Brain Advance Access originally published online on June 1, 2005
Brain 2005 128(7):1480-1497; doi:10.1093/brain/awh560
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Review Article |
Apraxia in movement disorders
Morton and Gloria Shulman Movement Disorders Center, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
Correspondence to: Dr Anthony E. Lang, Morton and Gloria Shulman Movement Disorders Center, McL-7, Toronto Western Hospital, 399 Bathurst Street, Toronto, ON, Canada, M5T 2S8 E-mail: lang{at}uhnres.utoronto.ca
The definition of apraxia specifies that the disturbance of performed skilled movements cannot be explained by the more elemental motor disorders typical of patients with movement disorders. Generally this does not present a significant diagnostic problem when dealing with ‘higher-level’ praxic disturbances (e.g. ideational apraxia), but it can be a major confound in establishing the presence of limb-kinetic apraxia. Most motor disturbances characteristic of extrapyramidal disorders, particularly bradykinesia and dystonia, will compromise the ability to establish the presence of loss of dexterity and deftness that constitutes this subtype. The term ‘apraxia’ has also been applied to other motor disturbances, such as ‘gait apraxia’ and ‘apraxia of eyelid opening’, that perhaps are misnomers, demonstrating the lack of a coherent nomenclature in this field. Apraxia is a hallmark of corticobasal degeneration (CBD) and historically this has received the most attention among the movement disorders. Corticobasal degeneration is characterized by various forms of apraxia affecting limb function, particularly ideomotor apraxia and limb-kinetic apraxia, although buccofacial and oculomotor apraxia can be present as well. The syndrome of parkinsonism and prominent apraxia, designated the ‘corticobasal syndrome’ (CBS), may be caused by a variety of other central nervous system pathologies including progressive supranuclear palsy (PSP), Alzheimer's disease, dementia with Lewy bodies and frontotemporal dementias. Distinct from the CBS, PSP and Parkinson's disease can demonstrate varying degrees of apraxia on selected tests, especially in those patients with more severe cognitive dysfunction. Diseases that cause the combination of apraxia and a primary movement disorder most often involve a variety of cerebral cortical sites as well as basal ganglia structures. Clinical-pathological correlates and functional imaging studies are compromised by both this diffuse involvement and the confusion experienced in the clinical evaluation of apraxia in the face of the additional elemental movement disorders. Finally, although apraxia results in clear disability in patients with the CBS, it is not clear how milder ideomotor apraxia found on specific testing contributes to patients' overall day-to-day motor disability.
Key Words: apraxia; corticobasal degeneration; Huntington's disease; movement disorders; Parkinson's disease; progressive supranuclear palsy
Abbreviations: ALO = apraxia of eyelid opening; CBD = corticobasal degeneration; CBS = corticobasal syndrome; DLB = dementia with Lewy bodies; IMA = ideomotor apraxia; LKA = limb-kinetic apraxia; MSA = multiple system atrophy; OFA = orofacial apraxia; PSP = progressive supranuclear palsy
Received November 1, 2004. Revised March 10, 2005. Accepted May 12, 2005.
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