Poor visuospatial skills can disrupt activities of daily living. The cerebellum has been implicated in visuospatial processing, and patients with cerebellar injury often exhibit poor visuospatial skills, as measured by impaired memory for the figure within the Rey-Osterrieth complex figure task (ROCF). Visuospatial skills are an inherent aspect of the ROCF; however, figure organization (i.e., the order in which the figure is reconstructed by the participant) can influence recall ability. The objective of this study was to examine and compare visuospatial and organization skills in people with cerebellar ataxia. We administered the ROCF to patients diagnosed with cerebellar ataxia and healthy controls. The cerebellar ataxia group included patients that carried a diagnosis of spinocerebellar ataxia (any subtype), autosomal dominant cerebellar ataxia, or cerebellar ataxia with unknown etiology. Primary outcome measures were organization and recall performance on the ROCF, with supplemental information derived from cognitive tests of visuospatial perception, working memory, processing speed, and motor function. Cerebellar ataxia patients revealed impaired figure organization relative to that of controls. Figure copy was impaired in the patients, but their subsequent recall performance was normal, suggesting compensation from initial organization and copying strategies. In controls, figure organization predicted recall performance, but this relationship was not observed in the patients. Instead, processing speed predicted patients’ recall accuracy. Supplemental tasks indicated that visual perception was intact in the cerebellar ataxia group and that performance deficits were more closely tied to organization strategies than with visuospatial skills.
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We would like to thank the faculty, staff, patients, and family members of the Johns Hopkins Ataxia Center.
Funding for this study was provided by the Gordon and Marilyn Macklin Foundation and the Margaret Q. Landenberger Research Foundation.
Conflict of Interest
The authors declare that they have no conflicts of interest.
Electronic Supplementary Material
Example of Level 5 Figure Organization. This video shows an ataxia patient’s actual process of drawing the ROCF during the copy condition, sped up 35 fold. This approach was assigned a level 5 figure organization, and exemplifies the overall less efficient figure organization employed by the ataxia group. (AVI 6869 kb)
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Slapik, M., Kronemer, S.I., Morgan, O. et al. Visuospatial Organization and Recall in Cerebellar Ataxia. Cerebellum 18, 33–46 (2019). https://doi.org/10.1007/s12311-018-0948-z