Sarah Qurrotun Aini 130110110021 F4 case 5

Clock Drawing Test

Definition: A technique used in clinical
neuropsychological examinations whereby the test
taker draws the face of a clock, usually indicating a
particular time that is then evaluated for distortions
that may be symptomatic of dementia or other

neurological or psychiatric conditions1.

What for: The clock has been proposed as a quick
screening test for cognitive dysfunction secondary

MMSE

to dementia, delirium, or a range of neurological

and psychiatric illnesses2. The CDT is used to
quickly assess visuospatial and praxis abilities,
and may determine the presence of both attention
and executive dysfunctions.3
How to: The CDT was administered by asking
patients to first draw the face of the clock and then
to place the hands to indicate 10 minutes past 10
oclock

Definition: The Mini-Mental State Examination

(MMSE) is psychometric screening assessment of
cognitive functioning.
What for: screen patients for cognitive
impairment, track changes in cognitive functioning
over time, and oftentimes to assess the effects of
therapeutic agents on cognitive function.6
How to: 7

Score: The clock was scored from 04. The

scoring system awards one point for drawing a

Category

closed circle, one point for placing numbers in the

Possibl
e points

Description

correct position, one point for including all 12

correct numbers, and one point for placing hands
in the correct positions. 4

1http://highered.mcgrawhill.com/sites/0073129097/student_view0/glossary.html

2http://www.neurosurvival.ca/ClinicalAssistant/scales/cl
ock_drawing_test.htm#whydo

Orientation
5
to time

From broadest to most

narrow. Orientation to time
has been correlated with
future decline.

Orientation
5
to place

From broadest to most

narrow. This is sometimes
narrowed down to
streets and sometimes to
floor.

Registratio 3

Repeating named prompts

5 http://www.jabfm.org/content/16/5/423/F3.large.jpg
3http://strokengine.ca/assess/module_cdt_intro-en.html
6http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2587038
4 The Clock Drawing Test: Diagnostic, Functional, and

Neuroimaging Correlates in Older Medically Ill

AdultsJulia B. Samton, M.D.; Stephen J. Ferrando, M.D.;
Pina Sanelli, M.D.; Sassan Karimi, M.D.; Valentine
Raiteri, M.D.; John W. Barnhill, M.D.

7www.framinghamheartstudy.org/share/.../mm1_8s_prot
ocol.pdf

Sarah Qurrotun Aini 130110110021 F4 case 5

Attention
and
5
calculation

Serial sevens, or spelling

"world" backwards. It has
been suggested that serial
sevens may be more
appropriate in a population
where English is not the
first language.

Recall

Registration recall

Language

Naming a pencil and a

watch

Repetition

Speaking back a phrase

Varies. Can involve

drawing figure shown.
Complex
6
commands

Score:

Subjects whose education levels are 7

tb

grade

or lower, a score on the MMSE of 22 or below

Subjects whose education attainment level is

th
8 grade or some high school (but not a
graduate of), a score on the MMSE of 24 or
below

Subjects whose education attainment level is

high school graduate, a score on the MMSE of
25 or below

Subjects whose education attainment level is

some college or higher, a score on the MMSE
of 26 or below.

ADL

Sarah Qurrotun Aini 130110110021 F4 case 5

Definition: An activity of daily living (ADL)
evaluation is an assessment of an individual's
physical and sometimes mental skills.8
Activities of Daily Living (ADLs) are a defined set
of activities necessary for normal self-care. The
activities are movement in bed, transfers,
locomotion, dressing, personal hygiene, and
feeding.9

Movement in bed. means sitting in, rising from,

and moving around in, bed;

Transfers. means moving from one seat to

Assess each activity and sum it up.

Score:

another, changing position from sitting to

standing, and transferring to and from the toilet

and bed;
Locomotion. means walking on the level, on

gentle slopes and down stairs;

Dressing. means putting on socks, stockings,
and shoes, as well as clothing the upper and

lower trunk;
Personal hygiene. means grooming, and
washing of face, trunk, extremities and

perineum;
Feeding. means eating and drinking, but not
the preparation of food.

What for: ADL evaluations help practitioners

determine how independent patients are and what
skills they can accomplish on their own, as well as
to gauge how independent each individual can
become after intervention by a health professional.
The goal of practitioners performing ADL
evaluations is to help patients become as
independent as possible, using appropriate
adaptations if needed.
How to:

8 Activities of Daily Living Evaluation." Encyclopedia of

Nursing & Allied Health. ed. Kristine Krapp. Gale Group,
Inc., 2002. eNotes.com. 2006.

9 www.vrb.gov.au/pubs/garp-chapter16.pdf

Other impairment rating:

Sarah Qurrotun Aini 130110110021 F4 case 5

IADL
Definition: Instrumental activities of daily living
refer to skills beyond basic self care.
What for: evaluate how individuals function within
their homes, workplaces, and social environments.
Instrumental ADLs may include typical domestic
tasks, such as driving, cleaning, cooking, and
shopping, as well as other less physically
demanding tasks such as operating electronic
appliances and handling budgets. In the work
environment, an ADL evaluation assesses the
qualities necessary to perform a job, such as
strength, endurance, manual dexterity, and pain
management.
Score: The patient receives a score of 1 for each
item labeled A H if his or her competence is rated
at some minimal level or higher. Add the total
points circled for A H. The total score may range
from 0 8. A lower score indicates a higher level of
dependence.
How to:10

10www.healthcare.uiowa.edu/igec/tools/function/lawton
brody.pdf

Sarah Qurrotun Aini 130110110021 F4 case 5

Aphasia11

Strings together nonsense words and real

words fluently but makes no sense

Some people with aphasia have trouble using

words and sentences (expressive aphasia).
Some have problems understanding others

Characteristics of Receptive Aphasia

messages (e.g., like translating a foreign

(receptive aphasia). Others with aphasia struggle

with both using words and understanding (global
aphasia).

Requires extra time to understand spoken

language)
Finds if very hard to follow fast speech (e.g.,

radio or television news)

Misinterprets subtleties of language-takes the

Aphasia may be mild or severe. The severity of

literal meaning of figurative speech (e.g., "it's

communication difficulties depends on the amount

raining cats and dogs")

Is frustrating for the person with aphasia and

and location of the damage to the brain.

for the listenercan lead to communication

A Person With Mild Aphasia

may be able to carry on normal conversations

in many settings
may have trouble understanding language

when it is long and/or complex

may have trouble finding the words
(called anomia) to express an idea or explain
himself/herself-this is like having a word "on
the tip of your tongue"

A Person With Severe Aphasia

may not understand anything that is said to

him/her
may say little or nothing at all
may make approximations of common
phrases, such as "yes," "no," "hi," and "thanks"

Characteristics of Expressive Aphasia

Speaks only in single words (e.g., names of

objects)
Speaks in short, fragmented phrases
Omits smaller words like "the," "of," and "and"

(so message sounds like a telegram)

Puts words in wrong order
Switches sounds and/or words (e.g., bed is

called table or dishwasher a "wish dasher")

Makes up words (e.g., jargon)

11
http://www.asha.org/public/speech/disorders/aphasia.ht
m

breakdown
Very often, a person with aphasia has both
expressive and receptive difficulties to varying
degrees.