Baycrest

BrainMatters • Fall/Winter 2022 • 11 Clock A: All 12 numbers on one side of the clock, indicating a planning problem Clock B: Clock with all zeros, indicating a language problem (difficulty producing numbers) Clock C: Spokes of a wheel clock, indicating perseveration (i.e., repeating an action without stopping — in this example, the interval marks extended to the centre of the clock) Clock D: Numbers drawn both inside and outside of the clock, indicating a visuospatial problem Source: Toronto Dementia Research Alliance, Scientist Explains, May 31, 2022. The origins of the clock drawing test are relatively unknown, but it is believed it was developed in the early 1900s. Since the first clinical mention of the test in the early 1950s (i.e., The Parietal Lobes by MacDonald Critchley), the test has since become one of the most widely used cognitive screening instruments in clinical and research settings. In 1994, Dr. Freedman published a book on clock drawing with a team of multidisciplinary experts. The book, Clock Drawing: A Neuropsychological Analysis, is a practical guide to the assessment of clock drawing, which takes a process-oriented approach to qualitative impairment. Dr. Freedman and his team also largely popularized the time setting for the test as 10 minutes after 11. At Baycrest, Dr. Freedman and his former fellow, Dr. Eslam Abdellah, are now leading a study, in conjunction with the Temerty Faculty of Medicine at the University of Toronto, which examines the sequencing of drawing a clock. This is to investigate whether the order in which people draw the different elements of the clock has any diagnostic value. This is being conducted with data from the TDRA Memory Clinics Database. Analyzing the clock involves the skill of looking at the process the person uses to draw their clock, and then determining what cognitive functions go into the process. Different types of errors point to different problems with brain functions. The problems most commonly identified using the clock test are executive dysfunctions, such as those used with planning, attention, repetitive behaviours and visuospatial deficits, such as the inability to identify visual and spatial relationships among objects. Some examples are described below:

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