October 12, 1998
Psychiatric Times.
No. 10
10-Point Clock Test Screens for Cognitive Impairment in Clinic and Hospital Settings
Peter J. Manos, M.D., Ph.D.
Dr. Manos is staff physician in the section of psychiatry and psychology at Virginia Mason Medical Center in Seattle.
Although the 10-point clock test is reasonably good at identifying CI, its value is not limited to screening. It can be used repeatedly to monitor cognitive improvement as illustrated below (Manos, in press). Mr. P, an 80-year-old man living independently in an apartment, developed a delirium the night after an operation. The consultant was asked to see him on postoperative day 3 because of his agitation and confusion. He was too somnolent and confused to take the 10-point clock test at that time. By postoperative day 10, his delirium had cleared although he remained cognitively impaired (10-point clock score=5). Figure 2 illustrates the course of Mr. P's cognitive improvement. The consultant is often asked to see the delirious elderly patient, especially when delirium lasts for more than a few days (Manos and Wu, 1997). Impaired cognition following the resolution of delirium may be common in the elderly, representing lingering signs and symptoms of the delirium (Levkoff et al., 1992; Rockwood, 1993) or baseline cognitive disturbance or both. Patients accept the 10-point clock test relatively well, even if it is administered day after day in the general hospital. The drawing of a deranged clock in a patient's chart serves to immediately and graphically notify staff of potential problems in patient management, education and compliance. It is also a confirmation of a clinical impression. As the patient population ages and the criteria for hospital admission become more restricted, the percentage of cognitively impaired patients in the clinic and in the general hospital will increase. This test may prove useful to the busy practitioner in both settings.
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