Why patients with dementia need a motor examination

Movement Disorders, 1999

BACKGROUND: Prehension is an ideationally simple, cued movement requiring proximal (transport) and distal (manipulation) limb control. Patients with this syndrome of progressive apraxia are unable to perform many activities of daily living that require prehension. There is little known about how this syndrome kinematically disrupts such movements or whether concurrent dementia might play a critical role. OBJECTIVES: Using prehension as a paradigm for an ideationally simple, cued functional movement, we sought to (1) characterize the kinematic features of progressive apraxia in general, and (2) contrast the kinematic differences between apraxic patients with and without dementia. METHODS: Eight patients with the syndrome of progressive apraxia (including five without dementia, one of whom had autopsy-confirmed corticobasal ganglionic degeneration, and three with dementia, one of whom had autopsy-confirmed Alzheimer's disease) were compared with eight age-matched normal control subjects on a prehension task using an Optotrak camera system. RESULTS: Compared with control subjects, apraxic subjects had slowed reaction time, slowed transport and manipulation kinematics, greater lateral deviation from the linear prehension trajectory, greater intermanual asymmetry, motor programming disturbances, and mild transport-manipulation uncoupling. There were minor differences between the apraxia subgroups such as greater intermanual differences and impaired grip aperture velocity in the nondemented group, and overall slower movement in the demented group. CONCLUSIONS: There are major kinematic differences between apraxic and control subjects on a prehension task. The differences between clinical-pathologic subgroups are more subtle, and the movement disorder itself rather than concurrent dementia is the greatest determinant of motor disability.

Acta Neurologica Scandinavica, 2009

Springer eBooks, 2014

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Neurology, 2004

Background: Motor signs (MOSIs) are common in Alzheimer disease (AD) and may be associated with rates of cognitive decline, mortality, and cost of care.Objective: To describe the progression and identify predictors of individual MOSIs in AD.Methods: A cohort of 474 patients with AD at early stages was followed semiannually for up to 13.1 years (mean 3.6 years) in five centers in Europe and the United States. MOSIs were rated using a standardized portion of the Unified Parkinson’s Disease Rating Scale. Overall, 3,030 visits/assessments of MOSIs (average 6.4/patient) were performed. Prevalence and incidence rates were calculated, and cumulative risk graphs were plotted for individual non-drug-induced MOSI domains. Rates of change over time taking into account potential covariates were also estimated. With use of each MOSI domain as outcome in Cox models, predictors of MOSI incidence were identified.Results: At least one MOSI was detected in 13% of patients at first examination and in ...

Indian Journal of Psychological Medicine, 2015

Praxis is ability to formulate skilled movements in a nonparetic limb by planning a schema based on stored complex representations and previously learned movements and apraxia is inability to carry out a learned motor act in the absence of motor, sensory or cerebellar deficit on command. According to Geshwind, apraxia is failure to produce a correct movement in response to verbal command, imitate an action performed by the examiner, and perform the movement correctly in response to a seen object and failure to handle an object correctly. The errors may be temporal, spatial, content or lack of response (Disconnection model of Geschwind 1965). According to Liepman there is a motor engram which is the space, time plan which is conveyed by the left parietal lobe through association fibers to central regions which includes pre-and postcentral gyrus, superior frontal gyrus and the underlying

Neuropsychologia, 1999

Many patients with Alzheimer|s disease "AD# are apraxic and the apraxia has been posited to be related to a loss of movement representations[ Whereas patients with Alzheimer|s disease have been reported to demonstrate normal motor learning on a rotor pursuit skill acquisition task\ it is unknown whether AD subjects who are apraxic demonstrate normal skill!learning[ We tested subjects with probable AD and normal controls on a rotor pursuit task[ We also tested the AD subjects for ideomotor apraxia[ Subjects with AD who were apraxic had normal motor learning[ In addition\ praxis score did not correlate with performance on the skill!acquisition task[ The results suggest that ideomotor praxis and motor learning are at least partly dissociable[ Þ 0888 Elsevier Science Ltd[ All rights reserved[

Cortex, 2007

The purpose of this study was to devise quantitative methods for the assessment of praxic skills of the upper limbs by developing a computerised task which permits each component of a sequence of actions to be timed precisely. Furthermore, two versions of such a quantitative measure were developed to investigate the relationship between meaningful and meaningless movements. The praxic skills of 35 patients with Alzheimer's disease (AD) and 75 healthy controls were assessed on two 3-item sequential movement tasks involving either meaningful or meaningless actions. A qualitative rating scale assessment of gesture imitation and pantomime was also administered. AD patients were significantly slower than controls on both the sequential movement tasks. Indeed, the correlation between AD patients' abilities on the novel and traditional tasks provided evidence that the sequential movement tasks constitute valid measures of praxis. Within the AD population, disease severity was also found to have a minimal and inconsistent influence upon praxis. The apraxia assessment results are considered in relation to the debate over whether apraxia constitutes an early or late feature of AD, and also to theoretical claims about the cognitive neuropsychological deficit underlying ideational apraxia.

Neuroscience Letters, 1999

Movement accuracy in normal subjects depends on feedforward commands based on representation in memory of spatial and biomechanical features. Here we ask whether memory deficits in Alzheimer's disease (AD) interfere with movement planning and execution. Nine AD patients and nine age-matched controls moved a cursor to targets without seeing their limb. Starting and target positions were always visible on a screen, while, during movement, cursor position was either visible or blanked. Patients' paths showed discontinuous segments and prolonged movement time; movement inaccuracy, which increased without visual feedback, correlated significantly with scores of disease severity, working memory and attention.

The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 1997

Journal of Psychiatric Research, 2008

Sensory-motor dysfunctions are often associated with Alzheimer's disease (AD) or mild cognitive impairment (MCI). This study suggests that deterioration in fine motor control and coordination characterizes sensory-motor deficiencies of AD and MCI. Nine patients with a clinical diagnosis of probable AD, 9 amnestic MCI subjects and 10 cognitively normal controls performed four types of handwriting movement on a digitizer. Movement time and smoothness were analyzed between the groups and across the movement patterns. Kinematic profiles were also compared among the groups. AD and MCI patients demonstrated slower, less smooth, less coordinated, and less consistent handwriting movements than their healthy counterparts. The theoretical relevance and practical implications of fine motor tasks, such as these movements involved in handwriting, are discussed relative to the deteriorated sensory-motor system of AD and MCI patients.