DEMENTIA TEST INSTRUCTIONS

Please read and follow the steps below.

Important Note Before You Begin:

Terms & Conditions

I understand that this test cannot be a substitute for medical advice, diagnosis or treatment by a trained medical professional. Diagnosis and treatment of human illness should be based collectively on medical history, including family medical history, and a physical examination along with a doctor’s professional judgment and review of all test results. The material contained in this test does not contain standards that are meant to be applied rigidly and followed in virtually all cases. A doctors judgment must remain central to the selection of diagnostic tests and therapy options of a specific patient’s medical condition.

This test is provided AS IS, WITHOUT REPRESENTATION AS TO ITS FITNESS FOR ANY PURPOSE, AND WITHOUT WARRANTY OF ANY KIND, EITHER EXPRESS OR IMPLIED, INCLUDING WITHOUT LIMITATION THE IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE.

No guarantees are made with respect to accuracy, completeness, errors, or omissions of content. dementiatest.co.uk has no obligation to provide support, updates, enhancements, or other modifications. In no event will dementiatest.co.uk be liable for any decision made or action taken in reliance upon the information provided through the test. dementiatest.co.uk SHALL NOT BE LIABLE FOR ANY COMPENSATORY OR NON-COMPENSATORY DAMAGES, INCLUDING BUT NOT LIMITED TO SPECIAL, INDIRECT, INCIDENTAL, OR CONSEQUENTIAL DAMAGES, WITH RESPECT TO ANY CLAIM ARISING OUT OF OR IN CONNECTION WITH THE USE OF THE TEST, EVEN IF IT HAS BEEN OR IS HEREAFTER ADVISED OF THE POSSIBILITY OF SUCH DAMAGES.

If you decide to administer this memory test, and the results of the memory test seem suspicious, you should consult with your personal care assistant, doctor or neurologist for a more thorough memory examination and diagnosis.

By taking this test you hereby agree to the terms and conditions stated above.

1. INTRODUCTION

This test is called the 'Clock Drawing Test'.

The clock-drawing test is a good screening test for dementia and cognitive dysfunction. Doing the test requires verbal understanding, memory and spatially coded knowledge in addition to constructive skills.

Note: Education, age and mood can influence the test results, with subjects of low education, advanced age and depression performing more poorly.

2. BEFORE YOU TAKE THE TEST

When you are ready to take the test you should have:

• 1 x Print of the pre-drawn circle page (the last page in this file) • 1 x Pen• Somewhere where you can sit and write (e.g. table and chair)

3. TAKING THE CLOCK DRAWING TEST

Step 1: Give patient the sheet of paper with the pre-drawn circle on it.

Step 2: Instruct patient to draw numbers in the circle to make the circle look like the face of a clock.

Step 3:Then Instruct patient to draw the hands of the clock to read "10 after 11".

4. SCORING

Score the clock based on the following six-point scoring system:

Score the clock based on the following six-point scoring system:

Score

Error(s) Examples

1 "Perfect" No errors in the task 2 Minor visuospatial errors a) Mildly impaired spacing of times

b) Draws times outside circle c) Turns page while writing so that some numbers appear upside down d) Draws in lines (spokes) to orient spacing

3 Inaccurate representation of 10 after 11 when visuospatial organization is perfect or shows only minor deviations

a) Minute hand points to 10 b) Writes "10 after 11" c) Unable to make any denotation of time

4 Moderate visuospatial disorganization of times such that accurate denotation of 10 after 11 is impossible

a) Moderately poor spacing b) Omits numbers c) Perseveration: repeats circle or continues on past 12 to 13, 14, 15, etc. d) Right-left reversal: numbers drawn counterclockwise e) Dysgraphia: unable to write numbers accurately

5 Severe level of disorganization as described in scoring of 4

See examples for scoring of 4

6 No reasonable representation of a clock

a) No attempt at all b) No semblance of a clock at all c) Writes a word or name

5. TEST RESULTS

Patient Test Score:[ ]

Higher scores reflect a greater number of errors and more impairment.

A score of 1 or 2 is considered normal.

A score of ≥3 represents a cognitive deficit.

You should always consult with your personal care assistant, doctor or neurologist for a more thorough memory examination and diagnosis.

Pre-Drawn Circle Page