Affiliations: Department of Neuroscience, University of Parma,
Parma, Italy | Outpatient Clinic for the Diagnosis and Therapy of
Cognitive Disorders, AUSL, Parma, Italy | Fondazione Don Gnocchi, Milan, IRCCS, Italy | Medical Department Bracco SPA, Milan, Italy
Note: [] Address for correspondence: Paolo Caffarra M.D., Department of
Neuroscience, University of Parma, Via Gramsci, 14, 43100 Parma, Italy.
Tel./Fax: +39 0521 704116; E-mail: paolo.caffarra@unipr.it
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.
Keywords: Dementia with Lewy Body, Alzheimer's disease, copy of pentagons, differential diagnosis, MMSE
