Thus, novice raters may have difficulty reliably scoring clocks. slight imperfection on closing the circle)’. ‘the clock face must be a circle with only minor distortion acceptable (e.g. Criteria appear open to interpretation, e.g. Likely to maximize clinical time, clock scoring criteria are basic with 1 point per clock contour, numbers and hands. Within the MoCA, clock drawing is one test item involving 3 of the total 30 points possible. Consider the modern dementia screening test, the Montreal Cognitive Assessment (MoCA ), which has gained popularity due to its clinical value over the Mini Mental State Examination (MMSE). This makes it difficult to accurately follow patients longitudinally for clinical change or to compare patient groups. Without assessing one’s reliability for test scoring, there is questionable validity. This should be a primary consideration when employing cognitive tests. Thus, when command and copy conditions are used together, clock drawing appears particularly helpful for differentiating dementia subtypes.įirst, clinicians using clock drawing rarely consider rater/scorer reliability. Alzheimer’s disease, AD) typically improve from command to copy. By contrast, individuals with less executive dysfunction relative to other domains of cognitive impairment (e.g. In dementia, poor command and copy performance is often seen among individuals with frontal system deficits like Parkinson’s disease with dementia (PDD) or Huntington’s disease. They present with an inability to improve in their drawing despite the presentation of a clock model errors from the command condition are transferred to the copy condition. Individuals with deficits in visuospatial and executive functions typically perform poorly on command and copy conditions. While the command condition requires numerous cognitive functions, the copy condition largely draws upon visuospatial and executive functions. On a separate sheet, patients then copy a predrawn clock model. As classically defined by Edith Kaplan (1988), clock test administration involves first commanding patients to ‘draw the face of a clock with all the numbers and set the two hands to 10 after 11’. Clock drawing is considered particularly beneficial for dementia assessment when both command and copy conditions are used and analyzed for errors.

Interpreting moca test scores