The Japanese journal of neuropsychology

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ArticleTitle	Closing-in phenomenon in Alzheimer's disease and dementia with Lewy bodies (DLB): An analysis for each subtype in each disease
Language	J
AuthorList	Mai Sanpei¹⁾, Erina Yamazaki²⁾, Takuya Sato³⁾, Atsushi Sato³⁾⁴⁾, Toru Imamura¹⁾⁴⁾⁵⁾
Affiliation	¹⁾Department of Speech Therapy, School of Health Sciences, Niigata University of Health and Welfare ²⁾Department of Rehabilitation, Toyama Rosai Hospital ³⁾Division of Speech Therapy, Department of Rehabilitation, Niigata Rehabilitation Hospital ⁴⁾Division of Speech, Hearing and Cognitive Sciences, Graduate School of Health Sciences, Niigata University of Health and Welfare ⁵⁾Department of Neurology, Niigata Rehabilitation Hospital
Publication	Japanese Journal of Neuropsychology: 26 (3), 231-241, 2010
Received	May 29, 2009
Accepted	Jan 22, 2010
Abstract	We examined closing-in phenomenon in 316 patients with Alzheimer's disease (AD) and 54 patients with dementia with Lewy bodies (DLB). For each patient, the adherent or overlapping type and the involving type of closing-in phenomenon were assessed in the construction tasks in the MMSE and the Alzheimer's Disease Assessment Scale (ADAS), and in the copy task of the Rey's complex figure. We determined the relative risk of demographic, disease and cognitive factors associated with each type of closing-in phenomenon in the AD and the DLB patients, using the repeated analysis of logistic regression. The statistical model contained the presence or absence of each type closing-in phenomenon as the dependent variable, and the factors (age at examination, educational attainment, disease duration, digit span, the score of MMSE, and the scores of the word recall, following commands, naming, ideational praxis, orientation and word recognition subtests in ADAS) as the independent variables. The worse subscore of the ideational praxis in ADAS was associated with the adherent or overlapping type of closing-in phenomenon both in the AD and the DLB patients. The longer disease duration was associated with the involving type of closing-in phenomenon in the DLB patients. While, the shorter disease duration and the worse subscore of the naming in ADAS was associated with the involving type in the AD patients. These results suggested that executive dysfunction underlies the adherent or overlapping type of closing-in phenomenon in AD and DLB. On the other hand, the involving type may be associated with visuocognitive dysfunction. In DLB, longer disease duration may result in worse degree of visuocognitive dysfunction sufficient to manifest the involving type of closing-in phenomenon. In AD, patients of 'visual variant' and 'posterior cortical atrophy' types may showed the involving type of closing-in phenomenon and naming difficulties in the early stage of the disease.
Keywords	closing-in phenomenon, Alzheimer's disease, dementia with Lewy bodies, visuocognitive dysfunction, executive dysfunction