Psychometric Characteristics of the Rey–Osterrieth Complex Figure Test in a Sample of Patients with Neurological Diseases and Healthy Individuals
Ahmad Qazaqzeh *1, Moh'd A. Shoqeirat 2, Ahmad M. Al-Masri 3
*Correspondence to: Ahmad Qazaqzeh, Clinical Psychologist.
Copyright
© 2026 Ahmad Qazaqzeh, This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 05 June 2026
Published: 01 July 2026
DOI: https://doi.org/10.5281/zenodo.21066360
Abstract
The present study aims to examine the psychometric properties of the Rey-Osterrieth Complex Figure (ROCF) Test. The study sample consisted of 200 participants, with 100 individuals diagnosed with diseases of the nervous system and 100 individuals considered healthy. The Osterrieth Complex Figure Test (ROCF), the Trail Making Test, and the Mini-Mental State Examination were used in the study. The results showed that the ROCF Test has acceptable validity characteristics (construct and discriminative) and acceptable reliability characteristics (consistency, split-half, and test-retest). In addition, the results showed that there are differences in performance on the ROCF Test between patients with neurological diseases, and the results indicated that there are no differences due to sex and age. Finally, the results showed that there was a positive relationship between the Mini-Mental State Examination Test and the ROCF, and an inverse relationship between the Trail Making Test and the ROCF.
Keywords: Psychometric properties, Rey–Osterrieth Complex Figure Test, Trail Making Test, Mini-Mental State Examination Test.
Introduction
Neurodegenerative diseases cause atrophy in distinct neural networks, thereby affecting visuospatial perception in specific and distinctive ways. The effects of these neurotoxic diseases depend on the topographic patterns of brain pathology; consequently, assessing spatial perception is crucial for diagnosis and monitoring disease progression (Possin, 2010).
It is noted that these cognitive deficits are linked to disruptions in the frontal-basal ganglia neural circuits, which are critical for these functions. However, this functional impairment does not appear to be the sole cause of Parkinson's disease (Crucian & Okun, 2003).
The Rey-Osterrieth Complex Figure (ROCF) test is used to evaluate visuospatial abilities. The test comprises three stages: copying, immediate recall, and delayed recall. During the copying stage, the examinee is presented with the figure and asked to draw it. The drawing is then recorded. After a 30-minute interval, the examinee is asked to draw the figure again from memory (Shin et al., 2021).
Study problem and questions
The Rey-Osterrieth Complex Figure (ROCF) test was developed by Rey in 1941. The definition provided by Wallon et al. (2014) is considered culturally unbiased.
In view of the lack of psychometric properties of this test in Jordan and the need for it in the field of clinical neuropsychological assessment and diagnosis, in addition to the fact that the psychometric properties outside Jordan of this test may not cover all disorders or diseases that affect the nervous system, the purpose of the study is to find the psychometric properties of the complex form test for Ray- Ostreth among a sample of people with nervous system diseases and healthy people in Jordan.
Study Questions
Practical importance
It provides psychometric measures for assessing cognitive abilities and personality traits, and potentially identifying mental disorders.
Definitions
Psychometric properties: The field concerned with the statistical description of data as variables and the relationships between them (Keszei et al., 2010). Psychometric properties refer to two key aspects related to the validity and reliability of a test (Pliskin et al., 2020).
Validity: The degree to which empirical evidence supports the conclusions drawn, ensuring they are sufficient and consistent with specific forms of evaluation (APA, 2013).
Stability (Reliability): The degree of consistency and stability of a specific measure; theoretically, it represents the consistency of an individual's scores on the measure over time. Stability overtime is considered one of the conditions of a good test (Keszei, 2010).
Definition of the Rey-Osterrieth Complex Figure (ROCF) Test: The test consists of a complex series of geometric components. The examinee is provided with a pencil and asked to manually copy the figure. Subsequently, they are asked to reproduce the figure from memory after three minutes, and again after 30 minutes. The test comprises 18 units. Scoring ranges from 0 to 2 points per unit based on drawing accuracy, with a maximum total score of 36 (Rivera et al., 2015). Operationally, the score is defined as the result obtained by the individual on the Rey-Osterrieth Complex Figure test, ranging from 0 to 36.
Visual Memory: It is a form of memory that preserves certain characteristics of our senses related to visual experience, as we can store visual information that resembles objects, places, animals, or people in a mental image. And the memory of sight is one of several cognitive systems, all parts of which are interconnected to form human memory. And the continuation or repetition of the image al ??? ?? ??? ???????? ??????, ?? ??? (Dysfunction of the optic sphincter (Magnussen, 2009).
The Trail Making Test consists of two parts, each featuring 25 circles distributed across a sheet of paper. In Part A, the circles are numbered 1 through 25, and the examinee must draw a line connecting them in ascending numerical order. In Part B, the circles contain both numbers (1–13) and letters (A–L); as in Part A, the examinee must connect the circles in ascending order, but must alternate between the two sequences (e.g., 1–A, 2–B, etc.). The examinee is instructed to connect the circles as quickly as possible without lifting the pencil from the paper (Corrigan and Hinkeldey, 1987).
Mental Test (MMSET): It is a tool used to evaluate the state of mind and It is usually used to evaluate the functions of the profession, consisting of (10) questions. The test duration is (5-10) minutes, and the score ranges from (0-30) (Folstein and Mchugh, 1975). It is defined clinically as: It is the grade that the examinee gets when applying for the test.
Diseases of the nervous system
Neurological disorders refer to a wide range of disorders affecting the brain and spine. And there are nearly (600) neurological diseases Neurological conditions can arise from a variety of causes, including These include congenital conditions, nutritional deficiencies, non-communicable diseases, intentional and unintentional injuries, and genetic and environmental factors. Determining the cause can be difficult, and in some cases, there may be multiple underlying reasons. The category encompasses both neurodegenerative conditions and neurodevelopmental disorders—which appear in childhood and affect cognitive and/or functional development. Key types of neurological disorders include: genetic neurological disorders (such as Huntington's disease and muscular dystrophy), developmental disorders (such as cerebral palsy), adult-onset neurological disorders (such as Parkinson's disease and Alzheimer's disease), metabolic diseases (such as Gaucher's disease), cerebrovascular diseases, injuries (such as spinal cord and head injuries), chronic conditions (such as epilepsy), infectious diseases (such as dementia associated with HIV/AIDS), and brain tumors (Canadian Institute for Health Information, 2007).
Diagnostic criteria for nervous system disorders according to the DSM-5-TR:
Evidence of:
Interfering with deficits in daily activities
Note: Each type of sub-category has specific diagnostic criteria and according to the text, it follows the general discussion of major and minor neurological disorders (alzheimer disease, chronic liver disease, liver disease, blood vessel disease, brain injury, drug use/ drugs, human immunodeficiency virus infection, brion disease, lung disease, huntington disease, other medical conditions, multiple causes, non - multiple causes).
Effect of diseases of the nervous system on the processes of knowledge:
Almost 33% of survivors of cerebral palsy suffer from impairment directly due to the palsy. In a prospective study by Srikanth et al. (2006), it was found that 7% of stroke survivors experienced cerebral palsy in the um and 48% in the ambulatory stroke (25), a significant increase compared to the previous study. Additionally, 71% of patients who showed symptoms of heart disease were found to be asymptomatic. Risk factors for impairment include advanced age, weakness, common illness, depression, post-traumatic anxiety, diabetes, dehydration, sleep disorders, hypothyroidism, and a history of falls. And so much so. Yes, yes, yes, yes, yes. (Recreational substance abuse), deficiency of vitamin B (12), exposure to organic solvents, and diabetes, led to an increase in the risk of cognitive impairment after a uterine mercy and stroke.
Visuospatial perception comprises a multifaceted set of functions mediated by a right-hemisphere network involving widely distributed brain regions—including the parietal cortex (specifically the inferior parietal cortex), frontal cortex, occipital cortex, basal ganglia, and white matter pathways. This domain of awareness encompasses skills such as directing attention and learning to navigate movement. Visuospatial deficits are a hallmark of neurodegenerative diseases; however, because this area of perception is multifaceted, it is often not adequately assessed in standard evaluations. These deficits manifest in distinct ways, and specialized visuospatial assessment can assist clinicians in making early, accurate diagnoses. Visuospatial function is crucial for successful daily living; for instance, elderly individuals with reduced spatial performance often report difficulties such as feeling unsafe while driving, navigating new routes, or remembering where they placed their keys or parked their cars. Such declines are more pronounced in older adults (Possin, 2010).
The severity of traumatic brain injury (TBI) generally correlates with behavioral and neurological outcomes, affecting functional efficiency. Studies cited by Lezak et al. (2012) indicate that only 40% of patients returned to work following injury. Quality of life—reflecting patient and family satisfaction as well as levels of distress—is also significantly impacted, with risks and adverse effects intensifying alongside the severity of the injury.
Based on a review of relevant literature and scientific studies, researchers identified a specific group of... Cheah et al. (2022) conducted a study aimed at evaluating the utility of the Rey-Osterrieth Complex Figure Test in distinguishing between individuals with Alzheimer's disease, those with Mild Cognitive Impairment (MCI), and healthy controls. The study sample consisted of 118 participants comprising patients with Alzheimer's, individuals with cognitive impairment, and a healthy control group. The results indicated that the Rey-Osterrieth Complex Figure Test was effective in differentiating between the cognitive profiles associated with MCI and Alzheimer's disease. Furthermore, the test demonstrated efficacy in distinguishing between the patient groups and the healthy controls.
Jamus et al. (2022) conducted a study aimed at evaluating the performance of patients on the Rey-Osterrieth Complex Figure Test following temporal lobe resection. The study sample consisted of 37 patients who had undergone left temporal lobe resection and 38 patients who had undergone right temporal lobe resection. The results indicated that performance differed between the groups; specifically, patients with right temporal lobe resections exhibited more errors—such as direct transcription errors—than those with left temporal lobe resections.
Kim et al. (2020) conducted a study utilizing a digital pen-based registration system to assess performance on the Rey-Osterrieth Complex Figure Test among patients with Alzheimer's disease. The study sample comprised 50 Alzheimer's patients. The results indicated that patients with Alzheimer's disease produced more fragmented copies and exhibited longer pauses compared to the control group. Padilla et al. (2016) conducted a study to examine differences in memory processes—specifically regarding the Rey-Osterrieth Complex Figure—and the role of executive functions in memory. The study sample consisted of 63 participants, divided into a group of patients with hemiplegia and a control group of 23 individuals. The results indicated differences in recall performance, suggesting the presence of brain impairments in individuals with hemiplegia; these impairments affect the organizational and planning abilities required for visual memory.
Burk et al. (1999) conducted a study aimed at assessing cognitive performance in patients with spinocerebellar ataxia. The sample comprised 17 patients with spinocerebellar ataxia and a control group of 15 individuals. The findings indicated that 25% of the patient sample suffered from dementia. Memory and attention tasks were administered to the group of patients who did not have dementia, as well as to the control group.
García-Herranz et al. (2022) conducted a study aimed at establishing updated normative data for tests commonly used to assess the nervous system in Spanish-speaking elderly individuals: verbal fluency tests, the Trail Making Test, and the Rey-Osterrieth Complex Figure Test. The performance sample consisted of 382 healthy individuals aged 60 to 90. The results indicated correlations between age and performance scores on the verbal fluency tests and the Rey-Osterrieth Complex Figure Test.
Vicente et al. (2021) conducted a study to establish normative data adapted for European Portuguese speakers regarding two psychological tests widely used to evaluate learning and memory: the Hopkins Verbal Learning Test-Revised (HVLT-R) and the Rey-Osterrieth Complex Figure Test. The sample comprised 300 individuals aged 18 to 92. The study examined the influence of age and gender on performance in the HVLT-R and the Rey-Osterrieth Complex Figure Test. Demographic variables accounted for 61% of the variance in HVLT-R short-delay recall, 54% in HVLT-R long-delay recall, 18% in HVLT-R recognition, 55% in the Rey-Osterrieth Complex Figure Test (copy condition), and 39% in the Rey-Osterrieth Complex Figure Test (immediate recall). Galic et al. (2021) conducted a study aimed at evaluating the Rey-Osterrieth Complex Figure (ROCF) test in patients with lateralized temporal lobe epilepsy (TLE) affecting either the left or right hemisphere. The study sample consisted of 24 subjects with left-sided lesions and 33 subjects with right-sided lesions. The results showed that 78.3% of the participants were affected on the left side and 66.7% on the right side. Notably, more than 90% of participants with left-sided lesions made two or more errors during delayed recall, whereas the error rate was significantly higher (six or more errors) among those with right-sided lesions—specifically involving "Error X" during immediate and/or delayed recall.
Le Monda et al. (2020) conducted a study to evaluate the utility of the ROCF test in lateralizing temporal lobe epilepsy. The sample comprised 84 patients with lateralized temporal lobe epilepsy—classified into right-sided (n=41) and left-sided (n=43) groups based on clinical data and MRI findings—along with a control group of 46 individuals. The study results indicated that the test has the ability to discriminate between patient groups. Eldeib (2020) conducted a study aimed at providing Egyptian normative data for the Rey-Osterrieth Complex Figure Test. The sample consisted of 521 individuals aged 9 to over 21 years (272 females, mean age = 17.268; 249 males). The study covered five age groups (9–12, 12.01–15, 15.01–18, 18.01–21, and 21.01+ years), with unequal numbers of males and females in each category. The findings indicated that age and years of education influenced performance on the immediate recall task.
Conson et al. (2019) conducted a study to provide normative data for the direct copy and immediate recall versions of the Rey-Osterrieth Complex Figure Test among Italian-speaking children. The sample consisted of 348 children (147 males and 199 females) aged 7 to 11 years. The results showed that performance was influenced by age, with a steady increase in accuracy.
Salvadori et al. (2019) conducted a study comparing performance on the Rey-Osterrieth Complex Figure Test between healthy controls and patients with neurodegenerative diseases. The sample consisted of 30 healthy controls and 27 patients with neurodegenerative diseases. The study results indicated... Mistridis et al. (2019) conducted a 12-year longitudinal study on Mild Cognitive Impairment (MCI) and Alzheimer's disease. The sample consisted of 27 individuals who progressed from MCI to Alzheimer's disease (monitored over the course of the disease's 12-year progression) and 60 healthy controls. The study found that, prior to the clinical diagnosis of cognitive impairment, the group that progressed to Alzheimer's exhibited declines in verbal memory (specifically verbal learning and the animal naming task) and executive function. Notably, performance on delayed recall tasks was weaker than on immediate recall tasks—a pattern that differed from that observed in patients with other neurodegenerative conditions.
Method
Curriculum study
Approved in This Study on Curriculum Description Comparative.
Community Study and its sample
The study population is composed of patients with diseases of the nervous system admitted to hospitals, neurology clinics and surgeries in the governorates of Amman, Balqa, and Irbad.
From those available among patients with neurological disorders, and the method of selection of the study sample was from visiting hospitals and clinics for trauma and surgery in the governorates of Amman, Balqa, and Rab, including Al-Jama'a Jordanian Hospital, Al-Bashir Hospital, Al-Malik Abd- Allah Hospital in the University of Science and Technology, Al-Sult Governmental Hospital, and outpatient clinics affiliated to the Ministry of Health, and the Darat Samir Shamma Hospital for the Elderly. The sample of patients with narcolepsy consisted of (100) individuals, a group of kinship patients with an age range of (56.71) years. Table (1) shows the characteristics of this sample.
|
No. |
Disease |
Total |
|
1 |
Alzheimer's Disease |
15 |
|
2 |
Dementia |
6 |
|
3 |
Brain Injury |
19 |
|
4 |
Vascular Diseases |
25 |
|
5 |
Epilepsy |
9 |
|
6 |
Multiple Sclerosis |
17 |
|
7 |
Parkinson's Disease |
8 |
|
8 |
Huntington's Disease |
1 |
|
Final Total |
100 |
Table 01 Description of the Sample by Disease
The healthy group consisted of individuals who had not been diagnosed with neurological or psychiatric disorders. The sample consisted of 100 individuals with a mean age of 56.71 years and was matched with the clinical sample in terms of demographic characteristics (age and gender).
Study Instruments
Regarding the reliability of the original scale (Meyers & Meyers, 1995), reliability for the original Rey–Osterrieth Complex Figure Test was verified through inter-rater reliability, which reached (0.94), indicating excellent reliability in the scoring method. Reliability was also examined using temporal stability. Paired-sample t-tests were calculated between the mean scores of the first and second administrations. The results indicated no statistically significant differences in mean scores for any variable across the two administrations, indicating that the results were highly stable from the first to the second administration.
Regarding the validity of the original scale (Meyers & Meyers, 1995), the Rey–Osterrieth Complex Figure Test possesses both convergent and discriminant validity, as it is capable of distinguishing between clinical and control samples, which is considered a strong indicator of validity. In addition, factorial validity was established through the extraction of five factors after applying Varimax rotation.
Validity and Reliability in the Current Study:
The reliability of the Rey–Osterrieth Test was examined using the test–retest method on first-year secondary science students from Al-Numu Educational Schools. Internal consistency coefficients ranged between (0.42–0.60). As for the reliability of the subtests, it was examined using Cronbach’s Alpha. Pearson correlations between test scores were calculated to estimate longitudinal reliability. The average reliability coefficients for the test sections ranged between (0.78–0.83), which are considered good values. Table (2) presents the reliability coefficients of the Rey–Osterrieth Test.
|
Test |
Number of Items |
Cronbach's Alpha |
|
Copy |
18 |
0.828 |
|
Immediate Recall |
18 |
0.815 |
|
Delayed Recall |
18 |
0.781 |
Table 02 Reliability Coefficients of the Rey–Osterrieth Test
Table (3) presents the correlation coefficients between the two administrations (test–retest reliability).
|
Test |
Correlation |
|
Copy |
0.418* |
|
Immediate Recall |
0.603** |
|
Delayed Recall |
0.572** |
Table 3 Correlation Coefficients Between the Two Administrations (Test–Retest Reliability)
Table (4) presents the correlation coefficients between the total score and the sub-scores of the Copy Test of the Rey–Osterrieth Test.
|
Item |