Disruption of spatial organization and interjoint coordination in Parkinson's disease, progressive supranuclear palsy, and multiple system atrophy

Patients with basal ganglia diseases may exhibit ideomotor apraxia. To defi ne the nature of the impairment of the action production system, we studied a repetitive gesture of slicing bread by three-dimensional computergraphic analysis in eight nondemented patients with Parkinson's disease in the "on " state, five with progressive supranuclear palsy and four with multiple sy stem atrophy. Two patients with Parkinson's disease and two with progressiv e supranuclear palsy showed ideomotor apraxia for transitive movements on s tandard testing. A Selspott II system was used for kinematic analysis of wr ist trajectories and angular motions of the shoulder and elbow joints. Pati ents with Parkinson's disease, progressive supranuclear palsy, and even som e with multiple system atrophy exhibited kinematic deficits in the spatial precision of movement and velocity-curvature relationships; in addition, th ey failed to maintain proper angle/angle relationships and to apportion the ir relative joint amplitudes normally. Spatial disruption of wrist trajecto ries was more severe in patients with ideomotor apraxia. We posit that the basal ganglia are part of the parallel parieto-frontal circuits devoted to sensorimotor integration for object-oriented behavior. The severity and cha racteristics of spatial abnormalities of a transitive movement would theref ore depend on the location and distribution of the pathologic process withi n these circuits.