The Benton Judgment of Line Orientation (JLO) test is one of the most frequently used tests for assessing visuospatial function.
Objective
This study aimed to determine the diagnostic and differential performance of JLO for different types of dementia.
Methods
A total of 258 participants, including 68 patients with Alzheimer's disease (AD), 86 with subcortical ischemic vascular dementia (SIVD), 30 with frontotemporal lobar degeneration (FTLD), 22 with Lewy body dementia (LBD), and 52 cognitively unimpaired (CU) controls, were enrolled from a memory clinic. The total scores and error types in the JLO test were compared between groups. Receiver operating characteristic curve analyses were used to estimate the diagnostic and differential abilities of the JLO test for patients with different types of dementia.
Results
We found that the JLO score was significantly lower in patients with AD, SIVD, FTLD, or LBD than in CU controls (12.90 ± 8.72 versus 17.06 ± 6.14 versus 15.47 ± 8.39 versus 9.23 ± 8.96 versus 21.69 ± 3.72, respectively; all p < 0.05). In particular, for patients with LBD, the JLO score was significantly lower than that for patients in the other groups (all p < 0.05) and showed excellent performance in distinguishing LBD patients from CU controls, with an AUC of 0.888 (sensitivity 72.73% and specificity 94.23%) at a cutoff value of 16. Intraquadrant oblique error was the most common type of error in dementia patients.
Conclusions
The JLO test is an effective tool for evaluating visuospatial function in patients with dementia, particularly for identifying LBD patients.
HillEStuartSLordS, et al.Vision, visuo-cognition and postural control in Parkinson's disease: an associative pilot study. Gait Posture2016; 48: 74–76.
2.
TrojanoLSicilianoMPedoneR, et al.Italian Normative data for the battery for visuospatial abilities (TERADIC). Neurol Sci2015; 36: 1353–1361.
3.
PelakVS. The clinical approach to the identification of higher-order visual dysfunction in neurodegenerative disease. Curr Neurol Neurosci Rep2022; 22: 229–242.
4.
HaradaCNNatelson LoveMCTriebelKL. Normal cognitive aging. Clin Geriatr Med2013; 29: 737–752.
5.
SpillantiniMGGoedertM. The alpha-synucleinopathies: Parkinson's disease, dementia with Lewy bodies, and multiple system atrophy. Ann N Y Acad Sci2000; 920: 16–27.
6.
SatoTHanyuHHiraoK, et al.Deep gray matter hyperperfusion with occipital hypoperfusion in dementia with Lewy bodies. Eur J Neurol2007; 14: 1299–1301.
7.
WalkerZPossinKLBoeveBF, et al.Lewy body dementias. Lancet2015; 386: 1683–1697.
8.
TiraboschiPSalmonDPHansenLA, et al.What best differentiates Lewy body from Alzheimer's disease in early-stage dementia?Brain2006; 129: 729–735.
9.
HarciarekMJodzioK. Neuropsychological differences between frontotemporal dementia and Alzheimer's disease: a review. Neuropsychol Rev2005; 15: 131–145.
10.
StopfordCLSnowdenJSThompsonJC, et al.Variability in cognitive presentation of Alzheimer's disease. Cortex2008; 44: 185–195.
11.
TianRZhangYLiuF, et al.A neuropsychological profile and its correlation with neuroimaging markers in patients with subcortical ischaemic vascular dementia. Int J Geriatr Psychiatry2023; 38: e5900.
12.
BentonALVarneyNRHamsherKD. Visuospatial judgment. A clinical test. Arch Neurol1978; 35: 364–367.
13.
BiloLSantangeloGImprotaI, et al.Neuropsychological profile of adult patients with nonsymptomatic occipital lobe epilepsies. J Neurol2013; 260: 445–453.
14.
SilverHGoodmanC. Verbal as well as spatial working memory predicts visuospatial processing in male schizophrenia patients. Schizophr Res2008; 101: 210–217.
15.
ValentiRCharidimouAXiongL, et al.Visuospatial functioning in cerebral amyloid angiopathy: a pilot study. J Alzheimers Dis2017; 56: 1223–1227.
16.
MontseAPereVCarmeJ, et al.Visuospatial deficits in Parkinson's disease assessed by judgment of line orientation test: error analyses and practice effects. J Clin Exp Neuropsychol2001; 23: 592–598.
17.
TranelDViannaEManzelK, et al.Neuroanatomical correlates of the Benton facial recognition test and judgment of line orientation test. J Clin Exp Neuropsychol2009; 31: 219–233.
18.
MerabetLBManleyCEPamirZ, et al.Motion and form coherence processing in individuals with cerebral visual impairment. Dev Med Child Neurol2023; 65: 1379–1386.
19.
SkaBPoissantAJoanetteY. Line orientation judgment in normal elderly and subjects with dementia of Alzheimer's type. J Clin Exp Neuropsychol1990; 12: 695–702.
20.
FintonMJLucasJAGraff-RadfordNR, et al.Analysis of visuospatial errors in patients with Alzheimer's disease or Parkinson's disease. J Clin Exp Neuropsychol1998; 20: 186–193.
21.
GaltierINietoAMataM, et al.Analyses of visuospatial and visuoperceptual errors as predictors of dementia in Parkinson's disease patients with subjective cognitive decline and mild cognitive impairment. J Int Neuropsychol Soc2021; 27: 722–732.
22.
DuboisBFeldmanHHJacovaC, et al.Advancing research diagnostic criteria for Alzheimer's disease: the IWG-2 criteria. Lancet Neurol2014; 13: 614–629.
23.
SachdevPKalariaRO'BrienJ, et al.Diagnostic criteria for vascular cognitive disorders: a VASCOG statement. Alzheimer Dis Assoc Disord2014; 28: 206–218.
24.
RascovskyKHodgesJRKnopmanD, et al.Sensitivity of revised diagnostic criteria for the behavioural variant of frontotemporal dementia. Brain2011; 134: 2456–2477.
25.
Gorno-TempiniMLHillisAEWeintraubS, et al.Classification of primary progressive aphasia and its variants. Neurology2011; 76: 1006–1014.
26.
McKeithIGBoeveBFDicksonDW, et al.Diagnosis and management of dementia with Lewy bodies: fourth consensus report of the DLB consortium. Neurology2017; 89: 88–100.
27.
EmreMAarslandDBrownR, et al.Clinical diagnostic criteria for dementia associated with Parkinson's disease. Mov Disord2007; 22: 1689–1707. quiz 1837.
28.
MengMLiuFMaY, et al.The identification and cognitive correlation of perfusion patterns measured with arterial spin labeling MRI in Alzheimer's disease. Alzheimers Res Ther2023; 15: 75.
29.
HudonCBellevilleSBelzileF, et al.Normative data for the Judgment of Line Orientation Test (long and short forms) in the Quebec-French population aged between 50 and 89 years. Arch Clin Neuropsychol2023. doi: https://doi.org/10.1093/arclin/acad077
30.
Pena-CasanovaJQuintana-AparicioMQuinones-UbedaS, et al.Spanish multicenter normative studies (NEURONORMA project): norms for the visual object and space perception battery-abbreviated, and judgment of line orientation. Arch Clin Neuropsychol2009; 24: 355–370.
31.
GullettJMPriceCCNguyenP, et al.Reliability of three Benton Judgment of Line Orientation short forms in idiopathic Parkinson's disease. Clin Neuropsychol2013; 27: 1167–1178.
32.
ZinkDNMillerJBCaldwellJZK, et al.The relationship between neuropsychological tests of visuospatial function and lobar cortical thickness. J Clin Exp Neuropsychol2018; 40: 518–527.
33.
Liebermann-JordanidisHRohegerMBoosfeldL, et al.Which test is the best to assess visuo-cognitive impairment in patients with Parkinson's disease with mild cognitive impairment and dementia? A systematic review and meta-analysis. J Parkinsons Dis2022; 12: 1749–1782.
34.
Caparelli-DaquerEMOliveira-SouzaRMoreira FilhoPF. Judgment of line orientation depends on gender, education, and type of error. Brain Cogn2009; 69: 116–120.
35.
GurRCAlsopDGlahnD, et al.An fMRI study of sex differences in regional activation to a verbal and a spatial task. Brain Lang2000; 74: 157–170.
36.
LucasJAIvnikRJSmithGE, et al.Mayo's older African Americans normative studies: norms for Boston naming test, controlled oral word association, category fluency, animal naming, token test, WRAT-3 Reading, trail making test, stroop test, and judgment of line orientation. Clin Neuropsychol2005; 19: 243–269.
37.
EslingerPJBentonAL. Visuoperceptual performances in aging and dementia: clinical and theoretical implications. J Clin Neuropsychol1983; 5: 213–220.
38.
EslingerPJDamasioARBentonAL, et al.Neuropsychologic detection of abnormal mental decline in older persons. JAMA1985; 253: 670–674.
39.
PossinKL. Visual spatial cognition in neurodegenerative disease. Neurocase2010; 16: 466–487.
40.
KeslerSRHaberechtMFMenonV, et al.Functional neuroanatomy of spatial orientation processing in Turner syndrome. Cereb Cortex2004; 14: 174–180.
41.
LeeTMLiuHLHungKN, et al.The cerebellum's involvement in the judgment of spatial orientation: a functional magnetic resonance imaging study. Neuropsychologia2005; 43: 1870–1877.
42.
NgVWBullmoreETde ZubicarayGI, et al.Identifying rate-limiting nodes in large-scale cortical networks for visuospatial processing: an illustration using fMRI. J Cogn Neurosci2001; 13: 537–545.
43.
BiesbroekJMvan ZandvoortMJKuijfHJ, et al.The anatomy of visuospatial construction revealed by lesion-symptom mapping. Neuropsychologia2014; 62: 68–76.
44.
LiuFShiYWuQ, et al.The value of FDG combined with PiB PET in the diagnosis of patients with cognitive impairment in a memory clinic. CNS Neurosci Ther2024; 30: e14418.
45.
LobotesisKFenwickJDPhippsA, et al.Occipital hypoperfusion on SPECT in dementia with Lewy bodies but not AD. Neurology2001; 56: 643–649.
46.
MinoshimaSFosterNLSimaAA, et al.Alzheimer's disease versus dementia with Lewy bodies: cerebral metabolic distinction with autopsy confirmation. Ann Neurol2001; 50: 358–365.
47.
ShimizuSHanyuHHiraoK, et al.Value of analyzing deep gray matter and occipital lobe perfusion to differentiate dementia with Lewy bodies from Alzheimer's disease. Ann Nucl Med2008; 22: 911–916.
48.
MapstoneMSteffenellaTMDuffyCJ. A visuospatial variant of mild cognitive impairment: getting lost between aging and AD. Neurology2003; 60: 802–808.
49.
KandiahNNarasimhaluKLeeJ, et al.Differences exist in the cognitive profile of mild Alzheimer's disease and subcortical ischemic vascular dementia. Dement Geriatr Cogn Disord2009; 27: 399–403.
50.
SalimiSIrishMFoxeD, et al.Visuospatial dysfunction in Alzheimer's disease and behavioural variant frontotemporal dementia. J Neurol Sci2019; 402: 74–80.
51.
KerteszA. Clinical features and diagnosis of frontotemporal dementia. Front Neurol Neurosci2009; 24: 140–148.
52.
RahmanSSahakianBJHodgesJR, et al.Specific cognitive deficits in mild frontal variant frontotemporal dementia. Brain1999; 122: 1469–1493.
53.
Delgado-AlvarezACabrera-MartinMNValles-SalgadoM, et al.Neural basis of visuospatial tests in behavioral variant frontotemporal dementia. Front Aging Neurosci2022; 14: 963751.
54.
FlorisGBorgheroGCannasA, et al.Constructional apraxia in frontotemporal dementia associated with the C9orf72 mutation: broadening the clinical and neuropsychological phenotype. Amyotroph Lateral Scler Frontotemporal Degener2015; 16: 8–15.
55.
Garcia-GutierrezFDelgado-AlvarezADelgado-AlonsoC, et al.Diagnosis of Alzheimer's disease and behavioural variant frontotemporal dementia with machine learning-aided neuropsychological assessment using feature engineering and genetic algorithms. Int J Geriatr Psychiatry2022; 37. doi: https://doi.org/10.1002/gps.5667
56.
HallamBJJacovaCHsiungGY, et al.Early neuropsychological characteristics of progranulin mutation carriers. J Int Neuropsychol Soc2014; 20: 694–703.
57.
RanasingheKGRankinKPLobachIV, et al.Cognition and neuropsychiatry in behavioral variant frontotemporal dementia by disease stage. Neurology2016; 86: 600–610.
58.
SimardMvan ReekumRMyranD. Visuospatial impairment in dementia with Lewy bodies and Alzheimer's disease: a process analysis approach. Int J Geriatr Psychiatry2003; 18: 387–391.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
