Constructional ability in two- versus three-dimensions: Relationship to spatial vision and locus of cerebrovascular lesion

IntroductionClinical evaluation and research on constructional ability have come to rely almost exclusively on two-dimensional tasks such as graphomotor copying or mosaic Block Design (BD). A return to the inclusion of a third dimension in constructional tests may increase the spatial demands of the task, and improve understanding of the relationship between visual perception and constructional ability in patients with cerebral disease.MethodSubjects were patients (n = 43) with focal or multifocal cerebrovascular lesions as determined by CT or MRI. Tests of temporal orientation, verbal intelligence, language, object vision and spatial vision were used to determine which factors were predictive of performance on two-dimensional BD and Three-Dimensional Block Construction (3-DBC) tasks.ResultsStepwise linear regression indicated that spatial vision predicted BD performance, and was even more strongly predictive of 3-DBC. Other cognitive domains did not account for significant additional variance in performance of either BD or 3-DBC. Bilateral cerebral lesions produced more severe deficits on BD than did unilateral cerebral lesions. The presence of a posterior cerebral lesion was the significant factor in producing deficits in 3-DBC.ConclusionsThe spatial aspect of a constructional task is enhanced when the patient is required to assemble an object in all three dimensions of space. In the typical patient with cerebrovascular disease, constructional deficits typically occur in the context of a wider syndrome of deficits in spatial vision.