{"id":2752,"date":"2024-11-27T17:16:21","date_gmt":"2024-11-27T17:16:21","guid":{"rendered":"https:\/\/news.psva.org\/?p=2752"},"modified":"2024-11-27T17:48:29","modified_gmt":"2024-11-27T17:48:29","slug":"the-future-of-the-cdt","status":"publish","type":"post","link":"https:\/\/news.psva.org\/?p=2752","title":{"rendered":"The Future of the CDT"},"content":{"rendered":"\n

By Jason Burton, MD<\/strong>
VCU Health System
Richmond, VA<\/em><\/p>\n\n\n\n

Recently, while teaching medical students the Clock Drawing Test (CDT), I realized I was surrounded by a group wearing smartwatches. This made me reflect on something I\u2019ve thought about before, but that felt particularly relevant that day: Is the CDT becoming outdated? Even the phrasing we use when describing the time\u2014\u201dmake it 10 past 11\u201d\u2014seems antiquated and might not be understood by future generations. While there\u2019s no impending crisis of inability to assess cognitive dysfunction if the CDT becomes extinct, I can\u2019t help but feel a bit nostalgic when considering the future of the CDT. I think the CDT\u2019s days may be numbered.<\/p>\n\n\n\n

That said, for now, the CDT remains a simple yet invaluable tool for assessing cognitive function, and it\u2019s certainly worth revisiting and reviewing as we continue using it in clinical practice.<\/p>\n\n\n\n

The CDT is widely used in psychiatry to evaluate executive functions, spatial awareness, and overall cognitive abilities. Developed in the 20th century and popularized in the 1980s, it serves as a quick, effective method for screening patients for signs of cognitive impairment, especially among older adults at risk for dementia and Alzheimer\u2019s disease.1<\/sup> For psychiatrists, the CDT provides a unique window into the cognitive functions that more traditional methods, such as questionnaires, may not fully reveal. The CDT is versatile, easy to administer, adaptable to various clinical settings, and cheap. It is best used as part of a larger neuropsychological evaluation, complemented by tests like the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA).<\/p>\n\n\n\n

The CDT is straightforward: patients are given a blank sheet and asked to draw a clock showing a specified time, usually \u201c10 past 11.\u201d They must draw a circle, place numbers accurately within the circle, and position the hands correctly. This seemingly simple task assesses several cognitive domains, including visuospatial skills, planning, and numerical sequencing. <\/p>\n\n\n\n

Interpreting the CDT requires nuance, as it is not particularly sensitive or specific for pinpointing dysfunction in one particular brain area.2<\/sup> Instead, it offers a general glimpse into cognitive function, adding information to be considered within the larger clinical picture. Still, certain common errors can hint at specific cognitive dysfunctions or suggest the involvement of certain brain regions. Here are some common CDT mistakes and the types of disorders in which they appear.<\/p>\n\n\n\n

Pull-to-Stimulus Error<\/strong>
When giving the instruction\u2014\u201ddraw a clock and set it to 10 past 11\u201d\u2014the numbers \u201c10\u201d and \u201c11\u201d serve as stimuli. A person with frontal lobe dysfunction may place the clock hands on the 10 and 11, rather than correctly setting the long hand on the 2. This error, known as \u201cpull-to-the-stimulus,\u201d reflects the frontal lobe\u2019s role in inhibiting this automatic response and correctly interpreting the task.<\/p>\n\n\n\n

\"\"<\/figure>\n\n\n\n

Perseveration<\/strong>
Drawing multiple hands, multiple circles, or continuing to place numbers past 12 may indicate perseveration from a poorly functioning frontal lobe.\u00a0<\/p>\n\n\n\n

\"\"<\/figure>\n\n\n\n

Spatial and Planning Deficits<\/strong>
Spatial and planning deficits appear as layout errors in the clock drawing. Common examples include neglecting the left side of the clock, uneven spacing between numbers, disorganized arrangement, and numbers placed outside the clock face. These deficits are more frequently observed in Alzheimer\u2019s disease (AD) compared to other dementias or might be due to a stroke.3<\/sup> Such errors often arise from impairments in the non-dominant right hemisphere, especially the right parietal lobe.<\/p>\n\n\n\n

\"\"<\/figure>\n\n\n\n

Graphical Difficulties<\/strong>
Graphical difficulties occur when lines lack precision, causing distortions in the clock face or making numbers challenging to read. The clock hands may appear uneven\u00a0or jagged or not meet at the center. Although the drawing typically remains identifiable as a clock, it seems inaccurate overall. These graphical errors are more frequently seen in conditions like Huntington\u2019s disease and vascular dementia.4<\/sup><\/p>\n\n\n\n

\"\"<\/figure>\n\n\n\n

References<\/strong><\/p>\n\n\n\n

    \n
  1. Hazan E, Frankenburg F, Brenkel M, Shulman K. The test of time: a history of clock drawing. Int J Geriatr Psychiatry<\/em>. 2018 Jan;33(1):e22-e30. doi: 10.1002\/gps.4731. Epub 2017 May 26. PMID: 28556262.<\/li>\n\n\n\n
  2. Heyrani R, Sarabi-Jamab A, Grafman J, Asadi N, Soltani S, Mirfazeli FS, Almasi-Dooghaei M, Shariat SV, Jahanbakhshi A, Khoeini T, Joghataei MT. Limits on using the clock drawing test as a measure to evaluate patients with neurological disorders. BMC Neurol.<\/em> 2022 Dec 31;22(1):509. doi: 10.1186\/s12883-022-03035-z. PMID: 36585622; PMCID: PMC9805016.<\/li>\n\n\n\n
  3. Blair M, Kertesz A, McMonagle P, et al: Quantitative andqualitative analyses of clock-drawing in frontotemporal de-mentia and Alzheimer\u2019s disease. J Int Neuropsychol Soc<\/em> 2006;12:159\u2013165<\/li>\n\n\n\n
  4. Kitabayashi Y, Ueda H, Narumoto J, et al: Qualitative analysesof clock-drawings in Alzheimer\u2019s disease and vascular de-mentia. Psychiatry Clin Neurosci<\/em> 2001; 55:485\u2013491
    <\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

    By Jason Burton, MDVCU Health SystemRichmond, VA Recently, while teaching medical students the Clock Drawing Test (CDT), I realized I was surrounded by a group wearing smartwatches. This made me reflect on something I\u2019ve thought about before, but that felt particularly relevant that day: Is the CDT becoming outdated? Even the phrasing we use when […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[65],"class_list":["post-2752","post","type-post","status-publish","format-standard","hentry","category-uncategorized","tag-winter-2024"],"yoast_head":"\nThe Future of the CDT - PSV News<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/news.psva.org\/?p=2752\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"The Future of the CDT - PSV News\" \/>\n<meta property=\"og:description\" content=\"By Jason Burton, MDVCU Health SystemRichmond, VA Recently, while teaching medical students the Clock Drawing Test (CDT), I realized I was surrounded by a group wearing smartwatches. 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