The most commonly utilized system of qualitative clock-drawing errors was described by Rouleau. The wide variability in how clock-drawing tests are administered and scored is beyond the scope of this review. The focus of this review is to present the major qualitative clock-drawing errors and the evidence linking performance with neuroanatomy. It also has great educational value for patients’ families and in teaching trainees, as it provides an easily understood demonstration of subtle cognitive deficits sometimes challenging to identify in a routine bedside exam. 5 Documenting the type of clock-drawing errors can contribute to the clinical evaluation of patients with suspected neuropsychiatric disorders and syndromes, both in the initial and subsequent assessments. Shulman’s review, concluding that clock-drawing tests are complementary to the Mini-Mental State Exam (MMSE) and provide a significant advance in the early detection of dementia and monitoring cognitive change, also noted that a simple scoring system with emphasis on the qualitative aspects of clock-drawing should maximize its utility. 10– 12 At least 13 scoring systems have been introduced over the years. For example, recent studies have reported the use of a clock-drawing test for diagnosing and grading the severity of hepatic encephalopathy, predicting rehabilitation outcomes after traumatic brain injury (TBI), and assessing functional status in veterans with deployment-related mild TBI. 7– 9 Although the majority of studies utilize the clock-drawing test to assess cognition in the context of screening for dementia, other conditions have also been evaluated. 5, 6 Although in use since the 1960s, it was made popular in 1983, when Goodglass and Kaplan incorporated it into the Boston Aphasia Battery. 4 Reviews of the research literature support its use as a reliable screening tool for cognitive dysfunction, particularly for dementia. 2020 323(8):764-785.Clock-drawing is a simple and effective test to include in the neuropsychiatric assessment of patients. Screening for cognitive impairment in older adults: updated evidence report and systematic review for the US Preventive Services Task Force. Practice guideline update summary: mild cognitive impairment: report of the guideline development, dissemination, and implementation subcommittee of the American Academy of Neurology. Petersen RC, Lopez O, Armstrong MJ, et al. Brief cognitive tests for distinguishing clinical Alzheimer-type dementia from mild cognitive impairment or normal cognition in older adults with suspected cognitive impairment. Hemmy LS, Linskens EJ, Silverman PC, et al. 2020 Alzheimer's disease facts and figures. Rockville, Md.: Agency for Healthcare Research and Quality April 2020. (Prepared by the Minnesota Evidence-based Practice Center under contract no. Diagnosis and treatment of clinical Alzheimer's-type dementia: a systematic review. Jay Siwek, MD, Editor Emeritus Sumi Sexton, MD, Editor-in-Chiefįink HA, Hemmy LS, Linskens EJ, et al. As long as copyright holders of these tools restrict their use, clinicians should know that there are alternatives to the MMSE and MoCA, including the Saint Louis University Mental Status examination. This commercialization of a cognitive screening test seems antithetical to the advancement of science and the practice of medicine. The training is one hour, and the cost is $125 for the initial two years of certification, which will then require renewal. The creators of the Montreal Cognitive Assessment (MoCA) have followed suit by requiring training and certification to administer the test with restricted use starting in 2021. PAR insists that all users register with their site, complete a four-page permissions request form, and purchase MMSE forms ($99 for 50 forms) and a test manual ($114). Folstein and others) began enforcing its copyright and in 2001 arranged for Psychological Assessment Resources (PAR) to manage worldwide rights. The Mini-Mental State Examination (MMSE) had been freely available and widely disseminated after first being released in 1975. Wechsler Memory Scale logical memory Wechsler Adult Intelligence Scale digital symbol Boston Naming Test 60Įditor's Note: Dr. Trail Making Test part B, completion time Median prevalence of clinical Alzheimer-type dementia (range)
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