Development of scoring criteria for the clock drawing task in Alzheimer's disease

J Am Geriatr Soc. 1992 Nov;40(11):1095-9. doi: 10.1111/j.1532-5415.1992.tb01796.x.


Objective: To investigate the reliability and validity of free-hand clock drawings, a frequently used measure of constructional apraxia, in patients with Alzheimer's disease.

Design: Survey for the purpose of testing reliability and validity of a new scale.

Setting: Memory Disorder Clinic at a university-affiliated hospital in the Upper Midwest.

Patients: Forty-six patients were diagnosed with clinically probable dementia of the Alzheimer type after a dementia evaluation, and 26 normal elderly controls were research volunteers without a history of cognitive dysfunction.

Measurements: Neuropsychological tests, dementia-related scales, and clock drawings rated by a new 20-item Clock Drawing Interpretation Scale. Reliability measures, correlations, and clustering of items in the CDIS.

Results: The CDIS had inter-rater reliability (r = .94), internal consistence (rtt = .95), and reproducibility over a 6-month interval. CDIS scores were significantly correlated with two dementia-related scales and all neuropsychological tests and had the highest correlations with other measures of constructional apraxia. All but four Alzheimer patients (91%) and none of the controls had CDIS scores of 18 or less.

Conclusion: Clinicians may reliably screen patients with Alzheimer's disease with the clock-drawing task, a measure sensitive to deficits in constructional apraxia.

MeSH terms

  • Activities of Daily Living
  • Aged
  • Aged, 80 and over
  • Alzheimer Disease / complications
  • Alzheimer Disease / diagnosis*
  • Alzheimer Disease / epidemiology
  • Apraxias / diagnosis*
  • Apraxias / epidemiology
  • Apraxias / etiology
  • Art*
  • Evaluation Studies as Topic
  • Female
  • Humans
  • Male
  • Mass Screening
  • Mental Status Schedule / standards
  • Middle Aged
  • Neuropsychological Tests / standards*
  • Observer Variation
  • Reproducibility of Results
  • Sensitivity and Specificity