Tip Sheet 4 – The Clock
Drawing Test (CDT)
What is the CDT: The Clock Drawing Test
(CDT) is a measure of dementia severity.
There are variations in the administration
of the test including using a pre-drawn
circle and a clock copying task. This tip The CDT could be used to supplement the
sheet refers to the free drawn test where recommended tools. Educational
the client is presented with a blank piece of attainment can influence this test, so be
paper. Clients are asked to draw a clock face aware when interpreting scores.
and mark in the hours and then draw in the
hands to indicate a particular time (for Consider physical impairment including any
example quarter to two – see below, ten issues with muscles in the hand/arm or
past eleven, or ten to two. The CDT assesses vision.
frontal and temporo-parietal functioning. Remove/cover any clocks in the room and
Benefits of the CDT: The way a client be aware if participants have a wrist watch
draws a clock face can provide an assessor on during this test.
with insight into the severity of dementia
and it only takes two minutes to administer.
It is also appropriate in multiethnic
populations due to the ‘universal’ nature of
the clock.
The CDT can complement other screening
tests, especially those, which do not include
an item to assess frontal lobe impairment.
Scoring
There are a number of scoring systems used
in the literature but no one scoring system
Things to be shows superior predictive validity.
aware of The main aspects to consider are
A valid scoring method in a (i) correct spacing with even spaces
multiethnic Australian between numbers and correct
population has not been placement of 12,3,6,and 9, and
demonstrated with the CDT. The one study (ii) correct placement of hands (e.g.10
in Australia using a multiethnic sample past 11)
demonstrated low specificity using five
different scoring methods; between 42%- (Brodaty et al, 2002). Much is gained by
84% of cognitively intact people were observation of the task, and scoring is
incorrectly classified as having dementia. descriptive.
1
The Assessment of Older People with dementia and depression of Culturally and Linguistically Diverse Backgrounds: A
review of current practice and the development of guidelines for Victorian Aged Care Assessment Services (funded by the
Victorian Department of Health; undertaken by the National Ageing Research Institute, 2011)
Another more complicated scoring system
is described if required:
Sunderland et al. 1989 A PRIORI
criteria for evaluating clock drawings.
Cut off score = 5 or less indicates
impairment.
10 - 6 Drawing of clock face with number
and circle generally intact
10 Hands in correct position (i.e. Hours
hand approaching 3 o'clock)
9 Slight errors in placement of hands.
8 More noticeable errors in placement of
hour and minute hands. Further Resources and
7 Placement of hands is significantly off
References
course. Tool reference: Sunderland, T., Hill, J.L.,
6 Inappropriate use of clock hands (i.e. Mellow, A.M., Lawlor, B.A.,
use of digital display or circling Gundersheimer, J., Newhouse, P.A., &
numbers despite repeated Grafman, J.H. (1989). Clock drawing in
instructions). Alzheimer’s disease: a novel measure of
dementia severity. Journal of the
5 - 1 Drawing of clock face with circle and
American Geriatrics Society , 37, 725-
numbers is NOT intact
729.
5 Crowding of numbers at one end of the
clock or reversal of numbers. Hands Brodaty H, Pond D, Kemp NM, et al.
may still be present in some fashion. (2002). The GPCOG: A new screening
test for dementia designed for general
4 Further distortion of number sequence.
Integrity of clock face is now gone (i.e. practice. Journal of the American
numbers missing or placed outside of Geriatrics Society, 50(3), 530-534.
boundaries of the clock face).
3 Numbers and clock face no longer
obviously connected in the clock
drawing. Hands are not present.
2 Drawing reveals some evidence of
instructions being received but only
vague representation of a clock.
1 Either no attempt or an un-
interpretable effort is made.
2
The Assessment of Older People with dementia and depression of Culturally and Linguistically Diverse Backgrounds: A
review of current practice and the development of guidelines for Victorian Aged Care Assessment Services (funded by the
Victorian Department of Health; undertaken by the National Ageing Research Institute, 2011)
