Closing-in Behavior and Parietal Lobe Deficits: Three Single Cases Exhibiting Different Manifestations of the Same Behavior

Abstract

Closing-in behavior (CIB) is observed in copying tasks (graphic or gestural) when the copy is performed near or on the top of the model. This symptom has been classically considered to be a manifestation of constructional apraxia and is often associated with a visuospatial impairment. More recent work emphasizes the attentional and/or executive nature of the behavior and its association with frontal lobe dysfunction. We describe three patients in whom CIB was associated with posterior parietal deficits of different etiologies (stroke in Patient 1 and dementia in Patients 2 and 3). In copying figures, Patient 1 produced the shape with high accuracy but the rendering overlapped the model, while for Patients 2 and 3 the copies were distorted but overlapping or in close proximity to the target. In gesture imitation, Patient 2 performed the gestures toward the examiner’s space, while Patient 1 showed a peculiar form of CIB: when he was asked to place the ipsilesional arm in a position that mirrored the contralesional hand, Patient 1 moved his hand toward his contralesional hand. Patient 3 did not present gestural CIB. While CIB in Patient 1 was associated with selective deficits in executive functions and attention, additional visuospatial deficits were observed in Patients 2 and 3. The latter two patients showed a general visuoconstructional deficit. These case studies support a primary attentional account of CIB but also suggest that visuoconstructional impairments may contribute to the emergence of CIB, in some subjects. This evidence argues for different types of CIB with different cognitive and neural underpinnings. Furthermore, the data support the hypothesis of a differential involvement of fronto-parietal network in CIB.

Forensic neuropsychopathological analysis on altered brain structures in combat veterans: A systematic review

“…It is responsible for integrating information into various modes related to sensory perception. Impairment or damage to the parietal lobe can cause sensory dysfunction (Ambron et al, 2018). The occipital lobe interprets eye information and is responsible for different visual functions.…”

Eye-Tracking Metrics for Figure-Copying Processes in Early- vs. Late-Onset Alzheimer's Disease

“…Previous studies also employed the decomposition of copying processes into input (visuoperception) and output components that were labeled under different names such as visuoconstruction or graphic production ( 10 , 11 ). Other studies highlighted aspects of working memory when drawing complex figures ( 13 , 14 ). For instance, the closing-in phenomenon, a common behavior seen in patients with AD, might be a typical example that can be explained by a working memory hypothesis ( 42 , 43 ).…”

“…Then, we added another component (the third component), which is when individuals are holding the information of the sample figure on the visuospatial sketchpad ( 12 ), reflecting the working memory function. Earlier studies also underscored the importance of visual memory or working memory when participants copy target figures ( 13 , 14 ).…”

Visual Dysfunction in Parkinson’s Disease

“…Initially, it has been explained as a form of constructional apraxia, and some authors have proposed patients have difficulty in the visuospatial analysis of the model and/or in holding this representation in visual working memory [ 126 ]. Others suggest that the closing-in phenomenon would be an extreme manifestation of a default tendency of the motor system, so that the actions would be performed toward the focus of attention [ 127 ]. De Lucia et al [ 128 ] have proposed that the closing-in phenomenon is related to frontal-executive impairments in PD dementia.…”