Apraxias in Neurodegenerative Dementias

Abstract

Background:Apraxia is a state of inability to carry out a learned motor act in the absence of motor, sensory or cerebellar defect on command processed through the Praxis circuit. Breakdown in default networking is one of the early dysfunction in cortical dementias and result in perplexity, awkwardness, omission, substitution errors, toying behavior and unrecognizable gestures in response to command with voluntary reflex dissociation where, when unobserved patient will carry out reflex movements normally. Awareness into the organicity of these phenomenas will help in early diagnosis, which will help in initiating appropriate treatment and slowing down the progression of the disease.Aims and Objectives:The aim was to look for the various kinds of apraxias in patients with dementia using appropriate simple tests.Patients and Methods:Three hundred patients satisfying Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for dementia were evaluated in detail with mandatory investigations for dementia followed by testing for ideational, ideomotor, limb-kinetic, buccopharyngeal, dressing apraxia, constructional apraxia and gait apraxias in addition to recording of rare apraxias when present.Results:Alzheimer's disease showed maximum association with apraxias in all the phases of the disease ideational, ideomotor, dressing and constructional apraxias early and buccopharyngeal and gait apraxia late. Frontotemporal lobe dementia showed buccopharyngeal and gait apraxias late into the disease. Cortical basal ganglionic degeneration showed limb apraxias and diffuse Lewy body disease showed more agnosias and less apraxias common apraxias seen was Ideational and Ideomotor.Conclusion:Recognition of the apraxias help in establishing organicity, categorization, caregiver education, early strategies for treatment, avoiding anti-psychotics and introducing disease modifying pharmacotherapeutic agents and also prognosticating.

Gait dyspraxia as a clinical marker of cognitive decline in Down syndrome: A review of theory and proposed mechanisms

“…Disruptions in praxis can hinder a variety of basic and complex skills, including volitional movements of the eyelids, mouth, and tongue, speech production, the ability to mime practical movements (like lighting a match or brushing one's teeth), and gait. Dyspraxias, including gait dyspraxias, are often observed in people with dementia in both the general population and in individuals with DS (Chandra et al, 2015; Dalton and Fedor, 1998). …”

Accuracy of praxis test from Cambridge Cognitive Examination (CAMCOG) for Alzheimer’s disease: a cross-sectional study

“…[8][9][10][11][12] In 1920, Lipeman studied 84 patients who suffered strokes and discovered that, in addition to aphasia, the patients also had impairments of motor skills such as debilitated copying and imitative gestures. 13 Moreover, regarding more precise aspects of the diagnosis, CAMCOG has contributed towards evaluation of total praxis and its subitems through showing the relevance of some studies that have indicated that impairment of praxis abilities confirms that there is a risk of rapid evolution to severe cases of dementia. 10,14…”

Constructional apraxia screening and oral health among hospitalized older adults: A cross‐sectional study

“…IPT consists in copying two intersecting pentagons, and requires understanding, execution and visuospatial coordination. More specifically, IPT is aimed to evaluate constructional apraxia (CA), which is defined as the inability to draw two or three‐dimensional objects using single dimension lines . It has already been recognized as valuable screening tool to identify subjects with Alzheimer disease and to predict inability to perform pulmonary function tests correctly …”