I have googled everything trying to find out if the results of the clock test have any special meaning other than showing that the person has dementia. Jan. 09, before diagnosis, I had my hb draw the clock and it looked like a clock,so I had him sign and date it. Now, having been on aricept for over 18 months, I have noticed a downhill trend and thought I would do the clock drawing again. Two reasons for this, he was always asking me the time and his word search abilities seemed to be changing and becoming a bit difficult. Anyway, this time he put the 12 at the top and wrote all the numbers down the right side ending in 12 again at the 6 position. I had to really prompt him to get the hands drawn in and the asked him to date it and he didn't know the year, told me his birth year. What I want to know is if all the numbers on one side give any insight about the dementia. Anybody out there know?? Yes, we have an appt. with the dr.
You might want to look for signs of Lewy Body Dementia (Parkinson's symptoms are one possibility) because it involves more decline in executive function and less decline in memory relative to Parkinson's. I wish the Barkley Deficits in Executive Functioning Scale was available online--it is a thought-provoking list of symptoms. A few examples:
Has trouble doing what he/she tells self to do Has trouble considering various options for doing things and weighing their consequences Can't seem to get to the point of his/her explanations as quickly as others Finds it hard to take other people's perspectives about a problem or situation Has trouble calming self down once he/she is upset
Executive function is one of the things the clock drawing test measures (http://canadianmedicaljournal.ca/content/167/8/859.full).
I don't know, but I'd group it in the category of general ability to understand graphs and similar abstract ways of conceptualizing information. It's one thing to be able to look at a clock and say "That is a clock." Or look at a calendar and say "That is a calendar." Quite another to grasp that one wedge of the clock pie (iow, the space between the numerals 1 and 2,) represent one hour of time.
My experience is that the ability to draw real meaning from graph-based representations was lost very early in the process. For example, Jeff's ability to make sense of a highway map disappeared very early. Other things in the category include calendars (how do they work? Weeks horizontally, days of the week vertically...incomprehensible.) And also analog clocks. That is, he can sometimes still tell time if it's a digital readout, but a round clock face is a graph, and requires a higher level of processing. Most likely, once a person can no longer understand a clock, he can also no longer construct one from memory, because he no longer understands how it is set up. He does know it's round and has numbers on it, but putting them together properly involves knowing why the parts are in the positions they are.
I don't know that grouping the numbers on one side has any particular significance, but it may be showing a favoring of one side of the brain over another. I don't know whether this holds for standard Alzheimer's, but it is typical that in cases with a strong visual component (posterior cortical atrophy, our version,) the damage is usually worse on one side, often the left. A sign of this is hemi-neglect, where functions having to do with the more damaged side of the brain are overlooked. Maybe this would result in the numbers being bunched up on one side. I've seen Jeff do this on a clock test.
I noticed my dh couldn't tell time accurately when reading a digital clock. Couldn't figure out 10:15 meant 15 minutes past 10. DH is in early mid-stage. 85 yrs. old, severe memory loss, can take care of his ADL's but can't make a phone call, handle money, doesn't drive anymore. Two days ago I gave him the clock test and he drew it properly, round with 12 at the top, 3 to dead right, 6 at the bottom, and 9 to dead left. That really surprised me because, as you say, the clock test could signify dementia. Now I have all sorts of questions again. No two AD victims are the same. Several months ago he had forgotten my name; now he uses it.
Interesting. Who knows? But I suppose that when the organic process of Alz or other dementias are impairing various pathways in the brain, there's enough of a random aspect that functions lost or preserved will vary in surprising ways from person to person.
The inability to make the connection between a road map and the actual road was the very first thing that showed up and that was 8 years ago, right after we were married. At that time I couldn't understand how an educated, successful professional could not understand it.
Well all I can say about the clock test is that my art skills are so poor that even though I don' t have ALZ ( or at least don't think I do...at this point anyway...) I would flunk the test based on my bad art..I can't even draw decent stick men!
Andy—Dr. Josh's link, if you cut/paste it, will result in downloading a pdf file onto your hard drive which you could then read. Possibly your computer doesn't do that automatically. It could be emailed to you.
The first set of test DH took, he said he had dementia because he could not draw, and has never been able to draw. I just let him think that. He did the clock test last year and I got to see it. He ran out of numbers before he got back to the top and thought it was fine.
He worked with numbers and charts and spreadsheets all the time.It just seemed he started doing less and less over time until he was unable to do any thing.
<Can't seem to get to the point of his/her explanations as quickly as others Finds it hard to take other people's perspectives about a problem or situation Has trouble calming self down once he/she is upset>
The last few years before DH dx this was happening all the time. Is it part of Alzheimers or something else? Do we know?
I have been giving DH the clock test since the get-go. Always gets it right. His hobby was fixing clocks after he retired. Doesn't do that now, but can still draw on and can still tell time. Go figure.
When my mom first started showing signs something was odd and out of synch it was with the bookwork for the office. Mom always paid the household bills and did all the tax prep work for the CPA..and slowly she would start to agonize about it in ways that before were more of an annoyance in having to pay the wasteful govt so much $$$..she now was worrying about " having it all gathered up"..But no one put much on that as who in the right mind likes to figure out how much this govt is going to pick out of our pockets..BUT THEN she started to think those Publisher Clearing House things that came in the mail ( and later were under fire for this misrepresentation at least to the older folks) that said you MAY have won a million smakceroos,,,well she thought she really did...and we came later to find interest checks left undeposited....and then later she started ordering things and when the bill came wouldn't pay it..Thank goodness my brother who was local was able to sort that mess out ....but those were the fist clues something was wrong...It all happened in a fairly short span of time...maybe just a couple of years and then the disease went through her like Sherman"s march to the sea.
The clock draw can be scored a millions ways but I score it abnormal or normal. It tests a number of things from vision, to muscle/motor skills. It tests visual/spacial cognition, executive function (multistep commands), attention, memory. It does not test verbal cognition, speed.
It is a global test of cognition. used mainly to screen people who you think may have memory problems but can't tell easily. It does get worse as dementia progresses but it isn't so neat as the MMSE in scoring or monitoring progression.
If someone has all the numbers on the right side, you could worry about left sided neglect. One test is to have stand to their left and see if they pay attention to you less than when you stand on the right. Or if they think their left hand is not their own (common for some types of stroke). You could also draw a horizontal line and ask them to draw a line down the middle and see if they put it 1/4 of the way to the right. Things like that.
Just for fun (because this stuff is SO much fun,) I tried the horizontal line test. (ask him to draw a vertical line down the center of the paper.) Once he got the pen not upside-down he mostly tried to draw on the tablecloth instead of the paper, then finally drew a fairly vertical line, 2/3 of the way to the right, which started at the top and ran off onto the table. Ok, well what did I expect?
Because this has become the digital age, I have revised and updated the clock test to properly reflect the advance of digital time. Instead of drawing an obsolete old fashioned clock, the test is to have a patient write the time in digital format. For example, you ask the patient to write the time of 11:50. Score 10 points if they get it right. Score 5 points if they get it almost right. Score 2 points if they do not say "HUH?"
I have found that this simple modification increases the test score by 74%, and will vastly improve the mmse score. My research indicates that the typical patient will show vast signs of improvement. Further studies are underway to see if this simple change can prevent alzheimers, and whether this could actually cure this dreaded disease,,,,,