Anatomical Correlates of Interlocking Pentagon Drawing

BACKGROUND: The interlocking pentagon drawing test, a part of the Mini-Mental State Examination (MMSE), is a widely used clinical practice to measure visuoconstructional ability of dementia patients. We investigated the anatomical structures of brain associated with pentagon drawing in subjects with mild to moderate Alzheimer's disease (AD) by using voxel-based morphometry (VBM). METHODS: Medical records of forty-four AD patients were reviewed and a 1.5 T SPGR 3D image data were used for VBM analysis. A voxel-based multiple regression analysis was used to investigate correlation between gray matter loss and pentagon drawing performance of AD patients. The correlations between pentagon drawing score and MMSE score were evaluated by Spearman correlation analysis. RESULTS: There was a positive correlation between the interlocking pentagon copying scores and the MMSE scores (r=0.448, p=0.002). The lower the scores of interlocking pentagon copying were, the more severe the atrophy of right inferior frontal gyrus became ([x, y, z]=[52, 39, 3], Broadmann area 45, and z score=3.86). CONCLUSIONS: The performance of interlocking pentagon drawing is associated with a general cognitive function in patients with mild-to-moderate Alzheimer's disease. It is also associated with the atrophy of the right inferior frontal gyrus.

Correction of Involutional Entropion by the Bowlegs Procedure

Generally accepted mechanisms of involutional entropion are as follows: 1. dysfunction of the inferior eyelid retractors, 2. migration of the preseptal orbicularis fibers upward, 3. reduced support of the lower lid against glove due to enophthalmos, 4. reduced horizontal support because of involutional changes in the lateral and medical canthal tendons. Sanford D. Hecht reported that the above four problems could be corrected simply and successfully by a full thickness excision of Bowlegs shape(Pentagon-shape). Five eyelids of involutional entropion were treated by the Boelegs procedure. The results were successful.

Correction of Involutional Entropion by the Bowlegs Procedure

Generally accepted mechanisms of involutional entropion are as follows: 1. dysfunction of the inferior eyelid retractors, 2. migration of the preseptal orbicularis fibers upward, 3. reduced support of the lower lid against glove due to enophthalmos, 4. reduced horizontal support because of involutional changes in the lateral and medical canthal tendons. Sanford D. Hecht reported that the above four problems could be corrected simply and successfully by a full thickness excision of Bowlegs shape(Pentagon-shape). Five eyelids of involutional entropion were treated by the Boelegs procedure. The results were successful.