Journal List > Dement Neurocogn Disord > v.11(4) > 1120795

Dement Neurocogn Disord. 2012 Dec;11(4):141-145. Korean.
Published online Dec 31, 2012.
Copyright© 2012 Korean Dementia Association
Anatomical Correlates of Interlocking Pentagon Drawing
Eek-Sung Lee, M.D., Yun Jeong Hong, M.D.,* Bora Yoon, M.D., Sung-Chul Lim, M.D., Yong S. Shim, M.D., Kook Jin Ahn, M.D.,§ A-Hyun Cho, M.D., and Dong-Won Yang, M.D.
Graduate School of Medical Science and Engineering, KAIST, Daejeon, Korea.
*Hyoja Geriatric Hospital, Yongin, Korea.
Department of Neurology, Konyang University College of Medicine, Daejeon, Korea.
Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, Korea.
§Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Address for correspondence: Dong-Won Yang, M.D. Department of Neurology, The Catholic University of Korea College of Medicine, 222 Banpo-daero, Seocho-gu, Seoul 137-701, Korea. Tel: +82-2-2258-6077, Fax: +82-2-599-9686, Email:
Received Nov 17, 2012; Revised Dec 12, 2012; Accepted Dec 17, 2012.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.



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).


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.


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).


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.

Keywords: Interlocking pentagon drawing; Right inferior frontal gyrus; Voxel-based morphometry; Alzheimer's disease


Fig. 1
The result of voxel-based regression analysis. A pentagon drawing score was positively correlated with cortical atrophy in the right inferior temporal gyrus (p<0.001, uncorrected for multiple comparisons, extent threshold=100 voxels).
Click for larger image


Table 1
Intersecting pentagons scoring system
Click for larger image

Table 2
Baseline dermographics
Click for larger image

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