteria
J. Cacho and colleagues (1998) have proposed the following scoring scale: it has been established
a maximum score of 2 points for the drawing of the sphere, 4 points for the numbers and
4 points for the hands.
SCORING CRITERIA OF THE CLOCK TEST
CLOCK SPHERE (MAXIMUM 2 POINTS).
POINTS RESULTS
Drawing norm. Circular or oval sphere with small distortions due to
2
earthquake.
1 Incomplete or with some significant distortion. Very asymmetric sphere.
0 Absence or completely distorted drawing.
2. PRESENCE OR SEQUENCE OF NUMBERS (MAXIMUM 4 POINTS).
All the numbers present and in the correct order. Just "small mistakes".
4 in spatial location in less than 4 numbers (e.g. place the number 8
in the space of number 9).
When the 'small errors' in spatial placement occur in 4 or more
3.5
small numbers.
Everyone present with significant error in spatial localization (e.g. placing
3 the number 3 in the space of number 6).
Numbers with some disorder of sequence (less than 4 numbers).
Omission or addition of some number, but without significant distortions in the
remaining numbers.
Numbers with some disorder of sequence (4 or more numbers).
The 12 numbers arranged counterclockwise (reverse rotation).
2
All the numbers present, but with great spatial distortion (numbers
outside of the clock or drawn on a hemisphere, etc...)
Presence of the 12 numbers in a vertical, horizontal, or diagonal line
(numerical alignment).
Absence or excess of numbers with great spatial distortion.
1 Numerical alignment with lack or excess of numbers.
Inverse rotation with lack or excess of numbers.
Absence or low representation of numbers (fewer than 6 numbers)
0
drawn).
3. PRESENCE AND LOCATION OF THE HANDS (MAXIMUM 4 POINTS).
The hands are in the correct position and with the appropriate proportions.
4
of size (the one with the shortest hour).
3.5 The hands are in the correct position but both are of equal size.
Small errors in the positioning of the hands (to place one of the
3 needles in the space allocated for the previous or next number.
Minute hand shorter than the hour hand, with correct time marking.
Great distortion in the location of the hands (even if they mark the
once and ten, when the numbers show significant errors in the
2 spatial localization.
When the hands do not meet at the central point and indicate the hour
correct.
When the hands do not meet at the central point and indicate an hour.
1 incorrect.
Presence of a single hand or a sketch of both.
Absence of hands or perseveration in the drawing of the same. Effect on
0
car wheel shape.
Application criteria
It should be applied in two successive phases, according to the established order:
1. Watch test on demand (TRO). In this phase, the subject is presented with a sheet of
completely blank paper, a pencil, and an eraser, and are provided with the
I would like you to draw a large round clock in this
sheet, placing in it all its numbers and whose hands mark eleven and ten. In
in case I make any mistakes, here is an eraser for you to use.
correct it. This test has no time limit, so we ask you to complete it with
tranquility, giving it all the attention possible.
Se repite las instrucciones tantas veces como sea necesario. Si el sujeto, después de
draw the sphere, omit a number, he is asked if he has put them all, allowing him
correct the drawing if he becomes aware of his mistakes. If, on the contrary, he does not perceive the
error, either because there is an excess or a shortage of a number, you are reminded of the guideline instruction
schedule.
Once the numbers are drawn, you are reminded to place the hands marking
eleven ten. If after some time, the subject has not drawn the hands or is absent
One of them is asked if they have finished their watch. If so, they are informed.
that, subsequently, they are going to develop an easier test, starting then with the
execution of the TR phase 'to the copy'. Otherwise, a deadline is granted
additional time to complete the task.
2. Clock test of the copy (TRC). In this second condition, the subject is presented with
a sheet in vertical position, with a clock printed in the upper third of the page.
You are asked to pay the utmost attention to the drawing and to copy it as accurately as possible.
the drawing of the clock that appears at the top of the sheet. Since in this phase
a time limit is not set, it is suggested that you carry it out calmly and that
Use the eraser in case you make any mistakes.
At the end of this test, the sheet is removed for later evaluation and scoring. If the
the clock is incomplete, before picking up the sheet, one asks if the drawing is finished.
If the subject notices the existence of any error, they are allowed to correct it; otherwise,
he/she picks up the leaf.
Cut-off points for the estimation of cognitive impairment associated with dementia
Alzheimer type
In the condition of TRO, the cutoff point that shows the greatest efficacy is 6.
Therefore, the test is considered positive if the sum of the three scores is
(sphere, numbers and hands) 'to the order' is less than or equal to 6, and as negative if the
the sum of the scores is greater than 6. The high scores are used to dismiss the
disease, especially the scores close to 8 and 9.
In the condition of TRC, the point of highest efficacy is 8. Therefore, the test is considered.
as positive if the value of the sum of the three scores (sphere, numbers and
The hands) 'to the copy' is less than or equal to 8, and as negative if the sum of the
ratings are above 8.
The most effective cutoff point for TRO+ TRC is 15. Therefore, the test is considered
as positive if the value of the sum of the three scores (sphere, numbers and
the hands) in both conditions of the test (order and copy) is less than or equal to 15, and as
Negative if the sum of the scores is above 15.
The appearance of reverse rotation or numerical alignment, as well as of perseveration of
errors in either of the two experimental conditions (TRO and TRC) may indicate
a probable cognitive decline.