Kim, Ko Woon Lee, Sung Yun Choi, Jongdoo Chin, Juhee Lee, Byung Hwa Na, Duk L. Choi, Jee Hyun 2024-01-19T17:01:05Z 2024-01-19T17:01:05Z 2022-01-10 2020-08-12 1438-8871 https://pubs.kist.re.kr/handle/201004/118260 Background: The Rey-Osterrieth Complex Figure Test (RCFT) is a neuropsychological test that is widely used to assess visual memory and visuoconstructional deficits in patients with cognitive impairment, including Alzheimer disease (AD). Patients with AD have an increased tendency for exhibiting extraordinary behaviors in the RCFT for selecting the drawing area, organizing the figure, and deciding the order of images, among other activities. However, the conventional scoring system based on pen and paper has a limited ability to reflect these detailed behaviors. Objective: This study aims to establish a scoring system that addresses not only the spatial arrangement of the finished drawing but also the drawing process of patients with AD by using digital pen data. Methods: A digital pen and tablet were used to copy complex figures. The stroke patterns and kinetics of normal controls (NCs) and patients with early-onset AD (EOAD) and late-onset AD (LOAD) were analyzed by comparing the pen tip trajectory, spatial arrangement, and similarity of the finished drawings. Results: Patients with AD copied the figure in a more fragmented way with a longer pause than NCs (EOAD: P=.045; LOAD: P=.1). Patients with AD showed an increased tendency to draw the figures closer toward the target image in comparison with the NCs (EOAD: P=.005; LOAD: P=.01) Patients with AD showed the lower accuracy than NCs (EOAD: P=.004; LOAD: P=.002). Patients with EOAD and LOAD showed similar but slightly different drawing behaviors, especially in space use and in the initial stage of drawing. Conclusions: The digitalized complex figure test evaluated copying performance quantitatively and further elucidated the patients' ongoing process during copying. We believe that this novel approach can be used as a digital biomarker of AD. In addition, the repeatability of the test will delineate the process of executive functions and constructional organization abilities with disease progression. English JMIR PUBLICATIONS, INC CLOSING-IN DISCRIMINATION ASSOCIATION PERFORMANCE TASK A Comprehensive Evaluation of the Process of Copying a Complex Figure in Early- and Late-Onset Alzheimer Disease: A Quantitative Analysis of Digital Pen Data Article 10.2196/18136 1 JOURNAL OF MEDICAL INTERNET RESEARCH, v.22, no.8 JOURNAL OF MEDICAL INTERNET RESEARCH 22 8 scie scopus 000575055000003 2-s2.0-85089419846 Health Care Sciences & Services Medical Informatics Health Care Sciences & Services Medical Informatics Article CLOSING-IN DISCRIMINATION ASSOCIATION PERFORMANCE TASK alzheimer disease Rey-Osterrieth Complex Figure digital biomarkers copying process