Rc. Leiguarda et al., APRAXIA IN PARKINSONS-DISEASE, PROGRESSIVE SUPRANUCLEAR PALSY, MULTIPLE SYSTEM ATROPHY AND NEUROLEPTIC-INDUCED PARKINSONISM, Brain, 120, 1997, pp. 75-90
We studied 45 non-demented patients with Parkinson's disease (PD), 12
with progressive supranuclear palsy (PSP), 10 with multiple system atr
ophy (MSA) and 12 with neuroleptic-induced parkinsonism (NIP) for the
presence of apraxia. Our aim was to determine whether a standard compr
ehensive assessment of different praxic functions would demonstrate sp
ecific types of errors not attributable to bradykinesia, rigidity trem
or or any other abnormal elementary motor deficit. PD patients on chro
nic levodopa treatment were examined in the 'on' and 'off' (treatment)
states. Based on apraxia assessment scores, bilateral ideomotor aprax
ia for transitive movements was found in eight (75%) and 12 (27%) of P
SP and PD patients, respectively. Ideomotor apraxia was mainly charact
erized by spatial errors (i.e. external and internal configuration bod
y-part-as-object and trajectory). Four PSP but no PD patients exhibite
d ideomotor apraxia for intransitive movements. PSP as well as PD pati
ents with ideomotor apraxia also had difficulties in imitating hand an
d finger postures, but none of them failed on pantomime comprehension
and pantomime recognition/discrimination. Some PSP patients exhibited
in addition, a limbkinetic type of apraxia and a minority of them disp
layed deficits on tasks involving multiple steps. Neither MSA nor NIP
patients showed arty disturbance of praxic functions. There were no di
fferences in age, disease duration, Mini Mental State Examination (MMS
E), Unified Parkinson's Disease Racing Scale and Hoehn-Yahr scores bet
ween apraxic and non-apraxic PD patients, and ideomotor apraxia scores
were similar in the 'on' and 'off' states. A correlation was found be
tween ideomotor apraxia scores in PD patients and deficits in frontal
lobe-related neuropsychological tasks such as the Tower of Hanoi, verb
al fluency and the Trail Making Test. Furthermore, PD patients with ap
raxia showed higher Hamilton depression scores than non-apraxic PD pat
ients. In PSP patients, ideomotor apraxia scores correlated significan
tly with cognitive deficit as measured with MMSE. The presence or abse
nce of cortical involvement, and its severity and distribution might d
etermine the presence and type of apraxia in PD and PSP Apraxia in the
se conditions would therefore reflect combined cortico-striatal dysfun
ction.