{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T22:52:37Z","timestamp":1781563957416,"version":"3.54.5"},"reference-count":36,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T00:00:00Z","timestamp":1768348800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Despite digital advances in healthcare, clinical neuropsychology has been slow to adopt automated assessment tools. Automated scoring of the Rey-Osterrieth Complex Figure Test (ROCFT) could enhance efficiency and consistency in evaluating quantitative and qualitative aspects of the figure. However, clinical utility and accuracy compared to traditional scoring methods remain unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate whether digital automated scoring systems provide accuracy, reliability, and clinical utility equal to or superior to traditional clinician-driven scoring of the ROCFT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A rapid review following the PRISMA guidelines was conducted. PubMed and Web of Science were searched from January 1, 2015, to October 12, 2025, and included recent studies that benchmark automated scoring against human raters.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The review identified five articles, three with deep-learning approaches and two that used rule-based algorithms. Together, they analysed more than 41,000 ROCFT drawings with diverse capture methods. Overall, well-designed automated systems can achieve, and in some cases surpass, expert-level performance. The algorithmic approaches demonstrated close agreement with trained raters and reproducible outputs, with discrepancies primarily emerging in atypical drawings. Deep-learning models achieved high concordance with expert scoring when image quality was adequate, and training data were well-labelled. However, performance varied with data quality and distribution of scores.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion and conclusion<\/jats:title>\n                    <jats:p>This review demonstrates that digital automated ROCFT scoring achieves accuracy and reliability compared to traditional clinician ratings, with well-designed systems occasionally surpassing human performance. Expected advances in artificial intelligence and automation could further enhance clinical neuropsychology into the 21st century. However, clinical implementation faces several constraints: heterogeneous training datasets, limited evidence of usefulness across disorders, and lack of independent validation. Automated scoring should thus augment, not replace, clinical judgement. To address these limitations, future research should strive to establish disorder\u2212specific norms, conduct independent validation in real-world clinical settings, and develop human-in-the-loop pipelines that combine automated efficiency with clinical oversight. Responsible implementation will require explicit governance frameworks that regulate data use and sharing, address privacy and \u2018mental data\u2019 concerns. These advances would strengthen the evidence-base and utility for automated ROCFT scoring and support its responsible integration into neuropsychological practice.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpsyt.2025.1746720","type":"journal-article","created":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T06:30:30Z","timestamp":1768372230000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Automated versus human scoring of the Rey-Osterrieth Complex Figure Test: a rapid review"],"prefix":"10.3389","volume":"16","author":[{"given":"Sander Lindholm","family":"Andersen","sequence":"first","affiliation":[{"name":"Division of Psychiatry, Haukeland University Hospital","place":["Bergen, Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Astri J.","family":"Lundervold","sequence":"additional","affiliation":[{"name":"Department of Biological and Medical Psychology, Faculty of Psychology, University of Bergen","place":["Bergen, Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eivind Haga","family":"Ronold","sequence":"additional","affiliation":[{"name":"Department of Biological and Medical Psychology, Faculty of Psychology, University of Bergen","place":["Bergen, Norway"]},{"name":"Department of Neurology, Haukeland University Hospital","place":["Bergen, Norway"]},{"name":"Department of Radiology, Mohn Medical Imaging and Visualization Centre","place":["Bergen, Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,14]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"290","DOI":"10.1093\/arclin\/acae016","article-title":"Digital neuropsychology beyond computerized cognitive assessment: applications of novel digital technologies","volume":"39","author":"Harris","year":"2024","journal-title":"Arch Clin Neuropsychol"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2025.1537368\/full","article-title":"Precision neuropsychology in the area of AI","volume":"16","author":"Lundervold","year":"2025","journal-title":"Front Psychol"},{"key":"B3","first-page":"286","article-title":"L\u2019examen psychologique dans les cas d\u2019enc\u00e9phalopathie traumatique","volume":"28","author":"Rey","year":"1941","journal-title":"Arch Psychol"},{"key":"B4","volume-title":"A Compendium of Neuropsychological Tests: Fundamentals of neuropsychological assessment and test reviews for clinical practice","author":"Sherman","year":"2022"},{"key":"B5","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1037\/pas0000157","article-title":"Evaluating the prevalence and impact of examiner errors on the Wechsler scales of intelligence: a meta-analysis","volume":"28","author":"Styck","year":"2016","journal-title":"Psychol Assess"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1017\/S1355617717001060","article-title":"Neuropsychological assessment: past and future","volume":"23","author":"Casaletto","year":"2017","journal-title":"J Int Neuropsychol Soc"},{"key":"B7","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1017\/S1355617710001396","article-title":"Neuropsychology 3.0: evidence-based science and practice","volume":"17","author":"Bilder","year":"2011","journal-title":"J Int Neuropsychol Soc"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-2667(21)00249-8","article-title":"Estimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050: an analysis for the Global Burden of Disease Study 2019","volume":"7","author":"Nichols","year":"2022","journal-title":"Lancet Public Health"},{"key":"B9","doi-asserted-by":"crossref","DOI":"10.1109\/EURMIC.2000.874519","article-title":"Automated scoring of a neuropsychological test: the Rey Osterrieth complex figure","volume-title":"Proceedings of the 26th euromicro conference, EUROMICRO 2000 \u2013 informatics: inventing the future","author":"Canham","year":"2000"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1080\/13854046.2025.2552289","article-title":"Feasibility of AI-powered assessment scoring: can large language models replace human raters","volume":"10","author":"Jaworski","year":"2025","journal-title":"Clin Neuropsychol"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1037\/neu0000752","article-title":"Validation of an automated scoring program for a digital complex figure copy task within healthy ageing and stroke","volume":"35","author":"Webb","year":"2021","journal-title":"Neuropsychology"},{"key":"B12","doi-asserted-by":"publisher","first-page":"e96017","DOI":"10.7554\/eLife.96017","article-title":"A deep learning approach for automated scoring of the Rey\u2013Osterrieth complex figure","volume":"13","author":"Langer","year":"2024","journal-title":"eLife"},{"key":"B13","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1186\/s13195-023-01283-w","article-title":"Automating Rey Complex Figure Test scoring using a deep learning-based approach: a potential large-scale screening tool for cognitive decline","volume":"15","author":"Park","year":"2023","journal-title":"Alzheimers Res Ther"},{"key":"B14","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1038\/s41591-018-0300-7","article-title":"High-performance medicine: the convergence of human and artificial intelligence","volume":"25","author":"Topol","year":"2019","journal-title":"Nat Med"},{"key":"B15","doi-asserted-by":"publisher","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1016\/j.heliyon.2024.e39883","article-title":"A benchmark for Rey-Osterrieth complex figure test automatic scoring","volume":"10","author":"Guerrero-Mart\u00edn","year":"2024","journal-title":"Heliyon"},{"key":"B17","doi-asserted-by":"crossref","DOI":"10.1007\/978-3-030-62056-1_31","article-title":"Administrating cognitive tests through HRI: an application of an automatic scoring system through visual analysis","volume-title":"Social robotics","author":"Sangiovanni","year":"2020"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.3389\/frai.2022.787179","article-title":"Modeling users\u2019 cognitive performance using digital pen features","volume":"5","author":"Prange","year":"2022","journal-title":"Front Artif Intell"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.3758\/s13428-021-01746-8","article-title":"The use of a tablet-based app for investigating the influence of autistic and ADHD traits on performance in a complex drawing task","volume":"54","author":"Savickaite","year":"2022","journal-title":"Behav Res Methods"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2022.844341","article-title":"Eye-tracking metrics for figure-copying processes in early- vs. late-onset Alzheimer\u2019s disease","volume":"13","author":"Kim","year":"2022","journal-title":"Front Neurol"},{"key":"B21","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1186\/s13195-021-00821-8","article-title":"Use of the Clock Drawing Test and the Rey\u2013Osterrieth Complex Figure Test-copy with convolutional neural networks to predict cognitive impairment","volume":"13","author":"Youn","year":"2021","journal-title":"Alzheimers Res Ther"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.12779\/dnd.2021.20.4.70","article-title":"Comparison of RCF scoring system to clinical decision for the Rey Complex Figure using machine-learning algorithm","volume":"20","author":"Simfukwe","year":"2021","journal-title":"Dement Neurocogn Disord"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1080\/23279095.2022.2164198","article-title":"A machine-learning algorithm for predicting brain age using Rey-Osterrieth complex figure tests of healthy participants","volume":"32","author":"Simfukwe","year":"2025","journal-title":"Appl Neuropsychol Adult"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.2196\/31106","article-title":"A digital screening system for Alzheimer disease based on a neuropsychological test and a convolutional neural network: system development and validation","volume":"10","author":"Cheah","year":"2022","journal-title":"JMIR Med Inform"},{"key":"B25","doi-asserted-by":"publisher","first-page":"119226","DOI":"10.1016\/j.eswa.2022.119226","article-title":"A decision support system for Rey\u2013Osterrieth complex figure evaluation","volume":"213","author":"Di Febbo","year":"2023","journal-title":"Expert Syst Appl"},{"key":"B26","doi-asserted-by":"publisher","first-page":"14895","DOI":"10.1038\/s41598-021-94247-9","article-title":"Automated scoring for a tablet-based Rey Figure copy task differentiates constructional, organisational, and motor abilities","volume":"11","author":"Petilli","year":"2021","journal-title":"Sci Rep"},{"key":"B27","doi-asserted-by":"publisher","first-page":"16787","DOI":"10.1038\/s41598-024-67076-9","article-title":"Tablet-based Rey\u2013Osterrieth Complex Figure copy task: a novel application to assess spatial, procedural, and kinematic aspects of drawing in children","volume":"14","author":"Frigeni","year":"2024","journal-title":"Sci Rep"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1002\/mdc3.12552","article-title":"Handwriting analysis in Parkinson\u2019s disease: current status and future directions","volume":"4","author":"Thomas","year":"2017","journal-title":"Mov Disord Clin Pract"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1016\/j.clsr.2017.03.012","article-title":"Treatment of biometrically processed personal data: problem of uniform practice under EU personal data protection law","volume":"33","author":"\u0160titilis","year":"2017","journal-title":"Comput Law Secur Rev"},{"key":"B30","volume-title":"The protection of mental privacy in the area of neuroscience: societal, legal and ethical challenges","year":"2024"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.2311878121","article-title":"Explaining neural scaling laws","volume":"121","author":"Bahri","year":"2024","journal-title":"Proc Natl Acad Sci U S A"},{"key":"B32","doi-asserted-by":"publisher","first-page":"101085","DOI":"10.1016\/j.ecoinf.2020.101085","article-title":"How many images do I need?\u201d Understanding how sample size per class affects deep learning model performance metrics for balanced designs in autonomous wildlife monitoring","volume":"57","author":"Shahinfar","year":"2020","journal-title":"Ecol Inform"},{"key":"B33","first-page":"3","article-title":"Multi-stage fine-tuning deep learning models improves automatic assessment of the Rey\u2013Osterrieth Complex Figure Test","author":"Schuster","year":"2023"},{"key":"B34","doi-asserted-by":"publisher","first-page":"e1312","DOI":"10.1002\/widm.1312","article-title":"Causability and explainability of artificial intelligence in medicine","volume":"9","author":"Holzinger","year":"2019","journal-title":"Wiley Interdiscip Rev Data Min Knowl Discov"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmpb.2018.01.022","article-title":"Visuospatial working memory assessment using a digital tablet in adolescents with attention deficit hyperactivity disorder","volume":"157","author":"Hyun","year":"2018","journal-title":"Comput Methods Programs Biomed"},{"key":"B36","doi-asserted-by":"publisher","first-page":"896","DOI":"10.1016\/S2468-1253(25)00133-5","article-title":"Endoscopist deskilling risk after exposure to artificial intelligence in colonoscopy: a multicentre, observational study","volume":"10","author":"Budzy\u0144","year":"2025","journal-title":"Lancet Gastroenterol Hepatol"}],"container-title":["Frontiers in Psychiatry"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2025.1746720\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T06:30:33Z","timestamp":1768372233000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2025.1746720\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,14]]},"references-count":36,"alternative-id":["10.3389\/fpsyt.2025.1746720"],"URL":"https:\/\/doi.org\/10.3389\/fpsyt.2025.1746720","relation":{},"ISSN":["1664-0640"],"issn-type":[{"value":"1664-0640","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,14]]},"article-number":"1746720"}}