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Clock Test for Dementia

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Are you worried that someone you may know and care for might have dementia? This is a common concern, especially as the people close to you age and start becoming more forgetful. The good news is, there is a simple test you can perform to find out if there is cause for your worry or not.

The clock test for dementia is a simple, non-scientific way to screen for cognitive decline. These drawing tests can be done at home or in clinical settings to get a better idea of whether someone may have a condition like dementia or Alzheimer’s disease.

If your loved one fails the clock test, it could be an indicator of dementia. Dementia is a broad term used to describe a decline in cognitive abilities and can include problems with memory, language, and thinking.

Of course, there are other reasons why someone might fail the clock test. A poor result doesn’t necessarily mean they have dementia.

For example, someone might fail the test if they’re very tired or under a lot of stress. Age can also play a role. As we get older, our executive function skills naturally decline.

The clock drawing test is not diagnostic on its own, but can be used as part of a wider assessment to help identify early signs of dementia or other forms of cognitive decline. This simple tool can also be used to monitor the progression of dementia over a particular time.

While this test is not the final say in a dementia diagnosis, it can let you know if it’s time to consider a cognitive assessment for your loved one. Whether you are a caretaker or are simply worried about a family member, keep reading to learn more about the clock test for dementia so you’ll know when it is time to seek medical help for suspected dementia or Alzheimer’s disease.

What is the Clock Test for Dementia?

As we said in the introduction, the clock test for dementia is a simple way to help identify older adults who may need further dementia screening.

There are several forms of the test, any of which can be administered from the comfort of your home when you suspect a friend or a family member is experiencing some cognitive dysfunction.

Again, I would caution you that the test is not a definitive test. There are many different tests that can be used to detect dementia and the clock test is just one of them.

Others include the Montreal Cognitive Assessment (MoCA) and the Mini-Mental State Examination (MMSE). A dementia diagnosis will only be made after a person has undergone a full clinical assessment.

The digital clock-drawing test specifically measures executive function. Executive function includes things like planning, organization, and flexibility. These skills often decline in people with dementia. So, if someone fails the clock test, it may be an early sign of the condition.

How does the test work? There are a number of variations of the clock test, but all follow the same basic premise.

The aim is to gauge whether the individual can correctly execute a simple clock drawing task. If they are unable to complete the drawing correctly, it may be an indication that they are experiencing cognitive decline.

To do the test, you will need a piece of paper and a pen or pencil.

The screening test starts with you telling the person who is taking the test that you’re giving them a list of 3 (unrelated) words that you want them to remember. Have them listen to these words and then repeat them back to you.

Next, ask the person to draw the face of a clock on the piece of paper (a circle with the numbers of the clock in the correct position).

Or you can provide them with a pre-drawn clock face (without the hour and minute hand on them). Simply draw a circle on the paper, and then draw the numbers 1-12 around the edge of the circle.

After this, ask the person to draw clock hands on the drawing to represent a specific time. You’ll want to do so in a way that is both ambiguous and clear at the same time.

For example, you can ask them to draw “half past six” or “ten past four.” This way they will have to employ a little bit of critical thinking to come up with the answer.

Once they have done this, ask the person to recite the time aloud. Follow this by having them repeat the list of three unrelated words you gave them at the beginning of the test.

How Do You Score The Clock Draw Test?

Just as there are several forms of the clock drawing test, there are several scoring systems to determine the test results. Some are a little convoluted, too! Because the idea is just to find out if the person may need to have more in-depth testing done, the Alzheimer’s Association recommends using a simple method of scoring.

Per the Oregon Health and Science University, to score the results of the Clock Drawing Test for Dementia, you start by counting each word the person remembered correctly (total possible score = 3).

Next, look at three things in their clock face drawings: the clock face, the hands, and the numbers.

  • For the clock face, you are looking for whether or not all 12 numbers are included, and whether or not they are in the right place.
  • For the hands, you are looking to see if they are drawn in the right place and pointing to the correct numbers / time.
  • For the numbers, you are looking to make sure that they are legible and in order. Is the clock drawn in a fairly symmetrical way?

Scores:

  • A word recall score of 0 suggests the person should be screened for dementia.
  • If there are significant differences in the clock face along with a word recall score of 1 or 2, the person should be screened.
  • If there are no (or minor) differences in the clock face and a word score of 1 or 2, dementia screening is not indicated.
  • A score of 3 indicates normal cognition and no need for screening.

What Does It Mean If You Fail the Clock Drawing Test?

 If you have performed the clock drawing test on a friend or family member, you may become concerned if they draw an abnormal clock or different times than you request.

While this may indicate that your loved one is suffering from dementia or Alzheimer’s, this isn’t always the case. This is because the clock test only tests for cognitive deficits, not a particular disease.

To perform well on the clock test, your loved one must first understand your verbal instructions so they know what you want them to do. They also must have spatial knowledge, visual memory, and the ability to think abstractly. If they are missing even one of these things, they will be unable to perform well on the clock test.

A failed clock test could indicate Parkinson’s Disease, Huntington’s Disease, Alzheimer’s disease, vascular dementia, frontotemporal dementia, or dementia with Lewy bodies, depending on which aspects of the clock the individual is able to complete.

This is why you shouldn’t treat the failed clock test as the absolute answer as to whether or not your loved one has dementia. Instead, you should think of a failed clock test as a sign that your loved one needs some professional help.

How Accurate is the Clock Test for Dementia?

As mentioned above, the clock drawing test is not the absolute answer whether or not your loved one has dementia or not. While the clock drawing test is accurate in terms of knowing if there is something wrong, it is important not to treat the test as an actual diagnosis of dementia.

Indeed, there is some conflict about its accuracy between recent studies and previous studies. Some say it’s a great tool, others dispute this – especially where very mild cognitive impairment is concerned.

For example, one study that was published in 2002 in the journal, Neurology, evaluated the accuracy of the clock drawing test in diagnosing dementia. It concluded that, “Although the clock drawing test can be scored reliably and can differentiate cognitively normal older adults from those with at least mild dementia of the Alzheimer type, it does not appear to be a useful screening instrument for detecting very mild dementia.”

A more recent study by Kim, et al, and published in Dementia And Neurocognitive Disorders in 2018 concluded that, “The results demonstrated that the CDT [clock drawing test] is a useful cognitive screening tool that is comparable with the Mini-Mental State Examination, and that simple CDT scoring systems are sufficient for differentiating patients with MCI [mild cognitive impairment] and mild dementia from CN [cognitively normal adults].”

That said, the Alzheimer’s Association endorses the clock test, again, as one component of a battery of neuropsychological tests for measuring cognitive function.

So if you choose to try the test on a loved one you are concerned about, and they fail it, be sure to make an appointment for them with a doctor.

Let the doctor know about the failed clock test, and they will perform further tests to be able to evaluate the state of your loved one’s mind more in depth. They will then provide a medical diagnosis.

TIP: if your loved one does get a definite dementia diagnosis, there are many scenarios to start planning for. One of the first things you should do is to set up a power of attorney. You can read more here.

What is the Standard Test for Dementia (Instead of the Clock Test)?

The standard test used for dementia over the clock drawing test is something called the MMSE or Mini-Mental State Examination. This test shouldn’t take too long, and it is one of the most efficient tests for dementia.

This test is almost always performed by a doctor or mental health professional and should not be attempted to be performed at home. It is the most common screening tool for dementia and assesses numerous skills.

This test is made up of a series of questions that will gauge what information the patient knows about the world around them. The first set of questions is about the date, time, and location where the patient is taking the test.

Next, the examiner will gauge mental acuity by asking the patient to perform a task. This task is usually to count backwards from a certain number, or to spell a certain word. The test also evaluates whether or not the patient can remember facts they stated earlier in the test.

Late on, the examiner will begin asking the examinee to read, draw, and follow verbal directions. This helps the doctor to know exactly where the issues are in the patient’s mind.

The results of this test will not only let the examiner know if the individual taking the test has dementia or not, but it will additionally tell them the severity of the dementia, as there are points awarded for each of the tasks.

Final Thoughts

Thinking your loved one may have dementia or Alzheimer’s disease is a scary thing. If you’re worried about them, you can try giving the person the clock test at home to either confirm or ease your worries.

It is critical to remember however, that the clock test is not an official diagnostic test. If your loved one fails the clock test, this is a sign that something is wrong and that you should seek medical help. Once you do, a qualified professional will administer an Mini-Mental State Examination. The MMSE scores will help them determine whether or not your loved one is truly suffering from dementia.

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