Natascia De Lucia

Relationships between Environmental Dependency and Closing-in in Patients with Fronto-temporal Dementia.

Environmental dependency (ED) phenomena, including utilization behavior and imitation behavior, are clinical manifestations typically observed in patients with the behavioral variant of fronto-temporal dementia (bvFTD), who may also show the closing-in (CI) phenomenon. Here, we explored the neuropsychological correlates of ED and CI in bvFTD, and the association of ED with CI to clarify the mechanisms underlying these clinical manifestations. Thirty-one bvFTD patients underwent a wide cognitive assessment in addition to special tasks to detect occurrence of CI and ED phenomena. Both ED and CI phenomena were present in more than half of the sample. Logistic regression analyses revealed that both ED and CI phenomena were significantly associated with poor scores on frontal neuropsychological tests. Although ED and CI often co-occurred, 3/12 patients with CI did not show ED, and 5/18 patients with ED did not show CI. A logistic regression model showed that the presence of ED was not significantly associated to CI. CI and ED are associated to progressive derangement of frontal functions in bvFTD. However, specific frontal dysfunctions might explain the occurrence of either phenomenon in isolation.

The genesis of closing-in in Alzheimer disease and vascular dementia: A comparative clinical and experimental study.

OBJECTIVE Closing-in (CI) in visuo-constructional tasks occurs when a drawing is reproduced close to or superimposed on the original model. CI has been often observed in Alzheimer disease (AD) patients and only rarely investigated in patients with vascular dementia (VD). Recent studies suggested that CI in AD patients represents a default behavior released by frontal-executive impairments, but the cognitive mechanisms behind this phenomenon in VD patients have not been clarified. We aimed to ascertain whether the same mechanisms could determine CI in VD and in AD patients. For this purpose we explored whether CI is related to frontal-executive or visuospatial impairments in a prospective sample of AD and VD patients, and investigated whether CI can be induced by a secondary task in patients with either disease. METHOD Sixty-three VD patients and 70 AD patients underwent a neuropsychological assessment of frontal-executive and visuospatial skills, and a copying drawings task for CI. Moreover, VD and AD patients without CI also performed a drawing copying task combined with a simple or a demanding verbal task. RESULTS In both VD and AD patients CI was related to frontal-executive impairments, with more severe forms of CI related to greater frontal-executive defects. In AD patients the tendency to deviate toward a salient model was significantly enhanced by reduction of cognitive resources, whereas VD could compensate for this tendency. CONCLUSIONS CI is related to the tendency to deviate toward a salient model and can be released by frontal-executive impairments in demented patients, independently from clinical diagnosis.

The closing-in phenomenon in Parkinson's disease

INTRODUCTION Closing-in (CI) is a peculiar phenomenon consisting in the tendency to copy drawings close to or superimposed on a model. Recent findings showed that CI can be associated with frontal/executive dysfunctions, likely determining a failure in high-level monitoring of attention-action circuits. CI has been often observed in demented patients, but scarce data are available about CI in patients with Parkinsons disease (PD). In the present study, we detected occurrence of CI and investigated the cognitive processes associated to this phenomenon in a large sample of non-demented PD patients. METHODS We retrospectively analysed graphic reproductions in a copying task of 100 non-demented PD patients who had also completed cognitive, behavioural, and motor screening assessment. RESULTS CI phenomenon occurred in 50/100 non-demented PD patients (50%; 118/700 drawings). Among these patients, 46/50 patients copied drawings close to the model (near-CI), 2/50 patients superimposed their copy directly on the model (adherent-CI), whereas 2/50 patients showed both near-and adherent-CI. MANOVA showed that non-demented PD patients with CI showed more severe impairment on frontal/executive functions and visuo-constructional abilities than non-demented PD patients without CI. However, the logistic regression model revealed that occurrence of CI was significantly associated to lower scores on frontal/executive tasks only. CONCLUSION CI can be found in a large proportion of non-demented PD patients, and it is related to frontal monitoring defects that could hamper inhibition of action and attention toward a model.

Closing-in in Parkinson's disease individuals with dementia: An experimental study

Introduction: The tendency to reproduce figures close to or superimposed on the model in copying tasks, the so-called Closing-in (CI) phenomenon, has been rarely reported in individuals affected by Parkinson’s disease and associated dementia (PD-D). We aimed to comprehend the genesis of CI in PD-D individuals by assessing whether reduction of attention/executive resources can increase the tendency to deviate toward the model. Method: Thirty PD-D individuals underwent a neuropsychological evaluation exploring visuo-spatial, visuo-constructional, executive and memory abilities. An experimental copying task was employed in single and in two dual task conditions to assess whether a (verbal) cognitive load can increase CI in these individuals, compared with a matched sample of healthy adults. Results: CI occurred in 19/30 (63.3%) PD-D individuals: 4 of them produced copies close to the model (near-CI), whereas 15 individuals also superimposed their copies on the model (adherent-CI) besides showing near-CI. Presence of CI in PD-D individuals was significantly correlated with executive dysfunction but not with general cognitive impairment. In the experimental copying task the tendency to deviate toward the model was strongly correlated with executive dysfunction, and significantly increased when PD-D individuals were engaged in dual-task compared with single task conditions. Some individuals attempted to counteract CI, but this trend significantly decreased in dual-task compared with the single task conditions. In healthy adults the drift toward the model was significantly smaller than in PD-D individuals; in dual-task conditions healthy adults only showed a significant decrease in their ability to compensate for this drift. Conclusions: In PD-D individuals the tendency to deviate toward a salient model is strongly enhanced by a concurrent cognitive load. Such preliminary findings would suggest a relationship between reduction of executive attentional resources and the genesis of CI in PD-D individuals.

Cognitive Predictors of Copying and Drawing From Memory of the Rey-Osterrieth Complex Figure in 7- to 10-Year-Old Children

Cognitive models of drawing are mainly based on assessment of copying performance of adults, whereas only a few studies have verified these models in young children. Moreover, developmental investigations have only rarely performed a systematic examination of the contribution of perceptual and representational visuo-spatial processes to copying and drawing from memory. In this study we investigated the role of visual perception and mental representation in both copying and drawing from memory skills in a sample of 227 typically developing children (53% females) aged 7–10 years. Participants underwent a neuropsychological assessment and the Rey-Osterrieth Complex Figure (ROCF). The fit and invariance of the predictive model considering visuo-spatial abilities, working memory, and executive functions were tested by means of hierarchical regressions and path analysis. Results showed that, in a gender invariant way, visual perception abilities and spatial mental representation had a direct effect on copying performance, whereas copying performance was the only specific predictor for drawing from memory. These effects were independent from age and socioeconomic status, and showed that cognitive models of drawing built up for adults could be considered for predicting copying and drawing from memory in children.

Closing-in is related to Apathy in Alzheimer's Disease Patients

BACKGROUND Apathy and depression are behavioral manifestations that may occur often in Alzheimers disease (AD) patients. AD patients may also show Closing-in (CI) phenomenon, in graphic copying tasks. Recent evidence would suggest that apathetic symptoms are related to frontal dysfunctions in AD patients, whereas the cognitive bases of depressive symptoms in AD are still unclear. Recent studies demonstrated that frontal dysfunctions are also involved in the genesis of CI in AD patients. OBJECTIVE Since frontal dysfunctions are thought to be more strongly related to apathetic than depressive symptoms, here we tested the hypothesis that CI is significantly associated with apathy in AD patients. METHODS Forty-four AD patients were enrolled for this study. All patients completed a neuropsychological evaluation of visuo-spatial, frontal/executive, visuo-constructional, and memory skills. Moreover, graphic copying tasks were employed to detect CI, and behavioral scales to assess apathetic and depressive symptoms. RESULTS CI and apathetic and depressed symptoms occurred in more than half of the present AD sample, but regression models revealed that the number of CI was significantly related to apathy only. The number of CI was also significantly correlated with severity of apathetic but not of depressive symptoms. CONCLUSION The present study demonstrated that CI and apathy are correlated with each other in mild to moderate AD, likely because they share common pathogenic mechanisms related to frontal/executive dysfunctions.

Persistent Left Unilateral Mirror Writing: A Neuropsychological Case Study.

Mirror writing (MW) is a rare disorder in which a script runs in direction opposite to normal and individual letters are reversed. The disorder generally occurs after left-hemisphere lesions, is transient and is observed on the left hand, whereas usually motor impairments prevent assessment of direction of right handwriting. We describe a left-handed patient with complete left hand mirror writing, still evident 2 years after a hemorrhagic stroke in left nucleo-capsular region. Since the patient could write with his right hand he underwent several writing tasks with either hand, and a thorough assessment to clarify the nature of MW. MW was evident in writing to dictation with left hand only, both in right and left hemispace, but the patient could modify his behavior when a verbal instruction was provided. No mirror errors were found in reading words, in copying geometric figures and in spatial orientation tasks. MW in our patient could be accounted for by a failure in automatic transformation of grapho-motor programs to write with the left hand. A lack of concern (a sort of anosodiaphoria) and a poor cognitive flexibility could contribute to long-term persistence of MW.

Mirror man: A case of skilled deliberate mirror writing

Mirror writing is a striking behaviour that is common in children and can reemerge in adults following brain damage. Skilled deliberate mirror writing has also been reported, but only anecdotally. We provide the first quantitative study of skilled deliberate mirror writing. K.B. can write forward or backward, vertically upright or inverted, with the hands acting alone or simultaneously. K.B. is predominantly left handed, but writes habitually with his right hand. Of his writing formats, his left hand mirror writing is by far the most similar in style to his normal handwriting. When writing bimanually, he performs better when his two hands make mirror-symmetrical movements to write opposite scripts than if they move in the same direction to write similar scripts. He has no special facility for reading mirrored text. These features are consistent with prior anecdotal cases and support a motor basis for K.B.s ability, according to which his skilled mirror writing results from the left hand execution of a low-level motor program for a right hand abductive writing action. Our methods offer a novel framework for investigating the sharing of motor representations across effectors.

The Genesis of Graphic Perseverations in Alzheimer’s Disease and Vascular Dementia

Objective: Perseveration is the involuntary production of iterative responses. This study explored graphic perseverative errors in Alzheimer’s disease and vascular dementia, to comprehend the neuropsychological correlates of this behavior. Method: We performed a retrospective analysis of graphic productions in 114 individuals with clinical diagnosis of Alzheimer’s disease and in 63 individuals with clinical diagnosis of vascular dementia, who completed frontal-executive, visuo-spatial, visuo-constructional, and verbal memory tests. For assessing perseverative behavior, we considered recurrent perseverations (inappropriate re-drawing of a figure drawn in a previous trial) and continuous perseverations (inappropriate replication of the same figure or of its element within one trial) produced in a standard copying task. Results: Two or more graphic perseverative errors occurred in 66/114 individuals with Alzheimer’s disease (57.9%) and in 31/63 individuals with vascular dementia (49.2%). Participants with moderate-to-severe dementia produced a significantly higher number of perseverations than individuals with mild dementia. Logistic regression revealed a significant relationship of graphic perseverations with frontal and visuo-constructive impairments, in both Alzheimer’s disease and vascular dementia. Conclusions: Graphic perseverations are frequent in both Alzheimer’s disease and vascular dementia. Frontal-executive defects can hamper inhibition of iterative graphic productions. Identification of graphic perseverations can be useful for detection and monitoring of frontal-executive impairments throughout the disease course in individuals with dementia.

Mental simulation of drawing actions enhances delayed recall of a complex figure

Motor simulation implies that the same motor representations involved in action execution are re-enacted during observation or imagery of actions. Neurofunctional data suggested that observation of letters or abstract paintings can elicit simulation of writing or drawing gestures. We performed four behavioural experiments on right-handed healthy participants to test whether observation of a static and complex geometrical figure implies re-enactment of drawing actions. In Experiment 1, participants had to observe the stimulus without explicit instruction (observation-only condition), while performing irrelevant finger tapping (motor dual task), or while articulating irrelevant verbal material (verbal dual task). Delayed drawing of the stimulus was less accurate in the motor dual-task (interfering with simulation of hand actions) than in verbal dual-task and observation-only conditions. In Experiment 2, delayed drawing in the observation only was as accurate as when participants encoded the stimulus by copying it; in both conditions, accuracy was higher than when participants were instructed to observe the stimulus to recall it later verbally (observe to recall), thus being discouraged from engaging motor simulation. In Experiment 3, delayed drawing was as accurate in the observation-only condition as when participants imagined copying the stimulus; accuracy in both conditions was higher than in the observe-to-recall condition. In Experiment 4, in the observe-only condition participants who observed the stimulus with their right arm hidden behind their back were significantly less accurate than participants who had their left arm hidden. These findings converge in suggesting that mere observation of a geometrical stimulus can activate motor simulation and re-enactment of drawing actions.