In an 86‑year‑old woman evaluated for dementia who cannot copy intersecting pentagons or a three‑dimensional cube, which mental status examination domain is being assessed: executive functioning, gnosia, orientation, praxis, or visuospatial proficiency?

Visuospatial Proficiency

The inability to copy intersecting pentagons or a three-dimensional cube assesses visuospatial proficiency (option e). 1

Domain-Specific Assessment

The task of copying geometric figures—whether intersecting pentagons or three-dimensional cubes—is a validated measure of spatial perception and orientation, specifically evaluating the ability to perceive and mentally manipulate two- and three-dimensional objects. 1 This represents a pure assessment of visual-constructional abilities, defined as the translation of visual information into accurate motor output for figure reproduction. 1

Why Not the Other Options?

Executive Functioning (Option a)

• Executive functions encompass set-shifting, reasoning, problem-solving, and planning, which are measured by tasks like the Trail Making Test—not simple figure copying. 1
• While the Clock Drawing Test incorporates both visuospatial and executive components (requiring planning and sequencing), simple figure-copying tasks like pentagons or cubes remain pure visuospatial measures without these additional executive demands. 2, 1

Gnosia (Option b)

• Gnosia refers to recognition and identification of objects or faces, which does not involve reproducing spatial configurations and is therefore unrelated to figure-copying performance. 1

Orientation (Option c)

• Orientation (awareness of time, place, and person) is assessed through direct questioning, not through drawing tasks. 1

Praxis (Option d)

• Praxis involves learned motor gestures such as pantomiming tooth brushing or using tools, reflecting motor planning rather than visuospatial construction. 1
• The CAMCOG (Cambridge Cognitive Examination) explicitly separates its visuospatial/perception subscale from its praxis subscale, underscoring that these are distinct cognitive domains. 2, 1

Clinical Significance

Neuroanatomical Correlates

• Figure-copying deficits (historically termed "constructional apraxia") are specifically associated with parietal gray matter volume, not frontal, temporal, or occipital regions. 3
• The parietal cortex mediates spatial remapping—the integration of visual information from one fixation to the next—which is essential for accurate figure reproduction. 3

Diagnostic Utility in Dementia

• Drawing tasks (pentagons, cubes, Rey-Osterrieth Complex Figure) demonstrate significantly worse performance in Alzheimer's disease compared to behavioral variant frontotemporal dementia when controlling for disease severity, reflecting early parietal involvement in AD. 4
• The Rey-Osterrieth Complex Figure copy condition is recommended as the primary visuospatial test in vascular cognitive impairment protocols, requiring both organizational and visuoperceptual skill. 2
• Three-dimensional construction tasks (like cube copying) enhance the spatial demands beyond two-dimensional tasks and are more strongly predicted by spatial vision deficits, particularly with posterior cerebral lesions. 5, 6

Common Pitfall

Do not conflate visuospatial deficits with executive dysfunction. Recognizing that figure-copying is a pure visuospatial task helps clinicians avoid misattributing performance failures to executive impairment, thereby improving diagnostic accuracy for conditions where visuospatial deficits are prominent (e.g., Alzheimer's disease with early parietal involvement). 1