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Adult Norms for the Rey-Osterrieth Complex Figure

Test and for Supplemental Recognition and Matching
Trials from the Extended Complex Figure Test
Philip S. Fastenau, Natalie L. Denburg & Bradley J. Hufford
Version of record first published: 09 Aug 2010

To cite this article: Philip S. Fastenau, Natalie L. Denburg & Bradley J. Hufford (1999): Adult Norms for the Rey-Osterrieth
Complex Figure Test and for Supplemental Recognition and Matching Trials from the Extended Complex Figure Test, The
Clinical Neuropsychologist, 13:1, 30-47
To link to this article: http://dx.doi.org/10.1076/clin.13.1.30.1976

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The Clinical Neuropsychologist

1999, Vol. 13, No. 1, pp. 30-47

1385-4046/99/1301-030$15.00
Swets & Zeitlinger

Adult Norms for the Rey-Osterrieth Complex Figure Test and

for Supplemental Recognition and Matching Trials from the
Extended Complex Figure Test*
Philip S. Fastenau1, Natalie L. Denburg2,3, and Bradley J. Hufford1
1Indiana

University Purdue University Indianapolis (IUPUI), Indianapolis, IN, 2Michigan State University,
East Lansing, MI, and 3Department of Veterans Affairs Medical Center, San Diego, CA

Downloaded by [Indiana Universities] at 15:16 17 July 2012

ABSTRACT
The Rey-Osterrieth Complex Figure Test (the Rey; Osterrieth, 1944; Rey, 1941) has accumulated a
considerable literature as a test of visual-spatial perception/construction and memory. The Extended Complex Figure Test (ECFT; Fastenau, 1996a, in press-a; Fastenau & Manning, 1992) supplements the Rey
with Recognition and Matching trials that follow Copy, Immediate Recall, and Delayed Recall. The Rey
and ECFT were administered to 211 healthy adults. Age ranged from 30 years to 85 years (M = 62.9, SD
= 14.2), education ranged from 12 years to 25 years (M = 14.9, SD = 2.6), 55% were women, and over 95%
were Caucasian. Age and education effects were evident on all trials (Multiple R ranged .23 to .50, p < .05),
but education explained minimal variance (usually 2-3%) on copy and memory trials. Gender effects were
negligible, if present. Age-appropriate norms are presented using Osterrieths 36-point scoring, overlapping cells, and convenient tables for converting raw scores to scaled scores.

The Rey-Osterrieth Complex Figure Test (the

Rey; Rey, 1941; Osterrieth, 1944; Rey & Osterrieth, 1993) was designed to measure both
perceptual organization and visual memory in
brain-injured persons. It has become a standard
component in many neuropsychological batteries (e.g., Kaplan, 1988; Lezak, 1983, 1995; Orsini, Van Gorp, & Boone, 1988; Squire, 1986;
Weintraub & Mesulam, 1985).
In the most popular administration of this test
(Knight, Kaplan, & Ireland, 1994; Lezak, 1995),
a person is asked to copy a complex geometric
stimulus on a blank sheet of paper, often using
five or six colored pens which are presented one
at a time by the examiner. The examiner can
track the persons constructional approach by
recording the sequence of lines as they are
drawn or by recording the sequence of colors;
*

perceptual organization is inferred from the constructive procedure employed by the individual
during the copy production. The examiner may
also note the time that lapses between start and
finish. Immediately following the copy trial, the
stimulus and copy are removed. The examiner
provides a new blank sheet and asks the person
to reproduce the image from memory (immediate recall). After a delay of 15 to 60 min, the
memory trial is repeated to measure delayed
recall; within this time span, the length of the
delay appears to be inconsequential to recall
(Berry, Allen, & Schmitt, 1991).
The Rey uses an intricate stimulus that is
asymmetrical in its design. The complexity of
this stimulus seems to tax the upper range of
visual-spatial processing better than other geometric stimuli. As a product of this complexity,

This manuscript is an elaboration of a paper presented at the Annual Meeting of the International Neuropsychological Society in Orlando, FL in February, 1997.
Address correspondence to: Philip S. Fastenau, Department of Psychology (LD 124), 402 N. Blackford Street,
Indiana University Purdue University Indianapolis (IUPUI), Indianapolis, IN 46202-3275, USA. E-mail:
pfastena@iupui.edu.
Accepted for publication: July 21, 1998.

Downloaded by [Indiana Universities] at 15:16 17 July 2012

NORMS FOR THE REY AND ECFT

the Rey appears to be more resistant to verbal

mediation, even compared to other complex
figures such as the Taylor figure (Casey, Winner, Hurwitz, & DaSilva, 1991).
The Rey has proven useful in the study of
normal child development (e.g., Karapetsas &
Kantas, 1991; Waber & Holmes, 1985, 1986).
Atypical child development, also, has been investigated using the Rey (e.g., Brandys & Rourke, 1991; Klicpera, 1983; Prior & Hoffmann,
1990).
The Rey is useful with adults, as well. It has
proven to be sensitive to a wide range of
nervous system insults, including solvent exposure (Milanovic, Spilich, Vucinic, & Knezevic,
1990), hippocampal sclerosis (Miller, Muoz, &
Finmore, 1993), Wernickes encephalopathy
(Parkin, Dunn, Lee, OHara, & Nussbaum,
1993), asymptomatic HIV-seropositive status
(McManis, Brown, Zachary, & Rundell, 1993),
AIDS (Hamby, Wilkins, & Barry, 1993), Alzheimers-type dementia (Berry et al., 1991;
Brouwers, Cox, Martin, Chase, & Fedio, 1984),
mild head injury (Leininger, Gramling, Farrell,
Kreutzer, & Peck, 1990), lateralized strokes
(Binder, 1982), and lateralized seizure foci
(Fastenau & Fisk, 1997a, 1997b; Jones-Gotman,
1986; Loring, Lee, & Meador, 1988; Taylor,
1969).
Although the Rey has proven to be a very
useful tool, it lacks recognition and matching
trials, which can help clarify contributions of
perception and memory retrieval to defective
memory recall performances. Fastenau (Fastenau, 1996a, in press-a; Fastenau & Manning,
1992) expanded the administration of the Rey by
adding recognition and matching trials to the
existing copy, immediate recall, and delayed
recall trials of the Rey. This elaborated administration is collectively called the Extended
Complex Figure Test (ECFT).
Fastenau (in press-b) described how a fivetrial administration could be used for diagnostics
and rehabilitation planning. In the interpretive
process, the first step would be to examine
Matching to verify accurate perception of the
stimulus. If perception were intact, the Copy
trial could then be examined to assess the level
of construction ability. Immediate Recall could

31

be compared to Delayed Recall to determine

how much of the memory trace is retained over
time (i.e., forgetting rates). Finally, free recall
(both Immediate Recall and Delayed Recall)
could be compared to Recognition performance;
if the latter were significantly better than the
former, then inefficient retrieval processes
would be implicated. That is, the memory trace
would have been encoded and stored, but the
person would need memory aids in order to access the memory trace.
ECFT Recognition was first designed by
Fastenau and Manning (1992) using clinical records, developmental literature, and theoretical
literature. The original version was subjected to
pilot study and expert appraisal, after which it
was revised into its final version which included
a matching trial (Fastenau, 1996a, in press-a).
Reliability and validity for the new instrument
have been examined and reported in detail elsewhere (Fastenau, 1996a, in press-a, in press-b;
Fastenau & Denburg, 1994; Fastenau & Fisk,
1997a, 1997b; Fastenau & Manning, 1992). In
addition to showing strong reliability and validity, the Rey and ECFT have been shown to be
robust with respect to several variations in administration (Berry et al., 1991; Fastenau, Bennett, & Fisk, 1996; Fastenau & Denburg, 1997;
Fastenau, Denburg, & Domitrovic, 1997) and
with respect to different scoring systems for the
Rey figure drawings (Fastenau, Bennett, & Denburg, 1996).
The ECFT has been used with several clinical
populations. Recognition and matching scores
discriminate between patients with Alzheimers
and matched controls (Fastenau, Unverzagt,
Koop, & Hufford, 1998). In addition, ECFT
Recognition effectively discriminates patients
with right focal temporal lobe epilepsy from
those with left epileptic foci (Fastenau & Fisk,
1997b). The ECFT has discriminated also between patients with severe depression and
matched controls (Fastenau, Smet, et al., 1998).
Data collection is in progress with people who
have sustained lateralized strokes, particularly
for determining the sensitivity and specificity of
the Left- and Right-Detail Subscales of the
ECFT (D. Johnson-Greene, personal communication, July 15, 1997). Data collection has also

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32

PHILIP S. FASTENAU ET AL.

begun with people who have schizophrenia

(Smet, 1997), in whom retrieval has been shown
to be more affected than encoding (McClain,
1983; Paulsen et al., 1995).
Adult norms are available for the Rey (e.g.,
Berry et al., 1991; Boone, Lesser, Hill-Gutierrez, Berman, & DElia, 1993; Roselli & Ardila,
1991), but none of these include recognition or
matching trials. Optimally, clinicians would
want to compare all trial performances on the
same norms to make direct and equitable comparisons among trials.
Meyers and Meyers (1995) introduced a recognition trial for the Rey shortly after development began on the ECFT; they co-normed the
Rey with their recognition trial. Although theirs
appears to be a very useful recognition task, several differences between that test and the ECFT
limit the applicability of those norms for interpretation of the ECFT. First, the Meyers task
does not provide a matching trial. Second, the
Meyers recognition trial uses a different format
from the ECFT for assessing recognition. The
patient is shown 12 pieces of the Rey figure all
at once, together with an equal number of foils;
the patient is instructed to circle the units that
were part of the stimulus. Because the patient is
allowed to examine all of the items at once,
some pieces can be used to cue the recall of
other units. Finally, the immediate recall trial
is administered after a 3-min delay followed by
yet another recall trial 30 min later. This administration is not typical of the common practices
of neuropsychologists using the Rey (Knight et
al., 1994).
Preliminary norms for the ECFT were provided by Fastenau (1996a), but those, too, are
limited for several reasons. First, only 88 people
comprised the initial sample. Second, that sample retained individuals who were living independently in the community, even if they had
sustained significant neurological insults; that
inclusion criterion may be sufficient for treatment planning purposes (i.e., discriminating between people who can vs. cannot care for themselves), but is not optimal for diagnostic purposes. As a final limitation to Fastenaus
(1996a) preliminary norms, the data were published using a scoring system that was more

cumbersome than the equally reliable, equally

valid, and more widely used Osterrieth scoring
system (Fastenau et al., 1996; Knight et al.,
1994; Osterrieth, 1944; Rey & Osterrieth, 1993).
In the present study, data from a much larger,
healthier sample were scored using the popular
and efficient Osterrieth scoring system. Norms
are derived and tabulated in convenient conversion tables.

METHOD
Participants
The participants for this study were recruited at
three different sites, as part of other studies. For all
three sites, a stratified sampling procedure recruited community-dwelling adults with approximately equal numbers of men and women in every
age band. Participants were financially compensated for their participation. Volunteers with uncorrected visual or hearing impairment or with
impaired use of the preferred hand were not included. Based on a structured interview, volunteers
were excluded for history of cerebrovascular insult
(stroke or TIA), head injury with loss of consciousness exceeding 5-min duration, and chronic
substance abuse. Volunteers were excluded also
because of incomplete protocols.
An educational cutoff was also implemented.
Even though a concerted effort was made to recruit
people with lower education, there were very few
people (2%) who had fewer than 12 years of education after all three samples were assembled. People with fewer than 12 years of education score
significantly lower than those with 12 or more
years of education on a variety of neuropsychological tests (e.g., Bornstein & Suga, 1988; Hawkins
et al., 1993; Ross & Lichtenberg, 1997). Fastenau
and colleagues (Fastenau, in press-c; Fastenau,
Denburg, & Mauer, in press) have argued that this
can have dramatic effects on norms. Because the
least-educated population would be severely
underrepresented in the present sample, it would
be misleading to include these participants and to
suggest that these norms would serve that population equally well. Therefore, individuals with less
than 12 years education were excluded.
The first sample was selected from a larger
sample of 90 community-dwelling adults, who
were recruited from four religious organizations in
a city in the Midwestern U.S. The larger sample
was used in other published papers (Fastenau,
1996a, 1996b; Fastenau & Denburg, 1994; Faste-

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NORMS FOR THE REY AND ECFT

nau, Denburg, & Abeles, 1996a, 1996b; Fastenau,

Denburg, & Domitrovic, 1997), and part of the
larger sample was used by Fastenau, Bennett, and
Denburg (1996). Of that sample, 81 met inclusion
criteria for the present study. Age for the selected
portion of that sample ranged from 30 years to 79
years (M = 53.1, SD = 13.6), education ranged
from 12 years to 25 years (M = 15.6, SD = 2.8),
and 59% were women. WAIS-R (Wechsler, 1981)
Vocabulary subtest scores were obtained on this
subsample as an index of intellectual functioning.
Age-corrected scaled scores ranged from 7 to 19;
the mean was 12.7 (SD = 2.3), which is roughly
equivalent to High Average IQ (approximately 110
115 estimated IQ).
In another Midwestern sample, 100 participants
were recruited through two local churches and an
older adult organization. Of those, 84 were retained for the present sample. The ECFT data from
this sample have not appeared in any other published paper. Age for the selected portion of that
sample ranged from 60 years to 85 years (M =
72.9, SD = 6.8), education ranged from 12 years to
20 years (M = 13.9, SD = 2.3), and 50% were
women. For this subsample, WAIS-R Vocabulary
age-corrected scaled scores ranged from 7 to 15;
the mean was 11.1 (SD = 1.9), which is roughly
equivalent to Average IQ (estimated IQ of approximately 105). As an additional index of intellectual
functioning on this subsample, WRAT-3 (Wilkinson, 1993) Reading subtest scores were obtained, ranging from 86 to 117; the mean score (M
= 103.2, SD = 8.4) is roughly equivalent to midAverage IQ, consistent with Vocabulary-based
estimates.
The third sample was recruited in a major metropolitan area on the west coast of the U.S., using
newspaper advertisements, local churches, and
senior citizen organizations. A total of 49 participants completed testing in that study. Of those, 46
were retained for the present sample. The ECFT
data from this sample have not appeared in any
other published paper. Age for the selected portion
of that sample ranged from 40 years to 81 years (M
= 62.8, SD = 13.0), education ranged from 12 years
to 20 years (M = 15.4, SD = 2.1), and 59% were
women. Only WRAT-3 Reading subtest scores
were obtained on this subsample, ranging from 71
to 117; the mean score (M = 105.7, SD = 8.4) is
roughly equivalent to an estimated IQ in the Average range.
A total of 211 participants were retained for the
present study. For the entire sample, age ranged
from 30 years to 85 years (M = 62.9, SD = 14.2),
education ranged from 12 years to 25 years (M =
14.9, SD = 2.6), and 55% were women. The esti-

33

mated IQ for the total sample based on reading or

vocabulary indices was 107, which is in the Average range. This sample was predominantly Caucasian (over 95%).
Scores for the recall drawings were generated
using Osterrieths criteria (Osterrieth, 1944; Rey &
Osterrieth, 1993). Fastenau, Bennett, and Denburg
(1996) compared this relatively simple scoring
system to one that was much more elaborate. The
Osterrieth system was more efficient to learn, considerably easier to apply, and at least equally reliable for novice and experienced raters from different institutions. Correlations between recall and
recognition were equally strong for both scoring
systems; the same was true for correlations between copy and matching. The use of the Osterrieth system for the normative data is further
supported by survey data showing that most Rey
examiners use these scoring criteria (Knight et al.,
1994). The scoring system is reprinted in Lezak
(1995) and in Rey and Osterrieth (1993).
Recently, it has become popular to generate test
norms using multiple regression to correct for demographic influences statistically. Limits of regression-based norms have been argued theoretically (Fastenau & Adams, 1996) and demonstrated
empirically (Fastenau, 1998, in press-c). Thus,
ECFT norms will not rely on this method. Instead,
salient demographic influences are determined by
statistical analysis, and then the sample is subdivided into representative subgroups. Raw scores
are converted to T scores and tabulated by age and
education groups for easy reference.
Procedure
All participants were administered the Rey and the
ECFT as part of a larger battery of tests. Testing
was administered by graduate students in clinical
psychology, all of whom had completed the assessment training sequence of an APA-accredited doctoral training program and had substantial testing
experience.
Analyses
Multiple regression (MR) analyses were used to
assess the effects of age and education, both as
main effects and in interaction. MR was preferred
over the use of analyses of variance (ANOVAs)
because the former capitalizes on the full range of
variability in these two continuous independent
variables. Based on earlier studies with the Rey,
age and education effects have been observed with
some consistency; gender effects, on the other
hand, have consistently been very small and have
explained less than 3% of the variance (see Fastenau, in press-b, for more discussion). Therefore,

34

PHILIP S. FASTENAU ET AL.

age and education influences were tested under the

hypothesis of lower ECFT performance with increasing age and with decreasing education (onetailed). Dependent variables were ECFT Copy,
Immediate Recall, Delayed Recall, Recognition,
and Matching, together with all scale and subscale
scores for the latter two trials.

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RESULTS
For Copy, there was a main effect for age (p
.05, explaining 3% of the variance) and for education (p .05, explaining an additional 2% of
the variance), Multiple R = .23, p .005. For
Immediate Recall, there was a main effect for
age (p .00005, explaining 14% of the variance)
and for education (p .0005, explaining an additional 5% of the variance), Multiple R = .44, p
.00005. For Delayed Recall, there was a main
effect for age (p .00005, explaining 13% of the
variance) and for education (p .005, explaining
an additional 3% of the variance), Multiple R =
.40, p .00005. There were no interactions for
Copy, Immediate, or Delayed trials.
For Recognition Total Scale, there was a
main effect for age (p .00005, explaining 22%
of the variance) and for education (p .01, explaining an additional 2% of the variance), Multiple R = .49, p .00005. For Recognition Global
Scale, there was a main effect for age (p .0001,
explaining 8% of the variance) and for education
(p .001, explaining an additional 3% of the
variance), Multiple R = .32, p .00005. For Recognition Detail Scale, there was a main effect
for age (p .00005, explaining 23% of the variance) and for education (p .05, explaining an
additional 2% of the variance), Multiple R = .50,
p
.00005. For Recognition Left-Detail
Subscale, there was a main effect for age (p
.00005, explaining 18% of the variance) and for
education (p .05, explaining an additional 2%
of the variance), Multiple R = .45, p .00005.
For Recognition Right-Detail Subscale, there
was a main effect for age (p .00005, explaining
21% of the variance) but not for education (p >
.10), Multiple R = .46, p .00005. There were
no interactions for any Recognition scale or
subscale score.

For Matching Total Scale, there was an Age

Education interaction, Multiple R = .43, p
.00005. For Matching Left-Detail Subscale,
there was a main effect for education only, Multiple R = .25, p .0005. For Matching Right-Detail Subscale, there was an Age Education interaction, Multiple R = .36, p .00005.
In post hoc analyses, gender and its interactions with age and education were analyzed,
again using MR. There was a main effect for
gender on Copy (p .05); beyond the age and
education effects, however, very little variance
( < 2%) was explained by gender. For Immediate Recall, Delayed Recall, and all scales and
subscales of Recognition and Matching, gender
failed to enter into the equation as a main effect
or in interaction (p > .05, two-tailed).
In Tables 1 through 9, the data were tabulated
in a manner recommended by Fastenau and Adams (1996). Because education explained very
little variance beyond age on Copy, Immediate
Recall, Delayed Recall, and Recognition, these
data were stratified by age only; this observation
of very small education influences and the
choice to stratify by age alone follows the precedent by Meyers and Meyers (1995) for their recognition trial. Normative groups were created
using overlapping cells, a method introduced by
Pauker (1988). Scores were tabulated for easy
conversion to scaled scores that have a mean of
10 and a standard deviation of 3, using the same
layout as the WAIS-R tables (Wechsler, 1981)
and Mayo norms (Ivnik et al., 1992). The tables
were generated using the method described by
Ivnik and his colleagues (1992). The sample size
and gender ratio are provided for each age
group. Within each group, the mean and standard deviation are provided for each test score.
To use the tables, the user should first identify the table that has a midpoint age closest to
the examinees age. Each test score is tabulated
in its own column. Locate the examinees score
in the appropriate column. The value in the left
margin corresponding to the examinees score is
the age-corrected scaled score; the value in the
right margin is the centile rank corresponding to
that same scaled score.

Table 1. Raw Score to Scaled Score Conversions for the Rey and for the Extended Complex Figure Test Recognition Trial.
Midpoint Age = 40 (Age Range = 30 50; n = 48).
Recognition Scales
Copy

Immediate

Delayed

Total

Global

Detail

Left

Right

Percentile Range

2
3
4
5
6

022
22.525
25.5
2628.5

04
4.58
8.5
911

04
4.59

9.510

04
57
8
9

0
1
2

04
56

0
1

01
2

<1
1
2
35
610

7
8
9

2929.5
3030.5
3132.5

11.512.5
1313.5
1417.5

10.511
11.513.5
1416.5

1012
13
1415

3
4

7
89
1011

2
3

4
5
6

1118
1928
2940

10

3333.5

1820.5

1720

1619

1214

4159

11
12
13

3434.5

3535.5

2124
24.527
27.529.5

20.523
23.525.5
2629.5

2021
2223

15
1617

56

6071
7281
8289

14
15
16
17
18

36

3032.5
3333.5

3436

3031
31.532.5

3336

2426

2730

1819

2023

89

9
10

11

9094
9597
98
99
> 99

32.83
(3.10)

20.3
(7.42)

19.28
(7.29)

17.92
(5.63)

4.88
(1.79)

13.04
(4.29)

4.33
(1.95)

7.00
(2.21)

M
(SD)

NORMS FOR THE REY AND ECFT

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Scaled Scores

Note. 54% female.

35

36

Table 2. Raw Score to Scaled Score Conversions for the Rey and for the Extended Complex Figure Test Recognition Trial.
Midpoint Age = 48 (Age Range = 40 55; n = 47).
Recognition Scales
Copy

Immediate

Delayed

Total

Global

Detail

Left

Right

Percentile Range

2
3
4
5
6

013
13.519.5
2022
22.524.5

04
4.55.5
68
8.510

04
4.55
5.57.5
89

04
5
67
89

01

02
3
4
56

01
2

<1
1
2
35
610

7
8
9

2529.5
3030.5
3131.5

10.511
11.512.5
1315

9.510
10.511.5
1213.5

10
1113
14

78
910

3
4
5

1118
1928
2940

10

3233.5

15.518.5

1418

1517

1113

67

4159

11
12
13

3434.5
3535.5

1920.5
2123.5
2428.5

18.520
20.523.5
2426.5

1820
21
2223

14
15
1617

45
6

6071
7281
8289

14
15
16
17
18

36

2929.5
3031.5
3233.5

3436

2730.5
31
31.532.5

3336

24

2526

2730

18
19

2023

89

1011

9094
9597
98
99
> 99

31.79
(4.55)

17.87
(6.84)

17.13
(7.04)

16.60
(5.45)

4.62
(1.57)

11.98
(4.37)

3.70
(1.96)

6.66
(2.30)

M
(SD)
Note. 62% female.

PHILIP S. FASTENAU ET AL.

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Scaled Scores

Table 3. Raw Score to Scaled Score Conversions for the Rey and for the Extended Complex Figure Test Recognition Trial.
Midpoint Age = 53 (Age Range = 45 60; n = 43).
Recognition Scales
Copy

Immediate

Delayed

Total

Global

Detail

Left

Right

Percentile Range

2
3
4
5
6

013
13.519.5
2022
22.524.5

03.5
45.5
68
8.510

04
4.55
5.57.5
89.5

03
4
5
69

0
1
2

02
3
46

0
12

<1
1
2
35
610

7
8
9

2528.5
2930.5
3131.5

10.511
11.512.5
1315.5

10
10.513
13.5

10
1113
14

34

79
10

3
4
5

1118
1928
2940

10

3233.5

1619

1418

1517

1113

67

4159

11
12
13

3434.5

19.520.5
2125.5
2628.5

18.520.5
2124.5
2526.5

1820
21
2223

5
6

14
15
16

45

6071
7281
8289

14
15
16
17
18

3535.5

36

2929.5
3031.5
3233.5

3436

2730.5
31
31.532.5

3336

24

2526

2730

17
18
19

2023

6
7

89

1011

9094
9597
98
99
> 99

31.62
(4.61)

18.07
(7.11)

17.48
(7.11)

16.65
(5.61)

4.74
(1.77)

11.91
(4.43)

3.56
(2.00)

6.67
(2.36)

M
(SD)

NORMS FOR THE REY AND ECFT

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Scaled Scores

Note. 53% female.

37

38

Table 4. Raw Score to Scaled Score Conversions for the Rey and for the Extended Complex Figure Test Recognition Trial.
Midpoint Age = 58 (Age Range = 50 65; n = 57).
Recognition Scales
Copy

Immediate

Delayed

Total

Global

Detail

Left

Right

Percentile Range

2
3
4
5
6

013
13.517
17.522
22.524.5

03.5
45
5.5
68.5

04
4.55
5.57.5

03
45
68
9

0
1

02
34

0
12

<1
1
2
35
610

7
8
9

2528.5
2930.5
3131.5

910
10.512.5
1315

810
10.513
13.5

10
1112
13

3
4

56
7
89

3
4
5

1118
1928
2940

10

3232.5

15.517.5

1417.5

1416

1011

4159

11
12
13

3333.5

3434.5

1819.5
2021
21.523

1819
19.522.5
2324

17
1820
21

1213
14
15

3
4
5

7
8

6071
7281
8289

14
15
16
17
18

3535.5

36

23.525.5
2628.5
2931.5

3236

24.5
2527
27.531

31.536

22
2324

2530

16
17
18

1923

6
7

89

1011

9094
9597
98
99
> 99

31.17
(4.43)

16.55
(6.08)

16.44
(6.08)

15.77
(4.76)

4.82
(1.53)

10.95
(3.93)

3.05
(1.89)

6.32
(2.11)

M
(SD)
Note. 61% female.

PHILIP S. FASTENAU ET AL.

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Scaled Scores

Table 5. Raw Score to Scaled Score Conversions for the Rey and for the Extended Complex Figure Test Recognition Trial.
Midpoint Age = 63 (Age Range = 55 70; n = 77).
Recognition Scales
Copy

Immediate

Delayed

Total

Global

Detail

Left

Right

Percentile Range

2
3
4
5
6

017
17.523.5

2424.5
2527.5

03.5

45.5
68.5

03.5

47.5
88.5

03
45

67
8

0
1
2

02
3
4

0
12

<1
1
2
35
610

7
8
9

2829.5
3030.5
3131.5

910
10.511
11.513.5

910
10.512.5
1314

9
10
1112

56
7

1118
1928
2940

10

3233.5

1416.5

14.517

1314

89

4159

11
12
13

3434.5

1719
19.520.5
2122.5

17.518.5
1920.5
2123

1516
17
1819

1011

1213

6071
7281
8289

14
15
16
17
18

3535.5

36

2324.5
2526.5

2729
29.536

23.524.5
2526.5

2732
32.536

2021
2224

2530

14
1517

1823

67
89

911

9094
9597
98
99
> 99

31.94
(3.37)

15.52
(5.82)

15.91
(5.91)

14.38
(4.43)

4.71
(1.64)

9.66
(3.52)

2.70
(1.73)

5.39
(2.07)

M
(SD)

NORMS FOR THE REY AND ECFT

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Scaled Scores

Note. 55% female.

39

40

Table 6. Raw Score to Scaled Score Conversions for the Rey and for the Extended Complex Figure Test Recognition Trial.
Midpoint Age = 68 (Age Range = 60 75; n = 96).
Recognition Scales
Copy

Immediate

Delayed

Total

Global

Detail

Left

Right

Percentile Range

2
3
4
5
6

017
17.519
19.521
21.524.5
2527.5

03.5
45
5.5
68.5

03.5
45.5
66.5
78

02
3
4
56
78

02
3
4

0
1

<1
1
2
35
610

7
8
9

2828.5
2930.5
3131.5

99.5
1011
11.513

8.59.5
1011.5
1213.5

9
10
1112

5
6
7

1118
1928
2940

10

3233.5

13.516

1416

13

89

45

4159

11
12
13

3434.5

16.518
18.520
20.522

16.518
18.519
19.522

1415
1617
18

5
6

10
11
1213

3
4

6071
7281
8289

14
15
16
17
18

3535.5

36

22.524
24.5
2525.5
2629
29.536

22.524
24.5
2526
26.532
32.536

1920
2122

2324
2530

14
15
1617

1823

67
89

7
8

911

9094
9597
98
99
> 99

31.76
(3.63)

15.18
(5.58)

15.29
(5.57)

13.57
(4.43)

4.42
(1.69)

9.16
(3.45)

2.54
(1.78)

5.11
(1.87)

M
(SD)
Note. 56% female.

PHILIP S. FASTENAU ET AL.

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Scaled Scores

Table 7. Raw Score to Scaled Score Conversions for the Rey and for the Extended Complex Figure Test Recognition Trial.
Midpoint Age = 73 (Age Range = 6580; n = 102).
Recognition Scales
Copy

Immediate

Delayed

Total

Global

Detail

Left

Right

Percentile Range

2
3
4
5
6

014
14.519
19.521
21.523.5
2426.5

03.5
45
5.5
67.5

03.5
4
4.56
6.57

02
3
4
5
6

02
3

0
1

<1
1
2
35
610

7
8
9

2727.5
2829.5
3030.5

89
9.511
11.512.5

7.59
9.511
11.512.5

7
89
1011

2
3

45
6
7

1118
1928
2940

10

3132.5

1315.5

1315.5

1213

4159

11
12
13

3333.5
3434.5
3535.5

1617
17.519
19.521.5

1617
17.519
19.521.5

14
15
1618

910
11
12

5
6

6071
7281
8289

14
15
16
17
18

36

2224
24.5

2529
29.536

2223
23.525.5
26
26.532
32.536

19
2021
22

2330

13
1415

1617
1823

45

67
89

7
8

911

9094
9597
98
99
> 99

31.38
(4.00)

14.68
(5.49)

14.61
(5.58)

12.80
(4.44)

4.05
(1.77)

8.75
(3.35)

2.46
(1.73)

4.85
(1.74)

M
(SD)

NORMS FOR THE REY AND ECFT

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Scaled Scores

Note. 52% female.

41

42

Table 8. Raw Score to Scaled Score Conversions for the Rey and for the Extended Complex Figure Test Recognition Trial.
Midpoint Age = 78 (Age Range = 70 85; n = 83).
Recognition Scales
Copy

Immediate

Delayed

Total

Global

Detail

Left

Right

Percentile Range

2
3
4
5
6

014
14.519
19.521
21.522.5
2325.5

03.5
45.5
67

01.5
23.5
4
4.55.5
66.5

02
3
4

02
3

0
1

<1
1
2
35
610

7
8
9

2627.5
2828.5
2930.5

7.58.5
910
10.511.5

77.5
89.5
1012

6
78
910

1
2

4
5
6

1118
1928
2940

10

3132.5

1214

12.514

1113

78

4159

11
12
13

3333.5

3434.5

14.516.5
1718.5
1921

14.516.5
1718
18.520.5

14
15
1618

9
1011
12

2
3

5
6

6071
7281
8289

14
15
16
17
18

3535.5

36

21.523.5
24
24.5
2528
28.536

2122
22.524

24.525.5
2636

19
20
21
22
2330

1314
15

1623

45

69

8
911

9094
9597
98
99
> 99

30.87
(4.16)

14.01
(5.45)

13.64
(5.31)

12.08
(4.68)

3.80
(1.72)

8.29
(3.44)

2.30
(1.69)

4.63
(1.84)

M
(SD)
Note. 53% female.

PHILIP S. FASTENAU ET AL.

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Scaled Scores

Table 9. Raw Score to Scaled Score Conversions for the Rey and for the Extended Complex Figure Test Recognition Trial.
Midpoint Age = 80 (Age Range = 75 85; n = 49).
Recognition Scales
Copy

Immediate

Delayed

Total

Global

Detail

Left

Right

Percentile Range

2
3
4
5
6

014
14.519
19.522
22.524

03.5
45
5.57.5

01.5
24
4.5
56.5

03
4

02
3

0
1

<1
1
2
35
610

7
8
9

24.527
27.5
2828.5

8
8.510
10.511

77.5
89
9.511.5

78

0
1
2

45

2
3

1118
1928
2940

10

2931.5

11.514

1214

913

68

4159

11
12
13

3233.5

3434.5

14.516.5
1718.5
19

14.515.5
1617
17.519.5

14

1516

9
10
11

23

6071
7281
8289

14
15
16
17
18

3535.5

36

19.523
23.5
2428

28.536

2022
22.524
24.525.5

2636

1719
20

2130

5
6

1213
14
15

1623

4
5

69

811

9094
9597
98
99
> 99

30.14
(4.52)

13.67
(5.38)

13.17
(5.32)

11.47
(4.80)

3.45
(1.74)

8.02
(3.46)

2.27
(1.62)

4.51
(1.87)

M
(SD)

NORMS FOR THE REY AND ECFT

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Scaled Scores

Note. 51% female.

43

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44

PHILIP S. FASTENAU ET AL.

Matching data warranted different treatment

from the other trials for several reasons. First,
these subscales showed stronger education influences, in addition to age. Second, these distributions were very skewed. Finally, two of the three
Matching scores were based only on four items.
Thus, these scores were best treated as screening
tools. Table 10 lists each variable, stratified by
education and by age, together with the cutoff
values for the 5th centile and for the 15th percentile. For the appropriate scale and the appropriate age-education subgroup, a score at or below the tabled value would be abnormally low at
the specified level. For example, a score of 8
would be clearly abnormal for an older adult
with a college education (at or below the 5th
centile) but within normal limits for an elder
with a high school education (above the 15th
centile).

DISCUSSION
Research has been mounting for the Rey and for
the recognition and matching trials that supplement the Rey figure to comprise the ECFT. The
present study builds on the rapidly emerging
literature on these tests by providing norms from
a relatively large sample of healthy adults using
Table 10.

the popular Osterrieth scoring system. The data

are tabulated in a useful format, following many
of the recommendations by Fastenau and Adams
(1996).
This sample was moderately to well educated
(high school education or higher), although the
average estimated IQ was in the Average range.
The participants were predominantly Caucasian,
and all were fluent in English. Applications to
other ethnic or linguistic groups should be qualified accordingly. Although gender ratios vary
considerably among groups, these should be inconsequential given the lack of interaction between gender and age.
There are many new prospects for further research. First, although the ECFT was designed
with children in mind, there are currently no
normative data for children or adolescents. Second, it would be invaluable to examine the characteristics of the ECFT with theoretically relevant patient groups. For example, people with
left and right hemi-inattention should show differentiation of the Left- and Right-Detail Subscales on both Recognition and Matching; people with multiple sclerosis and people with
pseudodementia should show characteristic retrieval inefficiencies (i.e., poor recall and stronger recognition) whereas those with Alzheimers-type dementia should show encoding fail-

Extended Complex Figure Test Matching Trial Cutoff Scores (Percentile Rank), by Age and Education.
Younger
(Ages 30 65)

Subscale

Older
(Ages 66 85)

Less Educ
(12 14 Years)
(n = 39)

More Educ
(15+ Years)
(n = 62)

Less Educ
(12 14 Years)
(n = 65)

More Educ
(15+ Years)
(n = 45)

Matching Total
5th centile
15th centile

7
8

8
9

7
7

8
9

Matching Left-Detail
5th centile
15th centile

2
3

3
4

3
3

3
3

Matching Right-Detail
5th centile
15th centile

2
3

2
3

1
2

3
3

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NORMS FOR THE REY AND ECFT

ure and rapid forgetting (i.e., poor recall and

recognition).
Third, it could be very useful to standardize
alternative administrations of the ECFT for patients with manual impairments, develop parallel
forms for intervention studies and longitudinal
research, and assess test-retest reliability. Computing risk ratios for various diagnoses or functional outcomes is yet another avenue of research with the ECFT (see Bieliauskas, Fastenau, Lacy, & Roper, 1998).
Finally, the limited verbal demands of the
ECFT would seem to lend it to cross-cultural
applications. Cross-cultural investigations of
visual-spatial memory development are especially intriguing given the apparent role of reading training in the cerebral organization of visual memory span (Conant, Fastenau, Giordani,
Boivin, Chounramany et al., 1997; Conant, Fastenau, Giordani, Boivin, Opel, & Nseyila, 1997,
1998; Fastenau, Conant, & Lauer, 1998). These
research possibilities and others are considered
in greater detail by Fastenau (in press-b).

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