Visuospatial working memory assessment using a digital tablet in adolescents with attention deficit hyperactivity disorder

Tablet-based Rey-Osterrieth Complex Figure copy task: a novel application to assess spatial, procedural, and kinematic aspects of drawing in children

The paper-and-pencil Rey-Osterrieth Complex Figure (ROCF) copy task has been extensively used to assess visuo-constructional skills in children and adults. The scoring systems utilized in clinical practice provide an integrated evaluation of the drawing process, without differentiating between its visuo-constructional, organizational, and motor components. Here, a tablet-based ROCF copy task capable of providing a quantitative assessment of the drawing process, differentiating between visuo-constructional, organizational, and motor skills, is trialed in 94 healthy children, between 7 and 11 years of age. Through previously validated algorithms, 12 indices of performance in the ROCF copy task were obtained for each child. Principal component analysis of the 12 indices identified spatial, procedural, and kinematic components as distinct dimensions of the drawing process. A composite score for each dimension was determined, and correlation analysis between composite scores and conventional paper-and-pencil measures of visuo-constructional, procedural, and motor skills performed. The results obtained confirmed that the constructional, organizational, and motor dimensions underlie complex figure drawing in children; and that each dimension can be measured by a unique composite score. In addition, the composite scores here obtained from children were compared with previsions results from adults, offering a novel insight into how the interplay between the three dimensions of drawing evolves with age.

A tablet-based multi-dimensional drawing system can effectively distinguish patients with amnestic MCI from healthy individuals

The population with dementia is expected to rise to 152 million in 2050 due to the aging population worldwide. Therefore, it is significant to identify and intervene in the early stage of dementia. The Rey-Osterreth complex figure (ROCF) test is a visuospatial test scale. Its scoring methods are numerous, time-consuming, and inconsistent, which is unsuitable for wide application as required by the high number of people at risk. Therefore, there is an urgent need for a rapid, objective, and sensitive digital scoring method to detect cognitive dysfunction in the early stage accurately. This study aims to clarify the organizational strategy of aMCI patients to draw complex figures through a multi-dimensional digital evaluation system. At the same time, a rapid, objective, and sensitive digital scoring method is established to replace traditional scoring. The data of 64 subjects (38 aMCI patients and 26 NC individuals) were analyzed in this study. All subjects completed the tablet's Geriatric Complex Figure (GCF) test, including copying, 3-min recall, and 20-min delayed recall, and also underwent a standardized neuropsychological test battery and classic ROCF test. Digital GCF (dGCF) variables and conventional GCF (cGCF) scores were input into the forward stepwise logistic regression model to construct classification models. Finally, ROC curves were made to visualize the difference in the diagnostic value of dGCF variables vs. cGCF scores in categorizing the diagnostic groups. In 20-min delayed recall, aMCI patients' time in air and pause time were longer than NC individuals. Patients with aMCI had more short strokes and poorer ability of detail integration (all p < 0.05). The diagnostic sensitivity of dGCF variables for aMCI patients was 89.47%, slightly higher than cGCF scores (sensitivity: 84.21%). The diagnostic accuracy of both was comparable (dGCF: 70.3%; cGCF: 73.4%). Moreover, combining dGCF variables and cGCF scores could significantly improve the diagnostic accuracy and specificity (accuracy: 78.1%, specificity: 84.62%). At the same time, we construct the regression equations of the two models. Our study shows that dGCF equipment can quantitatively evaluate drawing performance, and its performance is comparable to the time-consuming cGCF score. The regression equation of the model we constructed can well identify patients with aMCI in clinical application. We believe this new technique can be a highly effective screening tool for patients with MCI.

Ocular and neural genes jointly regulate the visuospatial working memory in ADHD children

OBJECTIVE

Working memory (WM) deficits have frequently been linked to attention deficit hyperactivity disorder (ADHD). Despite previous studies suggested its high heritability, its genetic basis, especially in ADHD, remains unclear. The current study aimed to comprehensively explore the genetic basis of visual-spatial working memory (VSWM) in ADHD using wide-ranging genetic analyses.

METHODS

The current study recruited a cohort consisted of 802 ADHD individuals, all met DSM-IV ADHD diagnostic criteria. VSWM was assessed by Rey-Osterrieth complex figure test (RCFT), which is a widely used psychological test include four memory indexes: detail delayed (DD), structure delayed (SD), structure immediate (SI), detail immediate (DI). Genetic analyses were conducted at the single nucleotide polymorphism (SNP), gene, pathway, polygenic and protein network levels. Polygenic Risk Scores (PRS) were based on summary statistics of various psychiatric disorders, including ADHD, autism spectrum disorder (ASD), major depressive disorder (MDD), schizophrenia (SCZ), obsessive compulsive disorders (OCD), and substance use disorder (SUD).

RESULTS

Analyses at the single-marker level did not yield significant results (5E-08). However, the potential signals with P values less than E-05 and their mapped genes suggested the regulation of VSWM involved both ocular and neural system related genes, moreover, ADHD-related genes were also involved. The gene-based analysis found RAB11FIP1, whose encoded protein modulates several neurodevelopment processes and visual system, as significantly associated with DD scores (P = 1.96E-06, Padj = 0.036). Candidate pathway enrichment analyses (N = 53) found that forebrain neuron fate commitment significantly enriched in DD (P = 4.78E-04, Padj = 0.025), and dopamine transport enriched in SD (P = 5.90E-04, Padj = 0.031). We also observed a significant negative relationship between DD scores and ADHD PRS scores (P = 0.0025, Empirical P = 0.048).

CONCLUSIONS

Our results emphasized the joint contribution of ocular and neural genes in regulating VSWM. The study reveals a shared genetic basis between ADHD and VSWM, with GWAS indicating the involvement of ADHD-related genes in VSWM. Additionally, the PRS analysis identifies a significant relationship between ADHD-PRS and DD scores. Overall, our findings shed light on the genetic basis of VSWM deficits in ADHD, and may have important implications for future research and clinical practice.

Automating Rey Complex Figure Test scoring using a deep learning-based approach: a potential large-scale screening tool for cognitive decline

BACKGROUND

The Rey Complex Figure Test (RCFT) has been widely used to evaluate the neurocognitive functions in various clinical groups with a broad range of ages. However, despite its usefulness, the scoring method is as complex as the figure. Such a complicated scoring system can lead to the risk of reducing the extent of agreement among raters. Although several attempts have been made to use RCFT in clinical settings in a digitalized format, little attention has been given to develop direct automatic scoring that is comparable to experienced psychologists. Therefore, we aimed to develop an artificial intelligence (AI) scoring system for RCFT using a deep learning (DL) algorithm and confirmed its validity.

METHODS

A total of 6680 subjects were enrolled in the Gwangju Alzheimer's and Related Dementia cohort registry, Korea, from January 2015 to June 2021. We obtained 20,040 scanned images using three images per subject (copy, immediate recall, and delayed recall) and scores rated by 32 experienced psychologists. We trained the automated scoring system using the DenseNet architecture. To increase the model performance, we improved the quality of training data by re-examining some images with poor results (mean absolute error (MAE) [Formula: see text] 5 [points]) and re-trained our model. Finally, we conducted an external validation with 150 images scored by five experienced psychologists.

RESULTS

For fivefold cross-validation, our first model obtained MAE = 1.24 [points] and R-squared ([Formula: see text]) = 0.977. However, after evaluating and updating the model, the performance of the final model was improved (MAE = 0.95 [points], [Formula: see text] = 0.986). Predicted scores among cognitively normal, mild cognitive impairment, and dementia were significantly different. For the 150 independent test sets, the MAE and [Formula: see text] between AI and average scores by five human experts were 0.64 [points] and 0.994, respectively.

CONCLUSION

We concluded that there was no fundamental difference between the rating scores of experienced psychologists and those of our AI scoring system. We expect that our AI psychologist will be able to contribute to screen the early stages of Alzheimer's disease pathology in medical checkup centers or large-scale community-based research institutes in a faster and cost-effective way.

A novel tablet-based motor coordination test performs on par with the Beery VMI subtest and offers superior temporal metrics: findings from children with pediatric acute-onset neuropsychiatric syndrome

Neuropsychiatric and neurodevelopmental disorders are often associated with coordination problems. Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) constitutes a specific example of acute and complex symptomatology that includes difficulties with motor control. The present proof-of-concept study aimed at testing a new, bespoke tablet-based motor coordination test named SpaceSwipe, providing fine-grained measures that could be used to follow-up on symptoms evolution in PANS. This test enables computationally precise and objective metrics of motor coordination, taking into account both directional and spatial features continuously. We used SpaceSwipe to assess motor coordination in a group of children with PANS (n = 12, assessed on in total of 40 occasions) and compared it against the motor coordination subtest from the Beery-Buktenica Developmental Test of Visual-Motor Integration (Beery VMI) 6th edition, traditionally used to follow-up symptomatology. Using a bivariate linear regression, we found that 33 s of the directional offset from tracking a moving target in SpaceSwipe could predict the Beery VMI motor coordination (VMI MC) raw scores (mean absolute error: 1.75 points). Positive correlations between the predicted scores and the VMI MC scores were found for initial testing (r_adj = 0.87) and for repeated testing (r_adj = 0.79). With its short administration time and its close prediction to Beery VMI scores, this proof-of-concept study demonstrates the potential for SpaceSwipe as a patient-friendly tool for precise, objective assessment of motor coordination in children with neurodevelopmental or neuropsychiatric disorders.

The use of a tablet-based app for investigating the influence of autistic and ADHD traits on performance in a complex drawing task

This paper describes a smart tablet-based drawing app to digitally record participants’ engagement with the Rey-Osterrieth complex figure (ROCF) task, a well-characterised perceptual memory task that assesses local and global memory. Digitisation of the tasks allows for improved ecological validity, especially in children attracted to tablet devices. Further, digital translation of the tasks affords new measures, including accuracy and computation of the fine motor control kinematics employed to carry out the drawing Here, we report a feasibility study to test the relationship between two neurodevelopmental conditions: autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD). The smart tablet app was employed with 39 adult participants (18-35) characterised for autistic and ADHD traits, and scored using the ROCF perceptual and organisational scoring systems. Trait scores and conditions were predictor variables in linear regression models. Positive correlations were found between the attention-to-detail, attention-switching and communication subscales of the autistic trait questionnaire and organisational scores on the ROCF task. These findings suggest that autistic traits might be linked to differential performance on the ROCF task. Novelty and future applications of the app are discussed.

Overview of the Complex Figure Test and Its Clinical Application in Neuropsychiatric Disorders, Including Copying and Recall

The Rey–Osterrieth Complex Figure (ROCF) test is a commonly used neuropsychological assessment tool. It is widely used to assess the visuo-constructional ability and visual memory of neuropsychiatric disorders, including copying and recall tests. By drawing the complex figure, the functional decline of a patient in multiple cognitive dimensions can be assessed, including attention and concentration, fine-motor coordination, visuospatial perception, non-verbal memory, planning and organization, and spatial orientation. This review first describes the different versions and scoring methods of ROCF. It then reviews the application of ROCF in the assessment of visuo-constructional ability in patients with dementia, other brain diseases, and psychiatric disorders. Finally, based on the scoring method of the digital system, future research hopes to develop a new digital ROCF scoring method combined with machine learning algorithms to standardize clinical practice and explore the characteristic neuropsychological structure information of different disorders.

Automated scoring for a Tablet-based Rey Figure copy task differentiates constructional, organisational, and motor abilities

Accuracy in copying a figure is one of the most sensitive measures of visuo-constructional ability. However, drawing tasks also involve other cognitive and motor abilities, which may influence the final graphic produced. Nevertheless, these aspects are not taken into account in conventional scoring methodologies. In this study, we have implemented a novel Tablet-based assessment, acquiring data and information for the entire execution of the Rey Complex Figure copy task (T-RCF). This system extracts 12 indices capturing various dimensions of drawing abilities. We have also analysed the structure of relationships between these indices and provided insights into the constructs that they capture. 102 healthy adults completed the T-RCF. A subgroup of 35 participants also completed a paper-and-pencil drawing battery from which constructional, procedural, and motor measures were obtained. Principal component analysis of the T-RCF indices was performed, identifying spatial, procedural and kinematic components as distinct dimensions of drawing execution. Accordingly, a composite score for each dimension was determined. Correlational analyses provided indications of their validity by showing that spatial, procedural, and kinematic scores were associated with constructional, organisational and motor measures of drawing, respectively. Importantly, final copy accuracy was found to be associated with all of these aspects of drawing. In conclusion, copying complex figures entails an interplay of multiple functions. T-RCF provides a unique opportunity to analyse the entire drawing process and to extract scores for three critical dimensions of drawing execution.