Clock drawing in acute stroke.

We studied 118 elderly subjects with first-ever stroke free of severe cognitive impairment and able to write. Within 14 days of stroke we measured clock drawing, ability to copy drawings of dual pentagons and a house, line bisection, Mini-Mental State score, homonymous hemianopia and visual and tactile extinction. Thirty subjects had impaired clock drawing. When compared with the remaining 88 subjects with normal clock drawing the impaired group had similar pre-stroke characteristics but had significantly more severe stroke deficits. Hospital stay was significantly longer in the impaired group and a much greater proportion of subjects were discharged to long-term hospitals rather than home. Barthel ADL scores at days 7, 30, 60 and maximal recovery were significantly lower. Using a multivariate generalized linear model, clock drawing was a significant independent predictor of maximal Barthel ADL after accounting for other significant predictors such as Barthel score at day 7, limb power, visual extinction, line bisection error and Mini-Mental State score. Impaired clock drawing can reflect either cognitive impairment or spatial neglect.