Reversed Clock Drawing Phenomenon in a Patient with Vascular Dementia and Vascular parkinsonism: A Case Report

Abstract

Reversed Clock Phenomenon (RCP) occurs when the numbers are drawn counterclockwise in a clock drawing test. It is commonly associated with the decline in visuospatial function in dementia associated with lesions in the right cerebral hemisphere. While RCP typically manifests in the acute phase, this case reported a 64-year-old man with vascular dementia (VaD) and vascular parkinsonism who had exhibited persistent RCP one year after his last stroke. He presented with worsening memory impairment and frequent episodes of falls following recurrent strokes in 2018 and 2020. His Clinical Dementia Rating (CDR) was 1. MRI of the brain showed a hypodense lesion at the bilateral temporoparietal lobes. After treatment with acetylcholinesterase inhibitors and rehabilitation, his condition improved, suggesting the potential benefits of this combined approach in managing persistent RCP and visuospatial deficits in vascular dementia.