Rey Complex Figure Alternate Forms – Comparison with original

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Rey Complex Figure Alternate Forms – Comparison with original

Sometimes it is necessary for a patient to undergo neuropsychological assessments more than once.  For example, to determine if there is neuropsychological decline in a patient (for example with suspected Alzheimer’s disease), to determine if an intervention is improving cognitive functioning (e.g. with the use of a medication), or by a patient being tested by both a defendant and a plaintiff in a medico-legal case.  The problem with using the same test twice, though, is that one runs the risk of the patient being too familiar with it and scoring higher than is reflective of the patient’s ability, because of the practice effect.

The Rey-Osterreith Complex Figure Test (CFT), which is a test of visuospatial functioning and non-verbal memory, is a popular neuropsychological test in both South Africa and abroad.  Thankfully, there are alternate forms for the CFT, which can be found in Lezak’s book, “Neuropsychological Assessment” and in Strauss’s book, “A Compendium of Neuropsychological Tests“.

The difficulties with using alternate forms, though, include that norms are not readily available for the alternate forms (or are not available at all) and few, if any, studies have been done to determine if the alternate forms are at the same level of difficulty as the original CFT.

Researchers wanting to study this topic, can select a group of healthy people (children or adults) and ask each subject to do the original CFT and one or more of the alternate forms.  Statistical anaylsis can then be used to determine what the norms are for the original (for the population group tested) and the alternate forms, and to compare the alternate forms to the original in terms of level of difficulty.

Variations on the theme:

  • Other tests with their alternate forms can be added and then the two batteries can be compared with each other.
  • The order in which the drawings are done can be recorded (using different coloured pencils at different stages of the drawing, or by having them video recorded) and the orders can be investigated and compared.
  • Which alternate form is the closest to the original version can be investigated.
  • Doing the original CFT and then later the alternate form, can be compared to doing an alternate form first and then the original CFT later, to determine if the order affects the test results (i.e. is there still a practice effect because the complex figures are similar even though they are not the same?).

Recommendation by NeuropsychologySA:  There are different ways to administer the CFT.  For example, there is a copy version followed by a delayed recall approximately 30 minutes later.  There is also a copy version, followed by an immediate recall version and then later, a delayed recall.  It is recommended that the copy, immediate recall and then delayed recall administrative process be used, as the additional information on immediate non-verbal memory that is attained from the immediate recall is often very valuable in practice.

Please leave a reply/comment below, especially if you are thinking of doing this research.