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Updated: Jun 10, 2026

The 4 Mountains Test: A Short Test of Spatial Memory with High Sensitivity for the Diagnosis of Pre-dementia Alzheimer's Disease
Published on: October 13, 2016
The four-point scoring system for the clock drawing test does not differentiate between Alzheimer's disease and
April R Wiechmann1, James R Hall, Sid O'Bryant
1University of North Texas Health Science Center, Fort Worth, TX 76107, USA.
Abstract:
The purpose of this study was to explore the sensitivity and specificity of the Clock Drawing Test by using a widely employed four-point scoring system to discriminate between patients with Alzheimer's disease or vascular dementia. Receiver operating characteristic analysis indicated that the Clock Drawing Test was able to distinguish between normal elders and those with a dementia diagnosis. The cutoff score for differentiating patients with Alzheimer's disease from normal participants was < or =3. The cutoff score for differentiating those with vascular disease from normal participants was < or =3. Overall, the four-point scoring system demonstrated good sensitivity and specificity for identifying cognitive dysfunction associated with dementia; however, the current findings do not support the utility of the four-point scoring system in discriminating Alzheimer's disease and vascular dementia.
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