Clinical Implication of ■Closing-in■ in Patients with Dementia

J Korean Neurol Assoc > Volume 20(6); 2002 > Article

Journal of the Korean Neurological Association 2002;20(6): 618-623.

치매 환자에서 C l o s I n g -i n 현상의 임상적 의의

곽용태 , 한일우 ·김대훈

용인 효자병원 신경과

Clinical Implication of ■Closing-in■ in Patients with Dementia

Yong Tae Kwak, M.D.

Department of Neurology, Hyoja Geriatric Hospital

Abstract

"Background : Closing-in phenomenon is defined as a tendency to close in the model while copying tasks. This unique phenomenon is one of the constructional apraxia often observed in dementia, especially in Alzheimer s disease (AD). The aim of this study is to investigate the usefulness of closing-in in the differential diagnosis of AD and sub-cortical vascular dementia, and to clarify what the associated factors to this phenomenon are. Methods : Based on copy-ing data of alternating square and triangle in younger control, we operationally defined closing-in . Closing-in in copied figure was classified into three types: overlap, adherent and near types. With this criteria, we analyzed the inci-dence of closing-in in younger control (N=30), elderly control (N=22), AD (N=64), and subcortical vascular dementia (N=31). Results : Compared with subcortical vascular dementia, AD patients had a significantly higher occurrence of closing-in phenomenon. Among closing-in type, overlap and adherent type was exclusively occurred in AD. A dis-criminant analysis, calculated by combining results obtained by AD, showed that symptom onsets with age. Korean Mini-Mental State Examination, Clinical Dementia Rating Scale, Rey-Osterrieth Complex Figure Test were significant-ly correlated with closing-in . In EEG mapping, though AD patients with apraxia had significantly lower alpha spectra power in all fields, there is no statistical difference between patients with closing-in and those without. Conclusions : This study suggests that closing-in phenomenon was a phase- and AD-specific useful tool for differential diagnosis with subcortical vascular dementia. Moreover, overlap and adherent subtypes of closing-in was highly specific in AD, so further clinical study may be promising."