Apraxia of Creutzfeldt-Jakob disease: a case report / 中华神经科杂志

The clinical manifestations and examination results of a case of Creutzfeldt-Jakob disease (CJD) admitted to the Department of Neurology of Peking Union Medical College Hospital,Chinese Academy of Medical Sciences in August 2020 were analyzed, and a comprehensive neuropsychological assessment and assessment of apraxia were conducted. The neuropsychological characteristics of apraxia in CJD patient and the progress in the research and evaluation of apraxia were reviewed. The patient was a 65-year-old male with insidious onset and progressive symptoms, whose clinical manifestations were apraxia, rapidly progressing dementia, and extrapyramidal symptoms. The magnetic resonance imaging showed hyper-intense signal in diffusion weighted imaging in bilateral cerebral hemispheres, and 14-3-3 protein in cerebrospinal fluid was positive, which were consistent with the probable CJD diagnostic criteria. The patient exhibited prominent signs and symptoms of ideomotor apraxia. It has been reported in the literature that apraxia can also be the main neuropsychological manifestation of CJD. It is necessary to pay attention to the standard evaluation and timely identification of apraxia in clinical diagnosis.

Does the presence of ideomotor apraxia in stroke patients adversely affect rehabilitation outcomes? A prospective study

@#Background and Objectives: Ideomotor apraxia is an inability to perform a gesture following a verbal command despite having intact knowledge of the task. The presence of ideomotor apraxia may negatively affect functional outcome of stroke patients. The aim of this study was to evaluate the effect of ideomotor apraxia on rehabilitation outcomes following first ever stroke. Methods: A cross sectional observational study of 35 stroke patients admitted to a rehabilitation unit for treatment. Patients were evaluated for ideomotor apraxia using the ideomotor apraxia test. Function was assessed before and after treatment using the Functional Independence Measure, motricity index and functional ambulation scale. Cognitive function was evaluated using the Functional Independence Measure and mini mental state examination. Results: Ideomotor apraxia was present in 31.4% of patients. Mean Functional Independence Measure motor and cognitive scores of apraxic patients on admission and at discharge were lower than those of non-apraxic patients, (p<0.05). The cognitive and total Functional Independence Measure scores and motricity scores in the ideomotor apraxia group on discharge had not reached the admission values of the non-ideomotor apraxia group. Conclusion: The presence of ideomotor apraxia following stroke has a negative impact on overall function, both before and after rehabilitation, when compared to stroke patients without ideomotor apraxia. Stroke patients must be assessed for ideomotor apraxia prior to commencement of a rehabilitation program in order to guide treatment and determine realistic treatment goals.

The influence of education on performance of adults on the Clock Drawing Test / A influência da escolaridade no desempenho de adultos no teste do desenho do relógio

ABSTRACT. The Clock Drawing Test (CDT) is an important instrument for screening individuals suspected of having cognitive impairment. Objective: To determine the influence of education on the performance of healthy adults on the CDT. Methods: A total of 121 drawings by healthy adults without neurological complaints or impairments were analysed. Participants were stratified by educational level into 4 subgroups: 27 illiterate adults, 34 individuals with 1-4 years of formal education, 30 with 5-11 years, and 30 adults with >11 years' formal education. Scores on the CDT were analyzed based on a scale of 1-10 points according to the criteria of Sunderland et al. (1989).¹ The Kruskal-Wallis test was applied to compare the different education groups. Tukey's multiple comparisons test was used when a significant factor was found. Results: Although scores were higher with greater education, statistically significant differences on the CDT were found only between the illiterate and other educated groups. Conclusion: The CDT proved especially difficult for illiterate individuals, who had lower scores. These results suggest that this screening test is suitable for assessing mainly visuoconstructional praxis and providing an overall impression of cognitive function among individuals, independently of years of education.

RESUMO. O Teste do Desenho do Relógio (TDR) é um instrumento importante para rastrear indivíduos com suspeita de alterações cognitivas. Objetivo: Verificar a influência da variável sociodemográfica escolaridade no desempenho de adultos saudáveis no TDR. Métodos: Foram analisados os desenhos de 121 adultos saudáveis sem queixas e/ou alterações neurológicas, distribuídos em 4 subgrupos, a partir de quatro níveis de escolaridade: 27 adultos analfabetos, 34 adultos com 1-4 anos de estudo formal, 30 adultos com 5-11 anos de estudo formal, 30 adultos com >11 anos de estudo formal. Os desenhos obtidos foram analisados segundo os critérios propostos por Sunderland et all (1989),¹ com uma escala que variou de 1 a 10 pontos. A comparação dos grupos segundo a escolaridade foi feita utilizando-se o teste de Kruskal-Wallis seguido do teste de comparações múltiplas de Tukey para verificar onde as diferenças se deram. Resultados: Apesar dos escores terem aumentado conforme a escolaridade, foram observadas diferenças estatisticamente significantes apenas entre analfabetos e os demais grupos no TDR. Conclusão: O desempenho dos indivíduos melhorou de acordo com a escolaridade, porém o TDR não sofreu forte influência da escolaridade em sua aplicação, exceto para indivíduos analfabetos, que apresentaram escores diminuídos. Deste modo, acredita-se que o teste pode ser utilizado na avaliação da praxia visuo-construtiva em indivíduos independentemente dos anos de escolarização.

Limb apraxia in aphasic patients / Apraxia de membros em indivíduos afásicos

ABSTRACT Limb apraxia is usually associated with left cerebral hemisphere damage, with numerous case studies involving aphasic patients. The aim of this study was to verify the occurrence of limb apraxia in aphasic patients and analyze its nature. This study involved 44 healthy volunteers and 28 aphasic patients matched for age and education. AH participants were assessed using a limb apraxia battery comprising subtests evaluating lexical-semantic aspects related to the comprehension/production of gestures as well as motor movements. Aphasics had worse performances on many tasks related to conceptual components of gestures. The difficulty found on the imitation of dynamic gesture tasks also indicated that there were specific motor difficulties in gesture planning. These results reinforce the importance of conducting limb apraxia assessment in aphasic patients and also highlight pantomime difficulties as a good predictor for semantic disturbances.

RESUMO A apraxia de membros está frequentemente associada com lesões do hemisfério esquerdo, com inúmeros casos de pacientes afásicos. O objetivo deste estudo foi verificar a ocorrência da apraxia de membros em pacientes afásicos bem como a natureza desse distúrbio. O estudo foi realizado com 28 indivíduos afásicos e 44 controles pareados segundo a idade e a escolaridade. Todos os participantes foram avaliados com uma extensa bateria de apraxia de membros, consistindo de subtestes que avaliaram a compreensão e a produção dos aspectos léxico-semânticos relacionados aos gestos bem como produção motora propriamente dita. Os pacientes afásicos apresentaram dificuldades em tarefas envolvendo aspectos conceptuais da produção gestual. A dificuldade encontrada na imitação de gestos dinâmicos também indicou déficits no processamento gestual independente do déficit conceptual observado nestes pacientes. Esses resultados reforçam a importância da avaliação da apraxia de membros e apontam para a dificuldade de realização de pantomimas como indicativa de déficits semânticos.

Apraxia: Review and Update

Praxis, the ability to perform skilled or learned movements is essential for daily living. Inability to perform such praxis movements is defined as apraxia. Apraxia can be further classified into subtypes such as ideomotor, ideational and limb-kinetic apraxia. Relevant brain regions have been found to include the motor, premotor, temporal and parietal cortices. Apraxia is found in a variety of highly prevalent neurological disorders including dementia, stroke and Parkinsonism. Furthermore, apraxia has been shown to negatively affect quality of life. Therefore, recognition and treatment of this disorder is critical. This article provides an overview of apraxia and highlights studies dealing with the neurophysiology of this disorder, opening up novel perspectives for the use of motor training and noninvasive brain stimulation as treatment.

The influence of age, gender and education on the performance of healthy individuals on a battery for assessing limb apraxia / A influência da idade, do sexo e da escolaridade no desempenho de indivíduos normais em uma bateria para avaliação de praxia de membros

ABSTRACT Introduction: Apraxia is defined as a disorder of learned skilled movements, in the absence of elementary motor or sensory deficits and general cognitive impairment, such as inattention to commands, object-recognition deficits or poor oral comprehension. Limb apraxia has long been a challenge for clinical assessment and understanding and covers a wide spectrum of disorders, all involving motor cognition and the inability to perform previously learned actions. Demographic variables such as gender, age, and education can influence the performance of individuals on different neuropsychological tests. Objective: The present study aimed to evaluate the performance of healthy subjects on a limb apraxia battery and to determine the influence of gender, age, and education on the praxis skills assessed. Methods: Forty-four subjects underwent a limb apraxia battery, which was composed of numerous subtests for assessing both the semantic aspects of gestural production as well as motor performance itself. The tasks encompassed lexical-semantic aspects related to gestural production and motor activity in response to verbal commands and imitation. Results: We observed no gender effects on any of the subtests. Only the subtest involving visual recognition of transitive gestures showed a correlation between performance and age. However, we observed that education level influenced subject performance for all sub tests involving motor actions, and for most of these, moderate correlations were observed between education level and performance of the praxis tasks. Conclusion: We conclude that the education level of participants can have an important influence on the outcome of limb apraxia tests.

RESUMO Introdução: A apraxia é definida como sendo um distúrbio na realização de gestos ou atos motores aprendidos. Há poucos estudos sobre a avaliação da praxia de membros incluindo o controle de variáveis sócio-demográficas. Objetivo: O presente estudo teve por objetivo avaliar o desempenho de indivíduos saudáveis em uma bateria de praxia de membros, analisando-se a influência das variáveis sexo, idade e escolaridade nas habilidades práxicas avaliadas. Métodos: Quarenta e quatro indivíduos foram submetidos à aplicação de uma bateria de praxia de membros, composta de subtestes que avaliaram tanto aspectos semânticos relacionados à produção gestual, quanto a produção motora propriamente dita. Resultados: Não houve influência do sexo em nenhum dos subtestes. Apenas o subteste que envolvia o reconhecimento visual da correta realização de gestos transitivos, mostrou-se sensível à variação da idade. Já a escolaridade influenciou o desempenho dos participantes em todos os testes que envolviam a realização de atos motores, sendo que para a maior parte deles foram encontradas correlações moderadas entre a escolaridade e o desempenho nas tarefas práxicas. Conclusão: Variáveis sócio demográficas, principalmente a escolaridade, podem interferir no desempenho de indivíduos em testes que avaliam a praxia de membros e devem ser consideradas na avaliação clínica.

Reviewing the limb apraxia concept - from definition to cognitive neuropsychological models / Revisando o conceito da apraxia de membros - da definição aos modelos da neuropsicologia cognitiva

Apraxia is a disorder of learned skilled movements, in the absence of elementary motor or sensory deficits and general cognitive impairment such as inattention to commands, object-recognition deficits or poor oral comprehension. The first studies on apraxia were performed between the late 19th and early 20th centuries, however controversy remains in praxis literature concerning apraxia types, neuroanatomical and functional correlates, as well as assessment and treatment of apraxia. Thus, a critical review of the literature was conducted searching the literature for evidence contributing to a more detailed description of apraxia and its clinical patterns, physiopathology and clinico-anatomical correlations, as well as apraxia assessment.

A apraxia é um distúrbio da realização de gestos ou atos motores aprendidos sem que haja anormalidades em canais sensoriais aferentes ou motores eferentes, deterioração intelectual, nem alteração de atenção ou de compreensão dos comandos verbais. Os estudos sobre a apraxia iniciaram-se entre o fim do século XIX e início do século XX, no entanto, a literatura ainda apresenta controvérsias no que se refere à classificação desse quadro, seus substratos neuroanatômicos e funcionais, bem como suas formas de avaliação e tratamento. Assim, o presente estudo realizou uma revisão crítica da literatura visando buscar evidências científicas que contribuam para melhor delinear a apraxia e suas formas de manifestação clínica, sua fisiopatologia e as correlações anátomofisiológicas, bem como suas formas de avaliação.