Dement Neurocogn Disord.  2015 Mar;14(1):17-23. 10.12779/dnd.2015.14.1.17.

Anatomical Correlates of the "Closing-In" Phenomenon

• Kwon SY
• Lee ES
• Hong YJ
• Lim SC
• Ahn KJ
• Yoon B
• Shim Y
• Yang DW

• KMID: 2443039
• DOI: http://doi.org/10.12779/dnd.2015.14.1.17

Abstract

BACKGROUND AND PURPOSE
The "closing-in" phenomenon refers to the tendency to copy near or overlap a model while performing figure-copying tasks. The mechanisms underlying the closing-in phenomenon have not been fully elucidated, and previous studies only investigated the mechanisms through neuropsychological tests. We investigated the neuroanatomical correlates of the closing-in phenomenon using voxel-based morphometry (VBM).
METHODS
Thirty-eight patients diagnosed with probable Alzheimer's disease (AD) and 21 normal controls were included. All subjects underwent neuropsychological testing to diagnose dementia and magnetization prepared rapid acquisition gradient echo brain magnetic resonance imaging for the voxel-based statistical analysis. The subjects were asked to copy the modified Luria's alternating squares and triangles to quantify the closing-in phenomenon. We applied SPM8 for the VBM analysis to detect gray matter loss associated with the closing-in phenomenon.
RESULTS
The patients with probable AD showed a higher closing-in score than that of the normal control subjects (p<0.0001). The VBM analysis revealed more parietal and temporal atrophy in the patients with AD than that in the normal control group. Moreover, atrophy of the orbito-frontal area was associated with the closing-in phenomenon.
CONCLUSIONS
The closing-in phenomenon is dysfunction while performing figure-copying tasks and is more common in patients with AD. The analysis of the orbito-frontal area, which is associated with inhibiting primitive reflexes, revealed that the closing-in phenomenon is an imitation behavior commonly observed in patients with frontal lobe damage.

Keyword

closing-in phenomenon; voxel-based morphometry analysis; orbitofrontal; Alzheimer's disease

MeSH Terms

Alzheimer Disease
Atrophy
Brain
Dementia
Frontal Lobe
Humans
Magnetic Resonance Imaging
Neuropsychological Tests
Rabeprazole
Reflex

Figure

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  Fig. 1 Modified Luria's alternating squares and triangles.

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  Fig. 2 Percent distribution of the closing-in scores for patients with Alzheimer's disease (AD) and the normal controls

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  Fig. 3 Results of voxel-based morphometry t-test analysis comparing patterns of gray matter loss in the group of 38 patients with Alzheimer's disease (AD) with that of 21 healthy control subjects. Voxels showing significantly reduced gray matter volume in the patients with AD compared with the control group are indicated in red on a three-dimensional brain image (uncorrected p<0.05, left), in the gray scale on a glass-brain brain image (top right), and a template image with the color bar representing the t-statistic (corrected p<0.05, bottom right).

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  Fig. 4 Results of the voxel-based morphometry multiple regression analysis comparing patterns of gray matter loss associated with the closing-in phenomenon in 38 patients with Alzheimer's disease and 21 normal control subjects. Voxels show significantly reduced gray matter volume in the orbito-frontal areas in both groups (age and sex as covariates).

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