July 7 – Clock of the Week

This clock was drawn by a 77-year old male suffering with dementia.  Dementia is defined as a decline in cognitive – mental functioning in memory and activities of daily living

WESTBOROUGH, MA July 7, 2016 The clock drawing is something that I have grown quite fond of using to assess patients who might be impaired in their thinking skills. Here is the clock of the week for early July, 2016. Some patients become suspicious when the neuropsychologist gets involved often saying “What do they think I am crazy?”  No not at all.  But the clock drawing can provide a great deal of important clinical information about their cognitive functioning.  I have written about the clock drawing and other visuospatial functions for a few years now.  As you can see by the clock of the week for July 7th the patient who crafted this clock missed the boat.  I needed to prompt him for everything including placing the numbers around the clock.  The clock is nonthreatening.  Patients sometimes believe that the tests we use in our assessments require a high level of education.  Not true.  I published a post in January about the impact of dementia on caregivers.  Under normal circumstances taking care of a loved one is a stressful endeavor that requires sensitivity and supportive friends and family.

Dementia takes its toll on those whose responsibility it is to care for the failing loved one. The decline in cognitive functioning impacts all mental capacities including written language.  As a bonus this week I am adding a sample of the patient’s written language.  I ask for a writing sample that is always the same.  Two sentences: “He shouted the warning” and “Base ballplayers are tough”.  As you can see from this sample it is neither correct nor legible. The third line is the patient’s signature.  In this case, when asked to show  me his signature the patient asked “What is my full name?”  If you are interested in neuropsychological testing or physical rehabilitation please send me an email.  If you are so inclined send a copy of a clock you have seen and let me have a look. I enjoy posting the drawings that clinician’s send to me on this website.

“No greater sense of despair and futility exists as when the declining husband or wife can no longer remember a devoted caregiver or the memory of a shared life.” according to Michael Sefton at Whittier Rehabilitation Hospital in Westborough, MA.
This writing was made by the same patient whose clock is being honored this week on the Concussion Assessment website.  I ask patients to write simple sentences to screen their motor speed, skill and grammatic efficiency.

Whether it is written language or some other measure of constructional praxis the work I do is very gratifying.  I was once asked by a postdoctoral fellow that I was supervising “can the patient refuse to take the tests?” She was a bright experimental psychologist from Yale University who worried that the tests may be unfair to a patient with severe cognitive impairment –  especially if they were to be used to take away a driver’s license or for placement into a nursing home.  If someone does not wish to complete the testing it is entirely up to them.  I will usually make an attempt to establish rapport prior to any formal testing and rarely encounter resistance. When I do I will back off and leave it up to the patient to approve further testing.  Ultimately the success or failure of the assessment process requires that a ‘trust’ established and that patient dignity and respect be honored. While training to be a paramedic in 2012 the mantra we lived by was to treat the patient as you might want your mother or father to be treated.  That is the least we can do here at the hospital to preserve patient dignity and restore independence as much as possible.


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