13 February 2012

Is a clock face still an appropriate component of a mental status exam ?

The photo above comes from a StarTribune article about a "mini-cog[nition]" test that was recently given to veterans and revealed evidence of dementia or cognitive impairment that had not previously been diagnosed clinically.
The mini-cog is one of a number of memory tests that have started to pop up in routine checkups for older patients around the country, including at Allina clinics in Minnesota. In this case, the test involves memorizing three words and drawing the face of a clock.
Last summer my mother was diagnosed with dementia when a social worker at a senior housing complex administered the Saint Louis University Mental Status Exam (SLUMS) as part of an entrance evaluation.  For those not familiar with it, here is the full test -

I met with the social worker afterwords, and in our analysis of the results I noted that mom had misdrawn the clock face, but realized that for the past 20+ years, she had not seen one.  She did not wear a watch and had been living in a condo that had a digital clock in the bedroom, a digital clock on the stove, and a digital clock on the microwave.

Our discussion did not change the interpretation of the results in any meaningful way, but it did raise questions in both our minds as to whether interpreting a clock face is such a fundamental piece of knowledge that it should never be impaired, or whether current testing should be altered to reflect new technology.  Now I see interpreting a clock face is still part of an even-briefer screening exam for dementia.

If you're reading this blog, you certainly have no cognitive impairment, but if you'd like to try the SLUMS test on a parent (or spouse), you can view or print it from the Saint Louis University School of Medicine.


  1. The clock face draw has been validated in multiple studies, and is still generally respected as useful. It tests integration of multiple areas of the brain so has high sensitivity--- in other words, it often will show up problems before other tests. Even if you haven't seen a clock face in 20 years, something that everyone learned and was drilled on in grade school should still be intact, but it is only a screen, and shouldn't be used to actually diagnose. I continue to use it in my family practice.

  2. Though we try to teach children at school to use analogue clocks, it's rarely part of their everyday experience, so it's rather a struggle. What's also noticable is that they are missing some of the associated concepts, like using it as a rough measure of angle. One Year 5 boy was utterly foxed by a fighter pilot saying "Enemy spotted at three o'clock high".

  3. Is that a dozen apples at $3 for the dozen? or $3 each?

  4. Hah.. I have the secret now. I'm memorizing this answers to this test so if it's given to me in the future, I'll pass ;)

  5. Funnily enough, I watched my mom take this test just two weeks ago. She could draw the clock but not the requested time (11:10). I have a daughter who is 10 and who rarely sees an analogue clock. While watching the test, I wondered how my daughter would do on it -- and what the test would look like when I hit my 80s (hopefully). Reminds me a bit of historical bias in the SATs towards students with a white middle-to upper class background.


  6. The requested time is 10:50, not 11:10

  7. Some years ago my wife and I owned frozen yogurt stores. Late one evening, a group of high school students came up to the door of my shop and one of them yelled, "Mister, what time is it?" I replied that it was a quarter to ten. She then yelled, "What does that mean?" I thought for a second and said it was fifteen to ten. She yelled back, "That still don't make sense." I yelled back, "9:45" She yelled back, "Why didn't you say so in the first place?" Nobody in that group could cope with telling time by means of analogue depiction.


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