Is there a role for clock face drawing in palliative care: time will tell?
Background Several tools exist to assist screening and diagnosis of cognitive impairment, including the Abbreviated Mental Test; Mini-Mental State Examination; Confusion Assessment Method; and, clock-drawing test (CDT). There are now around 200 publications on the CDT, but largely published in geriatric medicine and psychiatry. Several variations of the CDT exist, but each typically requires the patient to draw the numbers as they would appear on the face of a clock, into a circle, and then add the arms to indicate a specified time. While clock face drawing may appear to be a relatively simple task, it actually requires several perceptual and cognitive functions: auditory comprehension, memory, planning, abstract thinking, perceptual-motor, visual perceptual, visual-motor, visual-spatial and executive functions.
Aim To explore the role of the CDT in palliative care. Clock face drawing has been validated in various settings in psychiatry and geriatric medicine for example, screening for Alzheimer's disease in psychiatry and assessment post-stroke in geriatric medicine. The tool may also have a valuable role in palliative care, particularly in patients with complex neuropsychiatric problems. In other settings it has been found to be easy/quick to administer, not threatening to the patient, and useful as a sequential graphical assessment in clinical records. Examples of a useful role in palliative care include (A) a patient with parietal lobe metastases (in assessment of constructional apraxia), (B) delirium in a patient with cancer and hypercalcaemia (in assessment of cognitive function before and after treatment) (C) screening for dementia in a patient known to the palliative care team with advanced Parkinson's disease.
Conclusion While most research has focused on the use of clock face drawing in psychiatry and geriatric medicine, it has a potentially useful role in palliative care. Further work to explore this area further is now planned.
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