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Relationship Between Clock-Drawing and Neuropsychological and Functional Status in Elderly Institutionalized Patients With Schizophrenia

Received July 11, 2003; revised August 6, 2003; accepted August 27, 2003. From the Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania. Send correspondence to Natasha Lowery, Ph.D., Brain Behavior Laboratory, Department of Psychiatry, 10th Floor Gates Building, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104. e-mail: nlowery{at}bbl.med.upenn.edu

Objective: The authors sought to examine the usefulness of the clock-drawing test (CDT) as a measure of general cognitive and adaptive functioning in elderly patients with schizophrenia. Methods: CDT performance of elderly institutionalized patients with schizophrenia were contrasted with a comparison group, similar in age. Cognitive and functional status was examined using an expanded battery from the Consortium to Establish a Registry for Alzheimer's disease and the Psychogeriatric Dependency Rating Scale. Results: Patients (N=21) performed more poorly overall on the CDT than the comparison group (N=21), with greater clock number and hand errors. Production of the clock's gestalt did not differ between groups. In patients, overall CDT performance and clock hand placement were significantly correlated with general cognitive functioning, memory, visuoconstruction, and word-list generation. CDT global and hand placement performances corresponded to patients' general orientation. Conclusions: Impaired CDT performance in elderly patients with schizophrenia is not attributable to normal aging. Also, the CDT uniquely relates to an array of cognitive abilities in this population, validating its multicognitive character and implicating multiple brain regions. The CDT's tolerability and brevity make it attractive for use in geriatric schizophrenia.

Key Words: Schizophrenia • Diagnostic Tests • Functional Status • Clock-Drawing