Brain, Vol 120, Issue 1 75-90, Copyright © 1997 by Oxford University Press
RC Leiguarda, PP Pramstaller, M Merello, S Starkstein, AJ Lees and CD Marsden
We studied 45 non-demented patients with Parkinson's disease (PD), 12 with
progressive supranuclear palsy (PSP), 10 with multiple system atrophy (MSA)
and 12 with neuroleptic-induced parkinsonism (NIP) for the presence of
apraxia. Our aim was to determine whether a standard comprehensive
assessment of different praxic functions would demonstrate specific types
of errors not attributable to bradykinesia, rigidity, tremor or any other
abnormal elementary motor deficit. PD patients on chronic levodopa
treatment were examined in the 'on' and 'off' (treatment) states. Based on
apraxia assessment scores, bilateral ideomotor apraxia for transitive
movements was found in eight (75%) and 12 (27%) of PSP and PD patients,
respectively. Ideomotor apraxia was mainly characterized by spatial errors
(i.e., external and internal configuration, body-part-as-object and
trajectory). Four PSP but no PD patients exhibited ideomotor apraxia for
intransitive movements. PSP as well as PD patients with ideomotor apraxia
also had difficulties in imitating hand and finger postures, but none of
them failed on pantomime comprehension and pantomime
recognition/discrimination. Some PSP patients exhibited, in addition, a
limbkinetic type of apraxia and a minority of them displayed deficits on
tasks involving multiple steps. Neither MSA nor NIP patients showed any
disturbance of praxic functions. There were no differences in age, disease
duration, Mini Mental State Examination (MMSE), Unified Parkinson's disease
Rating Scale and Hoehn-Yahr scores between apraxic and non-apraxic PD
patients, and ideomotor apraxia scores were similar in the 'on' and 'off'
states. A correlation was found between ideomotor apraxia scores in PD
patients and deficits in frontal lobe-related neuropsychological tasks such
as the Tower of Hanoi, verbal fluency and the Trail Making Test.
Furthermore, PD patients with apraxia showed higher Hamilton depression
scores than non-apraxic PD patients. In PSP patients, ideomotor apraxia
scores correlated significantly with cognitive deficit as measured with
MMSE. The presence or absence of cortical involvement, and its severity and
distribution might determine the presence and type of apraxia in PD and
PSP. Apraxia in these conditions would therefore reflect combined
cortico-striatal dysfunction.
ARTICLES
Apraxia in Parkinson's disease, progressive supranuclear palsy, multiple system atrophy and neuroleptic-induced parkinsonism
Raul Carrea Institute of Neurological Research, FLENI, Buenos Aires, Argentina.
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