SUMMARYThe clock-drawing test was used in a longitudinal study of 183 dementing individuals and their caregivers. Clockdrawing performance was measured by a simple standardized score which correlated significantly with other measures of cognitive function. Clock performance showed high individual consistency of performance as well as a significant deterioration from the initial level of performance to that obtained at 1-year follow-up. Dementing individuals who had experienced a significantly greater decline in clock-drawing performance at 1 -year follow-up were more likely to have caregivers who had already decided to institutionalize them. This suggests that the caregiver's decision to institutionalize was based in part on the perception of a rapid decline in their dependant's cognitive function. Thus, rate of change in cognitive function may prove to be as important a variable as the level of deterioration. The clock-drawing test appears to be a useful adjunct in the assessment and monitoring of the progressive dementias in the community.KEY woms-Clock-drawing, dementia, community, longitudinal.The utility of the clock-drawing test in the assessment of dementia has been investigated in a number of recent studies (Shulman et al., 1986;Sunderland et al., 1989;Wolf-Klein et al., 1989;Dastoor et al., 1991;Huntzinger et al., 1992;Tuokko et al., 1992). Clock-drawing appears to subsume a diverse range of higher-level cognitive abilities including visuospatial organization, integrative functions and abstract thinking. Because of the wide range of intellectual functions tapped by the clock-drawing test it is particularly suited for the purpose of assessing global cognitive function and reflecting subtle changes in overall brain functioning. As the test is still in its early stages of development, a variety of scoring systems have been used. While there is still no system that is widely accepted, Dastoor (1992) recently confirmed the test's usefulness in differentiating Alzheimer's disease from normal ageing changes. They used a more detailed scoring system dividing performance into three categories including clockdrawing, setting and reading.Clock-drawing as a measure of cognitive function is appealing for a number of practical reasons. It is easy to administer and well tolerated by patients and does not appear to be noticeably influenced by language, cultural, ethnic or educational factors. Since it provides a graphic measure of cognitive function it is useful in chart review and clinical follow-up. For clinicians and epidemiologists alike, a short easily administered test that correlates well with other more detailed and timeconsuming cognitive screens is attractive (Huntz-

The hypothesis that off-target verbosity, defined as extended speech that is lacking in focus or coherence, is mediated by an age-related decline in the ability to inhibit task-irrelevant thoughts, was evaluated in a sample of 205 community-dwelling elderly volunteers aged 61-90. Results showed that performance on four tasks that measured the ability to suppress or remove irrelevant information stored in working memory accounted for a significant proportion of the variance in verbosity, whereas performance on other cognitive measures was unrelated to it. Shared effects between the measures of the ability to inhibit task-irrelevant information and age suggested that age declines in this particular ability may underlie previously observed age-related increases in verbosity. In contrast, the contribution of psychosocial factors to explained variance in verbosity scores was relatively independent of that of inhibition-related measures and age. The results were discussed as suggesting a possible frontal lobe involvement in off-target speech.

This longitudinal study of 196 caregiver/care receiver dyads was undertaken to determine the variables predictive of caregiver decision to institutionalize a dependent with dementia. Seven variables (use of services, enjoyment of caregiving, caregiver burden and health, caregiver rating and reaction to care receiver behavior and memory problems, and presence of troublesome behaviors) predicted the decision to institutionalize. Six variables (caregiver health and burden, use of services, care receiver cognitive function and troublesome behaviors, and caregiver reaction to behaviors) predicted actual institutionalization at 18 months.

The frequency, nature, context, and caregivers' reactions to aggressive behavior in 213 dementia patients residing in the community was studied. Aggression was reported in 57.2% of the patients and in 10.6% of the caregivers. Predictors of patient aggression were greater frequency of behavior and memory problems, premorbid aggression, and a more troubled premorbid social relationship between patient and caregiver. Patient aggression predicted the decision to discontinue home care.

This study examined the effects of abilities as a young adult, an engaged lifestyle, personality, age, and health on continuity and change in intellectual abilities from early to late adulthood. A battery of measures, including a verbal and nonverbal intelligence test, was given to 326 Canadian army veterans. Archival data provided World War Two enlistment scores on the same intelligence test for this sample: Results indicated relative stability of intellectual scores across 40 years, with increases in vocabulary and decreases in arithmetic, verbal analogies, and nonverbal skills. Young adult intelligence was the most important determinant of older adult performance. Predictors for verbal intelligence were consistent with an engagement model of intellectual maintenance but also indicated the importance of introversion-extraversion and age. Nonverbal intelligence in late life was predicted by young adult nonverbal scores, age, health, and introversion-extraversion.