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The simplicity and unusually high information content of this test, including for mild dementia, makes it one of the most commonly used tools for diagnosing this clinical syndrome.

The test is carried out as follows. The patient is given a blank sheet of unlined paper and a pencil. The doctor says: “Please draw a round clock with numbers on the dial, and so that the clock hands show fifteen minutes to two.” The patient must independently draw a circle, put all 12 numbers in the correct places and draw arrows pointing to the correct positions. Normally, this task never causes difficulties. If errors occur, they are quantified on a 10-point scale:
10 points is the norm, a circle is drawn, the numbers are in the right places, the arrows show the specified time.
9 points – minor inaccuracies in the location of the arrows.
8 points – more noticeable errors in the placement of arrows
7 points – the hands show completely wrong time
6 points – the arrows do not perform their function (for example, the required time is circled)

5 points – incorrect arrangement of numbers on the dial: they are in the reverse order (counterclockwise) or the distance between the numbers is not the same.
4 points – the integrity of the clock is lost, some of the numbers are missing or located outside the circle
3 points – numbers and dial are no longer related to each other
2 points – the patient’s activity shows that he is trying to follow the instructions, but is unsuccessful
1 point – the patient makes no attempt to follow the instructions
The performance of this test is impaired both in frontal-type dementia and in Alzheimer's dementia and dementia with predominant damage to subcortical structures. ,For a differential diagnosis of these conditions, if the independent drawing is incorrect, the patient is asked to complete the arrows on a dial with numbers already drawn (by the doctor). In frontal-type dementia and dementia with a predominant lesion of subcortical structures of mild and moderate severity, only independent drawing suffers, while the ability to place hands on an already drawn dial is preserved. In dementia of the Alzheimer's type, both independent drawing and the ability to place hands on a ready-made dial are impaired.

By tradition, I remind you that this test can be used by relatives of an elderly person to initially identify problems. But detected deviations are a reason for a visit to the doctor, and not for dubious experiments with self-prescription of drugs. Remember, such actions can cause significant harm to the patient’s health!

Annex 1

Test "5 words" (B. Dubois, 2002)
1. Presentation of the material (the patient is given a list of 5 words: cinema, lemonade, grasshopper, saucer, truck)
2. Direct reproduction (the doctor takes a list of words from the patient and asks him to repeat it)
3. Interfering task (distract the patient’s attention for a sufficient period of time (from 3 to 5 minutes)
4. Delayed recall (the patient is asked to remember 5 words).

results
Direct playback:
0-5 points
Delayed playback:
0-5 points
Result: 0-10 points (8-9 points or less - Alzheimer's type dementia).

appendix 2

Schulte test

is carried out using a special table in which the numbers are arranged in random order from 1 to 25. The doctor uses a stopwatch to mark the time spent by the patient finding the numbers.

Normally, the Schulte test takes 25-30 seconds.

Appendix 3

Clock drawing test
(S. Lovenstone et S. Gauthier, 2001)

The patient is given a pencil and a blank sheet of unlined paper and asked to independently draw a round clock, put the numbers in the desired positions on the dial and draw arrows showing the given time. A test result of less than 10 points indicates the presence of cognitive impairment.

Appendix 4

Mini-mental status examination
(eng. Mini-Mental State Examination, M. Folstein et al., 1975)

Time orientation: the maximum score (5) is given if the patient independently and correctly names the date, month and year. If you have to ask additional questions, 4 points are given. Each error or lack of answer reduces the score by one point;

Orientation in the place: each mistake or lack of answer reduces the score by one point;

Perception: correct repetition of a word by the patient is scored one point for each word;

Concentration: each mistake reduces the score by one point;

Memory: each correctly named word is worth one point;

Speech: each correct answer is worth one point;

3-step command: each action is worth one point;

Reading: each mistake reduces the grade by one point;

Copy the picture: each mistake reduces the score by one point.

The test results may have the following meaning:

28-30 points - no cognitive impairment

24-27 points - pre-dementia cognitive impairment

20-23 points - mild dementia

11-19 points - moderate dementia

0-10 points - severe dementia.

Appendix 5

Frontal Dysfunction Battery
(eng. Frontal Assessment Batter - FAB, B. Dubois et al., 1999)

1. Conceptualization. The patient is asked: “What do an apple and a pear have in common?” An answer that contains a categorical generalization (“These are fruits”) is considered correct. If the patient finds it difficult or gives a different answer, he is told the correct answer. Then they ask: “What do a coat and a jacket have in common?” ... “What do a table and a chair have in common?” Each categorical generalization is worth 1 point. The maximum score in this test is 3, the minimum is 0.

2. Speech fluency. They are asked to close their eyes and say words starting with the letter “s” for a minute. In this case, proper names are not counted. Result: more than 9 words per minute - 3 points, from 7 to 9 - 2 points, from 4 to 6 - 1 point, 3 or less - 0 points.

3. Dynamic praxis. The patient is asked to repeat after the doctor with one hand a series of three movements: fist (placed horizontally, parallel to the surface of the table) - rib (the hand is placed vertically on the medial edge) - palm (the hand is placed horizontally, palm down). At the first presentation of the three series described above, the patient only follows the doctor, at the second presentation of the three series, he repeats the doctor’s movements, and finally, the next two times, three series each, he does it independently. When performing independently, prompting the patient is unacceptable. Result: correct execution of nine series of movements - 3 points, six series - 2 points, three series (together with a doctor) - 1 point.

4. Simple choice reaction. The instruction is given: “Now I will check your attention. We will tap out the rhythm. If I hit once, you must hit twice in a row. If I hit twice in a row, you only have to hit once.” The following rhythm is tapped: 1-1-2-1-2-2-2-1-1-2. Result assessment: correct execution - 3 points, no more than 2 errors - 2 points, many errors - 1 point, complete copying of the doctor's rhythm - 0 points.

5. Complicated choice reaction. The instruction is given: “Now if I hit you once, then you must not do anything. If I hit twice in a row, you only have to hit once.” The rhythm is tapped: 1-1-2-1-2-2-2-1-1-2. Evaluation of the result is similar to step 4.

6. Study of grasping reflexes. The patient is seated, he is asked to place his hands on his knees, palms up, and the grasping reflex is checked. The absence of a grasping reflex is assessed as 3 points. If the patient asks whether he should grab, a score of 2 is given. If the patient grabs, he is instructed not to do so, and the grasp reflex is retested. If the reflex is absent during repeated examination, 1 is given, otherwise - 0 points.

Evaluation of results: 17-18 - normal, 12-16 - mild cognitive impairment, 11 points or less - frontal-type dementia

Appendix 6

0 points - no violations

0-5 points - “doubtful” dementia

Memory: persistent minor forgetfulness, incomplete recall of past events, “benign forgetfulness”

Orientation: fully oriented, but there may be inaccuracies when naming the date

Thinking: minor difficulties in solving problems, analyzing similarities and differences

Social interaction: minor difficulties

Behavior at home and hobbies: minor difficulties

Self-service: no violations

1 point - mild dementia

Memory: greater forgetfulness about current events that interferes with daily life

Orientation: not completely oriented in time, but always correctly names the place; at the same time, there may be difficulties in independently navigating the terrain

Thinking: moderate difficulty solving problems, analyzing similarities and differences that do not affect everyday life

Social interaction: independence has been lost, however, it is possible to carry out certain social functions. With a superficial acquaintance, violations may not be obvious

Behavior at home and hobbies: mild but distinct everyday difficulties, loss of interest in complex activities

Self-service: needs reminders

2 points - moderate dementia

Memory: severe forgetfulness, current events do not remain in memory, only memories of the most significant events of life are preserved

Orientation: disoriented in time, not completely oriented in place

Thinking: severe difficulty solving problems and analyzing similarities and differences, which has a negative impact on daily activities

Social interaction: Lost independence outside of home, but can engage in social interactions under the supervision of others

Behavior at home and hobbies: extreme limitation of interest, ability to perform only the most simple activities

Self-service: needs assistance with dressing, hygiene procedures, and natural functions

3 points - severe dementia

Memory: fragmentary memories of life Orientation: oriented only in one’s own personality

Thinking: solving intellectual problems is impossible

Social interaction: impairments interfere with social interaction outside of one's home

Behavior at home and hobbies: unable to perform household duties

Self-service: constantly needs care; frequent incontinence

Appendix 7

General scale of violations
(eng. Global deterioration scale, B. Reisberg et al., 1982)

1 - there are no subjective or objective symptoms of memory impairment or other cognitive functions.

2 - very mild disorders: complaints of memory loss, most often of two types: (a) does not remember what he put where; (b) forgets the names of close friends. In a conversation with the patient, memory impairments are not revealed. The patient is fully able to cope with work and is independent in everyday life. Adequately alarmed by the existing symptoms.

3 - mild disorders: mild but clinically defined symptoms. At least one of the following: (a) inability to find the way when traveling to an unfamiliar place; (b) the patient's coworkers are aware of his cognitive problems; (c) difficulties in finding words and forgetting names are obvious to the family; (d) the patient does not remember what he just read; (e) does not remember the names of people he meets; (e) put it somewhere and could not find an important item; (g) Serial counting may be impaired on neuropsychological testing. It is possible to objectify cognitive disorders only through a thorough study of higher brain functions. Violations can affect work and home life. The patient begins to deny his existing disorders. Often mild to moderate anxiety.

4 - moderate violations: obvious symptoms. Main manifestations: (a) the patient is not sufficiently aware of the events occurring around him; (b) memory of certain life events is impaired; (c) serial counting is broken; (d) the ability to find one’s way, carry out financial transactions, etc. is impaired.

Usually there are no violations of: (a) orientation in place and in one’s own personality; (b) recognition of close acquaintances; (c) the ability to find a well-known road.

Inability to perform complex tasks. Denial of the defect becomes the main mechanism of psychological defense. There is a flattening of affect and avoidance of problematic situations.

5 - moderately severe disorders: loss of independence. Inability to remember important life circumstances, such as home address or telephone number, names of family members (for example, grandchildren), the name of the educational institution from which you graduated.

Usually disorientation in time or place. Difficulties in serial counting (from 40 to 4 or from 20 to 2).

At the same time, basic information about yourself and others is preserved. Patients never forget their own name, the name of their spouse and children. No assistance is required with eating or bowel movements, although there may be difficulties in dressing.

6 - severe violations: It is not always possible to remember the name of a spouse or other person on whom you are completely dependent in everyday life. Amnesia for most life events. Disorientation in time. Difficulty counting from 10 to 1, sometimes also from 1 to 10. Most of the time he needs outside help, although sometimes he retains the ability to find a well-known road. The sleep-wake cycle is often disrupted. The recall of one's own name is almost always preserved. Recognition of familiar people is usually intact. Personality and emotional state changes. There may be: (a) delusions and hallucinations, for example, ideas that the spouse has been replaced; talking with imaginary faces or with one’s own reflection in the mirror; (b) obsession; (c) anxiety, psychomotor agitation, aggression; (d) cognitive abulia - lack of purposeful activity as a result of loss of the ability to do it.

7 - very severe impairment: Speech is usually absent. Urinary incontinence, assistance with eating is required. Basic psycho-motor skills are lost, including walking. The brain is no longer able to control the body. Neurological symptoms of decortication are noted.

Appendix 8

Hachinski ischemic scale (Hachinski et al., 1975)
1) sudden onset (2 points)
2) step-like flow (1 point)
3) presence of fluctuations (2 points)
4) night confusion (1 point)
5) relative safety of personality (1 point)
6) depression (1 point)
7) somatic complaints (1 point)
8) incontinence of emotional reactions (1 point)
9) arterial hypertension (in history or currently) (1 point)
10) history of stroke (2 points)
11) other (somatic) signs of atherosclerosis (1 point)
12) subjective neurological symptoms (2 points)
13) objective neurological symptoms (2 points)

A score of more than 7 points suggests a vascular cause of dementia; a score of 4 or less does not confirm the vascular etiology of the process.

Appendix 9

Hamilton Scale (HDRS)

0-6 - no depressive episode, 7-15 - minor depressive episode, 16 and above - major depressive episode.

Appendix 10

Self-Depression Questionnaire CES-D

If a patient scores 19 or more points, then with very high confidence we can say that he has a depressive disorder. Scores from 19 to 26 correspond to mild depression, from 27 to 36 - moderate depression. If a patient scores 37 or more points, this indicates that he has severe depression.

Weidlich test

TMT test (Trail-Making test) by Reitan

The technique was proposed by Reitan in 1956 and is intended to assess concentration and switchability of attention, as well as the pace of sensorimotor reactions.

The test is a modified version of the classic "Tables Schulte" and consists of two separate subtests (A and B).

Subtest A includes a form on which numbers from 1 to 25 are randomly arranged. The test taker must find the numbers in order as quickly as possible and connect them with lines.

On the B subtest form, numbers from 1 to 13 and letters from A to M are randomly arranged. The test subject’s task is to find and alternately connect lines of numbers and letters in a certain order.

During testing, the completion time of each subtest is recorded.

Primary assessments are converted into standardized assessments taking into account the age of the subject.

A decrease in the score in subtest A compared to the age “norm” reflects a slowdown in the pace of mental activity, difficulty concentrating and maintaining attention, and a decrease in the score in subtest B shows difficulties in switching active attention and inertia of cognitive processes.

The Weidlihab technique was proposed in 1972 and is aimed at studying memory.

The principle of testing is to conduct multiple training trials. The test includes 9 sample cards, each of which depicts a geometric figure made up of 5 lines of the same length.

The cards are presented to the subject in strict sequence for a certain time (exposure time for the first presentation is 10 seconds, for the second and third - 5 seconds). The subject must reproduce the figures depicted on the cards, noting the order of presentation. The experiment is stopped after three repetitions.

The evaluation of the results is based on qualitative and quantitative analysis of reproduction errors. When interpreting the results, the indicator of short-term memory of the subject and the indicator of learning ability are taken into account, reflecting the peculiarities of memorizing figures when the experiment is repeated three times. Both indicators are calculated taking into account the age of the subject.

This technique determines the viability of cognitive functions and is a test for the rapid diagnosis of dementia.

The clock drawing test was proposed in the 1900s as a diagnostic technique for constructive apraxia. First, based on the results of a study of traumatic brain injuries of the First World War, it was found that disturbances in clock drawing are associated with damage to the occipital and parietal regions of the brain. Later, visual-spatial orientation disorders, manifested in the inability to correctly draw a clock, began to be regarded as early signs of dementia.

Diagnosis using the clock drawing test includes three forms of research:

· drawing a clock;

· time setting;

· determination of time.

Procedure for drawing a clock includes the task of drawing a clock face and correctly indicating the numerical time stamps on it.

Time setting procedure involves drawing the minute and hour hands indicating any specific time.

Definition of time The test involves showing the subject a dial without numbers, but with marks at the locations of the numbers and arranged arrows. The subject must determine the time on the dial.

In the process of developing the methodology, several systems for assessing the results obtained were developed, including such criteria as omissions of numbers, errors in location, repetitions, unequal spaces between numbers.

The Clock Drawing Assessment has high sensitivity and specificity for the diagnosis of dementia, right hemisphere lesions, and deficits in executive control in the frontal regions of the brain.

Wrist and table, wall and sand, pocket and fireplace, tower and cuckoo clocks... Clocks make our lives more orderly. At the same time, they remind us that time does not stand still, which means we need to hurry, otherwise all the most interesting things will pass by. And with the help of a watch you can determine the level of our vital energy. This is confirmed by the developers of the graphical express test, which is called “Clock”. Shall we try?

In front of you is a schematically depicted alarm clock. Your task is to redraw the picture onto a piece of paper and give it a finished look. You can draw only the necessary missing details, or you can also highlight the background, add some interior items... As your heart desires!

Is the work completed? Let's start the discussion.

Arrows

So, the hands are an integral attribute of any watch... If in your drawing they are directed up- there is no reason to worry: everything is in order with your vital energy: you are cheerful, full of strength and, undoubtedly, great achievements await you.

If the arrows are “looking” down, your strength is probably running low, which means it makes sense to think about “recharging”.

Things don't matter at all if your alarm clock shows half past six. This indicates a serious energy decline. And there is no time for thinking: no matter how your life circumstances are now, health comes first. Therefore, it’s definitely worth taking a time out.

Numbers

If you depicted, first of all, the numbers, focused on them, or drew the dial with special care, not forgetting about the second divisions, then today you are leading a rather hectic life. You probably lack regularity and orderliness. Try, if possible, to bring order to your daily affairs. Having become an effective time manager for yourself, you will be surprised to discover that by planning your time wisely, you can save energy and get a lot more done.

Call button

If you shaded this element, it looks like what you are currently doing professionally is not your dream job. Perhaps you should look for something you like. And then life will shine with new colors, and the morning trill of the alarm clock will not cause the usual irritation, but the joy that a new, interesting day is beginning.

If you paid special attention to the background, the interior surrounding the clock - you drew a table, “put” a napkin under the alarm clock, “put” a vase of flowers next to it, “scattered” pencils on the tabletop - you are most likely “recharging” by communicating with other people. By shining in society, catching admiring glances, attracting increased attention from others, you draw energy and vitality. By the way, how long has it been since you last went out into the world? Perhaps this is exactly what you need now?