Abstract
BackgroundThe Rey-Osterrieth Complex Figure Test (RCFT) is a neuropsychological test that is widely used to assess visual memory and visuoconstructional deficits in patients with cognitive impairment, including Alzheimer disease (AD). Patients with AD have an increased tendency for exhibiting extraordinary behaviors in the RCFT for selecting the drawing area, organizing the figure, and deciding the order of images, among other activities. However, the conventional scoring system based on pen and paper has a limited ability to reflect these detailed behaviors.ObjectiveThis study aims to establish a scoring system that addresses not only the spatial arrangement of the finished drawing but also the drawing process of patients with AD by using digital pen data.MethodsA digital pen and tablet were used to copy complex figures. The stroke patterns and kinetics of normal controls (NCs) and patients with early-onset AD (EOAD) and late-onset AD (LOAD) were analyzed by comparing the pen tip trajectory, spatial arrangement, and similarity of the finished drawings.ResultsPatients with AD copied the figure in a more fragmented way with a longer pause than NCs (EOAD: P=.045; LOAD: P=.01). Patients with AD showed an increased tendency to draw the figures closer toward the target image in comparison with the NCs (EOAD: P=.005; LOAD: P=.01) Patients with AD showed the lower accuracy than NCs (EOAD: P=.004; LOAD: P=.002). Patients with EOAD and LOAD showed similar but slightly different drawing behaviors, especially in space use and in the initial stage of drawing.ConclusionsThe digitalized complex figure test evaluated copying performance quantitatively and further elucidated the patients’ ongoing process during copying. We believe that this novel approach can be used as a digital biomarker of AD. In addition, the repeatability of the test will delineate the process of executive functions and constructional organization abilities with disease progression.
Highlights
BackgroundThe Rey-Osterrieth Complex Figure Test (RCFT) is widely used to examine the visuoconstruction and visual memory function of patients with brain injuries or cognitive impairment such as Alzheimer disease (AD) [1]
Patients with AD showed an increased tendency to draw the figures closer toward the target image in comparison with the normal controls (NC) (EOAD: P=.005; late-onset AD (LOAD): P=.01) Patients with AD showed the lower accuracy than NCs (EOAD: P=.004; LOAD: P=.002)
To investigate differences in neuropsychological scores among the 3 groups, we used Z scores based on age- and education-adjusted norms
Summary
BackgroundThe Rey-Osterrieth Complex Figure Test (RCFT) is widely used to examine the visuoconstruction and visual memory function of patients with brain injuries or cognitive impairment such as Alzheimer disease (AD) [1]. The number, length, and speed of strokes made by patients with brain injuries may differ from that of NCs. it is necessary to establish a scoring system using a digital device that records the spatial arrangement of the finished drawing and all the details of drawing processes, including the sequence in drawing the parts of the figures. It is necessary to establish a scoring system using a digital device that records the spatial arrangement of the finished drawing and all the details of drawing processes, including the sequence in drawing the parts of the figures This approach will augment our understanding of the organizing strategy and executive functions of patients with brain injuries. The conventional scoring system based on pen and paper has a limited ability to reflect these detailed behaviors
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