Does Rey Complex Figure Copy Performance Measure Executive Function in Children?

Bayesian modelling disentangles language versus executive control disruption in stroke

Stroke is the leading cause of long-term disability worldwide. Incurred brain damage can disrupt cognition, often with persisting deficits in language and executive capacities. Yet, despite their clinical relevance, the commonalities and differences between language versus executive control impairments remain under-specified. To fill this gap, we tailored a Bayesian hierarchical modelling solution in a largest-of-its-kind cohort (1080 patients with stroke) to deconvolve language and executive control with respect to the stroke topology. Cognitive function was assessed with a rich neuropsychological test battery including global cognitive function (tested with the Mini-Mental State Exam), language (assessed with a picture naming task), executive speech function (tested with verbal fluency tasks), executive control functions (Trail Making Test and Digit Symbol Coding Task), visuospatial functioning (Rey Complex Figure), as well as verbal learning and memory function (Soul Verbal Learning). Bayesian modelling predicted interindividual differences in eight cognitive outcome scores three months after stroke based on specific tissue lesion topologies. A multivariate factor analysis extracted four distinct cognitive factors that distinguish left- and right-hemispheric contributions to ischaemic tissue lesions. These factors were labelled according to the neuropsychological tests that had the strongest factor loadings: One factor delineated language and general cognitive performance and was mainly associated with damage to left-hemispheric brain regions in the frontal and temporal cortex. A factor for executive control summarized mental flexibility, task switching and visual-constructional abilities. This factor was strongly related to right-hemispheric brain damage of posterior regions in the occipital cortex. The interplay of language and executive control was reflected in two distinct factors that were labelled as executive speech functions and verbal memory. Impairments on both factors were mainly linked to left-hemispheric lesions. These findings shed light onto the causal implications of hemispheric specialization for cognition; and make steps towards subgroup-specific treatment protocols after stroke.

Associations between Executive Functions and Sensorimotor Performance in Children at Risk for Learning Disabilities

Executive functions (EF) and sensorimotor skills play a critical role in children's goal-directed behavior and school readiness. The aim of the current study is to provide new insights into the relationship between executive functions and sensorimotor development by considering the risks associated with learning difficulties. Therefore, we investigate the predictive role of EF and sensorimotor skills in the development of learning difficulties during preschool years. Ninety-five preschool children (5-7 years old) were tested, comparing the performance of children that are at risk of learning difficulties (n = 55) to the performance of typically developing children (n = 40). Participants completed a battery for the assessment of sensorimotor skills (i.e., Southern California Sensory Integration Test: postural imitation, body midline crossing, bilateral motor coordination, and standing balance with eyes open) and executive functions (i.e., inhibition, cognitive flexibility, and verbal working memory). Our results show that children at risk for learning difficulties exhibited more impairments on sensorimotor and EF measures (inhibition and verbal working memory) when compared with TD children. We ran three separate binary logistic regression analyses to assess the relative influence of EF and sensorimotor functions on predicting risk for learning difficulties. Our findings demonstrated that verbal working memory as EF function (odd ratio (OR) = 0.91, 95% CI 0.78-0.91, P = 0.05) and standing balance skills as a sensorimotor skill (odd ratio (OR) = 0.86, 95% CI 0.81-0.98, P = 0.01) were the strongest predictors of risk for learning difficulties. The findings point to the importance of supporting children's executive function development and promoting sensorimotor development, as both fundamentally influence school readiness.

Bayesian modeling disentangles language versus executive control disruption in stroke

Stroke is the leading cause of long-term disability worldwide. Incurred brain damage disrupts cognition, often with persisting deficits in language and executive capacities. Despite their clinical relevance, the commonalities, and differences of language versus executive control impairments remain under-specified. We tailored a Bayesian hierarchical modeling solution in a largest-of-its-kind cohort (1080 stroke patients) to deconvolve language and executive control in the brain substrates of stroke insults. Four cognitive factors distinguished left- and right-hemispheric contributions to ischemic tissue lesion. One factor delineated language and general cognitive performance and was mainly associated with damage to left-hemispheric brain regions in the frontal and temporal cortex. A factor for executive control summarized control and visual-constructional abilities. This factor was strongly related to right-hemispheric brain damage of posterior regions in the occipital cortex. The interplay of language and executive control was reflected in two factors: executive speech functions and verbal memory. Impairments on both were mainly linked to left-hemispheric lesions. These findings shed light onto the causal implications of hemispheric specialization for cognition; and make steps towards subgroup-specific treatment protocols after stroke.

A machine-learning algorithm for predicting brain age using Rey-Osterrieth complex figure tests of healthy participants

OBJECTIVE

Neuropsychologists widely use the Rey-Osterrieth complex figure test (RCFT) as part of neuropsychological test batteries to evaluate cognitive function and assess constructional ability, with age being the most significant factor. Our study investigated a supervised machine learning (ML) algorithm to predict brain age gap using RCFT drawings from the healthy elderly community for early dementia detection.

PARTICIPANTS AND METHODS

RCFT drawings from 1,970 healthy subjects (ages 45-90 years) were collected from the Korean elderly community. We recorded subject demographic information including: age, gender, and education level. We trained the ML model with RCFT copies, immediate recall, delayed recall, and education level of the healthy subjects using CNN regression algorithm from Keras (https://keras.io/) with the Tensorflow library.

RESULTS

The performance was evaluated by the mean absolute error (MAE) and root mean squared error (RMSE) between the predicted age and the chronological age based on a test dataset of 300 healthy subjects. The CNN regression model achieved an MAE of 7.2 years in predicting the brain age gap of the subjects, with an RMSE of 8.9 years.

CONCLUSION

The MAE and RMSE accuracies of the CNN regression model predicting the brain age gap showed the model could be a potential biomarker for individual brain aging and a cost-effective method for early dementia detection.

Do children with and without autism spectrum disorder use different visuospatial processing skills to perform the Rey-Osterrieth complex figure test?

Visuospatial organization abilities are closely related to other visuospatial processing skills, such as visuomotor coordination, perceptual abilities, mental rotation, and working memory (WM). One task that enables visuospatial organization abilities to be investigated is the Rey–Osterrieth complex figure test (ROCFT). When examining visuospatial functioning, individuals with autism spectrum disorder (ASD) have proved capable of operating both locally and globally, depending on the sub‐domain embraced, with a preference for a locally‐oriented processing of visuospatial information. The present research aimed to establish whether different underlying visuospatial skills might account for performance in the ROCFT in children and adolescents with ASD, compared with typically developing (TD), by considering the role of local/global visuospatial processing. The study involved 39 participants who have ASD without intellectual disability, and 57 TD aged 8–16 years. The participants were administered tasks assessing visuospatial organization abilities, manual dexterity, visual perception, mental rotation, spatial‐sequential, spatial‐simultaneous WM, and visuospatial processing. Our results suggest that manual dexterity and visuospatial processing similarly explain performance in both groups, while differences in visuospatial WM account for the two groups' visuospatial organization abilities. Spatial‐simultaneous WM predicted performance in copy and recall conditions in the TD group but not in the ASD group, while spatial‐sequential WM only did so in the latter group, reinforcing the tendency of children with ASD towards local bias in the visuospatial organization domain. The implications of these findings are discussed.

Exploratory study on the use of HMD virtual reality to investigate individual differences in visual processing styles

Purpose

Global and local processing is part of human perceptual organisation, where global processing helps extract the “gist” of the visual information and local processing helps perceive the details. Individual differences in these two types of visual processing have been found in autism and ADHD (Attention-Deficit Hyperactivity Disorder). Virtual reality (VR) has become a more available method of research in the last few decades. No previous research has investigated perceptual differences using this technology.

Design/methodology/approach

The objective of the research is to threefold: (1) identify if there is association between ADHD and autistic traits and the performance on the Rey-Osterrieth complex figure (ROCF) task, (2) investigate practical effects of using VR drawing tools for research on perceptual experiences and (3) explore any perceptual differences brought out by the three-dimensional nature of the VR. The standard ROCF test was used as a baseline task to investigate the practical utility of using VR as an experimental platform. A total of 94 participants were tested.

Findings

Attention-to-detail, attention switching and imagination subscales of autism quotient (AQ) questionnaire were found to be predictors of organisational ROCF scores, whereas only the attention-to-detail subscale was predictive of perceptual ROCF scores.

Originality/value

The current study is an example of how classic psychological paradigms can be transferred into the virtual world. Further investigation of the distinct individual preferences in drawing tasks in VR could lead to a better understanding of individual differences in the processing of visuospatial information.

Evidence of the validity of a novel version of the computerized cognitive screening battery CompCog

Although the availability of the computer-based assessment has increased over the years, neuropsychology has not carried out a significant paradigm shift since the personal computer’s popularization in the 1980s. To keep up with the technological advances of healthcare and neuroscience in general, more efforts must be made in the field of clinical neuropsychology to develop and validate new and more technology-based instruments, especially considering new variables and paradigms when compared to paper and pencil tests.

"Building blocks and drawing figures is not the same": Neuropsychological bases of block design and Rey figure drawing in typically developing children

Several studies investigated the neuropsychological bases of spatial construction in developmental samples. However, no study directly tested whether the pattern of the neuropsychological processes implied in spatial construction changed depending on whether a block building or a figure drawing task is considered. Here, we used the path analysis to test the direct and indirect effects of verbal abilities (naming and verbal knowledge), executive functions, figure disembedding and mental rotation on two classical spatial construction tasks: the Rey-Osterrieth Complex Figure (ROCF) and the Block Design (BD). We recruited a sample of 186 typically developing children (age range: 7-12 years). Results showed that ROCF copying was directly influenced by age and figure disembedding, and it was indirectly affected by executive functions, naming and verbal knowledge, whereas BD was influenced in a direct way by verbal knowledge, figure disembedding and mental rotation and indirectly affected by executive functions and naming skills. Moreover, the results showed a full measurement invariance of the path model between sexes, whereas only partial invariance was found for age. Thus, we tested the model in two age groups (age ranges: 7-9.5 and 9.6-12 years) and found that the relationships between the variables of the model changed across development. Although other variables might be relevant to spatial construction, the present findings demonstrate different neuropsychological bases of drawing figures and building blocks in typically developing children.

Switching between the Forest and the Trees: The Contribution of Global to Local Switching to Spatial Constructional Abilities in Typically Developing Children

Background: Spatial analysis encompasses the ability to perceive the visual world by arranging the local elements (“the trees”) into a coherent global configuration (“the forest”). During childhood, this ability gradually switches from a local to a global precedence, which contributes to changes in children’s spatial construction abilities, such as drawing or building blocks. At present, it is not clear whether enhanced global or local processing or, alternatively, whether switching between these two levels best accounts for children’s spatial constructional abilities. Methods: We assessed typically developing children 7 to 8 years old on a global/local switching task and on two widely used spatial construction tasks (the Rey–Osterrieth Complex Figure and the Block Design test). Results: The ability to switch from global to local level, rather than a global or a local advantage, best accounted for children’s performance on both spatial construction tasks. Conclusions: The present findings contribute to elucidate the relationship between visual perception and spatial construction in children showing that the ease with which children switch perception from global to local processing is an important factor in their performance on tasks requiring complex drawing and block assembling.

Cerebellar structural connectivity and contributions to cognition in frontotemporal dementias

Frontotemporal dementia (FTD) is a heterogeneous group of neurodegenerative brain disorders, primarily affecting the frontal and/or temporal lobes. Three main subtypes are recognised, each with distinct clinical and cognitive profiles: behavioural-variant FTD (bvFTD), semantic dementia (SD), and progressive nonfluent aphasia (PNFA). Subtype-specific cerebellar grey matter atrophy has been associated with cognitive dysfunction in FTD; however, the extent and severity of structural abnormalities in the cerebro-cerebellar circuits in these disorders has not been investigated. This study aimed to identify patterns of cerebellar white matter changes and their relations to cognitive deficits in the main FTD subtypes. Results revealed bilateral cerebellar white matter changes in all FTD subtypes compared with controls, with greater cerebellar white matter changes in bvFTD than SD and PNFA. Both afferent and efferent cerebellar pathways were associated with cognition. The profiles of the involvement of cerebellar pathways in cognition varied across FTD syndromes. In bvFTD, the output pathway of the cerebellum was only associated with measures of episodic memory. The input pathway was associated with measures of attention, working memory, visuospatial, episodic memory, executive function, and emotion. In SD, both the output and input pathways were associated with measures of working memory, language, and emotion. Finally, in PNFA, both the output and input pathway of the cerebellum were associated with attention, language, and executive function. Additionally, the input pathway was associated with working memory, visuospatial, and emotion. This study is the first to identify patterns of cerebellar white matter changes across FTD syndromes, which in turn relate to cognitive deficits. These findings extend our understanding of the cerebro-cerebellar networks and provide new insight into the role of cerebellar white matter in cognition.

Identifying neuropsychological predictors of drawing skills in elementary school children

Much evidence indicates that drawing is related to different neuropsychological abilities in children. However, a comprehensive cognitive model of drawing in children is still lacking. Here, we conducted a study on the neuropsychological predictors of drawing in a sample of 142 typically developing elementary school children (M age = 8.8 years; SD = 1.1). Based on a path analysis, we examined the contribution of visual perception (matching geometrical figures), complex spatial abilities (e.g., complex figures identification and mental rotation), visual attention, working memory, verbal and visual-motor skills, as well as of gender, age and socio-economic status, to copying the Rey-Osterrieth Complex Figure (ROCF). Results showed that ROCF copying was influenced in a specific and additive way by visual perception, visual-motor coordination, and verbal abilities as well as age, while it was indirectly related to visual attention, working memory, and to complex spatial abilities. These findings provide the grounds for identifying the neuropsychological bases of drawing in elementary school children.

Test-specific differences in verbal memory assessments used prior to surgery in temporal lobe epilepsy

OBJECTIVE

To study the relationship between two commonly used verbal memory tests in presurgical evaluation for temporal lobe epilepsy (TLE) in Sweden, the Claeson-Dahl Test for verbal learning and retention (CDT) and the Swedish version of the Rey Auditory Verbal Learning Test (RAVLT).

METHODS

Fifty-nine patients with TLE (male: 41%, mean: age 41.7 ± 12.3 years; epilepsy onset at mean age: 18.3 ± 13.1 years) previously tested with the CDT, the RAVLT, and three nonverbal memory tests on the same occasion were included. We performed (1) a principal component analysis (PCA) on test performances in the CDT and the RAVLT as well as in nonverbal memory tests; (2) a Pearson's correlation analysis for memory components, biological age, education, age at epilepsy onset, and self-rating scores for depression and anxiety; and (3) an estimation of clinically significant verbal memory impairment in patients with left TLE and left-sided hippocampal sclerosis.

RESULTS

The PCAs showed coherence between the learning variables of the CDT and the RAVLT and divergence between the recall variables of the two tests. The RAVLT delayed recall variable was correlated to four out of five nonverbal memory measures. Both tests showed 70-80% clinically significant impairment of verbal memory in patients with left TLE, with or without hippocampal sclerosis, similar to other cohorts with resistant TLE.

CONCLUSIONS

The construct structure of the two verbal memory differs. It was shown that the RAVLT correlated with visuospatial memory, whereas the CDT did not. The study highlights that there are important nonoverlapping features regarding verbal recall of the two tests, indicating that these tests cannot fully replace one another.

Executive and nonexecutive demands of constructional measures within a children's psychiatric inpatient setting

This study examined the role of executive functioning in constructional task performance (measured with the Rey Complex Figure Test-Copy Condition [RCFT] and Beery-Buktenica Developmental Test of Visual-Motor Integration [Beery-VMI]) within a children's psychiatric inpatient setting. A chart review was conducted for 88 children (aged 6-12) who received a neuropsychological evaluation during a psychiatric inpatient hospitalization. Multiple regression analyses investigated the role of executive and nonexecutive demands on RCFT and Beery-VMI performance. Forty-three percent of the sample displayed a constructional weakness. Children with a constructional weakness had lower FSIQ scores and a higher rate of executive dysfunction. Performance on the RCFT was independently predicted by perceptual ability (i.e., Matrix Reasoning; p = .008; β = .340) and attention/executive dysfunction (p = .003; β = -.342; 9.4% of variance), while performance on the Beery-VMI was independently predicted by constructional ability (i.e., Block Design; p = .004, β = .338). Results of this study demonstrate that the RCFT has greater executive demand than the VMI and yields a greater rate of impaired performance in an inpatient child sample as compared to the VMI. Clinical and research practices should consider the distinct differences between various constructional measures to ensure their proper use and interpretation with consideration to their varying executive and nonexecutive demands.

Cognitive predictors of copying and drawing from memory of the Rey-Osterrieth complex figure in 7- to 10-year-old children

Cognitive models of drawing are mainly based on assessment of copying performance of adults, whereas only a few studies have verified these models in young children. Moreover, developmental investigations have only rarely performed a systematic examination of the contribution of perceptual and representational visuo-spatial processes to copying and drawing from memory. In this study we investigated the role of visual perception and mental representation in both copying and drawing from memory skills in a sample of 227 typically developing children (53% females) aged 7-10 years. Participants underwent a neuropsychological assessment and the Rey-Osterrieth Complex Figure (ROCF). The fit and invariance of the predictive model considering visuo-spatial abilities, working memory, and executive functions were tested by means of hierarchical regressions and path analysis. Results showed that, in a gender invariant way, visual perception abilities and spatial mental representation had a direct effect on copying performance, whereas copying performance was the only specific predictor for drawing from memory. These effects were independent from age and socioeconomic status, and showed that cognitive models of drawing built up for adults could be considered for predicting copying and drawing from memory in children.