Posture recognition in Alzheimer’s disease

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.

Acta Neurologica Scandinavica, 2009

Neurological Sciences

Background We propose STIMA, a Short Test for Ideo-motor Apraxia, allowing us to quantify the apraxic deficit according to action meaning and affected body segment. STIMA is based on a neurocognitive model holding that there are two processes involved in action imitation (i.e., a semantic route for recognizing and imitating known gestures, and a direct route for reproducing new gestures). The test allows to identify which imitative process has been selectively impaired by brain damage (direct vs. semantic route) and possible deficits depending on the body segment involved (hand/limb vs. hand/fingers). Methods N=111 healthy participants were administered with an imitation task in two separated blocks of known and new gestures. In each block half of the gestures were performed mainly with the proximal part of the upper limb and the remaining half with the distal one. It resulted in 18 know gestures (nine proximal and nine distal) and 18 new gestures (nine proximal and nine distal) for a total of 36. Each gesture was presented up to a maximum of two times. Detailed criteria are used to assign the final imitation score. Cut-offs, equivalent scores and main percentile scores were computed for each subscale. Result and discussion Participants imitated better known than new gestures, and proximal better than distal gestures. Age influenced performance on all subscales while education only affected one subscale. STIMA is easy and quick to administer, and compared to previous tests it offers important information for planning adequate rehabilitation programs based on the functional locus of the deficit.

Brain and Cognition, 2004

Limb apraxia is a common symptom of corticobasal degeneration (CBD). While previous research has shown that individuals with CBD have difficulty imitating transitive (tool-use actions) and intransitive non-representational gestures (nonsense actions), intransitive representational gestures (actions without a tool) have not been examined. In the current study, eight individuals with CBD and eight age-matched healthy adults performed transitive, intransitive representational and intransitive non-representational gestures to imitation. The results indicated that compared to controls, individuals with CBD were significantly less accurate in the imitation of transitive and intransitive non-representational gestures but showed no deficits for the imitation of intransitive representational gestures. This advantage for intransitive representational gestures was thought to be due to fewer demands being placed on the analysis of visual-gestural information or the translation of this information into movement when imitating these gestures. These findings speak to the importance of context and the representation of gestures in memory in gesture performance.

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[

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.

Neuroscience, 2006

We studied the kinematics of shoulder displacement during sit-to-stand and back-to-sit in 6 healthy elderly subjects and six elderly subjects with mild to moderate Alzheimer's disease in order to elucidate the impact of Alzheimer's disease on motor planning and control processes. During sit-to-stand, Alzheimer's disease subjects reduced their forward displacement and started their upward displacement earlier than healthy elderly subjects. Furthermore, shoulder path curvatures were more pronounced for upward compared with downward displacement in healthy elderly group, in contrast with Alzheimer's disease group. Temporal analysis found that: 1) for both groups, profiles of velocity of sit-to-stand and back-to-sit showed two peaks corresponding respectively to forward/upward and to downward/backward displacements, 2) peaks of velocity were almost comparable between the two groups, 3) duration of sit-to-stand was shorter than duration of back-to-sit in the two groups and 4) duration of sit-to-stand and back-to-sit was shorter in Alzheimer's disease group than in healthy elderly group. However, dissimilarities were observed for transition and deceleration phases during sit-to-stand, and for acceleration and transition phases during back-to-sit, between the two groups. Interestingly, while sit-to-stand and back-to-sit differed in healthy elderly subjects during transition and deceleration phases, such a difference was not observed for Alzheimer's disease subjects. So, our study showed that invariant spatio-temporal movement parameters in the two groups differed, while non-invariant parameters did not, and suggests that higher level motor process of whole body motions are affected by Alzheimer's disease, while lower level motor features remain intact.

European Journal of Neurology, 2010

Background: Only few standardized apraxia scales are available and they do not cover all domains and semantic features of gesture production. Therefore, the objective of the present study was to evaluate the reliability and validity of a newly developed test of upper limb apraxia (TULIA), which is comprehensive and still short to administer. Methods: The TULIA consists of 48 items including imitation and pantomime domain of non-symbolic (meaningless), intransitive (communicative) and transitive (tool related) gestures corresponding to 6 subtests. A 6-point scoring method (0-5) was used (score range 0-240). Performance was assessed by blinded raters based on videos in 133 stroke patients, 84 with left hemisphere damage (LHD) and 49 with right hemisphere damage (RHD), as well as 50 healthy subjects (HS).

Dementia & Neuropsychologia, 2016

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 performa...

… Devoted to the Study of the …, 2001

Examines the roles of long-term memory, a motor programming component, and a working memory component, including short-term memory and supervisory attentional system, in imitation of symbolic and nonsymbolic gestures in 86 patients (aged 75+ yrs) with ideomotor apraxia following a left-hemisphere vascular lesion. Results show that the programming of gestures is impaired in these patients, suggesting damage in the motor programming and working memory systems for hand/arm gestures but not for fingers gestures. Results also indicate that, by generating syntactic representations of gestures, the supervisory attentional system might alleviate the short-term memory load, and thereby compensate for the short-term memory deficit. A similar explanation might hold for the paradoxical results obtained by patients on symbolic vs. nonsymbolic sequences. Ss performed better on symbolic hand/arm sequences, but showed the opposite effect on fingers sequences. These findings might reflect differences in the possibility to be "syntactically encoded' among the various subsets of sequences. Results did not provide evidence that the meaning of a gesture can compensate for either a working memory or motor programming deficit. (PsycINFO Database Record (c) 2010 APA, all rights reserved)