The Clock Drawing Test: How It Works, How It's Scored and What the Results Mean

This guide is for older adults who were asked to draw a clock at a checkup and wondered why, and for adult children who have seen a parent struggle with one and are now worried. The one thing to know: a clock drawing is a quick screening task, not a diagnosis. A poor clock is a reason to see a doctor for a fuller evaluation. A good clock doesn't rule out a problem if you are noticing real changes.

What is the clock drawing test?

The clock drawing test asks a person to draw an analog clock face, put in all the numbers, and set the hands to a specific time. It takes a couple of minutes and needs only a pencil and paper. Doctors, nurses and other clinicians use it to look for signs of cognitive impairment, often alongside other short tests.

It looks simple, but it isn't. To draw a clock that looks right and shows the correct time, the brain has to understand the instructions, remember what a clock looks like, plan where the numbers go, and work out that "ten past eleven" means one hand on the 11 and the other on the 2. A widely cited review in the International Journal of Geriatric Psychiatry (Shulman, 2000) concluded that the clock test "taps into a wide range of cognitive abilities including executive functions," the skills used for planning and organizing, and is quick and well accepted by the people taking it.

How the test is done

There is no single official version, but most follow the same pattern. Here is how the clock part of the Mini-Cog, one of the most common short screens, is given, according to its developers' step-by-step instructions:

1. The person gets a sheet of paper, often with a circle already drawn on it.
2. The clinician says, "Please draw a clock in the circle," then "Put all the numbers in the circle."
3. Next: "Now set the hands to show ten past eleven."
4. If the clock isn't finished in about three minutes, the clinician moves on.

Other versions use a different time, or ask the person to copy a clock instead of drawing one from memory. Setting the hands to "ten past eleven" also checks whether the person understands that "ten past" means a hand pointing to the 2, not the 10.

How it is scored, in general terms

Researchers have published many scoring systems over the years. Some give a point for each correct feature, such as all 12 numbers present, numbers in the right order and spacing, two hands, and hands pointing to the right numbers. Others rate the overall drawing on a scale from normal to severely impaired. The Shulman review found that, despite all that variety, the different systems reported similar accuracy.

The Mini-Cog keeps it simple. According to the Mini-Cog scoring guide, the clock gets either 2 points (normal) or 0 points (abnormal). A normal clock "must include all numbers (1-12), each only once, in the correct order and direction (clockwise)," with two hands, one pointing to the 11 and one to the 2. Hand length isn't scored. There is no partial credit, so that people without training in cognitive testing can score it consistently.

Common things clinicians notice in an abnormal clock include:

• Numbers bunched on one side, missing, repeated or outside the circle
• Numbers in the wrong order or running counterclockwise
• Hands missing or pointing to the wrong numbers, for example to the 11 and the 10 instead of the 11 and the 2

None of these, on its own, says what is causing the problem.

The Mini-Cog: clock drawing plus three words

The Mini-Cog combines the clock with a short memory task. The person hears three unrelated words, repeats them, draws the clock, then is asked to recall the three words. Each word remembered without a hint is worth 1 point, and the clock is worth 0 or 2, for a total of 0 to 5.

The scoring guide is clear that "the Mini-Cog is not a diagnostic test for dementia or other forms of cognitive impairment," and that anyone with a normal score who reports concerns about memory or thinking should still get a more detailed assessment.

The Mini-Cog's developers explain why the two parts are paired: brief memory tests alone flag too many people whose minor memory slips don't affect daily life, while the clock adds a check on the planning skills needed for independence. In the original study (Borson and colleagues, 2000), which included 249 older adults, about half of whom did not speak English, the Mini-Cog correctly classified 96% of participants, took about 3 minutes compared with 7 for the longer Mini-Mental State Exam, and was not thrown off by education level or language. That was one community sample, and the authors called for wider validation.

What the clock test can and cannot show

What it can do: flag that something may be wrong with thinking skills and that a closer look is worth it. Shulman's review reported average sensitivity and specificity of about 85% across published studies. A later meta-analysis of 15 studies (Park and colleagues, 2018) found pooled sensitivity of 82% and specificity of 75.7% with the Shulman scoring method, and 72.6% and 87.9% with the Sunderland method. In plain terms, the test catches most people with dementia, but it also misses some and flags some who turn out to be fine.

What it cannot do:

• Diagnose dementia or tell what type it is. Alzheimer's disease, vascular dementia, Lewy body dementia and other conditions all need a fuller medical workup.
• Rule out a problem. Some people with early changes draw a perfect clock.
• Account for everyone's background. The Mini-Cog developers note that people without basic literacy, or from cultures that don't use analog clocks, "may be cognitively normal but unable to perform that task." Poor eyesight, a hand tremor or arthritis can also make drawing harder, so tell the clinician about them.
• Tell you what's causing the change. According to the National Institute on Aging, memory problems can also come from thyroid, kidney or liver problems, medication side effects, depression and anxiety, sleep problems, low vitamin B12, and other conditions, and these problems usually go away once the condition is treated. That is one of the biggest reasons to see a doctor rather than guess.

Should everyone be screened?

Expert groups disagree on routine screening for people with no symptoms. The U.S. Preventive Services Task Force concluded in 2020 that the evidence is "insufficient to assess the balance of benefits and harms of screening for cognitive impairment in older adults" who have no signs or symptoms (JAMA, 2020). That statement doesn't apply when you or your family are already noticing changes. In that case, an evaluation is the right next step.

Medicare and cognitive checks

Medicare covers cognitive screening as part of regular preventive care. The yearly "Wellness" visit includes a step to "perform a cognitive assessment to look for signs of dementia," according to Medicare.gov. You pay nothing for the wellness visit if your provider accepts assignment. It is covered once every 12 months, starting at least 12 months after you enroll in Part B or have your "Welcome to Medicare" visit. Extra tests or services during the same visit may have costs.

The clinician chooses the method. It might be a clock drawing, the Mini-Cog, another short test or a conversation. The Mini-Cog's developers note that CMS and other groups include it among valid tools for detecting cognitive impairment in primary care, including in the Annual Wellness Visit.

If the doctor suspects a problem, Part B also covers a separate, more thorough cognitive assessment and care planning visit. According to Medicare.gov, the provider may review medicines and medical history, check for related conditions, identify caregivers and supports, build a care plan, and refer to specialists or community services. For that visit, you pay 20% of the Medicare-approved amount after the Part B deductible, which is $283 in 2026 according to Medicare.gov.

Next steps if you're worried

1. Write down what you've noticed. Specific examples help: missed bills, getting lost on a familiar drive, repeating the same question, trouble following a recipe. Note when each change started.
2. Make a full medication list, including over-the-counter pills and supplements, since side effects can affect memory.
3. Book a visit with the primary care doctor and say the appointment is about memory or thinking changes. Ask whether the Annual Wellness Visit or a cognitive assessment visit is the right fit.
4. Ask what comes next if the screen is abnormal: blood tests, a longer cognitive test, imaging or a referral to a neurologist, geriatrician or memory clinic.
5. Plan for safety in the meantime. If medicines are being missed or doubled, our guide to reminding someone with dementia to take medication can help. Tools like a dementia clock or a digital calendar can make each day easier to follow, whatever the diagnosis turns out to be.

If you help from a distance, our guide to checking on an elderly parent remotely has ideas for staying in the loop. More guides are in the memory section.