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Wednesday, July 06, 2016

Apraxia and AD

  • Cognitive neurology
  • Research paper

Utility of testing for apraxia and associated features in dementia

Open Access
  1. Christopher R Butler1
+Author Affiliations
  1. 1Nuffield Department of Clinical NeurosciencesUniversity of Oxford, John Radcliffe HospitalOxford, UK
  2. 2Russell Cairns UnitOxford University Hospitals NHS Trust, John Radcliffe HospitalOxford, UK
  3. 3Department of Clinical NeurologyOxford University Hospitals NHS TrustOxford, UK
  4. 4Department of Experimental PsychologyUniversity of Oxford, John Radcliffe HospitalOxford, UK
  1. Correspondence toDr Samrah Ahmed, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK;
  • Received 17 December 2015
  • Revised 31 March 2016
  • Accepted 27 April 2016
  • Published Online First 1 June 2016


Introduction Existing literature suggests that the presence or absence of apraxia and associated parietal deficits may be clinically relevant in differential diagnosis of dementia syndromes.
Aim This study investigated the profile of these features in Alzheimer's disease (AD) and frontotemporal dementia (FTD) spectrum disorders, at first presentation.
Methods Retrospective case note analysis was undertaken in 111 patients who presented to the Oxford Cognitive Disorders Clinic, Oxford, UK, including 29 amnestic AD, 12 posterior cortical atrophy (PCA), 12 logopenic primary progressive aphasia (lvPPA), 20 behavioural variant FTD (bvFTD), 7 non-fluent variant PPA (nfvPPA), 6 semantic variant PPA (svPPA) and 25 patients with subjective cognitive impairment (SCI). The clinical features of interest were: limb apraxia, apraxia of speech (AOS), and left parietal symptoms of dyslexia, dysgraphia, and dyscalculia.
Results The prevalence of limb apraxia was highest in PCA, amnestic AD, lvPPA and nfvPPA. AOS was only observed in nfvPPA. Associated parietal features were more prevalent in AD spectrum than FTD spectrum disorders. Group comparisons between key differential diagnostic challenges showed that lvPPA and nfvPPA could be significantly differentiated on the presence of left parietal features and AOS, and amnestic AD could be differentiated from bvFTD, svPPA and SCI by limb apraxia. Regression analysis showed that limb apraxia could successfully differentiate between AD and FTLD spectrum disorders with 83% accuracy.
Discussion Disease-specific profiles of limb apraxia and associated deficits can be observed. FTD and AD spectrum disorders can be difficult to differentiate due to overlapping cognitive symptoms, and measures of apraxia, in particular, appear to be a promising discriminator.
This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

J Neurol Neurosurg Psychiatry doi:10.1136/jnnp-2016-313466
  • Editorial commentary

Why patients with dementia need a motor examination

  1. Thomas H Bak
  1. Correspondence toHuman Cognitive Neuroscience, Department of Psychology, University of Edinburgh, 7 George Square, Edinburgh EH8 9JZ, UK;
  • Received 7 May 2016
  • Accepted 17 May 2016
  • Published Online First 3 June 2016
About 25 years ago, the world of neurodegenerative diseases was dominated by a clear and intuitively appealing distinction. On one hand, there were dementias, disorders of cognition, in which patients could develop problems with memory, language, attention or orientation, but in which motor functions were assumed to be preserved. On the other hand, there were motor disorders, affecting movement but leaving cognition intact. Dementia and movement specialists rarely interacted; they attended different conferences, read different journals (or at least articles) and used different assessment tools. The division was stronger in the Anglo-Saxon countries than in Continental Europe, with its tradition of linking neurology and psychiatry.
Since then, …

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