Clock Drawing Helps When Communication Fails

Abstract

To the Editor.—Recently we were called upon to do health assessments on a group of 18 Russian immigrants newly arrived at our Geriatric Community Health Center (GCHC), N.Y. Their ages were 64 to 87 years; 12 were women, and six were men. All but one were unable to speak or understand English. Although two Russian interpreters assisted in the examination, routine evaluation of mental status by usual instruments such as the Mini-Mental State Examination was problematic.1 In addition to the increased time required for translation and comprehension, the patients had experienced recent moves affecting their conceptions of time and place. Furthermore, the translators were not medically experienced in nuances of mental status evaluation and interpretation. Finally, physicians did not have access to family information regarding the examinees’ prior cognitive function and functional abilities. In our group of 18 subjects, 14 had normal clock drawing patterns, and four demonstrated abnormal clocks. Upon follow-up with these four patients’ families, the existence of unreported progressive cognitive loss was confirmed and the diagnosis of dementia documented. Our previous experience and that of others supported our use of the clock drawing test to screen for dementia.2-5 The test consists of a simple request to fill in the numbers of a clock on a pre-drawn 4-in circle. A set of patterns is used to distinguish among Alzheimer's disease, Multi-Infarct Dementias, and non-demented subjects, with a sensitivity of 86.7% and a specificity of 92.7% for Alzheimer's dementia. Since this test is simple and universal, it merits consideration, particularly in circumstances of recent immigration and language-barriers. Physicians will face these conditions as a result of the currents in our political geography.