International Psychogeriatrics

Review Article

Is the Clock Drawing Test a screening tool for the diagnosis of mild cognitive impairment? A systematic review

Lena Ehrekea1 c1, Melanie Luppaa1, Hans-Helmut Königa2 and Steffi G. Riedel-Hellera1a3

a1 Department of Psychiatry, Public Mental Health Research Unit, University of Leipzig, Leipzig, Germany

a2 Department of Psychiatry, Health Economics Research Unit, University of Leipzig, Germany

a3 Department of Social Medicine, University of Leipzig, Germany


Background: The clock drawing test (CDT) is a common and widely used cognitive screening instrument for the diagnosis of dementia. However, it has remained unclear whether it is a suitable method to identify mild cognitive impairment (MCI). The aim of this paper is to review systematically the studies concerning the utility of the CDT in diagnosing MCI.

Method: A systematic literature search was conducted. All studies dealing with utility of CDT in diagnosing MCI regardless of the applied CDT scoring system and MCI concept were selected.

Results: Nine relevant studies were identified. The majority of the studies compared average CDT scores of cognitively healthy and mildly impaired subjects, and four of them identified significant mean differences. If reported, sensitivity and specificity have been mostly unsatisfactory.

Conclusion: CDT should not be used for MCI-screening.

(Received April 27 2009)

(Revised May 26 2009)

(Revised June 16 2009)

(Accepted June 17 2009)

(Online publication August 20 2009)


c1 Correspondence should be addressed to: Lena Ehreke, University of Leipzig, Department of Mental Health, Psychiatry and Psychotherapy Clinic, Public Mental Health Research Unit, Semmelweisstraße 10, D-04103 Leipzig, Germany. Phone +49–341-9724591; Fax +49–341-9724539. Email: