Cohort effects in cognitive screening: evidence for analog familiarity influencing Clock Drawing Test performance

The Clock Drawing Test (CDT) is widely used as a brief cognitive screening measure in aging and neuropsychological populations, yet its validity depends on the assumption that analog time representation is universally understood. This assumption may not hold for younger cohorts raised in predominantly digital environments. The present study examined whether CDT performance reflects cognitive ability or familiarity with analog time representation in Generation Z adults. A within-subjects design was employed in which 84 participants completed the CDT, a visuospatial comparison task, Pizza Test, and an Analog Clock Literacy Questionnaire (ACLQ). Participants obtained higher scores on the Pizza Test than on the CDT, t(83) = 15.06, p < .001, d = 1.64. More importantly, analog-clock literacy significantly predicted CDT performance but did not predict Pizza Test performance. These findings indicate that CDT performance is partially influenced by cohort-specific experience rather than cognitive ability alone, suggesting a potential threat to construct validity. As digitally native cohorts age into populations routinely screened for cognitive impairment, reliance on analog-based tasks may warrant reconsideration to ensure valid and equitable assessment practices.