Judgement of Line Orientation error analysis distinguishes between severity of cognitive impairment in older adults

Research demonstrates visuospatial dysfunction as an early marker of neurocognitive disorders (NCDs) in older adults (OAs). The Benton Judgment of Line Orientation is a commonly administered visuospatial task, and error analysis of the degree of misjudgment has been validated to distinguish between cognitively normal and clinical populations in OAs. This study evaluates the utility of applying this previously established error analysis to the RBANS Update: Line Orientation (RBANS-LO).

This study used a retrospective review of OAs (age ≥60) of varying levels of cognitive functioning, who were administered a neuropsychological assessment (N = 197; M age = 74.28). Multiple regression was used to evaluate whether three error types (interquadrant errors [IQE], horizontal errors [HE], and horizontal switch errors [HSE]) were associated with NCD severity, other neurocognitive performances, and etiology of cognitive decline.

All three error types were significantly more common in the major NCD group. HSEs were associated with NCD etiology, such that non-Alzheimer's Disease participants were more likely to commit these errors. Two error types (IQEs and HEs) were associated with measures of working memory, while only one error type (HSEs) was related to visuospatial performance.

All three error types differentiated between cognitive severities and were almost exclusively observed in the major NCD group. RBANS-LO error analysis can thus provide additional data to support severity determinations, which supports the utility of applying it to this task. Only one error type was associated with visuospatial performance, suggesting that other cognitive abilities potentially impact RBANS-LO in a major NCD population. Additional work exploring the relationship of error types to biomarker-defined etiologies or other markers of neurodegeneration could provide information about the underlying mechanisms of these errors. Further research could also assess the utility of modifications to the RBANS-LO to reduce the occurrence of these errors.