Rey complex figure: memory error patterns and ...

Applied Neuropsychology

ISSN: 0908-4282 (Print) 1532-4826 (Online) Journal homepage: http://www.tandfonline.com/loi/hapn20

Rey complex figure: memory error patterns and functional abilities John E. Meyers , John D. Bayless & Kelly R. Meyers To cite this article: John E. Meyers , John D. Bayless & Kelly R. Meyers (1996) Rey complex figure: memory error patterns and functional abilities, Applied Neuropsychology, 3:2, 89-92, DOI: 10.1207/s15324826an0302_8 To link to this article: http://dx.doi.org/10.1207/s15324826an0302_8

Published online: 07 Jun 2010.

Submit your article to this journal

Article views: 53

View related articles

Citing articles: 14 View citing articles

Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=hapn20 Download by: [155.220.23.5]

Date: 23 September 2015, At: 12:55

Applred N~uropsy~holopy 1996 3 89-92 Prtnhd tn Denmark All r~ghtbrc5eru~d

Appl~edNeuropsychology l S S N 0908-4282

Short communication

Rey complex figure: memory error patterns and functional abilities John E Meyersl, John D ~ a ~ l e&s Kelly s ~ R Meyers3 ' ~ a r z a rHealth i Center, 'Cedar Centrt Psychiatric Group 3 S l o ~ Czty, r lowa, U S A

Downloaded by [155.220.23.5] at 12:55 23 September 2015

Key words Rey complex figure, Rancho Los Am~gas scale, memory patterns Abstract The functional abilities of braln injured persons to live Independently, were assessed using the Rancho Los Amigos Scale ratrngs of functional levels whrch were compared wrth memory error patterns on the Rey Complex Frgure (Rey 1941) and the Recogn~tionTrial developed by Meyers & Meyers (1995) Memory error patterns were descr~bedby Sohlberg & Mateer (1989), the least rmpaired memory error pattern was Retrieval, whlle Storage, Encodrng and Attent~onpatterns indicated greater defect Spearman rank order correlation revealed the strong associatron (r, = 86) of memory error pattern w~th Rancho Scale functronal ratlngs In rndependent subjects 96 Oh ach~eveda Retr~evalmemory error pattern whereas

93% of subjects whose memory error pattern was poorer than a Retr~evalpattern were unable to functlon independently Results rndicate that patients obta~ninga Retr~eval (or better) memory error pattern may be expected to possess adequate cognrtive resources for rndependent functloning Appl~edNeuropsychology, 1996 3 89-92 O Munksgaard, 1996 Accepted November 27, 1995

(1983) underscored the need for neuropsychological assessment to address systematically funchonal questions for patients as well as localization of brain lesions, and quantification of mental status He emphasized that functional decisions need to be made on the basis of empirical vali-

C

OSTA

CORRESPONDENCE johrz E Meyers, Departrnerlt of Physz~al Medlczne atzd Rehabllltatlon, Marlon Health Center, 801 5th Street, Szour Clty, lowa 51103, U S A

dation rather than through speculation "by the seat of our pants" Only a few studies have investigated the relationship of neuropsychological test performance to functional ability One functional measure is the Rancho Los Amigos Scale developed by Hagen et a1 (1972), the scale descriptors range from Level I (non-responsive) to Level VIII (purposeful - appropriate), based on rater judgments Return to work has also been used as a criterion for functional outcome Fraser et a1 (1988) found that higher scores in the Halstead - Reitan Neuropsychological Test Battery were associated with return to work Bayless et a1 (1989) found that braln injured patients who scored defectively in the Tmkertoy Test (Lezak 1995) were unlikely to return to competitive employment Lam et a1 (1991) found that brain-injured subjects with stronger cogmtive functiomng, better visuospatial memory, and freedom from distractibility were more apt to return to work A commonly used neuropsychological measure of such cognitive abilibes is the Rey Complex Figure (RCFT) Norms were inihally provided by Osterrieth (1944), and more recently by Spreen and Strauss (1991) Recent work (Meyers & Lange, 1994 Meyers & Meyers 1995) improved the scoring system and normative base, using more than 600 subjects ranging from age 18 - 89 A recognition trial (RT) was developed for the RCFT, the RT correct score is a measure of recognition, determined by the number of correctly identified RCFT parts RT correct score performance correlated with the Rancho Scale (r, = 77), suggesting that adequacy of performance on RT was a correlate of functional outcome (Meyers & Lange, 1994) Memory patterns using RCFT and RT performance were developed according to the model proposed by Sohlberg and Mateer (1989), using the configuration of immediate recall, delayed recall and RT correct scores (Meyers & Meyers, 1995) An Atten-

TABLE 1 Mean and ( S D ) T scores by Rancho lez7el on the RCFT and RT Rancho level

Copy score

Immediate recall

Delayed recall

FIT correct

Vlll (n=53) VII (n=22) VI (n=7)

30 03 (22 89) 20 95 (23 00) 2 28 (3 40) 8 53 (16 03) 1 00 (0 00) 21 85 (22 97)

36 83 (16 14) 29 27 (10 83) 16 14 (9 88) 12 76 (9 67) 6 60 (6 69) 29 08 (16 89)

33 32 (17 05) 26 68 (9 94) 15 28 (10 14) 11 76 (9 09) 3 60 (3 13) 26 31 (16 71)

46 96 (11 96) 18 18 (14 25) 13 42 (11 37) 9 30 (10 41) 8 00 (8 24) 31 44 (20 61)

v

Downloaded by [155.220.23.5] at 12:55 23 September 2015

(n=13) IV (n=5) Total (n=100)

tion pattern is a uniformly impaired profile with all three scores below a T score of 25 An encoding profile occurs when both immediate and delayed recall scores are below 25 T, and the recognition score is greater than, but no more than 10 T score points above the delayed recall score Both of these profiles represent very Impaired funchoning A storage profile has a downward slope, with Immediate greater than delayed, and delayed greater than recognit~on, the latter impaired A retrieval pattern is a "V" shaped configurahon w ~ t himmediate and recognition higher than delayed recall For the purpose of analysis a normal profile is any other configuration or an immediate and delayed recall scores greater than 40 T Memory pattern analysls has proven useful in determirung diagnosis, selechng appropriate

patients had left hemisphere damage, and 26 patients had right hemisphere damage Anoxla, multiple sclerosis, dementia, and encephalopathy were coded as bilateral cerebral dysfunction Gender balance was approximately equal, with 48 men and 52 women, with an average age of 46 92 years (SD = 17 77), and education of 12 36 years (SD = 2 54) Seven patlents were left-handed All patients had adequate visual acuity to perform the task, and in those patients with visual field impairment, the task was performed in the intact visual field For the traumatically brain injured subjects, mean loss of consciousness was 4 4 days (SD = 13 27), time since injury averaged 43 16 (SD = 84 98) months All subjects were rated using the Rancho scale prior to the administration of the RCFT and RT, subjects rating below Rancho IV were untestable All subjects who were independent m everyday life were rated at Rancho VIII Subjects were administered the RCFT according to manual instructions (Meyers & Meyers 1995) Memory error patterns were identified based on performance on the RCFT and RT as indicated above

Results Mean T score performance over the four RCFT conditions is presented in Table 1, with the results presented by Rancho level Table 2 presents a matrix of Spearman Rank Order Correlations with the RCFT and RT performance

rehabilitahon approaches, and in the detection of

Inspection of Table 2 reveals that the memory pat-

malingering It is hypothesized that for pahents with acute and chronic cerebral dysfunction, adequacy of memory pattern performance will be assoc~atedwith better functional outcome as measured by the Rancho Los Amigos scale

Subjects were 100 consecutively referred rehabilitation patients who represented a heterogeneous rehabilitation group, etiologies included brain injury (n = 50), vascular causes (n = 29), dementlng illness (n = 5), selzure dlsorder (n = 4), anoxla (n = 4), neoplasm (n = 4), mulhple sclerosis (n = 2), penetrating gun-

tern performance was sigruficantly correlated with Rancho level (r, = 86) and that all aspects of RCFT and RT performance were significantly intercorrelated with the RT performance showing the strongest correlation Results indlcate that MEP scores have both a sensitlve and specific relat~onshipto functional outcome Table 3 shows the distribution of memory pattern scores among the 100 subjects in terms of functional level (Rancho scale rahng), and illustrates the strong association between memory error pattern and functional level in patients with cerebral dysfunction Inspect~onreveals that 53 subjects were rated as independent, as evidenced by a Rancho rating of VIII, of these, 51 (96 2%) attained a normal or retrieval MEP score Conversely, among the 47 sub-

shot (n = I), and encephalopathy (n = 1) Principal

jects rated with a more dependent outcome (VII or

lateralization of ~njuryfor all subjects was made on the basis of available CT, MRI and neuropsychological data, 49 pahents had bilateral injuries, while 25

less), 44 (93 6%) could not attaln a normal or retrieval memory pattern The hme since injury, for subjects with traumatic brain injury or CVA (n = 79)

Method

Memorv Patterns and Funct~onalA b ~ l ~ t ~ e s

TABLE 2 Spearman Rank Correlation and one-talled t testfor RCFT and RT scores (N=I 00) lmmed~ate Delayed recall recall lmmed~aterecall Delayed recall RT correct Memory pattern Rancho level

0 95" 044'" 0 67** 0 58**

041"" 0 65** 0 54**

RT correct

Memory pattern

0 77" 0 82**

0 86"

TABLE 3 Dlstrzbutlon of M E P by Rancho lezlel for all sztblects (N= 100) MEP scores

Downloaded by [155.220.23.5] at 12:55 23 September 2015

Rancho level

Normal

Retr~eval Storage

Encodlng Attent~on

showed a significant correlation (r,= 32, p < 001) with longer hme post injury resulhng in higher functional ratings on the Rancho Scale

Chronlc brazn znjury It is important to determine whether time since injury has a bearing on the relationship between functional outcome and RCFT memory pattern, since pa-

tion between neuropsychological and functional performance was high, with RCFT memory pattern score having a specific and sensitive association to functional levels Patients obtaining a normal or retrieval RCFT memory pattern are very likely to be functioning independently At the same time, patients unable to attain such a memory pattern are apt to be in need of some level of supervision It is important to note that this relationship holds for patients wlth chronic brain injury as well as acute phases of brain injury Such findings are critical for the practicing Neuropsychologist, who is often called upon to make functional determinations on the basis of test performance The findings of this study are simllar to those found by McLean et a1 (1988) and Lam et a1 (1991) in that higher neuropsycholog~cal scores Indicate better functiorung ability However, this study provides an empirical and clinically useful method of separating independent functional from non independent functional patients for both chronically and acutely injured patient populations Recommendations regarding the need for 24 h supervision or independence can have both a safety and an economic impact on the patient and their family In this time of managed health care, economy of both the number of tests administered, and the time involved in assessment are important factors Therefore, the use of tests that have demonstrated ability to provide information about "real life" functional ability are important and economically necessary

tients with more acute injury might be expected to have more marked deficits in both memory and functional status, with greater recovery potential as well To investigate this question, analysis was restricted to the 36 subjects more than two years post injury All 24 (loo%),of the independent (Rancho VI11) chronically injured patients had normal or retrieval memory patterns, but only 1 of the 12 dependent patients (Rancho VII or less) could attain this level of memory performance That is, 91 7% of dependent patients had performance patterns lower than normal or retrieval The relationship between memory pattern performance and functional level held for the chronically brain injured pahents

Discussion The findings of this study demonstrated the expected relationship between MEP and functional abilities, while this result was certainly anticipated, the strength of the relationship was remarkable Correla-

References Bayless JD, Varnev NR, Roberts R (1989) Tinker Toy Test performance and \ocational outcome in patients with closedhead injuries Journal of Cllirr~aland Experrrnental Neuropsyclzologv 11, (6), 913-917 Costa L (1983) Presidential address to Division 40, Cli~ucal Neuropsychology, American Psychological Associahon Fraser R, Dikmen S, McLean A, Miller Temkin N, (1988) Employability of Head Inju~ySurvivors First Year Post -Injury Rehabllrtatror~Coutrsellng Bulletlrr 31, 276-288 Hagen C, Malkus D, Durham P (1972) Rancho Los Amigos Scale of Functiorung Rancho Los Amigos Rancho Los Amigos Hospital, Division of Neurological Sciences Lezak M (1995) Neuropsycholog~calAssessment, (2nd Ed) New York Oxford University Press Lam C, Priddv D, Johnson P (1991) Neuropsychological indicators of employability following traumatic brain injury Rehabrlrtatron Counselrng Bulletril 35, 1, 68-74 Meyers J, Lange D (1994) A Recognition Subtest for the Complex Figure The Clrnlcal Neuropsychologlst 8,2, 153-166 Meyers J, Meyers K (1995) Rey Complex Figure Test and Recognition Trial Professional Manual, Florida, Psychological Assessment Resources (PAR)

Downloaded by [155.220.23.5] at 12:55 23 September 2015

Rey A (1941) L'examen psycho1ogique dans les cas d'encephalopathie traumatique Archrues de Psychologre 28,286-340 Osterrieth PA (1944) Le test de copie d'une figure complex Contribution a l'etude de la perception et de memoire Arclllzles de Psychologre 30, 206-356

Sohlberg M, Mateer C (1989) lntroductron to Cognltlz1e Rehabllrtatlon Theory 6 Practrce N Y The Guilford Press Spreen 0 , Strauss E (1991) A Co~npendrumof Neuropsychologrcal Tests Admrnrstratlon, Norms and Commentary N Y Oxford University Press