The challenge of neuropsychological assessment of visual/visuo-spatial memory: A critical, historical review, and lessons for the present and future

Abstract

A proliferation of tests exists for the assessment of auditory-verbal memory processes. However, from a clinical practice perspective, the situation is less clear when it comes to the ready availability of reliable and valid tests for the evaluation of visual/visuo-spatial memory processes. While, at face value, there appear to be a wide range of available tests of visual/visuo-spatial memory, utilizing different types of materials and assessment strategies, a number of criticisms have been, and arguably should be, leveled at the majority of these tests. The criticisms that have been directed toward what are typically considered to be visual/visuo-spatial memory tests, such as (1) the potential for verbal mediation, (2) over-abstraction of stimuli, (3) the requirement of a drawing response, and (4) the lack of sensitivity to unilateral brain lesions, mean that, in reality, the number of readily available valid tests of visual/visuo-spatial memory is, at best, limited. This article offers a critical, historical review on the existing measures and resources for the neuropsychological assessment of visual/visuo-spatial memory, and it showcases some examples of newer tests that have aimed to overcome the challenges of assessing these important aspects of memory. The article also identifies new trends and examples of how technological advances such as virtual reality may add value to overcome previous obstacles to assessment, thereby offering professionals more reliable, accurate means to evaluate visual/visuo-spatial memory in clinical practice.

Eye-tracking paradigms for the assessment of mild cognitive impairment: a systematic review

“…It can also evaluate human gaze behavior in association with numerous stimuli categories, such as geometrical figures, illusions, and pictures of computerized human faces ( Simion and Shimojo, 2006 ; Prats et al, 2010 ; Borji et al, 2013 ; Gidlöf et al, 2013 ; Spinks and Mortimer, 2015 ; Vriens et al, 2020 ; Wolf and Ueda, 2021 ). Yet, the use of abstract stimuli may reduce the ecological validity of a neuropsychological study, defined by Sbordone and Long in 1996 as “ the functional and predictive relationship between the patient’s performance on a set of neuropsychological tests and the patient’s behavior in a variety of real-world settings (e.g., at home, work, school, and community) ” (p. 16; Sbordone, 1996 ; Diaz-Orueta et al, 2022 ). Hence, few research groups opt to use realistic stimuli to investigate visual processing among adults with MCI.…”

Ice Cream: new virtual reality tool for the assessment of executive functions in children and adolescents: a normative study

“…Despite the limitations of the current normative study (focused on population from Spain, and thus requiring as a priority for immediate future research a cross-cultural validation that allows its administration and clinical use in different international settings), the Nesplora Ice Cream VR test implies a clear hamper of ecological validity as described by Marcotte et al (2010) . As pointed out by Diaz-Orueta et al (2022) , VR-based tests like this (1) overcome the limitations of traditional sterile, distractor-free testing environments that do not capture real-life environmental demands, allowing a more accurate prediction of an individual’s level of function in real-life settings; (2) allow the monitoring of testee’s behavior in a more continuous way, increasing the sample of behavior usually captured by traditional standardized neuropsychological tests; and (3) provide more clarity to the nature of specific cognitive constructs measured, which per se is an innovation in the area of executive functions tests, by properly delineating the boundaries between planning, learning and cognitive flexibility measures. Separately, since the focus on the 8 to 16 years old group cannot provide a full picture on the trajectories of EF development, additional studies would be required with a more detailed focus on the use of the test to uncover the developmental trajectories of EF across the lifespan, which would require a comparison between different cohorts that falls beyond the scope of the current study.…”

“…However, developments in the area of VR, subject to adequate quality, allow both clinicians and researchers to administer ecologically relevant stimuli placed in a meaningful and familiar context and, as a result, they can measure responses and behaviors in a more comprehensive way (provided visual and physical characteristics of items, avatars and characters are of high quality and realistic). Additionally, as previously pointed out by Diaz-Orueta et al (2022) , VR technology allows tester-control over stimuli, distractors and other variables, and any or all of these factors can be adjusted depending on the response features of the individual undergoing assessment – thereby allowing more personalized assessment.…”

The puzzle of ideography

“…However, this ability does not strongly correlate with measures of visual and verbal recognition, leading to the conclusion that facial recognition is both specific and highly heritable, underscoring its importance to our survival as a mammalian species highly dependent on parental care and social interaction. Although this specificity of facial recognition could be seen as support for learnability-based theories of challenges to ideographies, it can also be interpreted as a lack of relevant and valid tools to reliably assess general visual recognition (Diaz-Orueta, Rogers, Blanco-Campal, & Burke, 2022). Along these lines, perhaps what is needed for the development of effective ideographies is a focus on less abstract, more organic shapes and features commonly found in human faces.…”