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Normative Norwegian scores on the clock drawing test using the Shulman version
Knut Engedal1,2, Jūratė Šaltytė Benth3,4, Anne-Brita Knapskog2,5
1The Norwegian National Center for Aging and Health, Vestfold Hospital Trust, Tønsberg, Norway.
Journal of Alzheimer'S Disease : JAD
|July 28, 2026
Summary
Normative data for the Clock Drawing Test (CDT) are essential, as performance varies with age and education. This study developed Norwegian CDT norms, revealing that scores of four or five are normal for individuals aged 60-90.
Area of Science:
- Neuroscience
- Gerontology
- Psychometrics
Background:
- Clock Drawing Test (CDT) performance is significantly influenced by demographic factors like age and educational attainment.
- Establishing normative data is crucial for accurate interpretation of CDT results.
- Previous research highlights the need for age- and education-adjusted norms.
Purpose of the Study:
- To establish normative scores for Shulman's version of the Clock Drawing Test (CDT) specifically for the Norwegian population.
- To provide age- and education-adjusted performance benchmarks for CDT.
- To aid in the accurate assessment of cognitive function using CDT in Norway.
Main Methods:
- Inclusion of 2572 cognitively healthy individuals aged 25–95 years in Norway.
- Utilization of ordinal regression analysis to derive regression-based norms.
- Inclusion of sex, age, and education as covariates in the normative model.
Main Results:
- A significant interaction between age and education was observed, impacting CDT scores.
- Higher CDT scores were associated with younger age and higher education levels.
- Scores of four and five were deemed normal for individuals aged 60–90 years, while lower scores indicated potential cognitive concerns depending on demographics.
Conclusions:
- Normative scores for the Clock Drawing Test (CDT) were successfully developed for the Norwegian population.
- Scores of four and five are considered normal for individuals aged 60-90, irrespective of other factors.
- A score of three requires careful consideration of sex, age, and education, while scores of zero to two are generally considered abnormal.
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