The Qualitative Scoring MMSE Pentagon Test (QSPT): A New Method for Differentiating Dementia with Lewy Body from Alzheimer’s Disease

Abstract

The differential diagnosis across different variants of degenerative diseases is sometimes controversial. This study aimed to validate a qualitative scoring method for the pentagons copy test (QSPT) of Mini-Mental State Examination (MMSE) based on the assessment of different parameters of the pentagons drawing, such as number of angles, distance/intersection, closure/opening, rotation, closing-in, and to verify its efficacy to differentiate dementia with Lewy Body (DLB) from Alzheimer's disease (AD). We established the reliability of the qualitative scoring method through the inter-raters and intra-subjects analysis. QSPT was then applied to forty-six AD and forty-six DLB patients, using two phases statistical approach, standard and artificial neural network respectively. DLB patients had significant lower total score in the copy of pentagons and number of angles, distance/intersection, closure/opening, rotation compared to AD. However the logistic regression did not allow to establish any suitable modeling, whereas using Auto-Contractive Map (Auto-CM) the DLB was more strongly associated with low scores in some qualitative parameters of pentagon copying, i.e. number of angles and opening/closure and, for the remaining subitems of the MMSE, in naming, repetition and written comprehension, and for demographic variables of gender (male) and education (6–13 years). Twist system modeling showed that the QSPT had a good sensitivity (70.29%) and specificity (78.67%) (ROC-AUC 0.74). The proposed qualitative method of assessment of pentagons copying used in combination with non-linear analysis, showed to be consistent and effective in the differential diagnosis between Lewy Body and Alzheimer’s dementia.

Drawing Disorders in Alzheimer’s Disease and Other Forms of Dementia

“…No 2-year decline in FTD Comparison AD-LBD Nervi [152] Figure copying LBD worse than AD Crowell [153] Figure copying LBD worse than AD Tiraboschi [154] Figure copying LBD worse than AD; no differences in pentagon copying Cahn-Wiener [156] CDT No differences in overall score, but more conceptual and planning errors in LBD Hamilton [157] Clock copying No differences, but lower scores predicted steeper decline in LBD Cagnin [158] CDT LBD worse than AD Palmqvist [159] CDT, cube copying LBD worse than AD Gnanalingham [162] CDT, clock copying No difference in CDT; LBD worse than AD in clock copying Ala [164] Pentagon copying LBD worse than AD Cormack [165] Pentagon copying LBD worse than AD Connor [166] Pentagon copying No difference Caffarra [167] Figure copying, No difference in figure copying, pentagon copying worse scores in LBD on an analytic scoring system for pentagon copying AD, Alzheimer's disease; VaD, vascular dementia; sVaD, subcortical VaD; FTD, frontotemporal dementia; bvFTD, behavioral variant of FTD; PA, progressive aphasia; LBD, Lewy body dementia; CDT, Clock drawing test; ROCF, copy of Rey's complex figure. Reference numbering follows the text.…”

“…Different scoring criteria can likely explain the reason why other authors failed to detect differences between LBD and AD in pentagon copying [108,159], but more extended copying tests might show significantly lower performance in LBD with respect to AD patients [108]. Recently, it has been demonstrated that qualitative analysis of the pentagon copy test can provide additional information for distinguishing AD from LBD patients, since a lower number of angles is among distinctive features of LBD patients' copies [73,167], and can also predict development of LBD in MCI patients [74].…”

Drawing-Based Automatic Dementia Screening Using Gaussian Process Markov Chains

“…If this statement is violated, then the subject will receive 0 score, otherwise he/she will receive 1 score. The binary scoring between 0 and 1 on the pentagon drawing test is not favorable to represent the visuospatial performance, thus a new qualitative scoring method for MMSE pentagon test has been proposed by Caffarra [16]. We referred it as another reference method.…”

“…From another point of view, we can also take drawing process as a reflection of human cognition functions. In fact, drawing tests for disease screening are very common in the field of clinical psychology, where a number of validated drawing tests [11][12][13][14][15][16] have been applied in healthcare settings. Most of the tests are still conducted in paper-and-pencil form and relied on human decision by healthcare professionals, which usually involves subjective judgment.…”

The Pentagon Copying Test and the Clock Drawing Test as Prognostic Markers in Dementia with Lewy Bodies

“…Therefore, points regarding the drawing of the face of the clock and the sequence of placing the numbers 3, 6, 9, and 12 were not included for the patients at Erasmus Medical Center. Several methods have been proposed to score the PCT and the CDT [21,23,24]. We chose the qualitative scoring method of Caffarra et al [21] for the PCT and a modified scoring method of Royall et al [22] for the CDT, as we assumed that these scoring methods have a moderately high discriminative value due to their relatively wide scoring range.…”