Quantitative and qualitative performance of stroke versus normal elderly on six clock drawing systems

The utility of the Clock Drawing Test (CDT) in localizing lesions has not been thoroughly examined to date. In the present study, six scoring systems (Freedman et al., 1994; Ishiai, Sugishita, Ichikawa, Gono, & Watabiki, 1993; Mendez, Ala, & Underwood, 1992; Rouleau, Salmon, Butters, Kennedy, & McGuife, 1992; Sunderland et al., 1989; Tuokko, Hadjistavropoulos, Miller, & Beattie, 1992; Watson, Arfken, & Birge, 1993; Wolf-Klein, Silverstone, Levy, & Brod, 1989) were used to assess clock drawings by 76 stroke patients and 71 normal controls. Significant differences were found between normals and stroke patients on all scoring systems for both quantitative and qualitative features of the CDT. Quantitative indices were not helpful in differentiating between various stroke groups (left versus right versus bilateral stroke; cortical versus subcortical stroke; anterior versus posterior stroke). Qualitative features were helpful in lateralizing lesion site and differentiating subcortical from cortical groups. Correlational analyses revealed that CDT performance was related to visuospatial processing and measures commonly used in cognitive screening.