Objective: The Clock Drawing Test (CDT) is a widely-used, brief screening measure for detecting cognitive decline. Due to the simplicity of the CDT, multiple scoring methods have been developed. While these methods vary in complexity and utility, most are subjective and lack sensitivity in detecting subtle differences in CDT performance. The purpose of this study was to introduce and explore the accuracy of the Gardony Map Drawing Analyzer (GMDA; Gardony et al., 2013), an open-source software system designed to analyze visuospatial reasoning and memory, in discriminating impaired CDT performance between simulated clinical groups from normal performance. Method: For this study, three doctoral-level neuropsychological experts were asked to draw 84 unique clocks representing stereotypical performance for three clinical groups (dementia, mild cognitive impairment (MCI), and hemispatial neglect) and a normal performance group. Each clock was assigned a random identification number to blind the conditions. The clocks were scored independently using GMDA and two semi-quantitative CDT scoring methods (Sunderland et al., 1989; Lin et al., 2002). Results: Descriptive and correlational analyses explored relationships between GMDA and other scoring methods. A discriminant function analysis (DFA) assessed multivariate differences in CDT scores between the three scoring methods. GMDA scores provided the most accurate discrimination among the four groups, correctly classifying 71.4% cases compared to 70.2% and 56.0% for the other scoring methods. Conclusion: Overall, this study shows preliminary evidence that the GMDA CDT scoring system provides additional and unique information in detecting differences among CDT performances. Future research is required to examine GMDA CDT scores among genuine clinical populations.

Supplemental tables for discriminant function analyses between the three Clock Drawing Test scoring methods

Table 1.

Discriminant function analysis predictions of group membership for GMDA CDT scoring system

 Predicted Group Membership
 
Group Normal MCI Dementia Neglect 
Normal (n = 21) 17 (81%) 4 (19%) 0 (0%) 0 (0%) 
MCI (n = 21) 6 (29%) 12 (57%) 3 (14%) 0 (0%) 
Dementia (n = 21) 0 (0%) 7 (33%) 13 (62%) 1 (38%) 
Neglect (n = 21) 0 (0%) 0 (0%) 3 (14%) 18 (62%) 
 Predicted Group Membership
 
Group Normal MCI Dementia Neglect 
Normal (n = 21) 17 (81%) 4 (19%) 0 (0%) 0 (0%) 
MCI (n = 21) 6 (29%) 12 (57%) 3 (14%) 0 (0%) 
Dementia (n = 21) 0 (0%) 7 (33%) 13 (62%) 1 (38%) 
Neglect (n = 21) 0 (0%) 0 (0%) 3 (14%) 18 (62%) 

Note: N = 84. GMDA = Gardony map drawing analyzer. CDT = Clock Drawing Test. MCI = Mild cognitive impairment. 71.4% of original grouped cases correctly classified.

Table 2.

Discriminant function analysis predictions of group membership for Sunderland et al. CDT scoring criteria

 Predicted Group Membership
 
Group Normal MCI Dementia Neglect 
Normal (n = 21) 20 (95%) 1 (5%) 0 (0%) 0 (0%) 
MCI (n = 21) 3 (14%) 17 (81%) 1 (5%) 0 (0%) 
Dementia (n = 21) 0 (0%) 4 (19%) 9 (43%) 8 (38%) 
Neglect (n = 21) 0 (0%) 0 (0%) 8 (38%) 13 (62%) 
 Predicted Group Membership
 
Group Normal MCI Dementia Neglect 
Normal (n = 21) 20 (95%) 1 (5%) 0 (0%) 0 (0%) 
MCI (n = 21) 3 (14%) 17 (81%) 1 (5%) 0 (0%) 
Dementia (n = 21) 0 (0%) 4 (19%) 9 (43%) 8 (38%) 
Neglect (n = 21) 0 (0%) 0 (0%) 8 (38%) 13 (62%) 

Note: N = 84. CDT = Clock Drawing Test. MCI = Mild cognitive impairment. 70.2% of original grouped cases correctly classified.

Table 3.

Discriminant function analysis predictions of group membership for Lin et al. CDT scoring criteria

 Predicted Group Membership
 
Group Normal MCI Dementia Neglect 
Normal (n = 21) 21 (100%) 0 (0%) 0 (0%) 0 (0%) 
MCI (n = 21) 6 (29%) 11 (52%) 0 (0%) 4 (19%) 
Dementia (n = 21) 2 (10%) 9 (43%) 4 (19%) 6 (29%) 
Neglect (n = 21) 1 (5%) 8 (38%) 1 (5%) 11 (52%) 
 Predicted Group Membership
 
Group Normal MCI Dementia Neglect 
Normal (n = 21) 21 (100%) 0 (0%) 0 (0%) 0 (0%) 
MCI (n = 21) 6 (29%) 11 (52%) 0 (0%) 4 (19%) 
Dementia (n = 21) 2 (10%) 9 (43%) 4 (19%) 6 (29%) 
Neglect (n = 21) 1 (5%) 8 (38%) 1 (5%) 11 (52%) 

Note: N = 84. CDT = Clock Drawing Test. MCI = Mild cognitive impairment. 56.0% of original grouped cases correctly classified.

Introducing a Novel Computerized Scoring System for the Clock Drawing Test Parks, A., Logue, E., Carter, K., Scarisbrick, D., and Linck, J.