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Considerations for Clock Drawing Scoring Systems in Perioperative Anesthesia Settings

Frei, Bailey W., BS*; Woodward, Kristen T., BS*; Zhang, Mitchell Y., BSE*; Amini, Shawna, MPH*,†; Tighe, Patrick, MD, MS*; Garvan, Cynthia W., PhD*; Giordano, Chris, MD*; Price, Catherine C., PhD*,†

doi: 10.1213/ANE.0000000000004105
Geriatric Anesthesia: Brief Report

The Clock Drawing Test is a cognitive screening tool gaining popularity in the perioperative setting. We compared 3 common scoring systems: (1) the Montreal Cognitive Assessment; (2) the Mini-Cog; and (3) the Libon scale. Three novice raters acquired interrater and intrarater reliability for each scoring system and then scored 738 preoperative clock drawings with each scoring system. Final scores correlated with each other but with notable discrepancies, indicating the need to attend to interrater and intrarater reliability when implementing any scoring approach in a clinical setting.

From the Departments of *Anesthesiology

Clinical and Health Psychology, University of Florida College of Medicine and Public Health and Health Professions, Gainesville, Florida.

Published ahead of print 28 January 2019.

Accepted for publication January 28, 2019.

Funding: Supported by the Lawrence M. Goodman Research Award (to B.W.F., K.T.W., and M.Y.Z.), National Institutes of Health (grant Nos. R01 NR014181 and IIS-1404494 to C.P.; R01 AG055337 to C.P. and P.T.; and P50AG047266), and the I. Heermann Anesthesia Foundation (to C.G. and C.C.P.).

The authors declare no conflicts of interest.

B. W. Frei, K. T. Woodward, and M. Y. Zhang contributed equally and share first authorship.

Reprints will not be available from the authors.

Address correspondence to Catherine C. Price, PhD, Departments of Clinical and Health Psychology and Anesthesiology, PO Box 100165, Gainesville, FL 32605. Address e-mail to

© 2019 International Anesthesia Research Society
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