The Japanese journal of neuropsychology

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ArticleTitle	Involving type of closing-in phenomenon in Alzheimer's disease (AD) and dementia with Lewy bodies (DLB): A study for sensitivity and specificity to differentiate DLB in earliest stage from AD
Language	J
AuthorList	Shoko Nakajima¹⁾, Hiroyuki Abe²⁾, Takuya Sato³⁾, Atsushi Sato³⁾ and Toru Imamura¹⁾⁴⁾
Affiliation	¹⁾Department of Speech Therapy, School of Health Sciences, Niigata University of Health and Welfare ²⁾Division of Speech Therapy, Numata Neurosurgery and Heart Disease Hospital ³⁾Division of Speech Therapy, Department of Rehabilitation, Niigata Rehabilitation Hospital ⁴⁾Department of Neurology, Niigata Rehabilitation Hospital
Publication	Japanese Journal of Neuropsychology: 30 (2), 150-157, 2014
Received	Oct 25, 2013
Accepted	Dec 26, 2013
Abstract	The involving type of closing-in phenomenon in constructional tasks was assessed in 543 consecutive patients with Alzheimer's disease (AD; 450 patients) and dementia with Lewy bodies (DLB; 93 patients) at their first visit. In this study, the diagnosis of DLB was based on the clinical criteria for possible DLB, and patients with one or more of the core clinical features (visual hallucination, cognitive fluctuation and Parkinsonism) were excluded form AD. We examined the sensitivity and specificity of the involving type of closing-in phenomenon for the detection of DLB, that is, (1) the sensitivity and the specificity for DLB detection at the first visit, and (2) the sensitivity and the specificity for the prediction of diagnostic conversion from AD to DLB in the patients who had a diagnosis of AD at the first visit and met the possible DLB criteria after the 2-year follow-up (patients with diagnosis converted from AD to DLB) and the patients with a diagnosis of AD both at the first visit and at the time two years after (AD patients without conversion of diagnosis). At the first visit, 48 patients (AD, 33: DLB, 15) showed the involving type of closing-in phenomenon. The sensitivity and the specificity for DLB detection were 16.1% (15/93) and 92.6% (417/450), respectively. We conducted a two-year follow-up for 146 patients who had a diagnosis of AD at the first visit. The involving type of closing-in phenomenon at the first visit was detected in 7 of the 146 patients. Two years after the first visit, 19 of the 146 patients met the possible DLB criteria and the remaining 127 patients met the AD criteria. In the 7 patients with the involving type of closing-in phenomenon at the first visit, 3 patients were those with diagnosis converted from AD to DLB and 4 patients were those without conversion of diagnosis. The sensitivity and the specificity for the prediction of diagnostic conversion from AD to DLB were 15.7% (3/19) and 96.8% (123/127), respectively. The sensitivity of the involving type of closing-in phenomenon for the diagnosis of DLB had similar values of approximately 16% both in patients who were diagnosed with DLB at the first visit and in patients with diagnosis converted from AD to DLB two years after the first visit. The involving type of closing-in phenomenon is considered to be present in the earliest stage of DLB, in which the core clinical features do not appear yet. The involving type of closing-in phenomenon may be a positive marker for detecting earliest-stage DLB, though the absence of it dose not necessarily deny the diagnosis of DLB.
Keywords	closing-in phenomenon, Alzheimer's disease, dementia with Lewy bodies, visuocognitive disturbance, clinical diagnosis