The objective of this study was to assess the correlation between (1) the Folstein Mini-Mental State Examination (MMSE) score and three methods of clock drawing scoring and (2) three methods of clock drawing scoring them selves. A convenience sample of consecutive community-dwelling seniors and attendees at a referral seniors clinic in a tertiary care hospital was used. One hundred fifty participants (72 women, 78 men) were seen with an aver age age of 76 years. There was a significant correlation (P = .01) between MMSE scores and all three methods of clock drawing (R = .67, .618, -.498, respectively), as well as among the three methods of clock drawing scoring. The clock drawing scores showed good correlation with the MMSE score. The clock drawing is well accepted (by the patient) and easily administered (by the health care provider). Clock drawings are recommended as the minimum requirement for cognitive assessment of elderly patients in busy primary care practices and can be used to high light those patients requiring additional cognitive testing. (J Geriatr Psychiatry Neurol 1999; 12:87-91).
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References
1.
Folstem MF, Folstem SE, McHugh PR. "Mini-Mental State": a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res1975; 12:189-198.
2.
Rosen WG, Mohs RC, Davis KLA new rating scale for Alzheimer's disease. Am J Psychiatry1984; 11:1356-1364.
3.
Shulman K., Gold D., Cohen C., Zucchero C.Clock-drawing and dementia in the community: a longitudinal study . Int J Geriatr Psychiatry1993; 8:487-496.
4.
Sunderland T. , Hill JL, Mellow AM, et al. Clock drawing in Alzheimer Disease: a novel measure of dementia severity. J Am Geriatr Soc1989; 37:725-729.
5.
Wolf-Klein GP , Silverstone FA, Levy AP, et al. Screening for Alzheimer disease by clock drawing. J Am Geriatr Soc1989; 27:730-734.
6.
Watson YI, Arfken CL, Birge SJClock completion: an objective screening test for dementia. J Am Geriatr Soc1993; 41: 1235-1240.
7.
Critchley M.The parietal lobes. New York: Hafner , 1953.
8.
Albert MS, Kaplan E.Organic implications of neuropsychological deficits in the elderly . In: Poon L, Fozard J, Cermak L, et al, eds. New directions in memory & aging: proceedings of the George A. Tallard Memorial Conference. Hillsdale, NJ: Erlbaum, 1980:
9.
Moore V., Wyke MADrawing disability in patients with senile dementia. Psychol Med1984; 14:97-105.
10.
Goodglass H., Kaplan E.The assessment of aphasia and related disorders. Philadelphia : Lea and Febiger, 1972.
11.
Mason CF, Garzler H.Adult norms for the Shipley Institute of Living Scale and Hopper Visual Organization Test based on age and education. J Gerontol1964; 19:419-424.
12.
Botwinick J.Intellectual abilities. In: Birren JE, Schale WK, eds. Handbook of psychology of aging. New York: Van Nostrand Reinhold , 1977:580-605.
13.
Kausler DHExperimental psychology, cognition and human aging. 2nd Ed. New York: John Wiley and Sons, 1991:639-649.
14.
Tuokko H., Hadjistavropoulos T., Miller JA, Beattie BLThe Clock Test: a sensitive measure to differentiate normal elderly from those with Alzheimer Disease. J Am Geriatr Soc1992 ; 40:579-584.
15.
Ainslie NK, Murden RAEffect of education on the clock-drawing dementia seen in non-demented elderly persons. JAm Geriatr Soc1993; 41:249-252.
16.
Leibovici D. , Ritchie K., Ledesert B., Touchon J.Does education level determine the course of cognitive decline? Age Ageing1996; 25:392-397.
17.
Tuokko H., Hadjistavropoulos T., Miller JA, et al. The Clock Test: administration and scoring manual. Toronto: Multi-Health Systems, 1995 .
18.
Shulman K., Shedletsky R., Silver ILThe challenge of time: clock drawing and cognitive functioning in the elderly . Int J Geriatr Psychiatry1986 ; 1:135-140.
19.
Rouleau I., Salmon DP, Butters N., et al. Quantitative and qualitative analyses of clock drawings in Alzheimer's and Huntington's disease. Brain Cogn1992; 18:70-87.
20.
Ganguli M., Ratcliff G., Huff FJ, et al. Effects of age, gender and education on cognitive tests in a rural elderly community sample: norms from the Monongahela Valley Independent Elders Survey. Neuroepidemiology1991; 10:42-52.
21.
Ishiai S., Sugishita M., Ichikawa T., et al. Clock-drawing test and unilateral spatial neglect. Neurology1993; 43:106-110.
22.
Mendez MF, Ala T., Underwood KLDevelopment of scoring criteria for the clock drawing task in Alzheimer's disease. JAm Geriatr Soc1992; 40:1095-1099.
23.
Death J., Douglas A., Kenny R.Comparison of clock drawing with Mini-Mental State Examination as a screening test in elderly acute hospital admissions. Postgrad Med J1993; 69: 696-700.
24.
Royall DR, Cordes JA, Polk M.CLOX: an executive clock drawing task. JNeurol Neurosurg Psychiatry1998; 64:588-594.
25.
Brodarty H. , Moore CMThe Clock Drawing Test for Dementia of the Alzheimer's type: a comparison of three scoring methods in a memory disorders clinic. Int J Geriatr Psychiatry1997; 12:619-627.
26.
Ferrucci L. , Cecchi F., Guralnik JM, et al. Does the clock drawing test predict cognitive decline in older persons independent of the Mini-Mental Status Examination ? J Am Geriatr Soc1996; 44:1326-1331.
27.
Inouye SK, van Dyck CH, Alessi GA, et al. Clarifying confusion : the Confusion Assessment Method. A new method for detection of delirium. Ann Intern Med1990; 113:941-948.
28.
Lee H., Swanwick Grj, Coen RE, et al. Use of the Clock Drawing Task is the diagnosis of mild and very mild Alzheimer's disease. Int Psychogeriatrics1996; 8:469-476.
29.
Patten SB, Fick GHClinical interpretation of the Mini-Mental State. Gen Hosp Psychiatry1993; 15:254-259.
30.
Levkoff SE, Evans DA, Liptzin B., et al. Delirium. The occurrence and persistence of symptoms among elderly hospitalized patients. Arch Intern Med1992 ; 152:334-340.
31.
Lee H., Lawlor BAState-dependent nature of the Clock Drawing Task in geriatric depression . J Am Geriatr Soc1995; 43: 796-798.
32.
Gruber NP, Varner RV, Chen YW, et al. A comparison of the Clock Drawing Test and the Pfeiffer Short Portable Mental Status Questionnaire in a geropsychiatry clinic. Int J Geriatr Psychiatry1997; 12:526-532.
33.
Bush C., Kozak J., Elmslie T.Screening for cognitive impairment in the elderly. Can Fam Physician1997; 43:1763-1768.
34.
Solomon PR, Hirschoff A., Kelly B., et al. A 7-minute neurocognitive screening battery highly sensitive to Alzheimer's disease. Arch Neurol1998; 55:349-355.
