Abstract

The Rey–Osterrieth complex figure (ROCF) and the free and cued selective reminding test (FCSRT) are frequently used in clinical practice. The ROCF assesses visual perception, constructional praxis, and visuospatial memory, and the FCSRT assesses verbal learning and memory. As part of the Spanish Normative Studies (NEURONORMA), we provide age- and education-adjusted norms for the ROCF (copy and memory) and for the FCSRT. The sample consists of 332 and 340 participants, respectively, who are cognitively normal, community dwelling, and ranging in age from 50 to 94 years. Tables are provided to convert raw scores to age-adjusted scaled scores. These were further converted into education-adjusted scaled scores by applying regression-based adjustments. Although age and education affected the score of the ROCF and FCSRT, sex was found to be unrelated in this normal sample. The normative data presented here were obtained from the same study sample as all other NEURONORMA norms and the same statistical procedures were applied. These co-normed data will allow clinicians to compare scores from one test with all the tests included in the project.

Introduction

The Spanish Multicenter Normative Studies (NEURONORMA project; Peña-Casanova et al., 2009) attempts to provide useful norms for people aged over 49 years for commonly used neuropsychological tests. In this paper we provide normative data for the Rey–Osterrieth complex figure (ROCF; Osterrieth, 1944; Rey, 1941) and the free and cued selective reminding test (FCSRT; Buschke, 1984).

Rey–Osterrieth Complex Figure

The purpose of the ROCF is to assess visual perception, visual–spatial constructional ability, and visual memory. It also measures a series of cognitive capacities including planning and problem-solving strategies (Lezak, Howieson, & Loring, 2004; Meyers & Meyers, 1995a; Mitrushina, Boone, Razani, & D'Elia, 2005). The ROCF has been used to study a variety of neurological disorders (Machulda et al., 2007).

The ROCF is a popular test with a long history in the field of neuropsychological assessment; it has been the object of multiple versions and modifications. The test developed by Rey (1941) consisted of a copy trial followed by a recall trial 3 min later. Current administration procedures vary considerably (Strauss, Sherman, & Spreen, 2006). Some investigators give both immediate- and delayed-recall trials. Furthermore, the amount of delay varies from 3 to 45 min (Taylor, 1969). After a long (e.g., 30 min) recall, a recognition subtest can be given (Meyers & Lange, 1994; Meyers & Meyers, 1995a). The recognition subtest includes 24 figures that are placed at random on four pages. The subject is required to indicate the 12 figures that were part of the original design.

There is little difference in performance in scores between immediate and 3 min delayed-recall performance (Meyers & Meyers, 1995a). In cases of a long delay, most forgetting tends to occur very quickly, within the first few minutes after copying (Berry & Carpenter, 1992; Chiulli, Haaland, LaRue, & Garry, 1995; Delaney et al., 1992). Because very little difference is observed between immediate- and delayed-recall trials in normal, healthy controls (Chiulli et al., 1995; Loring, Martin, Meador, & Lee, 1990), a decline between the immediate- and delayed-recall trials is considered to be of clinical significance.

Mitrushina and colleagues (2005) provide a review of a series of normative studies published on the ROCF, including norms from the samples of Spanish-speaking populations (see also Ardila & Rosselli, 2003; Ardila, Rosselli, & Puente, 1994; Ostrosky-Solis, Jaime, & Ardila, 1998; Ponton et al., 1996). A wide variability exists with regard to the type of administration (specifically number and timing of recall trials). A series of works provide data on cognitively normal, elderly subjects (Machulda et al., 2007).

Demographic effects such as age and education have been frequently associated with ROCF scores (Rosselli & Ardila, 1991). Age contributes significantly to performance in the ROCF. Copy scores increase with age, with adult levels being reached at about the age of 17 years (Meyers & Meyers, 1996). There is a decrement in scores with advancing age, particularly after the age of 70 years (Chervinsky, Mitrushina, & Satz, 1992). Rates of forgetting are calculated as copy score minus delay score. The effect of sex on the ROCF scores is controversial. Some studies have shown that men outperform women, but in general the differences are minor or nonexistent (Berry, Allen, & Schmitt, 1991; Boone, Lesser, Hill-Gurierrez, Berman, & D'Elia, 1993). As the ROCF is a complex constructional task, an effect of education on scores is expected (Ardila, Rosselli, & Rosas, 1989; Berry et al., 1991; Caffarra, Vezzadini, Dieci, Zonato, & Venneri, 2002).

Free and Cued Selective Reminding Test

The FCSRT measures verbal learning and memory. The test was originally introduced by Buschke and colleagues (Buschke, 1973; Buschke & Fuld, 1974) as the selective reminding test (SRT). Various forms were subsequently introduced (Mitrushina et al., 2005; Strauss et al., 2006). Buschke (1984) added a cued-recall component to the test. This version is known as FCSRT. The FCSRT emphasizes encoding specificity (Tulving & Osler, 1968) during learning and recall. Encoding specificity implies that information is processed in a precise manner (i.e., semantically) during the process of learning. Encoding specificity is a technique that in normal subjects produces efficient learning and memory (Ivnik et al., 1997). This task is particularly sensitive to pathological states; especially in early stages of Alzheimer's disease (Petersen, Smith, Ivnik, Kokmen, & Tangalos, 1994; Petersen et al., 1995; Tuokko et al., 1991). The FCSRT has been used with nondemented elderly, demented, and amnesic subjects (Degenszajn, Caramelli, Caixeta, & Nitrini, 2001; Grober, Lipton, Hall, & Crystal, 2000; Grober, Lipton, Katz, & Sliwinski, 1998; Grober, Merling, Heimlich, & Lipton, 1997; Ivnik et al., 1997; Petersen et al., 1999).

There are a number of studies that provide normative data for the different languages that SRT and FCSRT were adapted to (Lezak et al., 2004; Mitrushina et al., 2005; Strauss et al., 2006). Normative data for the elderly have been reported from the MOANS project (Ivnik et al., 1997) and from the Aging Project of the Einstein College of Medicine (Grober et al., 1998). A Spanish version of the SRT, using two letters as a cue, has been published recently (Campo & Morales, 2004; Campo, Morales, & Juan-Malpartida, 2000; Campo, Morales, & Martínez-Castillo, 2003).

Demographic effects such as age, education, and sex have been frequently associated with the FCSRT scores (Grober et al., 1998). There is, in general, a decline in most SRT measures with advancing age (Campo & Morales, 2004; Larrabee, Trahan, Curtiss, & Levin, 1988; Sliwinski, Buschke, Stewart, Masur, & Lipton, 1997; Stricks, Pittman, Jacobs, Sano, & Stern, 1998; Wiederholt et al., 1993). It is of interest that elderly subjects recall twice as many words in FCSRT than in SR (Grober et al., 1997). Free recall impairment on the FCSRT predicted the development of dementia by as much as 5 years in advance of the diagnosis (Grober et al., 2000).

Sex also affects the scores, women perform better than men on SRT and FCSRT (Bishop, Dickson, & Allen, 1990; Campo & Morales, 2004; Larrabee et al., 1988; Wiederholt et al., 1993).

The effect of education is inconsistent, some studies find it to be modest and relatively unimportant (Petersen, Smith, Kokmen, Ivnik, & Tangalos, 1992), whereas others (Campo & Morales, 2004) observed significantly better performance for those subjects with more education on all scores except the short-term memory index. See Strauss and colleagues (2006) for more information on the SR.

Materials and Methods

Research Participants

Socio-demographic and participant characteristics of the entire NEURONORMA sample have been reported in a previous paper (Peña-Casanova et al., 2009). In summary, the sample is composed of cognitively normal people aged over 49 years, including independently functioning, community dwelling people who have no active medical, neurologic, or psychiatric disorders which may potentially affect behavior or cognition. Following the MOANS model, volunteers did not need to be completely medically healthy to participate (Lucas et al., 2005). Demographic information concerning ROCF and FCSRT is presented in Table 1.

Table 1.

Sample size and basic demographic information by test

 ROCF
 
FCSRT
 
 Count Percentage of Total Count Percentage of Total 
Age group 
 50–56 73 21.99 76 22.35 
 57–59 49 14.76 50 14.70 
 60–62 33 9.94 32 9.41 
 63–65 15 4.52 16 4.71 
 66–68 24 7.23 26 7.65 
 69–71 48 14.46 48 14.12 
 72–74 29 8.73 32 9.41 
 75–77 30 9.04 29 8.53 
 78–80 20 6.02 20 5.88 
 >80 11 3.31 11 3.24 
Education (years) 
 ≤5 68 20.48 67 19.71 
 6–7 19 5.72 24 7.06 
 8–9 64 19.28 66 19.41 
 10–11 38 11.45 39 11.47 
 12–13 35 10.54 36 10.59 
 14–15 33 9.94 34 10.00 
 ≥16 75 22.59 74 21.76 
Sex 
 Men 137 41.27 137 40.29 
 Women 195 58.73 203 59.71 
Total sample 332  340  
 ROCF
 
FCSRT
 
 Count Percentage of Total Count Percentage of Total 
Age group 
 50–56 73 21.99 76 22.35 
 57–59 49 14.76 50 14.70 
 60–62 33 9.94 32 9.41 
 63–65 15 4.52 16 4.71 
 66–68 24 7.23 26 7.65 
 69–71 48 14.46 48 14.12 
 72–74 29 8.73 32 9.41 
 75–77 30 9.04 29 8.53 
 78–80 20 6.02 20 5.88 
 >80 11 3.31 11 3.24 
Education (years) 
 ≤5 68 20.48 67 19.71 
 6–7 19 5.72 24 7.06 
 8–9 64 19.28 66 19.41 
 10–11 38 11.45 39 11.47 
 12–13 35 10.54 36 10.59 
 14–15 33 9.94 34 10.00 
 ≥16 75 22.59 74 21.76 
Sex 
 Men 137 41.27 137 40.29 
 Women 195 58.73 203 59.71 
Total sample 332  340  

Notes: FCSRT = free and cued selective reminding test; ROCF = Rey–Osterrieth complex figure.

Ethical approval for the study, including the study protocol, written informed consents, and information, was granted by the Research Ethics Committee of the Municipal Institute of Medical Care of Barcelona, Spain, and from the different participating centers. The study was conducted in accordance with the Declaration of Helsinki (World Medical Association, 1977) and its subsequent amendments, and the European Union regulations concerning medical research.

Neuropsychological Measures

The neuropsychological measures were administered as part of a larger test battery, the NEURONORMA battery (Peña-Casanova et al., 2009). Tests were administered and scored by neuropsychologists specifically trained for this project.

Rey–Osterrieth complex figure

For the ROCF, participants were supplied with a sheet of paper (DIN-A4) placed horizontally on the table. Instructions were given following the administration procedures provided in the manual. The participants were not allowed to erase the paper or change its orientation.

The ROCF was scored according to the criteria developed by Rey (1941) and presented by Meyers & Meyers (1995b). The measures include a copy score (which reflects the accuracy of the original copy and is a measure of visual–spatial constructional ability), the time required to copy the figure, and 3-min and 30-min delayed-recall scores. The figure is divided into 18 scored elements. Between 0.5 and 2 points are awarded for each element depending on the accuracy, distortion, and location of its reproduction. The maximum score is 36.

Free and cued selective reminding test (Buschke, 1984)

The version included in the NEURONORMA project uses category cues at both acquisition and retrieval in an attempt to ensure semantic encoding and enhance recall. Materials and instruction of the FCSRT were provided to researchers by the author (Buschke's FCSRT. Copyright, 1996–2000. Albert Einstein College of Medicine of Yeshiva University, New York; due to copyright limitations items are not shown). Administration procedures were translated into Spanish as described in previous studies (Erzigkeit et al., 2001). The selection of stimulus words followed the same principles as the English version. To prevent a correct response due to chance, words were selected from the intermediate frequency of prototypicality within a semantic category (frequencies in Soto, Sebastian, García, & del Amo, 1994). The NEURONORMA version of the FCSRT presents its 16 items as words on stimulus cards (four cards with four items on each card). Participants were tested individually and told before presentation of test items that they should remember the items so that they could recall them later.

Each participant was presented with a DIN-A4 sheet with four items to be recalled. Each item belonged to a different category. The individual was asked to read items aloud and then asked to identify the name of each item (e.g., “owl”) when the tester said its category cue (e.g., “bird”). This procedure continued until all 16 items had been correctly read and identified. After a nonsemantic interference task (counting from 1 to 20 and back) lasting 20 s, the test taker attempted to freely recall as many items as possible, in any order. The time allowed for this task was 90 s. The task was stopped if there was no response in 15 s. Items that were not spontaneously remembered were then cued by the examiner (e.g., “Which one was a bird?”). In other words, the category cues were presented to elicit cued recall of only those items that were not retrieved by free recall. This procedure was repeated three times. A 30-min delayed-recall trial was included. Each trial was scored for the number of freely recalled items, the number of items recalled after cuing, and the sum of these two scores.

In the NEURONORMA version of the FCSRT, six derived scores were considered: (a) Trial 1 free recall (maximum score, 16); (b) total free recall (Trial 1 free recall + Trial 2 free recall + Trial 3 free recall; maximum score, 48); (c) total recall (free recall + cued recall; maximum score, 48); (d) delayed free recall (maximum score, 16); (e) delayed total recall (maximum score, 16); (f) retention index: total delayed recall/Trial 3 total recall (maximum score, 1).

Statistical Analysis

Considering that the ability to compare all co-normed test scores directly with each other facilitates clinical interpretation of neuropsychological test profiles, a uniform normative procedure was applied to all measures as in the MOANS studies (Ivnik et al., 1992; Lucas et al., 2005). The procedure is described in a previous paper (Peña-Casanova et al., 2009). In summary, the principal characteristics of this process were the following: (a) the overlapping interval strategy (Pauker, 1988) was adopted to maximize the number of subjects contributing to the normative distribution at each mid-point age interval; (b) effects of age, sex, and education on raw subtest scores were studied using coefficients of correlation (r) and determination (r2) (Lucas et al., 2005); (c) to ensure a normal distribution, the frequency distribution of the raw scores (RS) was converted into age-adjusted scaled scores, NSSA (NEURONORMA scaled score-age adjusted) following the methodology described by Ivnik and colleagues (1992). Raw scores were assigned percentile ranks in function of their place within a distribution. Subsequently, percentile ranks were converted to scaled scores (from 2 to 18) based on percentile ranges. This transformation of RS to NSSA produced a normalized distribution on which linear regressions could be applied; (d) Years of education were modeled with the following equation: NSSA = k + (β × Educ). The resulting equations were used to calculate age- and education-adjusted NEURONORMA scaled scores (NSSA&E) for each variable. The regression coefficients (β) from this analysis were used as the basis for education adjustments. A linear regression was employed to derive age- and education-adjusted scaled scores. The following formula outlined by Mungas, Marshall, Weldon, Haan, and Reed (1996) was employed: NSSA&E ≥ NSSA − (β × [Educ − 12]).

Results

The age distribution of the sample made it possible to calculate norms for 10 mid-point age groups. Sample sizes resulting from mid-point age intervals are presented in each normative table.

Correlations and shared variance of ROCF scores and FCSRT-derived scores, with age, education, and sex, are presented in Table 2. Concerning ROCF, age and education accounted both significantly and differentially for the RS variance for all measures (age: between 4% and 10%; education: between 10% and 17%). Sex differences were minimally observed (only 1% in the case of execution time), indicating no need to control this demographic variable. Concerning FCSRT, Table 2 data show that age and education account significantly for the RS variance for all measures (age: between 12% and 25%; education: between 12% and 16%). Sex differences were only observed in two measures (total recall and delayed free recall), the effect was, however, ≤3%, indicating minimal influence and suggesting that adjustments for sex are not needed.

Table 2.

Correlations (r) and shared variances (r2) of raw scores with age, education (years), and sex

Measures Age (years)
 
Education (years)
 
Sex
 
r r2 r r2 r r2 
ROCF copy  
 Time (s) 0.32380 0.10485 −0.42299 0.17892 0.11409 0.01302 
 Accuracy −0.21685 0.04702 0.35736 0.12771 −0.07768 0.00603 
ROCF memory 
 Immediate recall (accuracy) −0.31050 0.09641 0.32068 0.10284 −0.07146 0.00511 
 Delayed recall (accuracy) −0.31971 0.10221 0.33111 0.10963 −0.08528 0.00727 
FCSRT 
 Trial 1 free recall −0.34998 0.12249 0.34827 0.12129 0.15369 0.02362 
 Total free recall −0.50232 0.25233 0.40394 0.16317 0.20009 0.04004 
 Total recall (free recall + cued recall) −0.44646 0.19933 0.39884 0.15907 0.13634 0.01859 
 Delayed free recall −0.50442 0.25444 0.37660 0.14183 0.18241 0.03327 
 Delayed total recall −0.41145 0.16929 0.37315 0.13924 0.09302 0.00865 
 Total delayed recall/Trial 3 total recall −0.16601 0.02756 0.17910 0.03208 0.00532 0.00003 
Measures Age (years)
 
Education (years)
 
Sex
 
r r2 r r2 r r2 
ROCF copy  
 Time (s) 0.32380 0.10485 −0.42299 0.17892 0.11409 0.01302 
 Accuracy −0.21685 0.04702 0.35736 0.12771 −0.07768 0.00603 
ROCF memory 
 Immediate recall (accuracy) −0.31050 0.09641 0.32068 0.10284 −0.07146 0.00511 
 Delayed recall (accuracy) −0.31971 0.10221 0.33111 0.10963 −0.08528 0.00727 
FCSRT 
 Trial 1 free recall −0.34998 0.12249 0.34827 0.12129 0.15369 0.02362 
 Total free recall −0.50232 0.25233 0.40394 0.16317 0.20009 0.04004 
 Total recall (free recall + cued recall) −0.44646 0.19933 0.39884 0.15907 0.13634 0.01859 
 Delayed free recall −0.50442 0.25444 0.37660 0.14183 0.18241 0.03327 
 Delayed total recall −0.41145 0.16929 0.37315 0.13924 0.09302 0.00865 
 Total delayed recall/Trial 3 total recall −0.16601 0.02756 0.17910 0.03208 0.00532 0.00003 

Notes: FCSRT = free and cued selective reminding test; ROCF = Rey–Osterrieth complex figure.

Age-adjusted NEURONORMA scaled scores (NSSA) for the ROCF and FCSRT are presented in Tables 3–12. The tables include percentile ranks, ranges of ages contributing to each normative sub-sample, and the number of participants contributing to each normative estimate. To use the tables, select the appropriate table corresponding to the patient's age, find the patient's RS, and subsequently refer to the corresponding NSSA and percentile rank (left part of the table).

Table 3.

Age-adjusted NEURONORMA scores (NSSA) for age 50–56 (age range for norms = 50–60)

Scaled score Percentile range ROCF
 
FCSRT
 
Copy
 
Memory
 
Trial 1 free recall Total free recall Total recall Delayed free recall Delayed total recall TDR/T3TR 
Raw Score Time (s) Immediate recall RS Delayed recall RS 
<1 ≤13 ≥420 ≤2.5 ≤3 0–1 ≤11 ≤28 0–3 0–7 ≤0.62 
13.5–14 — 3.5 — 12–13 29–30 — 0.63–0.67 
14.5–17 410–419 3.5 — — 31–32 9–10 0.68–0.73 
3–5 17.5–19 365–409 4–6.5 4–6 14–17 33–34 — — 0.74–0.79 
6–10 19.5–23 310–364 7–8.5 6.5–7.5 — 18 35 11 0.8–0.86 
11–18 23.5–27 263–309 9–10.5 8–10 19–20 36–38 12–13 0.87–0.92 
19–28 27.5–29 229–262 11–12.5 10.5–12.5 21–22 39–40 — 0.93 
29–40 29.5–31 190–228 13–15.5 13–15.5 — 23–25 41–42 14 0.94 
10 41–59 31.5–33 155–189 16–19 16–18.5 26–28 43–44 10 15 — 
11 60–71 33.5–34 138–154 19.5–21 19–21 29–30 45 11 — — 
12 72–81 34.5–35 120–137 21.5–24.5 21.5–23.5 31–32 46 12 — — 
13 82–89 — 101–119 25–27 24–27 33 — 13 — — 
14 90–94 — 90–100 27.5–28 27.5–29 — 34–36 47 — — 0.95–1 
15 95–97 — 72–89 28.5–32 29.5–31 10 — — 14–15 — 1.01–1.08 
16 98 — 62–71 32.5–34 31.5–33 — 37–38 — — — — 
17 99 — 61 34.5–35 33.5–34 — — — — — 1.09–1.14 
18 >99 35.5–36 ≤60 35.5–36 34.5–36 11–16 39–48 48 16 16 ≥1.15 
Sample size  131 131 135 133 
Scaled score Percentile range ROCF
 
FCSRT
 
Copy
 
Memory
 
Trial 1 free recall Total free recall Total recall Delayed free recall Delayed total recall TDR/T3TR 
Raw Score Time (s) Immediate recall RS Delayed recall RS 
<1 ≤13 ≥420 ≤2.5 ≤3 0–1 ≤11 ≤28 0–3 0–7 ≤0.62 
13.5–14 — 3.5 — 12–13 29–30 — 0.63–0.67 
14.5–17 410–419 3.5 — — 31–32 9–10 0.68–0.73 
3–5 17.5–19 365–409 4–6.5 4–6 14–17 33–34 — — 0.74–0.79 
6–10 19.5–23 310–364 7–8.5 6.5–7.5 — 18 35 11 0.8–0.86 
11–18 23.5–27 263–309 9–10.5 8–10 19–20 36–38 12–13 0.87–0.92 
19–28 27.5–29 229–262 11–12.5 10.5–12.5 21–22 39–40 — 0.93 
29–40 29.5–31 190–228 13–15.5 13–15.5 — 23–25 41–42 14 0.94 
10 41–59 31.5–33 155–189 16–19 16–18.5 26–28 43–44 10 15 — 
11 60–71 33.5–34 138–154 19.5–21 19–21 29–30 45 11 — — 
12 72–81 34.5–35 120–137 21.5–24.5 21.5–23.5 31–32 46 12 — — 
13 82–89 — 101–119 25–27 24–27 33 — 13 — — 
14 90–94 — 90–100 27.5–28 27.5–29 — 34–36 47 — — 0.95–1 
15 95–97 — 72–89 28.5–32 29.5–31 10 — — 14–15 — 1.01–1.08 
16 98 — 62–71 32.5–34 31.5–33 — 37–38 — — — — 
17 99 — 61 34.5–35 33.5–34 — — — — — 1.09–1.14 
18 >99 35.5–36 ≤60 35.5–36 34.5–36 11–16 39–48 48 16 16 ≥1.15 
Sample size  131 131 135 133 

Notes: FCSRT = free and cued selective reminding test; ROCF = Rey–Osterrieth complex figure; RS = raw score; TDR/T3TR = total delayed recall/Trial 3 total recall.

Table 4.

Age-adjusted NEURONORMA scores (NSSA) for age 57–59 (age range for norms = 53–63)

Scaled score Percentile range ROCF
 
FCSRT
 
Copy
 
Memory
 
Trial 1 free recall Total Free recall Total recall Delayed free recall Delayed total recall TDR/T3TR 
Raw score Time (s) Immediate Recall RS Delayed recall RS 
<1 ≤13 ≥423 ≤2.5 ≤3 0–1 ≤11 ≤28 0–3 0–7 ≤0.62 
13.5–14 420–422 3.5 — 12 — 0.63–0.67 
14.5–17 — 3.5 — — — 29–30 — 0.68–0.73 
3–5 17.5–19 383–419 4–4.5 4–5.5 13–16 31–32 — 10 0.74–0.79 
6–10 19.5–23 316–382 5–7 6–6.5 17–19 33–35 11 0.8–0.86 
11–18 23.5–25 285–315 7.5–9.5 7–9 20 36–37 12 0.87–0.88 
19–28 25.5–28 237–284 10–11.5 9.5–11 — 21–22 38–39 — 13 0.92–0.93 
29–40 28.5–30 203–236 12–14 11.5–14 23 40–41 14 — 
10 41–59 30.5–33 175–202 14.5–17.5 14.5–17.5 24–27 42–43 9–10 — 0.94 
11 60–71 33.5–34 152–174 18–20 18–19.5 28–29 44 11 15 — 
12 72–81 34.5–35 133–151 20.5–22 20–21.5 30–31 45 12 — — 
13 82–89 — 104–132 22.5–25.5 22–24 32–33 46 — — — 
14 90–94 — 92–103 26–27 24.5–28 — 34–36 47 13 — 0.95–1 
15 95–97 — 82–91 27.5–32 28.5–30 10 37 — 14 — 1.01–1.07 
16 98 — 72–81 32.534 31.5–33 — 38 — 15 — 1.08 
17 99 — 61–71 34.5–35 33.5–34 11 39 — — — — 
18 >99 35.5–36 ≤60 35.5–36 34.5–36 12–16 40–48 48 16 16 ≥1.09 
Sample size  128 128 128 126 
Scaled score Percentile range ROCF
 
FCSRT
 
Copy
 
Memory
 
Trial 1 free recall Total Free recall Total recall Delayed free recall Delayed total recall TDR/T3TR 
Raw score Time (s) Immediate Recall RS Delayed recall RS 
<1 ≤13 ≥423 ≤2.5 ≤3 0–1 ≤11 ≤28 0–3 0–7 ≤0.62 
13.5–14 420–422 3.5 — 12 — 0.63–0.67 
14.5–17 — 3.5 — — — 29–30 — 0.68–0.73 
3–5 17.5–19 383–419 4–4.5 4–5.5 13–16 31–32 — 10 0.74–0.79 
6–10 19.5–23 316–382 5–7 6–6.5 17–19 33–35 11 0.8–0.86 
11–18 23.5–25 285–315 7.5–9.5 7–9 20 36–37 12 0.87–0.88 
19–28 25.5–28 237–284 10–11.5 9.5–11 — 21–22 38–39 — 13 0.92–0.93 
29–40 28.5–30 203–236 12–14 11.5–14 23 40–41 14 — 
10 41–59 30.5–33 175–202 14.5–17.5 14.5–17.5 24–27 42–43 9–10 — 0.94 
11 60–71 33.5–34 152–174 18–20 18–19.5 28–29 44 11 15 — 
12 72–81 34.5–35 133–151 20.5–22 20–21.5 30–31 45 12 — — 
13 82–89 — 104–132 22.5–25.5 22–24 32–33 46 — — — 
14 90–94 — 92–103 26–27 24.5–28 — 34–36 47 13 — 0.95–1 
15 95–97 — 82–91 27.5–32 28.5–30 10 37 — 14 — 1.01–1.07 
16 98 — 72–81 32.534 31.5–33 — 38 — 15 — 1.08 
17 99 — 61–71 34.5–35 33.5–34 11 39 — — — — 
18 >99 35.5–36 ≤60 35.5–36 34.5–36 12–16 40–48 48 16 16 ≥1.09 
Sample size  128 128 128 126 

Notes: FCSRT = free and cued selective reminding test; ROCF = Rey–Osterrieth complex figure; RS = raw score; TDR/T3TR = total delayed recall/Trial 3 total recall.

Table 5.

Age-adjusted NEURONORMA scores (NSSA) for age 60–62 (age range for norms = 56–66)

Scaled score Percentile range ROCF
 
FCSRT
 
Copy
 
Memory
 
Trial 1 free recall Total free recall Total recall Delayed free recall Delayed total recall TDR/T3TR 
Raw Score Time (s) Immediate recall RS Delayed recall RS 
<1 ≤13 ≥456 ≤2.5 ≤3 0–1 ≤11 ≤26 0–3 0–7 0.62 
13.5–14 423–455 3.5 — 12 27–30 — 0.63–0.64 
14.5–17 420–422 3.5 — — 13 31 — 0.65–0.67 
3–5 17.5–19.5 385–419 4–4.5 4–5 14–15 32 4–5 10 0.68–0.77 
6–10 20–22 360–384 5–7 5.5–6.5 16–18 33–35 — — 0.78–0.79 
11–18 22.5–25 295–359 7.5–9.5 7–8 19–20 36–37 11–12 0.8–0.87 
19–28 25.5–27 240–294 10–11 8.5–11.5 — 21 38–39 13 0.88–0.92 
29–40 27.5–29 192–239 11.5–13.5 12–13.5 22–23 40 — 0.93 
10 41–59 29.5–32 165–191 14–17.5 14–17.5 24–27 41–43 14 0.94 
11 60–71 32.5–33 142–164 18–19.5 18–18.5 28–29 44 10–11 15 — 
12 72–81 33.5–34 129–141 20–21 19–20.5 30–31 45 — — — 
13 82–89 34.5–35 108–128 21.5–25 21–23 32–33 46 12 — — 
14 90–94 — 93–107 25.5–26.5 23.5–26 — 34–36 47 13 — 0.95–1 
15 95–97 — 90–92 27–28 26.5–28.5 10 37 — 14 — 1.01–1.07 
16 98 — 83–89 28.5–32 29 — 38 — 15 — — 
17 99 — 82 32.5–34 29.5–34 11 39 — — — 1.08 
18 >99 35.5–36 ≤81 34.5–36 34.5–36 12–16 40–48 48 16 16 1.09–1.14 
Sample size  118 118 119 118 
Scaled score Percentile range ROCF
 
FCSRT
 
Copy
 
Memory
 
Trial 1 free recall Total free recall Total recall Delayed free recall Delayed total recall TDR/T3TR 
Raw Score Time (s) Immediate recall RS Delayed recall RS 
<1 ≤13 ≥456 ≤2.5 ≤3 0–1 ≤11 ≤26 0–3 0–7 0.62 
13.5–14 423–455 3.5 — 12 27–30 — 0.63–0.64 
14.5–17 420–422 3.5 — — 13 31 — 0.65–0.67 
3–5 17.5–19.5 385–419 4–4.5 4–5 14–15 32 4–5 10 0.68–0.77 
6–10 20–22 360–384 5–7 5.5–6.5 16–18 33–35 — — 0.78–0.79 
11–18 22.5–25 295–359 7.5–9.5 7–8 19–20 36–37 11–12 0.8–0.87 
19–28 25.5–27 240–294 10–11 8.5–11.5 — 21 38–39 13 0.88–0.92 
29–40 27.5–29 192–239 11.5–13.5 12–13.5 22–23 40 — 0.93 
10 41–59 29.5–32 165–191 14–17.5 14–17.5 24–27 41–43 14 0.94 
11 60–71 32.5–33 142–164 18–19.5 18–18.5 28–29 44 10–11 15 — 
12 72–81 33.5–34 129–141 20–21 19–20.5 30–31 45 — — — 
13 82–89 34.5–35 108–128 21.5–25 21–23 32–33 46 12 — — 
14 90–94 — 93–107 25.5–26.5 23.5–26 — 34–36 47 13 — 0.95–1 
15 95–97 — 90–92 27–28 26.5–28.5 10 37 — 14 — 1.01–1.07 
16 98 — 83–89 28.5–32 29 — 38 — 15 — — 
17 99 — 82 32.5–34 29.5–34 11 39 — — — 1.08 
18 >99 35.5–36 ≤81 34.5–36 34.5–36 12–16 40–48 48 16 16 1.09–1.14 
Sample size  118 118 119 118 

Notes: FCSRT = free and cued selective reminding test; ROCF = Rey–Osterrieth complex figure; RS = raw score; TDR/T3TR = total delayed recall/Trial 3 total recall.

Table 6.

Age-adjusted NEURONORMA scores (NSSA) for age 63–65 (age range for norms = 59–69)

Scaled score Percentile range ROCF
 
FCSRT
 
Copy
 
Memory
 
Trial 1 free recall Total free recall Total recall Delayed free recall Delayed total recall TDR/T3TR 
Raw Score Time (s) Immediate recall RS Delayed recall RS 
<1 ≤13 ≥456 ≤2.5 ≤2.5 0–1 ≤12 ≤25 0–3 0–7 ≤0.62 
13.5–17 423–455 — — — 26 — 0.63–0.64 
17.5 420–422 — — — — 0.65–0.67 
3–5 18–20.5 372–419 3.5–4.5 3.5–5 — 13–14 27–31 — 0.68–0.77 
6–10 21–22.5 333–371 5–6.5 5.5–6.5 15–16 32–33 — 10 0.78–0.8 
11–18 23–25.5 290–332 7–8.5 7–9 17–19 34–35 11–12 0.81–0.88 
19–28 26–28 240–289 9–11.5 9.5–11 20 36–38 — 0.89–0.92 
29–40 28.5–30 197–239 12–14 11.5–14.5 21–22 39–40 — 13 0.93 
10 41–59 30.5–33 173–196 14.5–18 15–17.5 — 23–25 41–42 8–9 14 0.94 
11 60–71 — 148–172 18.5–20.5 18–19 26–27 43 10 15 — 
12 72–81 33.5–34 134–147 21–22.5 19.5–21.5 28–30 44 11 — — 
13 82–89 34.5–35 120–133 23–24 22 31–32 45 12 — — 
14 90–94 — 108–119 24.5–26 22.5–24 33–34 46–47 13 — 0.95–1 
15 95–97 — 93–107 26.5 24.5–28 10 35–36 — 14 — 1.01–1.07 
16 98 — 92 — 28.5 — 37 — — — — 
17 99 — 90–91 27–28 — 11 38 — 15 — — 
18 >99 35.5–36 ≤89 28.5–36 29–36 12 39–48 48 16 16 ≥1.08 
Sample size  101 101 103 
Scaled score Percentile range ROCF
 
FCSRT
 
Copy
 
Memory
 
Trial 1 free recall Total free recall Total recall Delayed free recall Delayed total recall TDR/T3TR 
Raw Score Time (s) Immediate recall RS Delayed recall RS 
<1 ≤13 ≥456 ≤2.5 ≤2.5 0–1 ≤12 ≤25 0–3 0–7 ≤0.62 
13.5–17 423–455 — — — 26 — 0.63–0.64 
17.5 420–422 — — — — 0.65–0.67 
3–5 18–20.5 372–419 3.5–4.5 3.5–5 — 13–14 27–31 — 0.68–0.77 
6–10 21–22.5 333–371 5–6.5 5.5–6.5 15–16 32–33 — 10 0.78–0.8 
11–18 23–25.5 290–332 7–8.5 7–9 17–19 34–35 11–12 0.81–0.88 
19–28 26–28 240–289 9–11.5 9.5–11 20 36–38 — 0.89–0.92 
29–40 28.5–30 197–239 12–14 11.5–14.5 21–22 39–40 — 13 0.93 
10 41–59 30.5–33 173–196 14.5–18 15–17.5 — 23–25 41–42 8–9 14 0.94 
11 60–71 — 148–172 18.5–20.5 18–19 26–27 43 10 15 — 
12 72–81 33.5–34 134–147 21–22.5 19.5–21.5 28–30 44 11 — — 
13 82–89 34.5–35 120–133 23–24 22 31–32 45 12 — — 
14 90–94 — 108–119 24.5–26 22.5–24 33–34 46–47 13 — 0.95–1 
15 95–97 — 93–107 26.5 24.5–28 10 35–36 — 14 — 1.01–1.07 
16 98 — 92 — 28.5 — 37 — — — — 
17 99 — 90–91 27–28 — 11 38 — 15 — — 
18 >99 35.5–36 ≤89 28.5–36 29–36 12 39–48 48 16 16 ≥1.08 
Sample size  101 101 103 

Notes: FCSRT = free and cued selective reminding test; ROCF = Rey–Osterrieth complex figure; RS = raw score; TDR/T3TR = total delayed recall/Trial 3 total recall.

Table 7.

Age-adjusted NEURONORMA scores (NSSA) for age 66–68 (age range for norms = 62–72)

Scaled score Percentile range ROCF
 
FCSRT
 
Copy
 
Memory
 
Trial 1 free recall Total free recall Total recall Delayed free recall Delayed total recall TDR/T3TR 
Raw Score Time (s) Immediate recall RS Delayed recall RS 
<1 ≤12 ≥545 ≤2 ≤2 0–1 0–2 ≤13 0–6 0–0.63 
12.5–14 535–544 — 2.5–3 — 3–7 14–19 — — 
14.5–15 469–534 2.5 — — 20–25 — 0.64 
3–5 15.5–21 420–468 3–4 3.5–5 — 26–27 2–3 8–9 0.65–0.77 
6–10 21.5–22.5 372–419 4.5–6 5.5–6 10–14 28–29 4–5 10 0.78–0.79 
11–18 23–25.5 300–371 6.5–8.5 6.5–8 15–16 30–33 — 11 0.8–0.87 
19–28 26–28.5 247–299 9–11 8.5–10 17–19 34–35 12 0.88–0.92 
29–40 29–30 215–246 11.5–13 10.5–13.5 — 20–21 36–38 13 0.93 
10 41–59 30.5–32 174–214 13.5–17 14–16.5 22–23 39–41 14 0.94 
11 60–71 32.5–33 150–173 17.5–20 17–18.5 24–25 42 — — 
12 72–81 33.5–34 136–149 20.5–22 19–21 26–27 43–44 10 15 — 
13 82–89 34.5–35 119–135 22.5–23.5 21.5–23 28–30 45 11 — 0.95–1 
14 90–94 — 105–118 24–26.5 23.5–27.5 — 31 46 12 — 1.01–1.07 
15 95–97 — 92–104 27–28 28–28.5 32–33 47 13 — 1.08 
16 98 — 90–91 28.5 29 — 34 — 14 — 1.09–1.10 
17 99 — 76–89 — 29.5–31 10 — — — — 1.11–1.17 
18 >99 35.5–36 ≤75 29–36 31.5–36 11–16 35–48 48 15–16 16 ≥1.18 
Sample size  116 116 118 115 
Scaled score Percentile range ROCF
 
FCSRT
 
Copy
 
Memory
 
Trial 1 free recall Total free recall Total recall Delayed free recall Delayed total recall TDR/T3TR 
Raw Score Time (s) Immediate recall RS Delayed recall RS 
<1 ≤12 ≥545 ≤2 ≤2 0–1 0–2 ≤13 0–6 0–0.63 
12.5–14 535–544 — 2.5–3 — 3–7 14–19 — — 
14.5–15 469–534 2.5 — — 20–25 — 0.64 
3–5 15.5–21 420–468 3–4 3.5–5 — 26–27 2–3 8–9 0.65–0.77 
6–10 21.5–22.5 372–419 4.5–6 5.5–6 10–14 28–29 4–5 10 0.78–0.79 
11–18 23–25.5 300–371 6.5–8.5 6.5–8 15–16 30–33 — 11 0.8–0.87 
19–28 26–28.5 247–299 9–11 8.5–10 17–19 34–35 12 0.88–0.92 
29–40 29–30 215–246 11.5–13 10.5–13.5 — 20–21 36–38 13 0.93 
10 41–59 30.5–32 174–214 13.5–17 14–16.5 22–23 39–41 14 0.94 
11 60–71 32.5–33 150–173 17.5–20 17–18.5 24–25 42 — — 
12 72–81 33.5–34 136–149 20.5–22 19–21 26–27 43–44 10 15 — 
13 82–89 34.5–35 119–135 22.5–23.5 21.5–23 28–30 45 11 — 0.95–1 
14 90–94 — 105–118 24–26.5 23.5–27.5 — 31 46 12 — 1.01–1.07 
15 95–97 — 92–104 27–28 28–28.5 32–33 47 13 — 1.08 
16 98 — 90–91 28.5 29 — 34 — 14 — 1.09–1.10 
17 99 — 76–89 — 29.5–31 10 — — — — 1.11–1.17 
18 >99 35.5–36 ≤75 29–36 31.5–36 11–16 35–48 48 15–16 16 ≥1.18 
Sample size  116 116 118 115 

Notes: FCSRT = free and cued selective reminding test; ROCF = Rey–Osterrieth complex figure; RS = raw score; TDR/T3TR = total delayed recall/Trial 3 total recall.

Table 8.

Age-adjusted NEURONORMA scores (NSSA) for age 69–71 (age range for norms = 65–75)

Scaled score Percentile range ROCF
 
FCSRT
 
Copy
 
Memory
 
Trial 1 free recall Total free recall Total recall Delayed free recall Delayed total recall TDR/T3TR 
Raw Score Time (s) Immediate recall RS Delayed recall RS 
<1 ≤12 ≥564 ≤2 ≤1.5 0–2 ≤13 0–6 ≤0.57 
12.5–14 545–543 — 3–4 14–19 — — — 
14.5–15 535–544 2.5 2.5–3 — 5–7 20–22 — — 
3–5 15.5–21 413–534 3–4 3.5–4 — 8–9 23–26 0.58–0.7 
6–10 21.5–22 369–412 4.5–6 4.5–6 — 10–12 27–28 2–3 0.71–0.79 
11–18 22.5–25 320–368 6.5–8 6.5–7.5 13–14 29–32 4–5 10 0.8–0.85 
19–28 25.5–28 254–319 8.5–10.5 8–9.5 15–17 33–34 11 0.86–0.91 
29–40 28.5–30 222–253 11–12.5 10–12 18–19 35–36 — 12 0.92 
10 41–59 30.5–32 181–221 13–17 12.5–16.5 20–22 37–40 7–8 13–14 0.93–0.94 
11 60–71 32.5–34 152–180 17.5–20.5 17–19 — 23–25 41–42 — — 
12 72–81 — 136–151 21–22.5 19.5–22 26 43–44 10 15 — 
13 82–89 34.5–35 119–135 23–23.5 22.5–23 27–29 45 11 — 0.95–1 
14 90–94 — 105–118 24–26.5 24–27.5 30–31 46 — — 1.01–1.07 
15 95–97 — 90–104 27–29 28–29 32 47 12–13 — 1.08–1.10 
16 98 — 76–89 29.5–30 29.5–30 — 33 — — — 1.11–1.17 
17 99 — 64–75 — 30.5–31 10 — — 14 — 1.18 
18 >99 35.5–36 ≤63 30.5–36 31.5–36 11–16 34–48 48 15–16 16 ≥1.19 
Sample size  120 120 125 122 123 
Scaled score Percentile range ROCF
 
FCSRT
 
Copy
 
Memory
 
Trial 1 free recall Total free recall Total recall Delayed free recall Delayed total recall TDR/T3TR 
Raw Score Time (s) Immediate recall RS Delayed recall RS 
<1 ≤12 ≥564 ≤2 ≤1.5 0–2 ≤13 0–6 ≤0.57 
12.5–14 545–543 — 3–4 14–19 — — — 
14.5–15 535–544 2.5 2.5–3 — 5–7 20–22 — — 
3–5 15.5–21 413–534 3–4 3.5–4 — 8–9 23–26 0.58–0.7 
6–10 21.5–22 369–412 4.5–6 4.5–6 — 10–12 27–28 2–3 0.71–0.79 
11–18 22.5–25 320–368 6.5–8 6.5–7.5 13–14 29–32 4–5 10 0.8–0.85 
19–28 25.5–28 254–319 8.5–10.5 8–9.5 15–17 33–34 11 0.86–0.91 
29–40 28.5–30 222–253 11–12.5 10–12 18–19 35–36 — 12 0.92 
10 41–59 30.5–32 181–221 13–17 12.5–16.5 20–22 37–40 7–8 13–14 0.93–0.94 
11 60–71 32.5–34 152–180 17.5–20.5 17–19 — 23–25 41–42 — — 
12 72–81 — 136–151 21–22.5 19.5–22 26 43–44 10 15 — 
13 82–89 34.5–35 119–135 23–23.5 22.5–23 27–29 45 11 — 0.95–1 
14 90–94 — 105–118 24–26.5 24–27.5 30–31 46 — — 1.01–1.07 
15 95–97 — 90–104 27–29 28–29 32 47 12–13 — 1.08–1.10 
16 98 — 76–89 29.5–30 29.5–30 — 33 — — — 1.11–1.17 
17 99 — 64–75 — 30.5–31 10 — — 14 — 1.18 
18 >99 35.5–36 ≤63 30.5–36 31.5–36 11–16 34–48 48 15–16 16 ≥1.19 
Sample size  120 120 125 122 123 

Notes: FCSRT = free and cued selective reminding test; ROCF = Rey–Osterrieth complex figure; RS = raw score; TDR/T3TR = total delayed recall/Trial 3 total recall.

Table 9.

Age-adjusted NEURONORMA scores (NSSA) for age 72–74 (age range for norms = 68–78)

Scaled score Percentile range ROCF
 
FCSRT
 
Copy
 
Memory
 
Trial 1 free recall Total free recall Total recall Delayed free recall Delayed total recall TDR/T3TR 
Raw Score Time (s) Immediate recall RS Delayed recall RS 
<1 ≤12 ≥636 ≤2 ≤1.5 0–2 ≤13 0–6 ≤0.54 
12.5–13 564–635 — 3–4 14–19 — — 0.55–0.57 
13.5–14 545–563 2.5 2.5–3 — — 20–22 — — 0.58–0.6 
3–5 14.5–18.5 420–544 3–4 3.5–4 — 5–8 23–26 0.61–0.71 
6–10 19–22 383–419 4.5–5.5 4.5–6 9–12 27–28 2–3 0.72–0.73 
11–18 22.5–24.5 340–382 6–7.5 6.5–7.5 — 13 29–31 9–10 0.74–0.8 
19–28 25–27.5 290–339 8–9.5 8–9 14–15 32–33 11 0.81–0.87 
29–40 28–30 247–289 10–12 9.5–11.5 16–18 34–35 12 0.88–0.92 
10 41–59 30.5–32 196–246 12.5–15.5 12–14.5 19–21 36–39 7–8 13 0.93–0.94 
11 60–71 32.5–34 169–195 16–18.5 15–18 — 22–23 40–42 14 — 
12 72–81 34.5–35 148–168 19–22 18.5–21 24–25 43 10 15 — 
13 82–89 — 133–147 22.5–23.5 21.5–23 26–28 44 11 — 0.95–1 
14 90–94 — 110–132 24–26.5 23.5–27.5 29–30 45 — — 1.01–1.08 
15 95–97 — 77–109 27–29 28–29 31–32 46–47 12 — 1.09–1.15 
16 98 — — 29.5–30 29.5–30 10 33 — 13 — 1.16–1.17 
17 99 — 63–76 — 30.5–31 — — — — — 1.18–1.23 
18 >99 35.5–36 ≤62 30.5–36 31.5–36 11–16 34–48 48 14–16 16 ≥1.24 
Sample size  120 120 123 120 121 
Scaled score Percentile range ROCF
 
FCSRT
 
Copy
 
Memory
 
Trial 1 free recall Total free recall Total recall Delayed free recall Delayed total recall TDR/T3TR 
Raw Score Time (s) Immediate recall RS Delayed recall RS 
<1 ≤12 ≥636 ≤2 ≤1.5 0–2 ≤13 0–6 ≤0.54 
12.5–13 564–635 — 3–4 14–19 — — 0.55–0.57 
13.5–14 545–563 2.5 2.5–3 — — 20–22 — — 0.58–0.6 
3–5 14.5–18.5 420–544 3–4 3.5–4 — 5–8 23–26 0.61–0.71 
6–10 19–22 383–419 4.5–5.5 4.5–6 9–12 27–28 2–3 0.72–0.73 
11–18 22.5–24.5 340–382 6–7.5 6.5–7.5 — 13 29–31 9–10 0.74–0.8 
19–28 25–27.5 290–339 8–9.5 8–9 14–15 32–33 11 0.81–0.87 
29–40 28–30 247–289 10–12 9.5–11.5 16–18 34–35 12 0.88–0.92 
10 41–59 30.5–32 196–246 12.5–15.5 12–14.5 19–21 36–39 7–8 13 0.93–0.94 
11 60–71 32.5–34 169–195 16–18.5 15–18 — 22–23 40–42 14 — 
12 72–81 34.5–35 148–168 19–22 18.5–21 24–25 43 10 15 — 
13 82–89 — 133–147 22.5–23.5 21.5–23 26–28 44 11 — 0.95–1 
14 90–94 — 110–132 24–26.5 23.5–27.5 29–30 45 — — 1.01–1.08 
15 95–97 — 77–109 27–29 28–29 31–32 46–47 12 — 1.09–1.15 
16 98 — — 29.5–30 29.5–30 10 33 — 13 — 1.16–1.17 
17 99 — 63–76 — 30.5–31 — — — — — 1.18–1.23 
18 >99 35.5–36 ≤62 30.5–36 31.5–36 11–16 34–48 48 14–16 16 ≥1.24 
Sample size  120 120 123 120 121 

Notes: FCSRT = free and cued selective reminding test; ROCF = Rey–Osterrieth complex figure; RS = raw score; TDR/T3TR = total delayed recall/Trial 3 total recall.

Table 10.

Age-adjusted NEURONORMA scores (NSSA) for age 75–77 (age range for norms = 71–81)

Scaled score Percentile range ROCF
 
FCSRT
 
Copy
 
Memory
 
Trial 1 free recall Total free recall Total recall Delayed free recall Delayed total recall TDR/T3TR 
Raw Score Time (s) Immediate recall RS Delayed recall RS 
<1 ≤10.5 ≥637 ≤0.5 ≤1.5 0–1 ≤12 ≤0.53 
11 636 — — — 13 — 1–6 0.54 
11.5–12 564–635 — — 3–4 14–19 — — 0.55–0.57 
3–5 12.5–15 469–563 1–2.5 2.5–3.5 20–22 — — 0.56–0.6 
6–10 15.5–21 406–468 3–4.5 4–5 — 6–9 23–25 0.61–0.73 
11–18 21.5–22 342–405 5–7 5.5–7 10–12 26–28 2–3 8–9 0.74–0.79 
19–28 22.5–25.5 300–341 7.5–8.5 7.5–8.5 — 13–14 29–31 10 0.8–0.86 
29–40 26–29 276–299 9–11 9–11.5 15–16 32–34 11 0.87–0.92 
10 41–59 29.5–32 215–275 11.5–14 12–13.5 17–20 35–38 6–7 12–13 0.93–0.94 
11 60–71 32.5–33 181–214 14.5–17.5 14–16.5 21–22 39–41 — — 
12 72–81 33.5–34 152–180 18–19 17–18.5 23–25 42 14 — 
13 82–89 34.5–35 120–151 19.5–22.5 19–22 7–8 26–28 43–44 10 15 0.95–1.07 
14 90–94 — 110–119 23 22.5–25 — 29–30 45–46 11 — 1.08–1.10 
15 95–97 — 90–109 23.5–28 25.5–28 31 47 12 — 1.11–1.17 
16 98 — 76–89 28.5–29 28.5–30 10 32 — 13 — 1.18–1.22 
17 99 35.5 62–75 29.5–30 30.5–32 — — — — — 1.23 
18 >99 36 ≤61 30.5–36 32.5–36 11–16 33–48 48 14–16 16 ≥1.24 
Sample size  96 96 99 97 98 
Scaled score Percentile range ROCF
 
FCSRT
 
Copy
 
Memory
 
Trial 1 free recall Total free recall Total recall Delayed free recall Delayed total recall TDR/T3TR 
Raw Score Time (s) Immediate recall RS Delayed recall RS 
<1 ≤10.5 ≥637 ≤0.5 ≤1.5 0–1 ≤12 ≤0.53 
11 636 — — — 13 — 1–6 0.54 
11.5–12 564–635 — — 3–4 14–19 — — 0.55–0.57 
3–5 12.5–15 469–563 1–2.5 2.5–3.5 20–22 — — 0.56–0.6 
6–10 15.5–21 406–468 3–4.5 4–5 — 6–9 23–25 0.61–0.73 
11–18 21.5–22 342–405 5–7 5.5–7 10–12 26–28 2–3 8–9 0.74–0.79 
19–28 22.5–25.5 300–341 7.5–8.5 7.5–8.5 — 13–14 29–31 10 0.8–0.86 
29–40 26–29 276–299 9–11 9–11.5 15–16 32–34 11 0.87–0.92 
10 41–59 29.5–32 215–275 11.5–14 12–13.5 17–20 35–38 6–7 12–13 0.93–0.94 
11 60–71 32.5–33 181–214 14.5–17.5 14–16.5 21–22 39–41 — — 
12 72–81 33.5–34 152–180 18–19 17–18.5 23–25 42 14 — 
13 82–89 34.5–35 120–151 19.5–22.5 19–22 7–8 26–28 43–44 10 15 0.95–1.07 
14 90–94 — 110–119 23 22.5–25 — 29–30 45–46 11 — 1.08–1.10 
15 95–97 — 90–109 23.5–28 25.5–28 31 47 12 — 1.11–1.17 
16 98 — 76–89 28.5–29 28.5–30 10 32 — 13 — 1.18–1.22 
17 99 35.5 62–75 29.5–30 30.5–32 — — — — — 1.23 
18 >99 36 ≤61 30.5–36 32.5–36 11–16 33–48 48 14–16 16 ≥1.24 
Sample size  96 96 99 97 98 

Notes: FCSRT = free and cued selective reminding test; ROCF = Rey–Osterrieth complex figure; RS = raw score; TDR/T3TR = total delayed recall/Trial 3 total recall.

Table 11.

Age-adjusted NEURONORMA scores (NSSA) for age 78–80 (age range for norms = 74–84)

Scaled score Percentile range ROCF
 
FCSRT
 
Copy
 
Memory
 
Trial 1 free recall Total free recall Total recall Delayed free recall Delayed total recall TDR/T3TR 
Raw Score Time (s) Immediate recall RS Delayed recall RS 
<1 ≤10.5 ≥636 ≤0.5 ≤1.5 0–4 ≤20 0–5 ≤0.53 
11 — — — — — 21 — 0.54 
— 564–635 — — — — — — — — 
3–5 11.5–16 420–563 1–2 2–2.5 5–7 22 — — 0.55–0.6 
6–10 16.5–21 358–419 2.5–4.5 3–4 — 8–9 23–25 — 0.61–0.71 
11–18 21.5–22 330–357 5–6.5 4.5–7 10–12 26–28 1–2 0.72–0.73 
19–28 22.5–25.5 312–329 7–8 7.5–8.5 — 13 29–31 0.74–0.82 
29–40 26–29 280–311 8.5–10.5 9–11 14 32–33 10–11 0.83–0.9 
10 41–59 29.5–31 221–279 11–12 11.5–12.5 15–17 34–36 5–6 12 0.91–0.94 
11 60–71 31.5–33 194–220 12.5–14 13–14 18–20 37–38 7–8 13 — 
12 72–81 33.5–34 169–193 14.5–18 14.5–16.5 21 39–41 — — — 
13 82–89 34.5–35 134–168 18.5–19 17–18.5 22–25 42 9–10 14 0.95–1.07 
14 90–94 — 115–133 19.5–21 19–20 — 26–30 43 — 15 1.08–1.10 
15 95–97 — 100–114 21.5–23 20.5–23 — 44–45 11 — 1.11–1.17 
16 98 — — 23.5–24 23.5–25 31 46 12 — 1.18–1.22 
17 99 — 90–99 — — — — — — — — 
18 >99 36 ≤89 24.5–36 25.5–27 11–16 32–48 47–48 13–16 16 ≥1.23 
Sample size  63 63 63 64 
Scaled score Percentile range ROCF
 
FCSRT
 
Copy
 
Memory
 
Trial 1 free recall Total free recall Total recall Delayed free recall Delayed total recall TDR/T3TR 
Raw Score Time (s) Immediate recall RS Delayed recall RS 
<1 ≤10.5 ≥636 ≤0.5 ≤1.5 0–4 ≤20 0–5 ≤0.53 
11 — — — — — 21 — 0.54 
— 564–635 — — — — — — — — 
3–5 11.5–16 420–563 1–2 2–2.5 5–7 22 — — 0.55–0.6 
6–10 16.5–21 358–419 2.5–4.5 3–4 — 8–9 23–25 — 0.61–0.71 
11–18 21.5–22 330–357 5–6.5 4.5–7 10–12 26–28 1–2 0.72–0.73 
19–28 22.5–25.5 312–329 7–8 7.5–8.5 — 13 29–31 0.74–0.82 
29–40 26–29 280–311 8.5–10.5 9–11 14 32–33 10–11 0.83–0.9 
10 41–59 29.5–31 221–279 11–12 11.5–12.5 15–17 34–36 5–6 12 0.91–0.94 
11 60–71 31.5–33 194–220 12.5–14 13–14 18–20 37–38 7–8 13 — 
12 72–81 33.5–34 169–193 14.5–18 14.5–16.5 21 39–41 — — — 
13 82–89 34.5–35 134–168 18.5–19 17–18.5 22–25 42 9–10 14 0.95–1.07 
14 90–94 — 115–133 19.5–21 19–20 — 26–30 43 — 15 1.08–1.10 
15 95–97 — 100–114 21.5–23 20.5–23 — 44–45 11 — 1.11–1.17 
16 98 — — 23.5–24 23.5–25 31 46 12 — 1.18–1.22 
17 99 — 90–99 — — — — — — — — 
18 >99 36 ≤89 24.5–36 25.5–27 11–16 32–48 47–48 13–16 16 ≥1.23 
Sample size  63 63 63 64 

Notes: FCSRT = free and cued selective reminding test; ROCF = Rey–Osterrieth complex figure; RS = raw score; TDR/T3TR = total delayed recall/Trial 3 total recall.

Table 12.

Age-adjusted NEURONORMA scores (NSSA) for age 81–90 (age range for norms = 77–90)

Scaled score Percentile range ROCF
 
FCSRT
 
Copy
 
Memory
 
Trial 1 free recall Total free recall Total recall Delayed free recall Delayed total recall TDR/T3TR 
Raw Score Time (s) Immediate recall RS Delayed recall RS 
<1 ≤9.5 ≥636 0–4 ≤20 0–5 ≤0.53 
— — — — — — — — — — 
10 565–635 — 0.5 — — 21 — 0.54 
3–5 10.5–11 481–564 0.5 1–2 — 22 — — 0.55–0.58 
6–10 11.5–13 420–480 1–2 2.5–3.5 — 5–8 23–25 — — 0.59–0.62 
11–18 13.5–21 350–419 2.5–4.5 4–6.5 9–11 26 1–2 7–8 0.63–0.75 
19–28 21.5 323–349 5–7.5 7–8.5 — 12–13 27–28 0.76–0.82 
29–40 22–29 300–322 8–10 9–10 — 29–34 10–11 0.83–0.92 
10 41–59 29.5–30 256–299 10.5–11.5 10.5–12 14–16 35 12 0.93–0.94 
11 60–71 30.5–33 205–255 12–13 12.5–13.5 17–19 36–38 13 — 
12 72–81 — 180–204 13.5–15 14–15.5 — 20–21 39 7–8 — — 
13 82–89 33.5–35 144–179 15.5–18 16–18 22 40 — 14 0.95–1.08 
14 90–94 — 120–143 18.5–19.5 18.5 23 — — 1.09–1.10 
15 95–97 — 113–119 20–22 — 24–25 41–42 10–11 15 1.11–1.17 
16 98 — 90–112 — — — — — — — — 
17 99 — — — — — — — — — — 
18 >99 35.5–36 ≤89 22.5–36 19–36 9–16 31–48 43–48 12–16 16 ≥1.18 
Sample size  40 40 40 40 
Scaled score Percentile range ROCF
 
FCSRT
 
Copy
 
Memory
 
Trial 1 free recall Total free recall Total recall Delayed free recall Delayed total recall TDR/T3TR 
Raw Score Time (s) Immediate recall RS Delayed recall RS 
<1 ≤9.5 ≥636 0–4 ≤20 0–5 ≤0.53 
— — — — — — — — — — 
10 565–635 — 0.5 — — 21 — 0.54 
3–5 10.5–11 481–564 0.5 1–2 — 22 — — 0.55–0.58 
6–10 11.5–13 420–480 1–2 2.5–3.5 — 5–8 23–25 — — 0.59–0.62 
11–18 13.5–21 350–419 2.5–4.5 4–6.5 9–11 26 1–2 7–8 0.63–0.75 
19–28 21.5 323–349 5–7.5 7–8.5 — 12–13 27–28 0.76–0.82 
29–40 22–29 300–322 8–10 9–10 — 29–34 10–11 0.83–0.92 
10 41–59 29.5–30 256–299 10.5–11.5 10.5–12 14–16 35 12 0.93–0.94 
11 60–71 30.5–33 205–255 12–13 12.5–13.5 17–19 36–38 13 — 
12 72–81 — 180–204 13.5–15 14–15.5 — 20–21 39 7–8 — — 
13 82–89 33.5–35 144–179 15.5–18 16–18 22 40 — 14 0.95–1.08 
14 90–94 — 120–143 18.5–19.5 18.5 23 — — 1.09–1.10 
15 95–97 — 113–119 20–22 — 24–25 41–42 10–11 15 1.11–1.17 
16 98 — 90–112 — — — — — — — — 
17 99 — — — — — — — — — — 
18 >99 35.5–36 ≤89 22.5–36 19–36 9–16 31–48 43–48 12–16 16 ≥1.18 
Sample size  40 40 40 40 

Notes: FCSRT = free and cued selective reminding test; ROCF = Rey–Osterrieth complex figure; RS = raw score; TDR/T3TR = total delayed recall/Trial 3 total recall.

As expected, the normative adjustments eliminated variance with age. Education, however, continued to account for a significant amount of shared variance (Table 13). In the case of the ROCF, the effect of education affects slightly more copy (8%–14%) than the memory reproduction (6%). Concerning the FCSRT education continues to account significantly for age-adjusted test score variance up to 11%, although the effect is minor for the index of retention.

Table 13.

Correlations (r) and shared variances (r2) of age-adjusted NEURONORMA scores (NSSA) with age and education (years)

Variables Age (years)
 
Education (years)
 
r r2 r r2 
ROCF 
 Copy 
  Time (s) −0.03589 0.00129 0.38195 0.14995 
  Accuracy −0.05154 0.00266 0.29866 0.08920 
 Memory 
  Immediate recall (accuracy) −0.01915 0.00037 0.24934 0.06217 
  Delayed recall (accuracy) −0.03106 0.00096 0.25951 0.06735 
FCSRT 
 Trial 1 free recall −0.03634 0.00132 0.29129 0.08485 
 Total free recall −0.05400 0.00292 0.32462 0.10538 
 Total recall (free recall + cued recall) −0.07973 0.00636 0.33688 0.11349 
 Delayed free recall −0.07637 0.00583 0.30934 0.09569 
 Delayed total recall −0.15937 0.02540 0.34300 0.11765 
 Total delayed recall/Trial 3 total recall −0.13261 0.01759 0.21283 0.04530 
Variables Age (years)
 
Education (years)
 
r r2 r r2 
ROCF 
 Copy 
  Time (s) −0.03589 0.00129 0.38195 0.14995 
  Accuracy −0.05154 0.00266 0.29866 0.08920 
 Memory 
  Immediate recall (accuracy) −0.01915 0.00037 0.24934 0.06217 
  Delayed recall (accuracy) −0.03106 0.00096 0.25951 0.06735 
FCSRT 
 Trial 1 free recall −0.03634 0.00132 0.29129 0.08485 
 Total free recall −0.05400 0.00292 0.32462 0.10538 
 Total recall (free recall + cued recall) −0.07973 0.00636 0.33688 0.11349 
 Delayed free recall −0.07637 0.00583 0.30934 0.09569 
 Delayed total recall −0.15937 0.02540 0.34300 0.11765 
 Total delayed recall/Trial 3 total recall −0.13261 0.01759 0.21283 0.04530 

Notes: FCSRT = free and cued selective reminding test; ROCF = Rey–Osterrieth complex figure.

The transformation of RS to NSSA (Tables 3–12) produced a normalized distribution on which linear regressions could be applied. Regression coefficients from this analysis were used as the basis for education (years) corrections. The following formula was used: NSSA&E = NSSA − (β × [Educ − 12]). The values of β are presented in Tables 14–17.

Table 14.

ROCF: copy (time). Education adjustment applying the following formula: NSSA&E = NSSA − (β × [Education(years) − 12]), where β = 0.19735

NSSA Education (years)
 
10 11 12 13 14 15 16 17 18 19 20 
10 10 
11 11 10 10 10 10 10 
10 12 12 11 11 11 11 11 10 10 10 10 10 10 
11 13 13 12 12 12 12 12 11 11 11 11 11 11 10 10 10 10 10 
12 14 14 13 13 13 13 13 12 12 12 12 12 12 11 11 11 11 11 10 10 10 
13 15 15 14 14 14 14 14 13 13 13 13 13 13 12 12 12 12 12 11 11 11 
14 16 16 15 15 15 15 15 14 14 14 14 14 14 13 13 13 13 13 12 12 12 
15 17 17 16 16 16 16 16 15 15 15 15 15 15 14 14 14 14 14 13 13 13 
16 18 18 17 17 17 17 17 16 16 16 16 16 16 15 15 15 15 15 14 14 14 
17 19 19 18 18 18 18 18 17 17 17 17 17 17 16 16 16 16 16 15 15 15 
18 20 20 19 19 19 19 19 18 18 18 18 18 18 17 17 17 17 17 16 16 16 
NSSA Education (years)
 
10 11 12 13 14 15 16 17 18 19 20 
10 10 
11 11 10 10 10 10 10 
10 12 12 11 11 11 11 11 10 10 10 10 10 10 
11 13 13 12 12 12 12 12 11 11 11 11 11 11 10 10 10 10 10 
12 14 14 13 13 13 13 13 12 12 12 12 12 12 11 11 11 11 11 10 10 10 
13 15 15 14 14 14 14 14 13 13 13 13 13 13 12 12 12 12 12 11 11 11 
14 16 16 15 15 15 15 15 14 14 14 14 14 14 13 13 13 13 13 12 12 12 
15 17 17 16 16 16 16 16 15 15 15 15 15 15 14 14 14 14 14 13 13 13 
16 18 18 17 17 17 17 17 16 16 16 16 16 16 15 15 15 15 15 14 14 14 
17 19 19 18 18 18 18 18 17 17 17 17 17 17 16 16 16 16 16 15 15 15 
18 20 20 19 19 19 19 19 18 18 18 18 18 18 17 17 17 17 17 16 16 16 

Note: ROCF = Rey–Osterrieth complex figure.

Table 15.

ROCF: copy (accuracy). Education adjustment applying the following formula: NSSA&E = NSSA − (β × [Education(years) − 12]), where β = 0.21285

NSSA Education (years)
 
10 11 12 13 14 15 16 17 18 19 20 
10 10 10 
11 11 11 10 10 10 10 10 
10 12 12 12 11 11 11 11 11 10 10 10 10 10 
11 13 13 13 12 12 12 12 12 11 11 11 11 11 10 10 10 10 
12 14 14 14 13 13 13 13 13 12 12 12 12 12 11 11 11 11 10 10 10 10 
13 15 15 15 14 14 14 14 14 13 13 13 13 13 12 12 12 12 11 11 11 11 
14 16 16 16 15 15 15 15 15 14 14 14 14 14 13 13 13 13 12 12 12 12 
15 17 17 17 16 16 16 16 16 15 15 15 15 15 14 14 14 14 13 13 13 13 
16 18 18 18 17 17 17 17 17 16 16 16 16 16 15 15 15 15 14 14 14 14 
17 19 19 19 18 18 18 18 18 17 17 17 17 17 16 16 16 16 15 15 15 15 
18 20 20 20 19 19 19 19 19 18 18 18 18 18 17 17 17 17 16 16 16 16 
NSSA Education (years)
 
10 11 12 13 14 15 16 17 18 19 20 
10 10 10 
11 11 11 10 10 10 10 10 
10 12 12 12 11 11 11 11 11 10 10 10 10 10 
11 13 13 13 12 12 12 12 12 11 11 11 11 11 10 10 10 10 
12 14 14 14 13 13 13 13 13 12 12 12 12 12 11 11 11 11 10 10 10 10 
13 15 15 15 14 14 14 14 14 13 13 13 13 13 12 12 12 12 11 11 11 11 
14 16 16 16 15 15 15 15 15 14 14 14 14 14 13 13 13 13 12 12 12 12 
15 17 17 17 16 16 16 16 16 15 15 15 15 15 14 14 14 14 13 13 13 13 
16 18 18 18 17 17 17 17 17 16 16 16 16 16 15 15 15 15 14 14 14 14 
17 19 19 19 18 18 18 18 18 17 17 17 17 17 16 16 16 16 15 15 15 15 
18 20 20 20 19 19 19 19 19 18 18 18 18 18 17 17 17 17 16 16 16 16 

Note: ROCF = Rey–Osterrieth complex figure.

Table 16.

ROCF: immediate recall (accuracy). Education adjustment applying the following formula: NSSA&E = NSSA − (β × [Education(years) − 12]), where β = 0.12856

NSSA Education (years)
 
10 11 12 13 14 15 16 17 18 19 20 
10 10 10 10 10 
10 11 11 11 11 11 10 10 10 10 10 10 10 10 
11 12 12 12 12 12 11 11 11 11 11 11 11 11 10 10 10 10 10 10 10 
12 13 13 13 13 13 12 12 12 12 12 12 12 12 11 11 11 11 11 11 11 10 
13 14 14 14 14 14 13 13 13 13 13 13 13 13 12 12 12 12 12 12 12 11 
14 15 15 15 15 15 14 14 14 14 14 14 14 14 13 13 13 13 13 13 13 12 
15 16 16 16 16 16 15 15 15 15 15 15 15 15 14 14 14 14 14 14 14 13 
16 17 17 17 17 17 16 16 16 16 16 16 16 16 15 15 15 15 15 15 15 14 
17 18 18 18 18 18 17 17 17 17 17 17 17 17 16 16 16 16 16 16 16 15 
18 19 19 19 19 19 18 18 18 18 18 18 18 18 17 17 17 17 17 17 17 16 
NSSA Education (years)
 
10 11 12 13 14 15 16 17 18 19 20 
10 10 10 10 10 
10 11 11 11 11 11 10 10 10 10 10 10 10 10 
11 12 12 12 12 12 11 11 11 11 11 11 11 11 10 10 10 10 10 10 10 
12 13 13 13 13 13 12 12 12 12 12 12 12 12 11 11 11 11 11 11 11 10 
13 14 14 14 14 14 13 13 13 13 13 13 13 13 12 12 12 12 12 12 12 11 
14 15 15 15 15 15 14 14 14 14 14 14 14 14 13 13 13 13 13 13 13 12 
15 16 16 16 16 16 15 15 15 15 15 15 15 15 14 14 14 14 14 14 14 13 
16 17 17 17 17 17 16 16 16 16 16 16 16 16 15 15 15 15 15 15 15 14 
17 18 18 18 18 18 17 17 17 17 17 17 17 17 16 16 16 16 16 16 16 15 
18 19 19 19 19 19 18 18 18 18 18 18 18 18 17 17 17 17 17 17 17 16 

Note: ROCF = Rey–Osterrieth complex figure.

Table 17.

ROCF: delayed recall (accuracy). Education adjustment applying the following formula: NSSA&E = NSSA − (β × [Education(years) − 12]), where β = 0.13346

NSSA Education (years)
 
10 11 12 13 14 15 16 17 18 19 20 
10 10 10 10 10 
10 11 11 11 11 11 10 10 10 10 10 10 10 10 
11 12 12 12 12 12 11 11 11 11 11 11 11 11 10 10 10 10 10 10 10 
12 13 13 13 13 13 12 12 12 12 12 12 12 12 11 11 11 11 11 11 11 10 
13 14 14 14 14 14 13 13 13 13 13 13 13 13 12 12 12 12 12 12 12 11 
14 15 15 15 15 15 14 14 14 14 14 14 14 14 13 13 13 13 13 13 13 12 
15 16 16 16 16 16 15 15 15 15 15 15 15 15 14 14 14 14 14 14 14 13 
16 17 17 17 17 17 16 16 16 16 16 16 16 16 15 15 15 15 15 15 15 14 
17 18 18 18 18 18 17 17 17 17 17 17 17 17 16 16 16 16 16 16 16 15 
18 19 19 19 19 19 18 18 18 18 18 18 18 18 17 17 17 17 17 17 17 16 
NSSA Education (years)
 
10 11 12 13 14 15 16 17 18 19 20 
10 10 10 10 10 
10 11 11 11 11 11 10 10 10 10 10 10 10 10 
11 12 12 12 12 12 11 11 11 11 11 11 11 11 10 10 10 10 10 10 10 
12 13 13 13 13 13 12 12 12 12 12 12 12 12 11 11 11 11 11 11 11 10 
13 14 14 14 14 14 13 13 13 13 13 13 13 13 12 12 12 12 12 12 12 11 
14 15 15 15 15 15 14 14 14 14 14 14 14 14 13 13 13 13 13 13 13 12 
15 16 16 16 16 16 15 15 15 15 15 15 15 15 14 14 14 14 14 14 14 13 
16 17 17 17 17 17 16 16 16 16 16 16 16 16 15 15 15 15 15 15 15 14 
17 18 18 18 18 18 17 17 17 17 17 17 17 17 16 16 16 16 16 16 16 15 
18 19 19 19 19 19 18 18 18 18 18 18 18 18 17 17 17 17 17 17 17 16 

Note: ROCF = Rey–Osterrieth complex figure.

From these data, adjustment tables for ROCF (Tables 14–17) and FCSRT (Tables 18–23) were drawn up to help the clinician make the necessary adjustment. To use the tables, select the appropriate column corresponding to the patient's years of education, find the patient's NSSA, and subsequently refer to the corresponding NSSA&E. When these formulae were applied to the NEURONORMA normative sample, the shared variances between demographically adjusted NEURONORMA scaled scores and years of education fell to <1%.

Table 18.

FCSRT: Trial 1 free recall. Education adjustment applying the following formula: NSSA&E = NSSA − (β × [Education(years) – 12]), where β = 0.15266

NSSA Education (years)
 
10 11 12 13 14 15 16 17 18 19 20 
10 10 10 10 10 10 
10 11 11 11 11 11 11 10 10 10 10 10 10 10 
11 12 12 12 12 12 12 11 11 11 11 11 11 11 10 10 10 10 10 10 
12 13 13 13 13 13 13 12 12 12 12 12 12 12 11 11 11 11 11 11 10 10 
13 14 14 14 14 14 14 13 13 13 13 13 13 13 12 12 12 12 12 12 11 11 
14 15 15 15 15 15 15 14 14 14 14 14 14 14 13 13 13 13 13 13 12 12 
15 16 16 16 16 16 16 15 15 15 15 15 15 15 14 14 14 14 14 14 13 13 
16 17 17 17 17 17 17 16 16 16 16 16 16 16 15 15 15 15 15 15 14 14 
17 18 18 18 18 18 18 17 17 17 17 17 17 17 16 16 16 16 16 16 15 15 
18 19 19 19 19 19 19 18 18 18 18 18 18 18 17 17 17 17 17 17 16 16 
NSSA Education (years)
 
10 11 12 13 14 15 16 17 18 19 20 
10 10 10 10 10 10 
10 11 11 11 11 11 11 10 10 10 10 10 10 10 
11 12 12 12 12 12 12 11 11 11 11 11 11 11 10 10 10 10 10 10 
12 13 13 13 13 13 13 12 12 12 12 12 12 12 11 11 11 11 11 11 10 10 
13 14 14 14 14 14 14 13 13 13 13 13 13 13 12 12 12 12 12 12 11 11 
14 15 15 15 15 15 15 14 14 14 14 14 14 14 13 13 13 13 13 13 12 12 
15 16 16 16 16 16 16 15 15 15 15 15 15 15 14 14 14 14 14 14 13 13 
16 17 17 17 17 17 17 16 16 16 16 16 16 16 15 15 15 15 15 15 14 14 
17 18 18 18 18 18 18 17 17 17 17 17 17 17 16 16 16 16 16 16 15 15 
18 19 19 19 19 19 19 18 18 18 18 18 18 18 17 17 17 17 17 17 16 16 

Note: FCSRT = free and cued selective reminding test.

Table 19.

FCSRT: total free recall. Education adjustment applying the following formula: NSSA&E = NSSA − (β × [Education(years) − 12]), where β = 0.17127

NSSA Education (years)
 
10 11 12 13 14 15 16 17 18 19 20 
10 
11 10 10 10 10 10 10 
10 12 11 11 11 11 11 11 10 10 10 10 10 10 
11 13 12 12 12 12 12 12 11 11 11 11 11 11 10 10 10 10 10 
12 14 13 13 13 13 13 13 12 12 12 12 12 12 11 11 11 11 11 10 10 10 
13 15 14 14 14 14 14 14 13 13 13 13 13 13 12 12 12 12 12 11 11 11 
14 16 15 15 15 15 15 15 14 14 14 14 14 14 13 13 13 13 13 12 12 12 
15 17 16 16 16 16 16 16 15 15 15 15 15 15 14 14 14 14 14 13 13 13 
16 18 17 17 17 17 17 17 16 16 16 16 16 16 15 15 15 15 15 14 14 14 
17 19 18 18 18 18 18 18 17 17 17 17 17 17 16 16 16 16 16 15 15 15 
18 20 19 19 19 19 19 19 18 18 18 18 18 18 17 17 17 17 17 16 16 16 
NSSA Education (years)
 
10 11 12 13 14 15 16 17 18 19 20 
10 
11 10 10 10 10 10 10 
10 12 11 11 11 11 11 11 10 10 10 10 10 10 
11 13 12 12 12 12 12 12 11 11 11 11 11 11 10 10 10 10 10 
12 14 13 13 13 13 13 13 12 12 12 12 12 12 11 11 11 11 11 10 10 10 
13 15 14 14 14 14 14 14 13 13 13 13 13 13 12 12 12 12 12 11 11 11 
14 16 15 15 15 15 15 15 14 14 14 14 14 14 13 13 13 13 13 12 12 12 
15 17 16 16 16 16 16 16 15 15 15 15 15 15 14 14 14 14 14 13 13 13 
16 18 17 17 17 17 17 17 16 16 16 16 16 16 15 15 15 15 15 14 14 14 
17 19 18 18 18 18 18 18 17 17 17 17 17 17 16 16 16 16 16 15 15 15 
18 20 19 19 19 19 19 19 18 18 18 18 18 18 17 17 17 17 17 16 16 16 

Note: FCSRT = free and cued selective reminding test.

Table 20.

FCSRT: total recall (free recall + cued recall). Education adjustment applying the following formula: NSSA&E = NSSA − (β × [Education(years) − 12]), where β = 0.19386

NSSA Education (years)
 
10 11 12 13 14 15 16 17 18 19 20 
10 10 
11 11 10 10 10 10 10 
10 12 12 11 11 11 11 11 10 10 10 10 10 10 
11 13 13 12 12 12 12 12 11 11 11 11 11 11 10 10 10 10 10 
12 14 14 13 13 13 13 13 12 12 12 12 12 12 11 11 11 11 11 10 10 10 
13 15 15 14 14 14 14 14 13 13 13 13 13 13 12 12 12 12 12 11 11 11 
14 16 16 15 15 15 15 15 14 14 14 14 14 14 13 13 13 13 13 12 12 12 
15 17 17 16 16 16 16 16 15 15 15 15 15 15 14 14 14 14 14 13 13 13 
16 18 18 17 17 17 17 17 16 16 16 16 16 16 15 15 15 15 15 14 14 14 
17 19 19 18 18 18 18 18 17 17 17 17 17 17 16 16 16 16 16 15 15 15 
18 20 20 19 19 19 19 19 18 18 18 18 18 18 17 17 17 17 17 16 16 16 
NSSA Education (years)
 
10 11 12 13 14 15 16 17 18 19 20 
10 10 
11 11 10 10 10 10 10 
10 12 12 11 11 11 11 11 10 10 10 10 10 10 
11 13 13 12 12 12 12 12 11 11 11 11 11 11 10 10 10 10 10 
12 14 14 13 13 13 13 13 12 12 12 12 12 12 11 11 11 11 11 10 10 10 
13 15 15 14 14 14 14 14 13 13 13 13 13 13 12 12 12 12 12 11 11 11 
14 16 16 15 15 15 15 15 14 14 14 14 14 14 13 13 13 13 13 12 12 12 
15 17 17 16 16 16 16 16 15 15 15 15 15 15 14 14 14 14 14 13 13 13 
16 18 18 17 17 17 17 17 16 16 16 16 16 16 15 15 15 15 15 14 14 14 
17 19 19 18 18 18 18 18 17 17 17 17 17 17 16 16 16 16 16 15 15 15 
18 20 20 19 19 19 19 19 18 18 18 18 18 18 17 17 17 17 17 16 16 16 

Note: FCSRT = free and cued selective reminding test.

Table 21.

FCSRT: delayed free recall. Education adjustment applying the following formula: NSSA&E = NSSA − (β × [Education(years) − 12]), where β = 0.16171

NSSA Education (years)
 
10 11 12 13 14 15 16 17 18 19 20 
10 10 10 10 10 10 
10 11 11 11 11 11 11 10 10 10 10 10 10 10 
11 12 12 12 12 12 12 11 11 11 11 11 11 11 10 10 10 10 10 10 
12 13 13 13 13 13 13 12 12 12 12 12 12 12 11 11 11 11 11 11 10 10 
13 14 14 14 14 14 14 13 13 13 13 13 13 13 12 12 12 12 12 12 11 11 
14 15 15 15 15 15 15 14 14 14 14 14 14 14 13 13 13 13 13 13 12 12 
15 16 16 16 16 16 16 15 15 15 15 15 15 15 14 14 14 14 14 14 13 13 
16 17 17 17 17 17 17 16 16 16 16 16 16 16 15 15 15 15 15 15 14 14 
17 18 18 18 18 18 18 17 17 17 17 17 17 17 16 16 16 16 16 16 15 15 
18 19 19 19 19 19 19 18 18 18 18 18 18 18 17 17 17 17 17 17 16 16 
NSSA Education (years)
 
10 11 12 13 14 15 16 17 18 19 20 
10 10 10 10 10 10 
10 11 11 11 11 11 11 10 10 10 10 10 10 10 
11 12 12 12 12 12 12 11 11 11 11 11 11 11 10 10 10 10 10 10 
12 13 13 13 13 13 13 12 12 12 12 12 12 12 11 11 11 11 11 11 10 10 
13 14 14 14 14 14 14 13 13 13 13 13 13 13 12 12 12 12 12 12 11 11 
14 15 15 15 15 15 15 14 14 14 14 14 14 14 13 13 13 13 13 13 12 12 
15 16 16 16 16 16 16 15 15 15 15 15 15 15 14 14 14 14 14 14 13 13 
16 17 17 17 17 17 17 16 16 16 16 16 16 16 15 15 15 15 15 15 14 14 
17 18 18 18 18 18 18 17 17 17 17 17 17 17 16 16 16 16 16 16 15 15 
18 19 19 19 19 19 19 18 18 18 18 18 18 18 17 17 17 17 17 17 16 16 

Note: FCSRT = free and cued selective reminding test.

Table 22.

FCSRT: delayed total recall. Education adjustment applying the following formula: NSSA&E = NSSA − (β × [Education(years) − 12]), where β = 0.26748

NSSA Education (years)
 
10 11 12 13 14 15 16 17 18 19 20 
-1 
10 
11 10 10 10 10 
12 11 11 11 11 10 10 10 10 
10 13 12 12 12 12 11 11 11 11 10 10 10 10 
11 14 13 13 13 13 12 12 12 12 11 11 11 11 10 10 10 
12 15 14 14 14 14 13 13 13 13 12 12 12 12 11 11 11 10 10 10 10 
13 16 15 15 15 15 14 14 14 14 13 13 13 13 12 12 12 11 11 11 11 10 
14 17 16 16 16 16 15 15 15 15 14 14 14 14 13 13 13 12 12 12 12 11 
15 18 17 17 17 17 16 16 16 16 15 15 15 15 14 14 14 13 13 13 13 12 
16 19 18 18 18 18 17 17 17 17 16 16 16 16 15 15 15 14 14 14 14 13 
17 20 19 19 19 19 18 18 18 18 17 17 17 17 16 16 16 15 15 15 15 14 
18 21 20 20 20 20 19 19 19 19 18 18 18 18 17 17 17 16 16 16 16 15 
NSSA Education (years)
 
10 11 12 13 14 15 16 17 18 19 20 
-1 
10 
11 10 10 10 10 
12 11 11 11 11 10 10 10 10 
10 13 12 12 12 12 11 11 11 11 10 10 10 10 
11 14 13 13 13 13 12 12 12 12 11 11 11 11 10 10 10 
12 15 14 14 14 14 13 13 13 13 12 12 12 12 11 11 11 10 10 10 10 
13 16 15 15 15 15 14 14 14 14 13 13 13 13 12 12 12 11 11 11 11 10 
14 17 16 16 16 16 15 15 15 15 14 14 14 14 13 13 13 12 12 12 12 11 
15 18 17 17 17 17 16 16 16 16 15 15 15 15 14 14 14 13 13 13 13 12 
16 19 18 18 18 18 17 17 17 17 16 16 16 16 15 15 15 14 14 14 14 13 
17 20 19 19 19 19 18 18 18 18 17 17 17 17 16 16 16 15 15 15 15 14 
18 21 20 20 20 20 19 19 19 19 18 18 18 18 17 17 17 16 16 16 16 15 

Note: FCSRT = free and cued selective reminding test.

Table 23.

FCSRT: retention index (total delayed recall/Trial 3 total recall). Education adjustment applying the following formula: NSSA&E = NSSA – (β × [Education(years) − 12]), where β = 0.12962

NSSA Education (years)
 
10 11 12 13 14 15 16 17 18 19 20 
10 10 10 10 10 
10 11 11 11 11 11 10 10 10 10 10 10 10 10 
11 12 12 12 12 12 11 11 11 11 11 11 11 11 10 10 10 10 10 10 10 
12 13 13 13 13 13 12 12 12 12 12 12 12 12 11 11 11 11 11 11 11 10 
13 14 14 14 14 14 13 13 13 13 13 13 13 13 12 12 12 12 12 12 12 11 
14 15 15 15 15 15 14 14 14 14 14 14 14 14 13 13 13 13 13 13 13 12 
15 16 16 16 16 16 15 15 15 15 15 15 15 15 14 14 14 14 14 14 14 13 
16 17 17 17 17 17 16 16 16 16 16 16 16 16 15 15 15 15 15 15 15 14 
17 18 18 18 18 18 17 17 17 17 17 17 17 17 16 16 16 16 16 16 16 15 
18 19 19 19 19 19 18 18 18 18 18 18 18 18 17 17 17 17 17 17 17 16 
NSSA Education (years)
 
10 11 12 13 14 15 16 17 18 19 20 
10 10 10 10 10 
10 11 11 11 11 11 10 10 10 10 10 10 10 10 
11 12 12 12 12 12 11 11 11 11 11 11 11 11 10 10 10 10 10 10 10 
12 13 13 13 13 13 12 12 12 12 12 12 12 12 11 11 11 11 11 11 11 10 
13 14 14 14 14 14 13 13 13 13 13 13 13 13 12 12 12 12 12 12 12 11 
14 15 15 15 15 15 14 14 14 14 14 14 14 14 13 13 13 13 13 13 13 12 
15 16 16 16 16 16 15 15 15 15 15 15 15 15 14 14 14 14 14 14 14 13 
16 17 17 17 17 17 16 16 16 16 16 16 16 16 15 15 15 15 15 15 15 14 
17 18 18 18 18 18 17 17 17 17 17 17 17 17 16 16 16 16 16 16 16 15 
18 19 19 19 19 19 18 18 18 18 18 18 18 18 17 17 17 17 17 17 17 16 

Note: FCSRT = free and cued selective reminding test.

Discussion

The purpose of this report was to provide normative comprehensive data for older Spaniards for the ROCF and the FCSRT. Age-adjusted normative data and regression-based adjustments for education are presented.

Rey–Osterrieth Complex Figure

Although age and education affected the score of the ROCF, sex was found to be unrelated in this normal sample. The results observed concerning sex confirm that the differences are minor or nonexistent (Berry et al., 1991; Boone et al., 1993).

Education has a more important role than age on scores (10%–17% vs. 4%–10% of shared variances). Time to complete the task increases with age and is more affected by education (10% vs. 17% of shared variance). This study confirms previous ones (Ardila & Roselli, 1989; Ardila et al., 1989, 1994; Berry et al., 1991; Caffarra et al., 2002; Rosselli & Ardila, 1991) in which scores were affected by education. The differences observed with the study of Machulda and colleagues (2007) were probably due to sample variations. It is important to point out that the study of Machulda and colleagues included subjects with a minimal education of 9 years.

In agreement with previous studies (e.g., Chiulli et al., 1995; Loring et al., 1990), very little difference (0.5–1 point) was observed between immediate- and delayed-recall trials. This fact also confirms that a decline between immediate- and delayed-recall trials should be considered to be of clinical significance.

Free and Cued Selective Reminding Test

As observed by Ivnik and colleagues (1997), the frequency distribution of some FCSRT derived scores was skewed. This fact is psychometrically very important and underscores the need to use cumulative percentile frequencies to assign age-adjusted NEURONORMA scaled score to each FCSRT derived score.

This study confirms that age and education affect the scores of the FCSRT, whereas sex is found to be minor or irrelevant. We also confirm that there is a decline in all measures with advancing age (Campo & Morales, 2004; Larrabee et al., 1988; Sliwinski et al., 1997; Stricks et al., 1998; Wiederholt et al., 1993). Concerning education, there is an obvious discrete effect (up to 11% in total recall). This effect was probably not observed by Ivnik and colleagues (1997), due to the higher education level of the MOANS cohort compared with the NEURONORMA. In fact, Ivnik and colleagues (1997) recognized the need for special caution when using MOANS norms with persons having fewer than 8 years of formal education.

Present norms for the FCSRT are hardly comparable with other studies due to the different populations and versions of the test used by researchers. For example, the MOANS project (Ivnik et al., 1997) included pictures as stimuli, and previous Spanish studies used different words and two letters as cues (Campo & Morales, 2004; Campo et al., 2000, 2003).

General Discussion

As in the MOANS projects, NEURONORMA volunteers did not need to be completely medically healthy to participate (Pedraza et al., 2005). Patients with active, chronic medical, psychiatric, or neurological conditions or with physical disabilities were included if the researcher judged that the condition was correctly controlled or resolved and did not cause cognitive impairment. The same criterion was applied in the case of use of psychoactive medications. This broader definition of normality provided a more accurate representation of the normative population of interest (Pedraza et al., 2005).

In order to use the present normative data adequately, it is important to pay attention to the method of administration, the scoring criteria, and the similarity between the characteristics of the studied subject and the demographic features of the NEURONORMA normative samples.

The education adjustment tables of NSSA (Tables 14–17 for the ROCF and Tables 18–23 for the FCSRT) will help the clinician obtain the expected score considering the number of years of formal education (NSSA&E). In these tables, figures were rounded to an integer and the use of the regression formula described above was avoided. In the case of extreme and unexpected cases, the resulting adjustment may be placed beyond the defined scaled score ranges (e.g., 19 or 1, respectively). In these extreme cases, the final score should be 18 or 2, respectively.

Despite limitations (restricted representation of very elderly participants and the convenience sample of community volunteers), this study reflects the largest normative study to date for neuropsychological performance of Spanish older subjects on the ROCF and the FCSRT.

The normative data presented here were obtained from the same study sample as all other NEURONORMA norms. In addition, the same statistical procedures for data analyses were applied. These co-normed data will allow clinicians to compare scores across all NEURONORMA normed tests and scales. The present data should provide a useful resource for clinical and research studies and may reduce the risk of misdiagnosis of cognitive impairment in normal individuals.

Funding

This study was mainly supported by a grant from the Pfizer Foundation and by the Medical Department of Pfizer, SA, Spain. It was also supported by the Behavioral Neurology Group of the Program of Neuropsychopharmacology of the Institut Municipal d'Investigació Mèdica, Barcelona, Spain. JP-C has received an intensification research grant from the CIBERNED (Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas), Instituto Carlos III (Ministry of Health & Consumer Affairs of Spain).

Conflict of Interest

None declared.

Appendix

Members of the NEURONORMA.ES study team

Steering Committee: JP-C, Hospital del Mar, Barcelona, Spain; RB, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Miguel Aguilar, Hospital Mútua de Terrassa, Terrassa, Spain.

Principal Investigators: JP-C, Hospital de Mar, Barcelona, Spain; RB, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; MA, Hospital Mútua de Terrassa, Terrassa, Spain; JLM, Hospital Clínic, Barcelona, Spain; AR, Hospital Clínico Universitario, Santiago de Compostela, Spain; MSB, Hospital Clínico San Carlos, Madrid, Spain; CA, Hospital Virgen Arrixaca, Murcia, Spain; CM-P, Hospital Virgen Macarena, Sevilla, Spain; AF-G, Hospital Universitario La Paz, Madrid, Spain; MF, Hospital de Cruces, Bilbao, Spain.

Genetics Sub-study: Rafael Oliva, Service of Genetics, Hospital Clínic, Barcelona, Spain.

Neuroimaging Sub-study: Beatriz Gómez-Ansón, Radiology Department and IDIBAPS, Hospital Clínic, Barcelona, Spain. Research Fellows: Gemma Monte, Elena Alayrach, Aitor Sainz, and Claudia Caprile, Fundació Clinic, Hospital Clinic, Barcelona, Spain; Gonzalo Sánchez, Behavioral Neurology Group, Institut Municipal d'Investigació Mèdica, Barcelona, Spain.

Clinicians, Psychologists and Neuropsychologists: NG-F (Coordinator), Peter Böhm, Sonia González, Yolanda Buriel, MQ-A, SQ-U, GSB, Rosa M. Manero, and Gracia Cucurella, Institut Municipal d'Investigació Mèdica. Barcelona, Spain; Eva Ruiz, MS, and Laura Torner, Hospital Clínic. Barcelona, Spain; Dolors Badenes, Laura Casas, Noemí Cerulla, Silvia Ramos, and Loli Cabello, Hospital Mútua de Terrassa, Terrassa, Spain; and Dolores Rodríguez, Clinical Psychology and Psychobiology Department, University of Santiago de Compostela, Spain; María Payno and CV, Hospital Clínico San Carlos. Madrid, Spain; Rafael Carles, Judit Jiménez, and Martirio Antequera, Hospital Virgen Arixaca, Murcia, Spain; Jose Manuel Gata, Pablo Duque, and Laura Jiménez, Hospital Virgen Macarena. Sevilla, Spain; Azucena Sanz and María Dolores Aguilar, Hospital Universitario La Paz, Madrid, Spain; Ana Molano and Maitena Lasa, Hospital de Cruces. Bilbao, Spain.

Data Management and Biometrics: JMS, Francisco Hernández, Irune Quevedo, Anna Salvà, and VA, European Biometrics Institute, Barcelona, Spain.

Administrative Management: Carme Pla (†) and Romina Ribas, Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, and Behavioral Neurology Group, Institut Municipal d'Investigació Mèdica, Barcelona, Spain.

English Edition: Stephanie Lonsdale, Program of Neuropsychopharmacology, Institut Municipal d'Investigació Mèdica, Barcelona, Spain.

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Author notes

Deceased.
The members of the NEURONORMA Study Team are listed in the Appendix.