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PubMed2000

Upper and lower face apraxia: role of the right hemisphere.

The aim of this study was to evaluate face apraxia in left- and right-hemisphere-damaged patients both in the acute and chronic stage of their disease. Two newly devised tests that assess movements of the upper and lower face districts were employed. On the whole, the proportion of left-hemisphere-damaged patients showing face apraxia were 46 and 68% for upper and lower face, respectively. A substantial proportion of right-hemisphere-damaged patients also showed face apraxia, i.e. 44% upper face and 38% lower face. Concomitant variables such as general severity, locus of lesion, language or visuo-spatial impairments, presence of neglect, interval from stroke, peculiarity of clusters of items or scoring procedures did not account for these results. These findings suggest that face apraxia in some patients may affect movements of the upper face district and that the right hemisphere plays a significant part in both upper and lower face praxis.

Adult↗
PubMed2004

Frequency and phenotypic spectrum of ataxia with oculomotor apraxia 2: a clinical and genetic study in 18 patients.

Ataxia with oculomotor apraxia type 2 (AOA2) is a newly described autosomal recessive cerebellar ataxia (ARCA) defined by genetic location to 9q34 of three families sharing gait ataxia, oculomotor apraxia and/or elevated alpha-foetoprotein (AFP) levels. We have evaluated 77 families with progressive non-Friedreich ARCA and have identified six families with a phenotype suggestive of AOA2. Linkage was confirmed in all six families, with a maximal lod score of 5.91 at D9S1830. We report the first detailed phenotypic study, including neuropsychological, oculographic and brain imaging investigations, in the largest series of AOA2 patients yet recruited. The mean age at onset was 15.1 +/- 3.8 years. Sensory motor neuropathy (92%) and choreic or dystonic movements (44%) were frequent. Oculomotor apraxia was observed in 56% of patients and characterized by increased horizontal saccade latencies and hypometria. AFP levels were elevated in 100% of the families, making it a useful biological marker. This study shows for the first time that AOA2 can be found in Europe, North Africa and the West Indies, and its relative frequency represents approximately 8% of non-Friedreich ARCA, which is more frequent than ataxia telangiectasia and ataxia with oculomotor apraxia type 1 (AOA1), in our series of adult patients. In adults, AOA2 may be, therefore, the most frequent cause of ARCA identified so far, after Friedreich's ataxia.

Adolescent↗
PubMed2006

Spinocerebellar ataxia with ocular motor apraxia and DNA repair.

At least four disorders, ataxia telangiectasia (AT), an ataxia-telangiectasia-like disorder, early-onset ataxia with ocular motor apraxia and hypoalbuminemia (EAOH)/ ataxia with oculomotor apraxia type 1 (AOA1), and ataxia with oculomotor apraxia type 2, are accompanied by ocular motor apraxia (OMA), which is an impairment of saccadic eye movement initiation. The characteristic pathological findings of EAOH/AOA1 and AT are a severe loss of Purkinje cells, severe myelin pallor of the posterior columns, and moderate neuronal loss in the dorsal root ganglia and anterior horn. Purkinje cells stimulate the fastigial nucleus and suppress omnipause neurons to initiate saccadic eye movement. The selective loss of Purkinje cells might cause OMA and disturb the cancellation of the vestibulo-ocular reflex. These disorders have the following common clinical features: ataxia, involuntary movements, and peripheral neuronopathy. In addition, the causative genes for these disorders are associated with the DNA/RNA quality control system. The impairment of DNA/ RNA integrity results in selective neuronal loss in these recessive-inherited ataxias.

Animals↗
PubMed1995

[Apraxia of the larynx].

Disturbances of vocal function in patients with apraxia of speech are well known in the literature and have often been described. Although apraxia of phonation is presumed, only 1 case is mentioned in the literature. We present a 51-year-old man (with missing signs of dysarthria and aphasia after spontaneous right temproparietal hemorrhagia) who had aphonia and missing respiration during speaking, whereas articulation was nearly undisturbed. After differential diagnostic exclusion of other central disorders of phonation we classify this patient as having apraxia of phonation or laryngeal apraxia.

Aphonia↗
PubMed1993

Development of aphasia, apraxia, and agnosia and decline in Alzheimer's disease.

OBJECTIVE: The purpose of this study was to compare the stage and the subtype models of disease progression in Alzheimer's disease. The authors address the issue of whether the overall rate of clinical decline is different in Alzheimer's disease patients with and without early development of aphasia, apraxia, or agnosia. METHOD: The study was a case series study. Two separate cohorts of Alzheimer's disease patients were used, one from an ongoing single center study at Stanford University (N = 57) and the other from a multicenter project across the state of California (N = 70). Patients were assessed every 6 months in the Stanford study and yearly in the state study. All patients were assessed at least three times. The outcome measure was the average rate of decline on the Mini-Mental State examination. RESULTS: The average rates of decline on the Mini-Mental State were computed for each subject. Subjects were then divided among groups according to whether and when they exhibited aphasia, agnosia, or apraxia. The effects of the presence of aphasia, agnosia, or apraxia were assessed by comparing the average rates of decline on the Mini-Mental State. CONCLUSIONS: Alzheimer's disease patients who developed aphasia or apraxia declined more rapidly than those patients who did not develop either sign. These results were not attributable to differences in Mini-Mental State scores at entry into the study. The results suggest the presence of subtypes of Alzheimer's disease in which accelerated decline is associated with the early appearance of certain neurological signs.

Age Factors↗
PubMed2000

The predictive value of dysgraphia and constructional apraxia for delirium in psychiatric inpatients.

OBJECTIVE: To evaluate the predictive value of dysgraphia and constructional apraxia for delirium among psychiatric inpatients. METHOD: Data were collected from 2 sources. First, a series of nondelirious psychiatric inpatients that had participated in a previous study was selected to determine the specificity of various indices of dysgraphia and constructional apraxia. Second, a series of 56 psychiatric inpatients with delirium as identified using electronic administrative data and clinical records was selected to evaluate sensitivity. RESULTS: Of the various indices of dysgraphia examined, only a global rating of writing quality and evidence of jagged or angled letter loops were informative clinical signs. The predictive value of constructional apraxia resembled the predictive value of the 2 dysgraphia indices. CONCLUSIONS: Dysgraphia and constructional apraxia are useful clinical signs of delirium in the psychiatric inpatient population. Evaluation of these functions can substantially impact diagnostic decisions where diagnostic uncertainty exists. An evaluation of writing and constructional praxis can be easily incorporated into bedside mental status examinations.

Adult↗
PubMed2006

Rehabilitation of limb apraxia improves daily life activities in patients with stroke.

We randomly assigned 33 patients with left hemisphere stroke, limb apraxia, and aphasia to an apraxia or a control (aphasia) treatment group. Before and after each treatment, patients underwent a comprehensive neuropsychological testing battery and a caregiver evaluation of patient's activities of daily life (ADL) independence. Apraxia severity was related with ADL independence. Control (aphasia) treatment improved patients' language and intelligence performance. Apraxia treatment specifically improved praxic function and ADL.

Activities of Daily Living↗
PubMed1995

Apraxia during Wada testing.

Apraxia is the loss of the ability to perform learned skilled movements correctly. In right-handers, apraxia and aphasia are most frequently associated with left-hemisphere lesions. When they are dissociated, however, aphasia is more common in the absence of apraxia than vice versa. There are two hypotheses that can account for this discrepancy: (1) in right-handers, praxis is more likely than language to be mediated by the right hemisphere, or (2) the left-hemisphere network that mediates language is either more widely distributed than the network that mediates praxis or is more likely to be in the middle cerebral artery distribution. We studied apraxia in a group of right-handers undergoing selective hemispheric anesthesia, or Wada testing. All nine subjects had language lateralized to the left hemisphere, and seven of the nine had praxis lateralized to the left hemisphere. Two of the subjects had praxis bilaterally represented. Although our data suggest that speech and praxis functions tend to be lateralized to the left hemisphere in most right-handers, praxis appears to be more distributed between the hemispheres than speech-language functions. Furthermore, an analysis of the types of errors made during praxis testing suggests differential roles of the hemispheres in praxis functions.

Adolescent↗
PubMed2000

Hemispheric asymmetries of limb-kinetic apraxia: a loss of deftness.

OBJECTIVES: Unlike patients with ideomotor apraxia who make temporal and spatial errors and patients with ideational or conceptual apraxia who make content errors, patients with limb-kinetic apraxia have loss of deftness, including fine and precise movements, independent finger movements, and difficulty coordinating simultaneous movements. This study was conducted to learn the relationship between limb-kinetic apraxia and hemisphere dysfunction by using selective hemisphere anesthesia, the Wada test. METHODS: Subjects were 90 patients undergoing Wada testing for intractable epilepsy. They were divided into typical (right-handed with left hemisphere language dominance) and atypical (nonright-handed, or without left hemisphere language dominance). Before and during Wada testing, subjects were shown line drawings of tools, four for each hand tested. After being shown each picture, subjects pantomimed the use of this tool. A behavioral neurologist and neuropsychologist scored the pantomimes for the presence of limb-kinetic errors. RESULTS: For the typical group, during left hemisphere anesthesia, the limb-kinetic errors made by the right and left hands did not differ, but during right hemisphere anesthesia the left hand made more errors than the right. Unlike the typical subjects, when the left hemisphere was anesthetized, the atypical subjects made more errors with their right hands than left. However, similar to the typical subjects with right hemisphere anesthesia, the atypical subjects made more left- than right-hand limb-kinetic errors. CONCLUSIONS: For people with typical brain organization, the left hemisphere mediates motor deftness for both hands, but the right hemisphere primarily controls deftness for the left hand. For people with atypical brain organization, each hemisphere primarily controls deftness for the contralateral hand.

Adult↗
PubMed2003

Ecological implications of ideomotor apraxia: evidence from physical activities of daily living.

OBJECTIVE: To learn if ideomotor apraxia (IMA) adversely influences skilled acts in the environment and interferes with independent functioning after stroke. METHODS: The relationship between IMA severity, based on scores from a verbal gesture-to-command (pantomime) task, and the dependency score, as defined by increased caregiver assistance on the Physical Self-Maintenance Scale (PSMS), was investigated in 10 unilateral left hemisphere-damaged stroke patients and 10 matched control subjects. RESULTS: There was a significant relationship between apraxia severity and dependency in physical functioning (PSMS). Impairment on the PSMS in the patients with IMA could not be accounted for based on overall cognitive impairment, poststroke depression, content-conceptual errors, elementary motor impairment, lesion size, or stroke-test interval. Analysis of categories composing the PSMS revealed that the patients with apraxia had increased dependency in grooming, bathing, and toileting relative to age-matched control subjects. CONCLUSIONS: These findings emphasize the ecological implications of apraxia and the need for rehabilitation strategies to improve the execution and efficiency of coordinated skilled movements in stroke patients with left hemisphere damage.

Activities of Daily Living↗
PubMed1981

Relationship of constructional apraxia and body scheme disorders in dressing performance in adult CVA.

The relationship between constructional apraxia and body scheme disorders and failure of post-cerebral vascular accident (CVA) patients to achieve independence in upper extremity dressing was investigatged in this study. One hundred and one subjects with right- and left-CVA were given tests that measured body scheme dysfunction and constructional apraxia on admission to an inpatient rehabilitation unit, and then rated on upper extremity dressing performance at discharge. Scores on the apraxia and body scheme tests were statistically correlated with dressing performance. The results indicated that both constructional apraxia and body scheme dysfunction contribute to failure in achieving upper exremity dressing, but that body scheme performance is a better predictor of dressing ability. In addition, the presence of visual field deficits, medical complications, and aphasia were found to exert significant influence on subject performance.

Activities of Daily Living↗
PubMed1999

[The significance of the study of aphasia, apraxia and agnosia at present time].

Neuropsychology initiated by the study of aphasia, apraxia and agnosia had been regarded as one division of psychiatry. This is one of the reasons why neuropsychology is minor territory in neurology. Some people say that neuropsychology seems difficult to understand, not scientific, not useful and is rather a man's taste than a medicine. I try to respond in this paper to these critics by way of analyzing our own cases while insisting on the today's importance of the study of aphasia, apraxia and agnosia. Our personal cases consist of the following three categories. 1) Primary progressive apraxia: proposal of the symptomatic concept suggested by the investigation of our own eight cases and those in the literature. 2) Musical alexia with agraphia in a trombone player: study of the cerebral localization in a person with special ability. 3) Disturbance of reaching proposal of intracerebral pathways in kinesthesia. Therefore it is highly possible that the significance of the study of aphasia, apraxia and agnosia should become enlarged now and after; and it seems urgent to answer its need that younger neurologists participate in this area.

Aged↗
PubMed2000

[A case of callosal apraxia without agraphia and acquired stuttering associated with callosal infarction].

We report a 52-year-old right-handed man with cerebral infarction of the right anterior cerebral artery area. The MRI findings showed cerebral infarction in the trunk of the right corpus callosum, although some part of the posterior half of the trunk was spared. Some part of right precuneal gyrus, cingulate gyrus were also involved. The clinical feature of this case is characterized by following two points. First, although callosal apraxia is usually accompanied by agraphia, he showed apraxia with the left hand, but showed no agraphia. Secondary, he showed speech dysfluency mainly characterized by initial syllable repetitions. The nature of this speech dysfluency was determined as acquired stuttering. This case suggests that the pathway for praxis locates distinct portion from that for writing on corpus callosum. We analyzed callosal lesions of previous studies reporting callosal apraxia without agraphia, then compared to that of this case. And we also reviewed acquired stuttering report caused by callosal lesions. Consequently, we suggest that apraxia and stuttering were caused by damage of the trunk of the corpus callosum. While writing was preserved by the intact fibers in the posterior half of the trunk.

Apraxias↗
PubMed2002

Mechanisms of dressing apraxia: a case study.

OBJECTIVE: To investigate the neural mechanisms that differentiate dressing apraxia from other forms of apraxia such as ideomotor apraxia. Hypotheses examined included (1) that dressing is more sensitive to alternations in body schema, (2) that dressing is a demanding bimanual task, and (3) that clothing represents a particularly complex spatial problem. BACKGROUND: A focal degenerative condition can specifically target a function such as dressing, allowing a unique approach to its study. METHOD: A case study of the cognitive impairments of a 75-year-old man who presented with progressive dressing difficulties in the absence of neglect or motor disturbances. RESULTS: Neuropsychologic testing indicated possible executive function deficits as well as visuospatial and visuocontructional deficits, but intact praxic skills, verbal abilities, and visual recognition skills. In addition, testing revealed no evidence of Balint's or impairments in body schema. CONCLUSION: Overall, the test results suggested that visuospatial dysfunction is the underlying deficit in dressing apraxia. The present case study confirmed the independence of praxic functioning from spatial ability and conversely, the dependence of dressing on spatial ability.

Aged↗
PubMed2002

[A case of motor neuron disease with dementia and apraxia of the upper limbs].

We report a 61-year-old, right-handed woman with motor neuron disease, dementia, and apraxia of the upper limbs. The patient developed clumsiness of the right hand and dysarthria two years and a half prior to admission. Neurological examination showed limb-kinetic apraxia and ideomotor apraxia, predominantly on the right side, in addition to dementia and anarthria. There was mild muscle wasting in the neck and hands. A muscle biopsy from the biceps muscle of arm as well as needle EMG revealed neurogenic changes compatible with motor neuron disease. Brain MRI indicated pyramidal tract degeneration. Three-dimensional brain perfusion imaging generated from SPECT demonstrated an asymmetric decrease in cerebral blood flow in the fronto-temporo-parietal regions, predominantly on the left side. This case suggests that asymmetric limb apraxia can be associated with motor neuron disease.

Apraxia, Ideomotor↗
PubMed2004

Walking difficulties in patients with Alzheimer's disease might originate from gait apraxia.

OBJECTIVES: To investigate whether gait apraxia is a possible cause for some of the walking abnormalities shown by patients with Alzheimer's disease. METHODS: 60 patients with Alzheimer's disease, selected as being free from overt extrapyramidal impairment or other potential causes of walking deficits, were assessed with a new test evaluating aspects of walking and related movements. Norms for this test were collected from a sample of 182 healthy volunteers. RESULTS: 40% of the Alzheimer group performed below the cut off score on this test, and half performed poorly. Performance of the Alzheimer group in the walking skills test correlated highly with scores in a test assessing limb apraxia and with dementia severity. CONCLUSIONS: Gait apraxia may be the cause of walking disorders found in a subgroup of patients with Alzheimer's disease. Its detection is made easier by the use of a standardised test, but still relies heavily on the exclusion of other causes of walking deficits. It is a recognisable and independent form of apraxia.

Adult↗
PubMed1991

[Ideational apraxia in confusional psychosis].

Traditionally, Pick's ideational apraxia has been considered a neurologist's realm since it is one of the permanent manifestations of brain lesions located in the left hemisphere posterior territory. Besides, however, the ideational apraxia is likely to appear--altogether with misidentifications and spatial disorientation--as a part of the transient manifestations of confusional psychosis. It is thus quite possible that a reversible alteration of the posterior brain mechanisms could be the basis for the confusional psychosis. It seems also reasonable to include the ideational apraxia within the symptoms to be sought in those cycloid psychotic states including confusional psychosis. This is why it can safely be said that Pick's ideational apraxia is also a psychiatrist's realm.

Adult↗
PubMed1983

[Finger imitation difficulty, constructional disorder and classical apraxias].

In the field of apraxia study, difficulty of finger pattern imitation was generally considered as parts of classical apraxias, i.e. ideomotor apraxia or limbkinetic apraxia. But there were some authors who considered it more related to constructional ability. To bring some clarity to this ambiguity, we studied 139 right-handed unilateral brain-damaged subjects: 70 with left hemisphere lesion and 69 with right hemisphere lesion: on various tasks. Three types of manual movements, i.e. object manipulation, representational movement to verbal command and finger imitation, and constructional task were tested. As for manual praxis, response patterns elicited were recorded according to Kaplan's original method, which was slightly modified. Responses were categorized as apractic only when either no movement was elicited, or when the response was amorphous or parapraxic. Of the 139 subjects tested, 35 subjects were classified as apractic in at least one category of the three types of manual praxis and 60 subjects were categorized as showing constructional disorder. Object manipulation disturbance was observed in 9 subjects. Finger imitation difficulty was seen in 16. Disturbance of representational movement to verbal command was confirmed in at least 17 subjects and was not determined in 7 more subjects who had comprehension difficulty to spoken language. With regard to relationship between apractic disorders and laterality of hemisphere lesions, object manipulation difficulty and deficient representational movement to verbal command was seen only in the left hemisphere lesions. On the contrary, finger imitation difficulty was found in either hemisphere lesion and has no tendency toward lateralization.(ABSTRACT TRUNCATED AT 250 WORDS)

Apraxias↗