Why you may be asked to ‘draw a clock’ at the hospital

Key points:

• In 2024, it is estimated that more than 421,000 Australians live with dementia

• More than two-thirds of aged care residents have moderate to severe cognitive impairment

• Cognitive assessment is most commonly conducted using the Standardised Mini Mental-State Examination, the Abbreviated Mental Test Score and the clock-drawing test

You may be asked to draw a clock upon admission to a hospital as part of a cognitive assessment. A cognitive assessment is conducted to help health professionals determine any changes in multiple mental abilities, including learning, thinking, reasoning, remembering, problem-solving, decision-making and attention span.

Typically, a person will be given a pre-drawn circle and they will be asked to write the numbers on the face of a clock and draw both hands of the clock to indicate a certain time, for instance, 10 minutes past 11 o’clock.

Depending on the method used by the health professional, a score will be given based on the accuracy of the drawing. Some scores will assign different values depending on the accuracy to account for things such as missing hands, inaccurate numbers or an inability to remember how to perform the task. Generally, however, assessors will simply pass or fail the person being assessed.

This screening process can help to determine whether a person has started to experience delirium or dementia.

Approximately 10 – 18 percent of Australians aged 65 years or older have delirium at the time of admission to hospital and a further two to eight percent develop delirium during their hospital stay.

People experiencing delirium may show signs of confusion, uncertainty, inattention, distress or psychosis. A person may experience delirium for a few days and be asked to take the clock-drawing test throughout their hospital stay to see if their score improves and rule out underlying conditions.

For people from culturally and linguistically diverse backgrounds, there are two alternative forms of cognitive assessment may be conducted to help health professionals gather insight into a person’s well-being, known as the ‘mini-cog’ and the ‘Rowland Universal Dementia Assessment Scale.’

For First Nations people, the Kimberley Indigenous Cognitive Assessment was specifically designed as an alternative cognitive assessment to assist health professionals.

Additionally, if a person is accompanied during their assessment by someone close to them, they may be asked to complete the Informant Questionnaire on Cognitive Decline in the Elderly to gather supplementary information.

Ruling out delirium can help health professionals identify whether a person is experiencing the early stages of dementia. It may also help to identify hepatic encephalopathy, along with predicting rehabilitation outcomes after traumatic brain injury.

People with dementia may struggle to recall what the hands on a clock represent, but the test can also screen for an inability to remember directions or an inability to map out the space on a clock face.

If this article has prompted any questions or concerns, please call the National Dementia Helpline 1800 100 500 (24 hours, seven days a week) or visit dementia.org.au/helpline.

Do you believe that the presence of digital clocks and modern technology will impact people’s ability to identify a clock face in the future? Let the team at Talking Aged Care know and subscribe to the newsletter for more information, news and industry updates.

Related content:

Dementia behaviour changes and challenges

What is dementia?

Specialised support for managing severe dementia behaviours