WESTBOROUGH, MA March 23, 2016 Here is a new clock drawn by a 85-year old male who is undergoing acute rehabilitation here is Westborough. As you can see from the measuring tape it is about 23 mm in size. It is just a bit over 1 inch in size. Although somewhat subjective, I would call this an example of micrographia. In general micrographic drawing refers to constructions and writing that are well below the expected size – especially when the patient is copying a design and produces a tiny drawing – micrographic in size. It is associated with lesions of the basal ganglia or neurodegeneration in the midbrain and is often seen in patients with Parkinson’s Disease. Some might argue that micrographia results from diminished frontal-executive functioning. This explanation is plausible to me but must include the system of attention as well. The patient who drew this clock needed two hands to craft some of his work by using his non-dominant left hand to steady the right as he wrote or drew. He had sustained a cardiac arrest and was successfully resuscitated. This man is not diagnosed with Parkinson’s.
I have added a second clock of the week also an example of micrographia. This clock was drawn by a 54-year old woman undergoing rehabilitation for a liver transplant. She
had had a long history of alcohol dependence resulting in damage to her liver. A transplant was undertaken in February 2016. Her drawing of 19 mm is only 3/4 inch in size. I use a mechanical pencil to be sure and get as much detail in the drawings as possible. Patients undergoing liver transplantation require weeks of rehabilitation due to the stress on the body this procedure instills. Below I have added another example drawn by the woman who is receiving treatment following a liver transplant.
The Luria patterns is a test of set switching – thought to be a frontal lobe function. This requires both attention to detail and the capacity to change the shape and angle of each character. Some people fail to appreciate that the pattern is only 2 shapes – flat & pointed – repeated over and over. I hope these drawings are of interest to those in training and or those with years of training in neuropsychology. I enjoy receiving the occasional clock drawing or some other construction of interest. Please do not hesitate to send your interesting clocks along with patient information and your interpretation.