How do I score a clock-drawing test with all numbers 1-12 present but unevenly spaced?

Clock Drawing Scoring on SLUMS with Unevenly Spaced Numbers

On the SLUMS examination, a clock drawing with all numbers 1-12 present but unevenly spaced should receive a score of 1 point out of the possible 2 points for the clock drawing component.

Understanding SLUMS Clock Drawing Scoring

The Saint Louis University Mental Status (SLUMS) examination uses a specific scoring system for the clock drawing test component:

• 2 points: Clock face with numbers and hands in the correct positions
• 1 point: Partial credit when all numbers are present but spacing is uneven
• 0 points: When numbers are missing or placed in incorrect sequence

Rationale for Scoring Decision

The presence of all 12 numbers indicates that the patient has preserved number recognition and conceptual understanding of a clock face. However, uneven spacing suggests mild visuospatial or executive function difficulties 1.

This scoring approach acknowledges that:

• The patient has maintained the basic conceptual understanding of a clock
• There is some mild deficit in planning, organization, or visuospatial function
• The error is not severe enough to warrant a score of zero

Clinical Significance

Uneven spacing on clock drawing tests can indicate:

• Mild executive dysfunction
• Early cognitive impairment
• Visuospatial processing difficulties
• Planning and organizational challenges

These findings should be interpreted within the context of the patient's overall SLUMS score and other cognitive assessments.

Common Pitfalls in Clock Drawing Assessment

• Over-penalization: Giving 0 points for minor spacing issues when all numbers are present
• Under-penalization: Giving full credit despite significant spacing problems
• Inconsistent scoring: Applying different standards to different patients
• Isolated interpretation: Evaluating the clock drawing without considering the full SLUMS score

Recommendations for Accurate Assessment

1. Confirm all 12 numbers are present (prerequisite for 1 point)
2. Assess whether spacing issues are mild or severe
3. Check if numbers are in the correct sequence
4. Evaluate if hands are pointing to the correct time (for full 2 points)
5. Document specific errors for longitudinal comparison

Remember that the SLUMS examination is designed to detect mild cognitive impairment and early dementia, making it more sensitive than some other screening tools 1. Proper scoring of each component, including the clock drawing test, is essential for accurate assessment of cognitive function.