This simple drawing test uses AI and the Apple Pencil to spot dementia

This simple drawing test uses AI and the Apple Pencil to spot dementia Mark Wilson

Draw me a clock. And set the time to 10 minutes past 11.

Easy, right? Kind of. Your mind might be asking, does the top of an analog clock start at 1 or . . . nope, it starts at 12. And 10 past 11 . . . oh wait, that’s 11:10, right? Okay. So where does the big hand go . . . ?

The Clock Drawing Test is a simple task that challenges your memory, concentration, ability to relate images in space, and the fine motor movements of drawing—which is why drawing a clock on paper has been a tool to specifically screen for dementia and other cognitive impairments for more than 30 years, after first being introduced in 1953.

Now, the Clock Drawing Test has been given a digital makeover, which received the 2023 Innovation by Design Award in the User Experience category. Developed by the Boston-based digital healthcare company Linus Health from research first conducted at MIT, the DCTclock lives on an iPad rather than paper. Instead of a pen, you draw with the Apple Pencil. And rather than relying on a clinician—who might use one of a dozen different scoring methods to analyze a patient’s work—the system leverages AI to analyze minutiae a human could miss.

While software analyzes the drawn image, like the roundness of the clock circle and the accuracy of the numbers, it also leverages the Apple Pencil’s movement sensors to track metrics ranging from the precise time it takes to start drawing letters to the efficiency of movements behind your strokes to tremors that might be in someone’s hand.

“All of these things are part of your cognitive ability,” says Casey Rae Coleman, director of product design at Linus Health. “[It’s about] following instructions in order. And then we’re basically analyzing the entire person’s process of drawing the clock, as well as picking up any errors that may be collected. You missed writing the number 2 on there, so that’s an error, because we asked you to draw an analog clock and put in all the numbers.”

After the two-minute test is done at your doctor’s office, the system produces a score that goes to the patient and healthcare provider. If issues are found—and incidentally, the DCTclock has proven able to spot patients who have the amyloid plaques of Alzheimer’s—the system will offer recommendations for treatment, which could involve getting more exercise or learning a new hobby (both of which have been proven to aid in cognition). A doctor might also reexamine a patient’s medications to see if any adjustments might help them think more clearly. If any issue is found, patients retake the test in three to six months.