TY  - JOUR
AU  - Kim, Ko Woon
AU  - Lee, Sung Yun
AU  - Choi, Jongdoo
AU  - Chin, Juhee
AU  - Lee, Byung Hwa
AU  - Na, Duk L
AU  - Choi, Jee Hyun
PY  - 2020
DA  - 2020/8/12
TI  - 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
JO  - J Med Internet Res
SP  - e18136
VL  - 22
IS  - 8
KW  - alzheimer disease
KW  - Rey-Osterrieth Complex Figure
KW  - digital biomarkers
KW  - copying process
AB  - 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=.01). 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. 
SN  - 1438-8871
UR  - https://www.jmir.org/2020/8/e18136
UR  - https://doi.org/10.2196/18136
UR  - http://www.ncbi.nlm.nih.gov/pubmed/32491988
DO  - 10.2196/18136
ID  - info:doi/10.2196/18136
ER  -