Aim 2: Organizational Approach

1. Rey-Osterrieth Complex Figure (ROCF) Flowchart Organizational Approach as a Measure of Executive Functioning in Parkinson’s Disease Shelley Leininger1, Alana Freedland1, Laura Umfleet1, Nadine Schwab1, Jade Ward1, Nicole Coronado1, Jared Tanner1, Peter Nguyen1, Michael S. Okun2, Dawn Bowers1, David J. Libon3, and Catherine C. Price1 1University of Florida, Department of Clinical & Health Psychology, 2UF Center for Movement Disorders & Neurorestoration, Gainesville, FL 3Drexel University College of Medicine, Department of Neurology, Philadelphia, PA Study supported in part by NINDS K23NS060660(CP) BACKGROUND METHODS RESULTS cont. • Introduction: • The Rey-Osterrieth Complex Figure (ROCF) is a common instrument used to evaluate visuospatial constructional ability and visual memory. It contains a copy, immediate, and delayed memory trial. See Figure 1. • Flowcharts recording the number of times a pencil is picked up (“UNITS”) and directional organization may hold important quantitative information for later memory performance processing. See Figure 2. • Flowchart information may be beneficial for individuals with idiopathic Parkinson’s Disease (PD) as disruptions to cortical-subcortical connections often result in poor memory due to reduced processing speed and mental planning  (Diamond, DeLuca, & Kelley, 1997; Eslinger & Grattan, 1990; Grossman et al., 1993). • Copy organizational approach may therefore be an important aspect to immediate and delayed memory performance, particularly in PD. • Figure 1: Rey-O Complex Figure Figure 2: Examiner Flowchart Example • Aims and Hypotheses: • Prospectively, flowcharts were used to examine associations between disorganized copy approach and ROCF memory in right-handed individuals with idiopathic non-demented PD and age and education matched controls. • Aim 1: Flowchart Segments were prospectively required to record number of times a person picked up a pencil during ROCF construction. • Prediction 1: PD patients will have worse memory than control participants. • Prediction 2: PD > Controls in number of copy units. • Prediction 3: Overall, more copy units will be associated with worse executive function and slower copy time. • Prediction 4: For PD patients, after controlling for UPDRS total, more copy units will be related to worse immediate and delayed memory trials. • Aim 2: Organizational Approach – Using criteria defined by a set of cognitively well controls, we examine: • Prediction 1: PD patients will demonstrate greater disorganization in copy trial approach (e.g., lack a gestalt approach) than controls • Prediction 2: Overall, good copy trial approach will be associated with higher immediate and delayed memory trial scores • Prediction 3:  Good copy trial approach will be associated with higher executive functioning, particularly planning ability, on external neuropsychological measures (e.g., WCST, D-KEFS Tower Task) • Participants: • Idiopathic non-demented PD (n=43) and non-demented non-PD peers (n=43) matching on age and education were enrolled after screening. All were recruited as part of a larger research investigation. Below, demographics, Parkinson’s rating scale scores, and language “control” task performance are compared. • Procedure: • As part of the neuropsychological protocol, all participants completed the ROCF copy, immediate, and delayed memory trials. • Three trained examiners recorded time to completion with detailed flowcharts. • Flowchart data were entered and ROCF scores completed with Denman scoring criteria by 2 blind raters with strong inter-rater reliability (ICC = .95 ). • Organizational approach: Using 20 controls with the highest executive functioning performance (e.g., D-KEFS Tower Test Achievement), two basic criteria were identified across 90% of this sample; all used left to right copy approach and copied the large rectangle within the first 7 flowchart units (See Figure 3). • Executive functioning measures (i.e., Wisconsin Card Sort Task (WCST), D-KEFS Tower Test) were compared to ROCF data. • Figure 3: Copy Organizational Approach of • the Large Rectangle within First 7 Units • Aim 1: Flowchart Segments • PD patients displayed worse memory than controls during the ROCF immediate t(3.8), p < .01 and delay t(3.9), p < .01 trials • There were no group differences in copy units t(.30), p > .05; however, PD group copy time was slower than the control group, t(-2.7), p < .01 • Copy units were associated with slower copy time for both PD (r = .54, p < .01) and controls (r = .47, p < .01), and worse organizational approach for only the PD group (r = -.31, p < .05). • For PD patients, controlling for UPDRS score, copy units did not relate to immediate (r = -.16) or delayed (r = -.16) memory trials. • Aim 2: Organizational Approach • PD patients demonstrated greater disorganization in copy trial approach than controls; t(2.09), p < .05. • Good copy trial approach significantly associated with higher ROCF copy and memory scores for both groups. • Good copy trial approach associated with better WCST problem-solving and efficiency, only with the PD patients. • Copy trial approach did not generally relate to Tower Test performance. • Better copy organizational approach associated with higher ROCF memory scores in both groups, although it did not relate to flow units. • Copy organizational approach positively correlated with WCST scores among the PD group. • Slower copy times in the PD group suggest that slower processing speed and motor function may impact performance. • Findings provide support for examining copy patterns and flow data for understanding memory functioning in PD. • In a clinical context, evaluating ROCF approach with this simple and time efficient method would be effective for measuring planning and organization. • Diamond, B. J., DeLuca, J., & Kelley, S. M. (1997). Memory and executive functions in amnesic and non-amnesic patients with aneurysms of the anterior communicating artery. Brain, 120(6), 1015–102. • Eslinger, P. J., & Grattan, L. M. (1990). Influence of organizational strategy on neuropsychological performance in frontal lobe patients. Journal of Clinical & Experimental Neuropsychology, 12, 54. • Grossman, M., Carvell, S., Peltzer, L., Stern, M. B., Gollump S., & Hurtig, H. I. (1993). Visual construction of impairments in Parkinson’s disease. Neuropsychology, 7, 536–547. CONCLUSIONS RESULTS REFERENCES