Clock of the Week – Sept 30

WESTBOROUGH, MA September 30, 2016  The clock of the week is drawn by a 77-year-old male with Parkinson’s Disease.  It is representative of his execution of the internal

Clock of 77-year old male

ized concept of “clock” with the given task of setting the hands to read 10 past 11. Many people discredit the utility of the clock drawing because on the outside it appears to lack psychometric rigor. I disagree and have used the clock drawing for many years as a tool to screen motor control, visual spatial capacity, problem solving, self-monitoring, and other frontal controls.  The particular clock above is not a complete disaster.  As you can see there is a circle.  The next feature illustrated is the presence (or absence) of all the numbers,  In this case it is clear that all 12 numerals are represented on the face of the clock.  Admittedly the numbers fail to appreciate the contour of the circle but they are grossly appropriate.  Finally, the task requires the patient to set the clock so that the time is set for 11:10 (intentionally vague).  The errors produced often provide grist for the diagnostic mill in terms of the types of mistakes, e.g. missing numbers, broken gestalt of circle, numbers crowded to one side of the clock, time set in error.  In the past several months I have published clocks drawn by patients here at Whittier.  Many people have expressed an interest in the clock drawing and I find that everyone is using the clock as a cognitive screening measure.  Here at Whittier our speech pathologists use it with every admission.  I have found it funny when someone says “what another clock?”.  These patients usually check out just fine on the tests we use as a measure of perfunctory neurocognition.

Written language – to dictation

Written Language in PD

Here is a sample of the same patient’s written language .  He is asked to write 2 sentences that are quite easy.  Poor written expression is common in most people who suffer with Parkinson’s because PD is a disease that attacks motor pathways resulting in sometimes wild tremors and poor motor control making them at risk for falls. These sentences do not replect the tremulous motor output often found in the work of patients with PD.  In this case his symptoms are well controlled on his current medication.  He is seen by a neurologist and intenal medicine physician almost daily.  The sentences are: He shouted the warning; and Baseball players are tough.