Further analyses of clock drawings among demented and nondemented older subjects.

In a previous article we described a 10-point scoring system (i.e., scale 1) to grade clock drawings to command and copy with hands set for "ten after 11" among demented patients. Alzheimer's subjects (AD) improved from the command to copy conditions, whereas subjects with ischaemic vascular dementia (IVD) did not. To investigate the underlying cognitive deficits responsible for this profile, an additional scale was developed (scale 2) that tallied errors in graphomotor functioning, hand/number placement, and executive control. On an independent sample of subjects, AD subjects, again, made significant improvement on scale 1 from the command to copy condition, whereas no such improvement occurred among the IVD subjects. On scale 2, IVD subjects made more graphomotor errors in the command condition, and more executive control and more total errors in the copy conditions than AD subjects. A number of positive correlations were noted between tests of language and memory on scale 1. By contrast, scores on tests of executive control declined as scale 2 errors increased. In addition, a principal component analysis indicated that scale 2 test performance loaded on a factor with other tests related to executive control. These results suggest that impairment in frontal systems functioning may explain why IVD subjects do not improve from the command to copy conditions on scale 1. Such a pattern of performance in clock drawing may also be helpful in making a differential diagnosis between AD and IVD.