Visuoconstructional Impairment: What Are We Assessing, and How Are We Assessing It?

Visuoconstruction (VC) is a commonly-assessed neuropsychological domain that involves the ability to organize and manually manipulate spatial information to make a design. Tests used to measure VC are considered multifactorial in nature given their multiple demands (e.g., visuospatial, executive, motor), and therefore, interpretation of VC impairment can be difficult. Additionally, a wide variety of tests and methods are used to measure VC, further complicating interpretation of results. Although clinicians and researchers spend a great deal of time studying VC, there has been much confusion about what it is, what is being measured, and how to best measure it. The following study compared a variety of commonly-used, commercially available VC tests for similarities and differences, and also examined the underlying neuropsychological domains of each test. Rather than conceptualizing VC as a unified construct, it was proposed that categorizing VC tests into the following subtypes may improve interpretation: assembly vs. graphomotor, copy vs. draw-to-command, and complex vs. simple tasks. Using 114 mixed neurologic and neuropsychiatric patients, VC test results were assessed with the use of impairment indices, correlational analyses, standard multiple regression, and multivariate analysis of covariance. Study results revealed that the most useful distinction between VC tests appears to based on complexity level. Complex VC tasks tended to be more heterogeneous in their underlying neuropsychological domains, had greater rates of impairment, and were more demanding of executive skills. In contrast, simple VC tests tended to have lower rates of impairment and were more homogenous in function, mostly assessing visuospatial and perceptual skills. Study limitations, future directions, and clinical implications are discussed