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Updated: Feb 17, 2026

Highlighting and Reducing the Impact of Negative Aging Stereotypes During Older Adults' Cognitive Testing
Published on: January 24, 2020
Specific algorithm method of scoring the Clock Drawing Test applied in cognitively normal elderly
Liana Chaves Mendes-Santos1, Daniel Mograbi1,2, Bárbara Spenciere3
1PhD, Department of Psychology, Pontifical Catholic University of Rio de Janeiro RJ, Brazil.
Abstract:
The Clock Drawing Test (CDT) is an inexpensive, fast and easily administered measure of cognitive function, especially in the elderly. This instrument is a popular clinical tool widely used in screening for cognitive disorders and dementia. The CDT can be applied in different ways and scoring procedures also vary.
Objective:
The aims of this study were to analyze the performance of elderly on the CDT and evaluate inter-rater reliability of the CDT scored by using a specific algorithm method adapted from Sunderland et al. (1989).
Methods:
We analyzed the CDT of 100 cognitively normal elderly aged 60 years or older. The CDT ("free-drawn") and Mini-Mental State Examination (MMSE) were administered to all participants. Six independent examiners scored the CDT of 30 participants to evaluate inter-rater reliability.
Results And Conclusion:
A score of 5 on the proposed algorithm ("Numbers in reverse order or concentrated"), equivalent to 5 points on the original Sunderland scale, was the most frequent (53.5%). The CDT specific algorithm method used had high inter-rater reliability (p<0.01), and mean score ranged from 5.06 to 5.96. The high frequency of an overall score of 5 points may suggest the need to create more nuanced evaluation criteria, which are sensitive to differences in levels of impairment in visuoconstructive and executive abilities during aging.

