The Draw-A-Clock Contest: A Strategy for Improving Cognitive Status Assessment by Trainees

Background: Historically, psychiatrists have been less inclined than neurologists to utilize pencil and paper tasks during bedside cognitive assessments. Objective: The Draw-AClock Contest was established in 1986 at the University of Massachusetts to promote use of cognitive assessment tasks by psychiatry residents. Methods: Used in neuropsychological assessments since the 1930’s, clock tasks have been popular screening tools for executive function, praxis, visuospatial and constructive ability, often as part of dementia screening. Given its broad utility as a screening tool and the ease and speed of its administration, the Draw-A-Clock task (with hands set to 11:10 and no circle provided) was selected for use by UMass psychiatry residents, with further bedside assessment encouraged to explore any detected deficits. To encourage participation and foster clinical inquiry, residents are asked to submit clinically interesting de-identified patient clocks. For 21 years, clock contest entries have been collected each spring, with basic demographic, diagnostic, and process notes. Resident names are encoded, and entries are judged by a neuropsychiatrist (SB) and a neuropsychologist (EK). A “clock trophy” and detailed analysis of the submission is presented to the winner at the annual graduation banquet. Results: As a result of this contest, mental status examinations by trainees have become more comprehensive and an atmosphere of neuropsychiatric inquiry has been maintained. Faculty members have also incorporated this task into their mental status assessments, thus establishing a culture of cognitive inquiry and an academic tradition. Examples of winning clocks and common findings will be presented. Published abstract: Sullivan J, Benjamin S, Case Report: CADASIL with Cysteine-Sparing Notch-3 Mutation, American Neuropsychiatric Association, abstract, Journal of Neuropsychiatry and Clinical Neuroscience 21(2):221, 2009. DOI 10.1176/appi.neuropsych.21.2.221

A resting state functional magnetic resonance imaging study of concussion in collegiate athletes

Sports-related concussions are currently diagnosed through multi-domain assessment by a medical professional and may utilize neurocognitive testing as an aid. However, these tests have only been able to detect differences in the days to week post-concussion. Here, we investigate a measure of brain function, namely resting state functional connectivity, which may detect residual brain differences in the weeks to months after concussion. Twenty-one student athletes (9 concussed within 6 months of enrollment; 12 non-concussed; between ages 18 and 22 years) were recruited for this study. All participants completed the Wisconsin Card Sorting Task and the Color-Word Interference Test. Neuroimaging data, specifically resting state functional Magnetic Resonance Imaging data, were acquired to examine resting state functional connectivity. Two sample t-tests were used to compare the neurocognitive scores and resting state functional connectivity patterns among concussed and non-concussed participants. Correlations between neurocognitive scores and resting state functional connectivity measures were also determined across all subjects. There were no significant differences in neurocognitive performance between concussed and non-concussed groups. Concussed subjects had significantly increased connections between areas of the brain that underlie executive function. Across all subjects, better neurocognitive performance corresponded to stronger brain connectivity. Even at rest, brains of concussed athletes may have to \u27work harder\u27 than their healthy peers to achieve similar neurocognitive results. Resting state brain connectivity may be able to detect prolonged brain differences in concussed athletes in a more quantitative manner than neurocognitive test scores