Rey Tangled Line Test: A measure of processing speed in TBI.

Objective: Neuropsychological assessment plays a key role in characterizing and detecting cognitive impairment after traumatic brain injury (TBI). The Rey Tangled Line Test (RTLT), an understudied neuropsychological assessment thought to be capable of detecting visual processing deficits, was examined to determine which cognitive abilities may contribute to performance on the test in participants with a history of TBI. Method: One-hundred participants with a history of mild to severe TBI were administered a battery of neuropsychological tests assessing attention, executive functioning, memory, visual construction, motor functioning, and processing speed between 30 days and 5 years postinjury. An exploratory principal components analysis (PCA) was performed to determine which cognitive tests the RTLT was most highly associated with. Results: No difference in RTLT latency was present between mild and moderate/severe TBI. The PCA resulted in 5 factors. RTLT latency had a significant primary factor loading on the "processing speed" factor, and a secondary loading on the "motor" factor. Forty-two percent of participants had an impaired latency score. Conclusions: RTLT latency appears to measure processing speed, and likely aspects of motor functioning, in our sample. The RTLT may be useful as a rapid assessment in individuals with a history of TBI to detect cognitive deficit before initiating further cognitive testing or rehabilitation efforts. Impact and Implications The current study is one of the first to investigate which cognitive processes contribute to performance on the Rey Tangled Line Test (RTLT) in adults with traumatic brain injury. Results of the study demonstrate that RTLT latency may measure processing speed in all injury severities, and poor performance may be indicative of deficits on other cognitive tests. From these results, it appears the test may be used as a rapid, standalone assessment of cognitive functioning, with poor performance on the test indicating further testing may be necessary to determine where deficits may be present. Providers are encouraged to utilize the RTLT as a screening tool or within a larger neuropsychological assessment battery to evaluate cognitive functioning throughout recovery and rehabilitation.