3 Rey Complex Figure Scoring Made Simple: Data from the Emory Healthy Brain Study
Authors: Loring David W. , Saurman Jessica L. , Simama Najé , Sanders Katherine , Lah James J. , Goldstein Felicia C. 
Published: December 2023

Objective:The Rey Complex Figure (CF) is a popular test to assess visuospatial construction and visual memory, but its broader use in clinical research is limited by scoring complexity. To widen its application, we developed a new CF scoring system similar to the Benson Figure in which 10 primary CF elements are scored according to presence and location. A novel recognition task was also created for each of these 10 items consisting of a 4-choice recognition condition containing the primary rectangle and major interior lines with qualitative variations of target elements as distractors. The current investigation was designed to characterize the relationship between scoring methods and establish whether comparable results are obtained across both traditional and new CF scoring approaches.Participants and Methods:Participants from the Emory Health Brain Study (EHBS) who had completed the Rey CF copy during their cognitive study visit were studied. All participants were self-identified as normal, and administered the CF according to our previously published procedure that included the Copy, Immediate Recall (∼ 30 seconds), and 30-minute Delayed Recall (Loring et al., 1990). Following delayed recall, CF recognition was assessed using the Meyers and Myers (1995) recognition followed by the newly developed forced choice recognition. The final sample included 155 participants ranging in age from 51.6 years to 80.0 years (M=64.9, SD=6.6). The average MoCA score was 26.8/30 (SD=6.6).Results:Mean performance levels across conditions and scoring approaches are included in the table. Correlations between Copy, Immediate Recall, Delayed Recall, and Recognition were calculated to evaluate the relationship between the traditional 18 item/36 point Osterrieth criteria and newly developed CF scoring criteria using both parametric and non-parametric approaches. Pearson correlations demonstrated high agreement between approaches when characterizing performance levels across all CF conditions (Copy r=.72, Immediate Recall r=.87, Delayed Recall r=.90, and Recognition r=.52). Similar correlations were present using non-parametric analyses (Copy ρ=.46, Immediate Recall ρ=.83, Delayed Recall ρ=.91, and Recognition ρ=.42). Table. Mean performance levels across conditions and scoring approachesConclusions:The high correlations, particularly for Immediate and Delayed Recall conditions, suggest that the modified simpler scoring system is comparable to the traditional approach, thereby suggesting potential equivalence between scoring methods. When comparing Rey’s original 47 point scoring approach to his 36 point scoring system, Osterrieth (1944) reported a correlation in fifty adults of ρ=.95 and a correlation in twenty 6-year-olds of ρ=.92. In this investigation, lower correlations were observed for copy and recognition conditions, in part representing smaller response distribution across participants. Although these preliminary results are encouraging, to implement the new EHBS scoring method in clinical evaluation, we are developing normative data in participants across the entire EHBS series, many of whom were not administered the new CF Recognition. We are also examining performances in patients undergoing DBS evaluation for Parkinson Disease to explore its clinical sensitivity. Simpler scoring will permit greater CF clinical and research application.