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.

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.

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.

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.

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.

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.

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:

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.

  • 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.

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.

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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 encephalitisDiagnosing delirium in hospitalized patientsEvaluating 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.

The clock drawing test has several other uses, including:

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.

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.