Abstract

Objective

Neuropsychologists labor over scoring the Rey Complex Figure Test (RCFT), a measure of visuospatial functioning and nonverbal memory. Compelling arguments suggest that pathognomonic signs of the RCFT are observable to the “naked eye.” Standard scoring systems are insensitive to lateralizing temporal lobe epilepsy (TLE) and alternative “qualitative” scoring systems are ineffective and time-consuming. Method: We examined accuracy of TLE lateralization using subjective classifications and standard scoring. Participants were 84 TLE patients (53 female; mean age₌36yrs) and 46 controls (27 female; mean age = 27.5). The former were classified as right (n = 41) or left (n = 43) TLE by neurologists using EEG and MRI studies. RCFT were scored using standard scoring with cut-offs of z ≤ –2 classified as impaired and were rated as “characteristic” of RTLE (Ugly) or LTLE (Not Ugly) performance by neuropsychologists. Accuracy of seizure lateralization for both methods was examined. Results: Neuropsychologists’ ratings accuracy were at or below chance. Standard scoring criteria showed chance or slightly better lateralization prediction. Standard scoring predicted RTLE laterality more accurately than subjective ratings for copy trials; standard scoring was no better at lateralizing RTLE with delays. Subjective ratings were better at distinguishing TLE patients from controls. Conclusion: Findings highlight concerns regarding the usefulness of the RCFT in TLE lateralization, regardless of scoring approach.

摘要

客观的

神经心理学家努力对雷伊复杂图形测试 (RCFT) 进行评分，这是一种衡量视觉空间功能和非语言记忆的方法。令人信服的论据表明，“肉眼”可以观察到 RCFT 的特征性迹象。标准评分系统对侧化颞叶癫痫 (TLE) 不敏感，替代的“定性”评分系统无效且耗时。方法：我们使用主观分类和标准评分检查了 TLE 偏侧化的准确性。参与者为 84 名 TLE 患者（53 名女性；平均年龄₌36 岁）和 46 名对照组（27 名女性；平均年龄 = 27.5）。神经学家使用 EEG 和 MRI 研究将前者分类为右侧 (n = 41) 或左侧 (n = 43) TLE。RCFT 使用标准评分进行评分，z ≤ –2 的截止值被归类为受损，并被神经心理学家评为 RTLE（丑陋）或 LTLE（不丑陋）表现的“特征”。检查了两种方法的癫痫偏侧化的准确性。结果：神经心理学家的评级准确性处于或低于偶然性。标准评分标准显示机会或稍微更好的侧化预测。标准评分比复制试验的主观评分更准确地预测 RTLE 偏侧性；标准评分在延迟 RTLE 方面并没有更好的表现。主观评分更能区分 TLE 患者和对照组。结论：研究结果强调了对 RCFT 在 TLE 偏侧化中有用性的担忧，无论评分方法如何。