How To Score The Clock Drawing Test

Purpose

The CDT is used to quickly assess visuospatial and praxis abilities, and may make up one's mind the presence of both attention and executive dysfunctions (Adunsky, Fleissig, Levenkrohn, Arad, & Nov, 2002; Suhr, Grace, Allen, Nadler, & McKenna, 1998; McDowell, & Newell, 1996).

The CDT may be used in addition to other quick screening Testing for affliction in people without symptoms.
tests such as the Mini-Mental State Examination (MMSE), and the Functional Independence Measure (FIM).

In-Depth Review

Purpose of the measure

The CDT is used to quickly appraise visuospatial and praxis abilities, and may determine the presence of both attention and executive dysfunctions (Adunsky, Fleissig, Levenkrohn, Arad, & November, 2002; Suhr, Grace, Allen, Nadler, & McKenna, 1998; McDowell & Newell, 1996).

Bachelor versions

The CDT is a uncomplicated task completion exam in its most bones grade. There are several variations to the CDT:

Verbal control:

Gratis drawn clock:
The individual is given a blank sheet of paper and asked first to depict the confront of a clock, place the numbers on the clock, and so draw the hands to signal a given time. To successfully complete this chore, the patient must start describe the contour of the clock, and so identify the numbers 1 through 12 within, and finally indicate the correct time past cartoon in the easily of the clock.
Pre-drawn clock:
Alternatively, some clinicians prefer to provide the individual with a pre-drawn circumvolve and the patient is only required to place the numbers and the hands on the face of the clock. They argue that the patient'south ability to make full in the numbers may be adversely affected if the contour is poorly fatigued. In this task, if an private draws a completely normal clock, it is a fast indication that a number of functions are intact. However, a markedly abnormal clock is an important indication that the individual may have a cognitive deficit, warranting further investigation.

Regardless of which blazon is used (gratuitous drawn or pre-drawn), the exact command CDT tin simultaneously appraise a patient's language function (verbal comprehension); memory function (call up of a visual engram, short-term storage, and recall of fourth dimension setting instructions); and executive office. The verbal control variation of the CDT is highly sensitive for temporal lobe dysfunction (due to its heavy involvement in both memory and language processes) and frontal lobe dysfunction (due to its arbitration of executive planning Planning ability involves anticipating future events, formulating a goal or endpoint, and devising a sequence of steps or deportment that will achieve the goal or endpoint" (Anderson, 2008, p. 17)
) (Shah, 2002).

Copy control:

The individual is given a fully drawn clock with a certain time pre-marked and is asked to replicate the cartoon as closely as possible. The successful completion of the copy command requires less use of language and retention functions but requires greater reliance on visuospatial and perceptual processes.

Copy command clock

Clock reading test:
A modified version of the copy command CDT only asks the patient to read aloud the indicated time on a clock fatigued by the examiner. The copy control clock-drawing and clock reading tests are good for assessing parietal lobe lesions such every bit those that may result in hemineglect. It is important to do both the verbal command and the re-create command tests for every patient equally a patient with a temporal lobe lesion may re-create a pre-drawn clock adequately, whereas their clock drawn to verbal command may testify poor number spacing and incorrect time setting. Conversely, a patient with a parietal lobe lesion may draw an acceptable clock to verbal command, while their clock drawing with the copy command may testify obvious signs of neglect.

Time-Setting Instructions:

The nearly common setting chosen past clinicians is "3 O'clock" (Freedman, Leach, Kaplan, Winocur, Shulman, & Delis, 1994). Although this setting adequately assesses comprehension and motor execution, it does non indicate the presence of whatsoever left neglect the patient may have because it does not require the left one-half of the clock to be used at all. The fourth dimension setting "ten subsequently 11" is an ideal setting (Kaplan, 1988). It forces the patient to nourish to the whole clock and requires the recoding of the control "x" to the number "ii" on the clock. It too has the added advantage of uncovering whatever stimulus-bound errors that the patient may make. For example, the presence of the number "ten" on the clock may trap some patients and prevent the recoding of the command "10" into the number "2." Instead of drawing the minute hand towards the number "ii" on the clock to betoken "10 after," patients prone to stimulus-jump errors will fixate and draw the minute mitt toward the number "ten" on the clock.

Features of the mensurate

Scoring:

There are a number of dissimilar ways to score the CDT. In full general, the scores are used to evaluate any errors or distortions such as neglecting to include numbers, putting numbers in the wrong place, or having incorrect spacing (McDowell & Newell, 1996). Scoring systems may exist elementary or complex, quantitative or qualitative in nature. As a quick preliminary screening Testing for illness in people without symptoms.
tool to simply detect the presence or absenteeism of cognitive impairment, you may wish to apply a simple quantitative method (Lorentz et al., 2002). All the same, if a more complex assessment is required, a qualitative scoring system would exist more than telling.

Dissimilar scoring methods have been found to be better suited for dissimilar subject groups (Richardson & Glass, 2002; Heinrik, Solomesh, & Berkman, 2004). In patients with stroke Too chosen a "brain assail" and happens when brain cells die because of inadequate blood flow. xx% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. lxxx% of cases are also know equally a "schemic stroke", or the formation of a blood clot in a vessel supplying claret to the encephalon. More , no unmarried standardized method of scoring exists. Suhr, Grace, Allen, Nadler, and McKenna (1998) examined the utility of the CDT in localizing lesions in 76 patients with stroke Also called a "encephalon attack" and happens when brain cells die considering of inadequate blood flow. xx% of cases are a hemorrhage in the brain caused by a rupture or leakage from a claret vessel. lxxx% of cases are besides know equally a "schemic stroke", or the formation of a blood clot in a vessel supplying claret to the brain. More than and 71 controls. 6 scoring systems were used to assess clock drawings (Freedman et al., 1994; Ishiai, Sugishita, Ichikawa, Gono, & Watabiki, 1993; Mendez, Ala, & Underwood, 1992; Rouleau, Salmon, Butters, Kennedy, & McGuire, 1992; Sunderland et al., 1989; Tuokko, Hadjistavropoulos, Miller, & Beattie, 1992; Watson, Arfken, & Birge, 1993; Wolf-Klein et al., 1989). Significant differences were found between controls and patients with stroke As well chosen a "brain set on" and happens when encephalon cells die because of inadequate blood flow. xx% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. More than on all scoring systems for both quantitative and qualitative features of the CDT. Yet, quantitative indices were not helpful in differentiating between diverse stroke Also chosen a "encephalon attack" and happens when brain cells dice considering of inadequate blood flow. 20% of cases are a hemorrhage in the encephalon caused past a rupture or leakage from a blood vessel. lxxx% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the encephalon. More groups (left versus correct versus bilateral stroke Too called a "brain attack" and happens when brain cells die because of inadequate claret flow. twenty% of cases are a hemorrhage in the encephalon caused by a rupture or leakage from a blood vessel. lxxx% of cases are as well know equally a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. More ; cortical versus subcortical stroke Also chosen a "brain attack" and happens when brain cells dice because of inadequate blood menstruum. 20% of cases are a hemorrhage in the encephalon caused by a rupture or leakage from a blood vessel. fourscore% of cases are also know equally a "schemic stroke", or the germination of a blood clot in a vessel supplying blood to the brain. More than ; anterior versus posterior stroke Besides chosen a "brain attack" and happens when encephalon cells die because of inadequate blood menstruum. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are besides know as a "schemic stroke", or the formation of a claret clot in a vessel supplying blood to the brain. More than ). Qualitative features were helpful in lateralizing lesion site and differentiating subcortical from cortical groups.

A psychometric study in patients with stroke Also called a "encephalon assail" and happens when brain cells die considering of inadequate claret menstruation. 20% of cases are a hemorrhage in the brain acquired by a rupture or leakage from a blood vessel. 80% of cases are also know equally a "schemic stroke", or the germination of a blood jell in a vessel supplying claret to the brain. More by Southward, Greve, Bianchini, and Adams (2001) compared iii scoring systems: the Rouleau rating calibration (1992); the Freedman scoring system (1994), and the Libon revised system (1993). These scoring systems were plant to exist reliable in patients with stroke As well called a "brain set on" and happens when brain cells die because of inadequate blood flow. twenty% of cases are a hemorrhage in the encephalon acquired by a rupture or leakage from a claret vessel. lxxx% of cases are also know every bit a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the encephalon. More (please run into for the details of this study).

Subscales:

None typically reported.

Equipment:

Simply a paper and pencil is required. Depending on the method chosen, y'all may need to fix a circumvolve (well-nigh x cm in diameter) on the paper for the patient.

Training:

The CDT can be administered by individuals with little or no grooming in cognitive assessment. Scanlan, Castor, Quijano, & Borson (2002) found that a simple binary rating of clock drawings (normal or abnormal) by untrained raters was surprisingly constructive in classifying subjects as having dementia or not. In this study, a common error of untrained scorers was failure to recognize incorrect spacing of numbers on the clock confront as abnormal. By directing at this type of fault, concordance between untrained and adept raters should better.

Time:

All variations of the CDT should take approximately one-two minutes to complete (Ruchinskas & Curyto, 2003).

Alternative forms of the CDT

The Clock Drawing Test-Modified and Integrated Arroyo (CDT-MIA) is a iv-pace, 20-item instrument, with a maximum score of 33. The CDT-MIA emphasizes differential scoring of contour, numbers, easily, and center. It integrates 3 existing CDT'southward:

Freedman et al'due south free-fatigued clock (1994) on some item definitions
Scoring techniques adapted from Paganini-Hill, Clark, Henderson, & Birge (2001)
Some items borrowed from Royall, Cordes, & Polk (1998) executive CLOX

The CDT-MIA was institute to exist reliable and valid in individuals with dementia, however this measure has not been validated in the stroke Too called a "brain attack" and happens when encephalon cells die because of inadequate blood menses. 20% of cases are a hemorrhage in the brain caused past a rupture or leakage from a claret vessel. fourscore% of cases are besides know every bit a "schemic stroke", or the formation of a claret clot in a vessel supplying blood to the brain. More population (Heinik et al., 2004).

Client suitability

Can be used as a screening musical instrument with:

Nearly whatsoever patient population (Wagner, Nayak, & Fink, 1995). The test appears to exist differentially sensitive to some types of disease processes. Particularly, information technology has proven to exist clinically useful in differentiating amidst normal elderly, patients with neurodegenerative or vascular diseases, and those with psychiatric disorders, such every bit depression Illness involving the body, mood, and thoughts, that affects the manner a person eats and sleeps, the way one feels about oneself, and the fashion one thinks most things. A depressive disorder is not the same as a passing blueish mood or a sign of personal weakness or a status that can be wished abroad. People with a depressive disease cannot merely "pull themselves together" and get better. Without handling, symptoms tin can last for weeks, months, or years. Appropriate treatment, however, tin help well-nigh people with low.
and schizophrenia (Dastoor, Schwartz, & Kurzman, 1991; Heinik, Vainer-Benaiah, Lahav, & Drummer, 1997; Lee & Lawlor, 1995; Shulman, Gold, & Cohen, 1993; Spreen & Strauss, 1991; Tracy, De Leon, Doonan, Musciente, Ballas, & Josiassen, 1996; Wagner et al., 1995; Wolf-Klein, Silverstone, Levy, & Brod, 1989).

Can be used with:

Patients with stroke Also called a "brain set on" and happens when brain cells die because of inadequate claret menses. 20% of cases are a hemorrhage in the brain acquired by a rupture or leakage from a blood vessel. 80% of cases are besides know as a "schemic stroke", or the formation of a claret jell in a vessel supplying blood to the brain. More than . Because the CDT requires a nonverbal response, it may be administered to those with speech difficulties but who have sufficient comprehension to understand the requirement of the task.

Should not be used in:

Patients who cannot understand spoken or written instructions
Patients who cannot write

As with many other neuropsychological screening Testing for disease in people without symptoms.
measures, the CDT is afflicted by age, education, weather condition such as visual neglect and hemiparesis, and other factors such as the presence of depression Affliction involving the body, mood, and thoughts, that affects the way a person eats and sleeps, the fashion one feels near oneself, and the way ane thinks about things. A depressive disorder is not the aforementioned as a passing blue mood or a sign of personal weakness or a condition that tin can exist wished away. People with a depressive disease cannot merely "pull themselves together" and get ameliorate. Without treatment, symptoms can last for weeks, months, or years. Advisable treatment, all the same, can help most people with depression.
(Ruchinskas & Curyto, 2003; Lorentz, Scanlan, & Borson, 2002). The degree to which these factors bear upon ones score depends much on the scoring method applied (McDowell & Newell, 1996). Moreover, the CDT focuses on right hemisphere function, so it is of import to use this test in conjunction with other neuropsychological tests (McDowell & Newell, 1996).

In what languages is the mensurate available?

The CDT can be conducted in whatever linguistic communication. Borson et al. (1999) constitute that language spoken did not have any direct effect on CDT exam performance.

Summary

What does the tool measure out?	Visuospatial and praxis abilities, and may decide the presence of both attention and executive dysfunctions.
What types of clients can the tool be used for?	Most any patient population. It has proven to be clinically useful in differentiating among normal elderly, patients with neurodegenerative or vascular diseases, and those with psychiatric disorders, such as depression Affliction involving the torso, mood, and thoughts, that affects the way a person eats and sleeps, the way one feels about oneself, and the fashion 1 thinks about things. A depressive disorder is not the same as a passing bluish mood or a sign of personal weakness or a condition that tin be wished away. People with a depressive disease cannot only "pull themselves together" and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, yet, can help well-nigh people with depression. and schizophrenia.
Is this a screening Testing for disease in people without symptoms. or assessment tool?	Screening Testing for illness in people without symptoms.
Time to administrate	All variations of the CDT should take approximately 1-ii minutes to consummate.
Versions	Verbal command: Free drawn clock; Pre-fatigued clock; Re-create control: Copy command; Clock reading test Time-setting: "10 subsequently xi" The Clock Drawing Test Modified and Integrated Arroyo (CDT-MIA)
Languages	The CDT can be conducted in whatever linguistic communication.
Measurement Properties
Reliability Reliability tin be defined in a diversity of ways. It is generally understood to exist the extent to which a measure is stable or consequent and produces similar results when administered repeatedly. A more than technical definition of reliability is that it is the proportion of "truthful" variation in scores derived from a particular measure out. The total variation in any given score may be thought of as consisting of true variation (the variation of interest) and mistake variation (which includes random mistake as well as systematic fault). True variation is that variation which actually reflects differences in the construct under study, e.g., the actual severity of neurological impairment. Random error refers to "noise" in the scores due to chance factors, east.g., a loud racket distracts a patient thus affecting his performance, which, in turn, affects the score. Systematic fault refers to bias that influences scores in a specific management in a fairly consequent style, e.k., 1 neurologist in a grouping tends to rate all patients as being more disabled than practise other neurologists in the group. In that location are many variations on the measurement of reliability including alternate-forms, internal consistency , inter-rater agreement , intra-rater agreement , and test-retest .	Test-retest: Out of four studies examining test-retest reliability A way of estimating the reliability of a scale in which individuals are administered the same calibration on two different occasions and then the two scores are assessed for consistency. This method of evaluating reliability is appropriate only if the phenomenon that the scale measures is known to exist stable over the interval betwixt assessments. If the phenomenon being measured fluctuates substantially over time, so the test-retest epitome may significantly underestimate reliability. In using test-retest reliability, the investigator needs to take into business relationship the possibility of do furnishings, which can artificially inflate the estimate of reliability (National Multiple Sclerosis Society). , three reported excellent examination-retest and i found adequate examination-retest. Inter-rater: Out of 7 studies examining inter-rater reliability A method of measuring reliability . Inter-rater reliability determines the extent to which two or more than raters obtain the same outcome when using the same instrument to measure out a concept. , half-dozen reported excellent inter-rater and one reported acceptable (for examiner clocks) to excellent (for free-drawn and pre-drawn clocks inter-rater.
Validity The degree to which an assessment measures what information technology is supposed to measure.	Criterion: Predicted lower functional power and increased need for supervision on hospital discharge; poor physical ability and longer length of stay in geriatric rehabilitation; activities As defined by the International Classification of Functioning, Disability and Wellness, activity is the performance of a task or activity by an individual. Action limitations are difficulties in performance of activities. These are also referred to as office. of daily living at maximal recovery. Construct: The CDT correlated adequately with the Mini-Mental Land Test and the Functional Independence Measure out. Known groups: Meaning differences between Alzheimer'south patients and controls detected by CDT.
Does the tool detect change in patients?	Not applicable
Acceptability	The CDT is short and simple. It is a nonverbal task and may be less threatening to patients than responding to a series of questions.
Feasibility	The CDT is inexpensive and highly portable. It can be administered in situations in which longer tests would be impossible or inconvenient. Even the most complex administration and scoring system requires approximately two minutes. It tin can exist administered by individuals with minimal training in cognitive assessment.
How to obtain the tool?	A pre-fatigued circle tin be downloaded by clicking on this link: pre-drawn circle

Psychometric Properties

Overview

Until recently, data on the psychometric properties of the CDT were limited. While in that location are many possible ways to administrate and score the CDT, the psychometric backdrop of all the various systems seem consistent and all forms correlate strongly with other cognitive measures (Scanlan et al., 2002; Ruchinskas & Curyto, 2003; McDowell & Newell, 1996). Further, scoring of the CDT has been found to be both accurate and consistent in patients with stroke Likewise called a "brain set on" and happens when brain cells dice because of inadequate blood flow. 20% of cases are a hemorrhage in the brain acquired by a rupture or leakage from a blood vessel. lxxx% of cases are also know as a "schemic stroke", or the formation of a claret clot in a vessel supplying blood to the brain. More than (South et al., 2001).

For the purposes of this review, we conducted a literature search to place all relevant publications on the psychometric backdrop of the more commonly applied scoring methods of the CDT. We then selected to review articles from high affect journals, and from a variety of authors.

Reliability

Exam-retest:

Using Spearman rank order correlations of the CDT has been reported by several investigators using a variety of scoring systems:

Manos and Wu (1994) reported an "excellent" 2-day examination-retest reliability A mode of estimating the reliability of a scale in which individuals are administered the same scale on two unlike occasions and and then the two scores are assessed for consistency. This method of evaluating reliability is appropriate merely if the phenomenon that the scale measures is known to be stable over the interval between assessments. If the miracle beingness measured fluctuates substantially over time, so the exam-retest paradigm may significantly underestimate reliability. In using test-retest reliability, the investigator needs to accept into business relationship the possibility of practice furnishings, which tin artificially inflate the approximate of reliability (National Multiple Sclerosis Society).
of 0.87 for medical patients and 0.94 for surgical patients.
Tuokko et al. (1992) reported an "adequate" examination-retest reliability A way of estimating the reliability of a scale in which individuals are administered the same scale on ii different occasions and then the ii scores are assessed for consistency. This method of evaluating reliability is advisable merely if the phenomenon that the calibration measures is known to be stable over the interval between assessments. If the miracle being measured fluctuates substantially over fourth dimension, then the test-retest image may significantly underestimate reliability. In using test-retest reliability, the investigator needs to accept into business relationship the possibility of practice effects, which can artificially inflate the estimate of reliability (National Multiple Sclerosis Society).
of 0.70 at 4 days.
Mendez et al. (1992) reported and "fantabulous" coefficients of 0.78 and 0.76 at 3 and 6 months, respectively.
Freedman et al. (1994) reported test-retest reliability A manner of estimating the reliability of a scale in which individuals are administered the same scale on ii unlike occasions and so the two scores are assessed for consistency. This method of evaluating reliability is advisable but if the miracle that the calibration measures is known to be stable over the interval between assessments. If the phenomenon being measured fluctuates substantially over time, then the examination-retest paradigm may significantly underestimate reliability. In using exam-retest reliability, the investigator needs to have into account the possibility of practice effects, which tin artificially inflate the estimate of reliability (National Multiple Sclerosis Society).
as "very depression". However, when the "10 later on 11" time setting was used with the examiner clock, which is known to be a more sensitive setting for detecting cognitive dysfunction, test-retest reliability A way of estimating the reliability of a scale in which individuals are administered the aforementioned scale on 2 different occasions and so the two scores are assessed for consistency. This method of evaluating reliability is appropriate only if the phenomenon that the scale measures is known to exist stable over the interval between assessments. If the phenomenon being measured fluctuates essentially over fourth dimension, then the exam-retest paradigm may significantly underestimate reliability. In using test-retest reliability, the investigator needs to take into account the possibility of practice effects, which tin artificially inflate the estimate of reliability (National Multiple Sclerosis Society).
was institute to be "splendid" (0.94).

Inter-rater:

Inter-rater reliability A method of measuring reliability . Inter-rater reliability determines the extent to which two or more than raters obtain the aforementioned result when using the same musical instrument to mensurate a concept.
of the CDT, equally indicated by Spearman rank order correlations (not the preferred method of analyses for assessing inter-rater reliability A method of measuring reliability . Inter-rater reliability determines the extent to which ii or more raters obtain the same effect when using the same musical instrument to measure a concept.
but one used in earlier measurement research), has likewise been reported by several investigators:

Sunderland et al. (1989) institute "splendid" coefficients ranging from 0.86 to 0.97 and found no difference between clinician and non-clinician raters (0.84 and 0.86, respectively).
Rouleau et al. (1992) institute "excellent" inter-rater reliability A method of measuring reliability . Inter-rater reliability determines the extent to which ii or more than raters obtain the aforementioned result when using the same musical instrument to measure a concept.
, with coefficients ranging from 0.92 to 0.97.
Mendez et al. (1992) reported "fantabulous" inter-rater reliability A method of measuring reliability . Inter-rater reliability determines the extent to which two or more raters obtain the same result when using the same instrument to measure a concept.
of 0.94.
Tuokko et al. (1992) reported high coefficients ranging from 0.94 to 0.97 across 3 annual assessments.
The modified Shulman calibration (Shulman, Aureate, Cohen, & Zucchero, 1993) also has "excellent" inter-rater reliability A method of measuring reliability . Inter-rater reliability determines the extent to which two or more raters obtain the same result when using the same instrument to measure a concept.
(0.94 at baseline, 0.97 at 6 months, and 0.97 at 12 months).
Manos and Wu (1994) obtained "first-class" inter-rater reliability A method of measuring reliability . Inter-rater reliability determines the extent to which ii or more raters obtain the same result when using the same musical instrument to measure a concept.
coefficients ranging from 0.88 to 0.96.
Freedman et al. (1994) reported coefficients ranging from 0.79 to 0.99 on the free-drawn clocks, 0.84 to 0.85 using the pre-drawn contours, and 0.63 to 0.74 for the examiner clocks, demonstrating "excellent" inter-rater reliability A method of measuring reliability . Inter-rater reliability determines the extent to which two or more raters obtain the aforementioned event when using the same instrument to measure a concept.
.

Southward et al. (2001) compared the psychometrics of three unlike scoring methods of the CDT (Libon revised arrangement; Rouleau rating scale; and Freedman scoring system) in a sample of 20 patients with stroke Also chosen a "brain attack" and happens when brain cells die because of inadequate blood catamenia. twenty% of cases are a hemorrhage in the encephalon caused by a rupture or leakage from a claret vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood jell in a vessel supplying blood to the brain. More . Intra-rater reliability This is a type of reliability assessment in which the same cess is completed by the same rater on two or more occasions. These different ratings are then compared, generally past means of correlation. Since the same individual is completing both assessments, the rater'south subsequent ratings are contaminated by knowledge of earlier ratings.
were measured using the intraclass correlation coefficient (ICC) Intraclass correlation (ICC) is used to measure inter-rater reliability for two or more raters. It may besides be used to assess examination-retest reliability. ICC may exist conceptualized as the ratio of betwixt-groups variance to full variance. . Raters used comparable criteria for each score demonstrating "first-class" inter-rater reliability A method of measuring reliability . Inter-rater reliability determines the extent to which two or more raters obtain the aforementioned result when using the same instrument to measure a concept.
. Raters used like scoring criteria throughout, demonstrating "fantabulous" intra-rater reliability This is a type of reliability assessment in which the aforementioned assessment is completed by the aforementioned rater on two or more occasions. These different ratings are then compared, mostly past means of correlation. Since the same individual is completing both assessments, the rater'southward subsequent ratings are contaminated past knowledge of before ratings.
. South et al. (2001) concluded that while the Libon scoring organisation demonstrated a range of reliabilities beyond different domains, the Rouleau and Freedman systems were in the fantabulous range.

Validity

In a review, Shulman (2000) reported that virtually studies achieved sensitivities and specificities of approximately 85% and concluded that the CDT, in conjunction with other widely used tests such as the Mini-Mental Country Test (MMSE), could provide a significant advance in the early detection of dementia. In contrast, Powlishta et al. (2002) concluded from their written report that the CDT did non appear to be a useful screening Testing for illness in people without symptoms.
tool for detecting very balmy dementia. Other authors take concluded that the CDT should not exist used solitary as a dementia screening Testing for affliction in people without symptoms.
exam because of its overall inadequate performance (Borson & Brush, 2002; Storey et al., 2001). All the same, nigh of the previous studies were based on relatively minor sample sizes or were undertaken in a clinical setting, and their results may non be applicable to a larger community population.

Nishiwaki et al. (2004) studied the validity The degree to which an cess measures what it is supposed to measure.
of the CDT in comparison to the MMSE in a large general elderly population (aged 75 years or older). The specificity Specificity refers to the probability that a diagnostic technique volition indicate a negative test result when the status is absent-minded (true negative).
of the CDT for detecting moderate-to-astringent cognitive impairment (MMSE score = 17) were 77% and 87%, respectively, for nurse In charge of, merely not limited to, the "assessment and provision of care needs; support and education for patients and families; discharge planning."(Suggested by Philips et al, 2002)
administration and 40% and 91%, respectively, for postal administration. The authors conclude that the CDT may have value as a brief face-to-face screening Testing for disease in people without symptoms.
tool for moderate/severe cerebral impairment in an older community population only is relatively poor at detecting milder cerebral impairment.

Few studies have examined the validity The degree to which an assessment measures what it is supposed to measure out.
of the CDT specifically in patients with stroke Also called a "brain assail" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. More than . Adunsky et al. (2002) compared the CDT with the MMSE and cerebral Functional Independence Measure (FIM) (cognitive tests used for the evaluation of functional outcomes at discharge in elderly patients with stroke Also called a "brain assail" and happens when encephalon cells die because of inadequate blood menstruum. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. eighty% of cases are also know every bit a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. More than ). The tests were administered to 151 patients admitted for inpatient rehabilitation following an acute stroke Besides called a "brain set on" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the encephalon acquired by a rupture or leakage from a blood vessel. 80% of cases are besides know as a "schemic stroke", or the germination of a blood jell in a vessel supplying claret to the brain. More than . Correlation The extent to which ii or more than variables are associated with one another. A correlation can be positive (as one variable increases, the other too increases – for example height and weight typically represent a positive correlation) or negative (as i variable increases, the other decreases – for instance every bit the cost of gasoline goes higher, the number of miles driven decreases. At that place are a broad variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-social club correlation.
coefficients (Pearson correlation The extent to which two or more than variables are associated with one another. A correlation can exist positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for case as the cost of gasoline goes college, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-gild correlation.
) betwixt the three cerebral tests resulted in r-values ranging from 0.51 to 0.59. Adunsky et al. (2002) ended that they share a reasonable caste of resemblance to each other, accounting for "adequate" concurrent validity To validate a new mensurate, the results of the mensurate are compared to the results of the gold standard obtained at approximately the aforementioned point in fourth dimension (concurrently), so they both reflect the aforementioned construct. This approach is useful in situations when a new or untested tool is potentially more efficient, easier to administer, more applied, or safer than another more than established method and is being proposed as an alternative instrument. See as well "gold standard."
of these tests.

Bailey, Riddoch, and Crome (2000) evaluated a test bombardment for hemineglect in elderly patients with stroke Too called a "brain attack" and happens when encephalon cells dice because of inadequate blood period. xx% of cases are a hemorrhage in the encephalon caused by a rupture or leakage from a blood vessel. 80% of cases are likewise know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. More and determined that the CDT had questionable validity The degree to which an assessment measures what it is supposed to mensurate.
in the cess of representational neglect. Further, consistent with previous findings (Ishiai et al., 1993; Kaplan et al., 1991), the utility of the CDT as a screening Testing for illness in people without symptoms.
mensurate for neglect was not supported from these results. Reasons include the subjectivity in scoring, and questionable validity The degree to which an assessment measures what it is supposed to measure.
in that the chore may also reverberate cognitive damage (Freidman, 1991), constructional apraxia, or impaired planning Planning ability involves anticipating time to come events, formulating a goal or endpoint, and devising a sequence of steps or actions that volition attain the goal or endpoint" (Anderson, 2008, p. 17)
ability (Kinsella, Packer, Ng, Olver, & Stark, 1995).

Responsiveness

Not applicable.

References

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See the measure

Click hither to find a pre-drawn circle that tin can be used when administering the CDT.

Source: https://strokengine.ca/en/assessments/clock-drawing-test-cdt/

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