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Apraxic agraphia can be caused by left hemispheric cerebral lesions in the area that contains the spatial representations of the movements required to write, from a lesion in, or connections to, the frontal premotor cortex that converts these spatial representations to motor programs (Exner's area). A right-handed woman with Marchiafava Bignami disease and lesions of the genu and splenium of her corpus callosum had apraxic agraphia without ideomotor apraxia of her left. A disconnection of Exner's area in the left hemisphere from the right hemisphere's premotor and motor areas may have led to her inability to write with her left hand.

Creutzfeldt-Jakob disease (CJD) is a rare, rapidly progressive, and fatal neurodegenerative disease with neuropsychological sequelae. This study highlighted a rare presentation of CJD (e.g. corticobasal syndrome [CBS]), reviewed updated diagnostic criteria and procedures for CJD (e.g. diffusion weighted imaging [DWI], real-time quaking-induced conversion [RT-QuIC]), and discussed differential diagnoses.Case report methodology focused on a 68-year-old, Hispanic, right-handed man with 11 years of education. He presented with a 1-2-month history of gait and motor difficulties (e.g. rigidity, myoclonus).After evaluation, a 'cortical ribboning' pattern on DWI and positive RT-QuIC was integrated with performance on neurobehavioral exam (i.e. alien limb phenomenon, unilateral ideomotor apraxia) and neuropsychological testing (i.e. frontal-parietal dysfunction pattern) to reach a diagnosis of sCJD-CBS. The patient expired 3 months after onset of symptoms.This literature review and case report highlighted the importance of staying abreast of developments in neurological literature and the added value of neuropsychology, when integrated with newer procedures, for confirming and excluding diagnostic considerations.

Crossover learning may aid rehabilitation in patients with neurological disorders. Ideomotor apraxia (IMA) is a common sequela of left-brain damage that comprises a deficit in the ability to perform gestures to verbal commands or by imitation. This study elucidated whether crossover learning occurred in two post-stroke IMA patients without motor paralysis after gesture training approximately 2 months after stroke onset. We quantitatively analysed the therapeutic intervention history and investigated whether revised action occurred during gesture production. Treatment intervention was to examine how to influence improvement and generalisation of the ability to produce the gesture. This study used an alternating treatments single-subject design, and the intervention method was errorless learning. Results indicated crossover learning in both patients. Qualitative analysis indicated that revised action occurred during the gesture-production process in one patient and that there were two types of post-revised action gestures: correct and incorrect gestures. We also discovered that even when a comparably short time had elapsed since stroke onset, generalisation was difficult. Information transfer between the left and right hemispheres of the brain via commissural fibres is important in crossover learning. In conclusion, improvements in gesture-production skill should be made with reference to the left cerebral hemisphere disconnection hypothesis.

Poor oral hygiene and dental health are very common among the institutionalized elderly. The purpose of this study was to evaluate the association of apraxia with oral hygiene and/or health.Ninety-two residents of 13 long-term care homes in southwest Germany participated in the study. For each participant, ideomotor apraxia scoring (AS) was conducted and demographic variables were collected. Participants underwent a comprehensive dental examination to assess the oral health indices gingival bleeding index (GBI), community periodontal index of treatment needs (CPITN) and denture hygiene index (DHI). Statistical comparison of dental indices among apraxic and non-apraxic individuals (cut-off45) was performed by use of t-tests. In addition, linear regression models were constructed with the dental indices as dependent variables. Each model was fitted with the dichotomized variable AS (pathologic or healthy) and adjusted for age and sex.Mean (SD) GBI of 48.5 (25.9), CPITN of 2.9 (0.7) and DHI of 82.6 (14.6) were observed among the participants. Statistical analysis revealed AS was significantly associated with all oral health indicators (p0.05). Linear regression models showed apraxia is a predictor of GBI (p = 0.002) and CPITN (p = 0.027), but not of denture hygiene (p = 0.916).Although this pilot investigation has limitations, the results suggest the presence of apraxia should be considered when planning oral healthcare strategies. Further research with larger samples is encouraged to confirm these relationships.

Studies of patients with brain lesions have demonstrated that language and praxis are mediated by dissociable networks. However, language has the capacity to influence the selection of purposeful actions. The abilities to use language and to program purposeful movements are often mediated by networks that have anatomic proximity. With hemispheric injury, the diagnosis of apraxia is often confounded by the specific influence of language impairments on the ability to select and produce transitive gestures. We report a patient who illustrates this confound. This patient is a right-handed man who developed global aphasia and neglect after a right hemispheric stroke. His right hand remained deft, and when asked to produce specific transitive gestures (pantomimes), he often performed normally but did make some body part as object and perseverative errors. However, he did not demonstrate the temporal or spatial errors typical of ideomotor apraxia. He also had a perseverative agraphia. Our patient’s left hemisphere praxis system appeared to be intact, and the error types demonstrated during production of transitive gestures cannot be attributed to a degradation of postural and movement (praxis) programs mediated by his left hemisphere. The praxis errors types are most consistent with a deficit in the ability to select the necessary praxis programs. Thus, our patient appeared to have dissociation between language and praxis programs that resulted in body part as object and perseverative errors.

A combination of detailed observation of dressing behaviour and neuropsychological assessment was used to identify the cognitive barriers to independent dressing in a series of eight stroke patients. For those with right hemisphere damage, dressing was disrupted by visuospatial problems or poor sustained attention. Those with left hemisphere damage and ideomotor apraxia were unable to learn the correct procedure to compensate for hemiparesis when dressing. The value of a therapeutic approach based on these observations was assessed in a single-blind randomised multiple-baseline experiment. A baseline phase of conventional dressing therapy which takes no account of individual patterns of cognitive impairment was contrasted with an approach which was formulated for each case. A permutation test demonstrated that there was a significant treatment effect for the right hemisphere cases but there was no therapy-related improvement for those with left or bilateral damage and apraxia. Observation of a naturalistic but controlled task (dressing with a standard item of clothing) appears to allow greater insight into the impact of specific neuropsychological deficits than has been found for more complex naturalistic tasks. The benefits of this ecological approach over conventional approaches to dressing therapy need to be evaluated further in a randomised clinical trial.

In the present study we analysed the perseverative behaviour of three apraxic patients (FG, CEO, and VCR) while they were pantomiming the use of common objects and during their real use. The three patients were found to perseverate from one trial to later ones aspects of a given action in the pantomiming and in real use tasks. In particular, our main result was a striking double dissociation between patients in perseverating hand and arm movements. Patients FG and CEO made more perseveration errors involving the hand than VCR did, whereas the perseverative errors made by VCR involving the arm were more numerous than those made by FG and CEO. The patients differed also in other aspects of the perseverations, e.g., their median lags. Results are used to exend previous theories developed in the linguistic domain to that of actions.

A case of a 50-year-old, right-handed female, mono-lingual native Spanish-speaker with a university-level education and cognitive changes is reported. Over approximately 2 years, she presented with a progressive deterioration of writing abilities associated with acalculia and anomia. An MRI disclosed a left parietal temporal atrophy. Two years later, further significant cognitive decline consistent with a dementia of the Alzheimer's type was observed. Amnesia, executive dysfunction, and ideomotor apraxia were found. Writing was severely impaired, and some difficulties in reading were observed. Copying abilities, however, were relatively well preserved, and the patient could drive and go to different city locations without significant spatial orientation difficulties. A second MRI approximately 2 years later showed that brain atrophy had progressed significantly. Spontaneous writing and writing to dictation were impossible. The ability to read words was preserved, but the ability to read pseudowords was lost. Changes in calligraphy were noted. This case clearly illustrates the progression of focal cognitive defects over time and the spread of abnormalities to other domains.

Dysgraphia (agraphia) is a common feature of posterior cortical atrophy (PCA). However, detailed analyses of these spelling and writing impairments are infrequently conducted. LM is a 59-year-old woman with dysgraphia associated with PCA. She presented with a two-year history of decline in her writing and dressmaking skills. A 3D T1-weighted MRI scan confirmed selective bi-parietal atrophy, with relative sparing of the hippocampi and other cortical regions. Analyses of LM's preserved and impaired spelling abilities indicated mild physical letter distortions and a significant spelling deficit characterised by letter substitutions, insertions, omissions, and transpositions that was systematically sensitive to word length while insensitive to real word versus nonword category, word frequency, regularity, imagery, grammatical class and ambiguity. Our findings suggest a primary graphemic buffer disorder underlies LM's spelling errors, possibly originating from disruption to the operation of a fronto-parietal network implicated in verbal working memory.

We report three PET experiments that examine the neural substrates of the conceptual components of action retrieval. In all three experiments, subjects made action or screen-size decisions to familiar objects presented either as pictures or written words (the names ofthe objects). In Experiment 1, a third task was included, requiring a decision on the real-life size of the stimuli. In Experiment 2, a third stimulus type was included, with action and size decisions also performed on pictures of meaningless novel objects. Finally, in Experiment 3, we changed the response mode from a button press to a more explicit movement made with a lsquo;lsquo;manipulandumlsquo;lsquo;. Based on neuropsychological findings, we predicted that when action responses were made to pictures of familiar or novel objects, relative to words, there would be less activation in semantic regions but greater activation in visual, motor, and perhaps parietal cor tices. We found that, action relative to screen-size decisions on both pictures and words activated the left hemisphere temporo-frontal semantic system with activation in the left posterior middle temporal cortex specific to action retrieval (Experiment 1). In addition, action retrieval elicited more activation for (1) words than pictures in areas associated with semantics; and (2) novel objects than words or familiar objects in areas associated with pre-semantic object processing. These results are discussed in the context of semantic and visual routes to action retrieval.

Basso, Burgio, Paulin, and Prandoni (2000) claimed evidence for recovery from ideomotor apraxia within the first year post-cerebrovascular accident. However, concerns about the excessive use of paired t tests and incongruous experimental designs challenge the reported findings. The ideomotor apraxia recovery data should be analysed with a completely within-subjects design one-way analysis of variance (ANOVA). Further, the locus of lesion by clinical examination time data should be analysed in a two-way mixed design ANOVA with repeated measures on the three levels of examination time. In addition, circularity assumptions (i.e., composition of the covariance matrices) should be addressed for the repeated measures in the recommended analyses. In a tutorial approach, using the proper experimental designs and statistics, the ideomotor apraxia data were reanalysed. The one-way results support the recovery improvements between the first and second examinations. However, conflict with the original findings was fo...

Although ideomotor apraxia (IM) has been a topic of investigation since the early 20th century, progress in studying the disorder has been hindered by important (and sometimes unarticulated) differences in the underlying theoretical models of various investigative groups. As a result, it is difficult to draw conclusions about the expected performance of IM patients on various tests of praxis (e.g. pantomime, single object use, gesture imitation, and naturalistic action); the relationship of IM to ideational apraxia (IA); the degree to which specific error types are diagnostic of one or the other disorder; the relationship of semantic knowledge to gesture representations; and the role of spatiomotor systems external to the stored gesture representation system. Here an updated model of IM is presented, informed by recent physiological and functional neuroimaging literature, as a step towards resolving some of these concerns. The model is intended to lay the groundwork for future investigations of specific performance patterns in different subtypes of IM.

There has been little research on recovery from ideomotor apraxia (IMA). We undertook a long-term follow-up study in a group of ideomotor apraxic patients (n = 44). The duration of follow-up ranged from 1.5 years to 7.2 years. The patients' ability to imitate gestures was evaluated three times (1.6 months, 9.4 months, and 27.9 months mean time post-onset). All but one patient made an important recovery from IMA in the period between the first and second examinations. Subsequently, very few of the patients showed further recovery and six patients worsened. In three cases deterioration was global, while in three it was confined to IMA. The performance of patients with anterior (n = 6) and posterior (n = 8) lesions was also compared. At all three examinations, patients with anterior lesions had more severe apraxia however, the degree of recovery was not significantly different in the two groups.

We describe the case of a 74-year-old man with selective apraxia for transitive gestures (gestures of object use) following a left temporo-parietal infarction. We document his neuropsychological progress over 2 years and assess his praxic abilities according to the best-developed cognitive model of praxis. Strikingly, PF was unable to pantomime transitive gestures in every test modality (verbal command, imitation, photographs of objects and handling actual tools), but could still execute symbolic (e.g. salute) and meaningless gestures. He was able to discriminate and recognize transitive gestures as well as controls. His praxic impairment has persisted through the years in the absence of dementia. His inability to use tools cannot be accounted for on the basis of a visual agnosia, impaired language comprehension or a classic ideomotor apraxia. Such a selective deficit of transitive gestures is incompatible with the cognitive model proposing that the production of all meaningful gestures (symbolic...

The internal consistency and the diagnostic value of a test for apraxia in patients having had a stroke are presented. Results indicate that the items of the test form a strong and consistent scale: Cronbach's alpha as well as the results of a Mokken scale analysis present good reliability and good scalability. The diagnostic value of the test was determined by comparison of test results in three groups of patients: 44 stroke patients with apraxia (patients), 35 stroke patients without apraxia (patient controls), and 50 healthy nursing home residents with no history of stroke (normal controls). The diagnostic value is expressed by means of the sensitivity and specificity and the predictive value of the test. In addition, Receiver Operator Characteristics (ROC) curves are presented. The sensitivity and specificity of the apraxia test appear to be good: all values are higher than 80%. The test also has high predictive value. The ROC curves illustrate that the test is sufficiently discriminative to allow a differentiation between persons with apraxia and persons without apraxia.

The concept of functional structures was introduced by Kepiński. At the Second Scandinavian Congress on Image Analysis in 1981 Kohonen provided evidence that the map of signals has the same topological order as the map of reactions. These topological concepts can be applied also to logical structures. The same is true also of functional structures described by Kepiński in schizophrenia, which may be created or destroyed, but their topological order remains unaltered. Functional structures change in obscuration and in hallucinogen-induced psychodelic states. Fixed pathological structures characterized by an altered topological order occur in paranoia. In the case of amnestic aphasia single elements of the topological functional structures fall out-these elements represent terms which patient is unable to recall. In motor aphasia, on the other hand, damage concerns the topological functional structures of speech related movements. In sensory aphasia damage concerns topological functional structures in the sensory area. In Goldstein's amnestic apraxia there is a loss of some elements of the topological functional structures governing the movements. In ideational apraxia the damage concerns topological functional structures representing entire sets of motor function and especially their creation. In ideomotor apraxia the respective topological functional structures are retained, albeit inaccessible, due to a disturbance in the motor association. In motor apraxia the damage seems to concern the topological functional structures governing precise movements and located at a lower level, i.e., closer to the effector. Constructive apraxia seems to result from the disturbed creation of the respective functional structures. Similarly the hypermotility of a maniacal type has a smooth and purposeful character, as far as the relation to a particular situation is concerned, which suggests that the respective topological functional structures are preserved. On the other hand, in the hyperkinetic phase of catatonic schizophrenia, in which the patient performs sequences of incoherent aimless movements without any relation to the current situation and environment, these structures are supposedly altered.

Forty-five aphasic patients, who had suffered a left middle cerebral infarction involving more than 2% of forebrain volume at least 4 months previously, were investigated for the presence of speech automatisms and their accompanying neurological and neuropsychological symptoms. Fourteen patients were found to produce automatisms. The presence of this symptom was correlated, although not closely, with degree of bucco–facial apraxia, but not significantly with lesion size. The correlation with Token Test scores was insignificant when the effects of ideomotor apraxia had been partialized. We interpret our observations on the basis of a theory that speech automatisms are a symptom of primary or secondary severe dysfunction in the periphery of the language production apparatus in the vicinity of processes of speech motor planning and execution.

Twelve aphasic subjects were given a referential communication task. Channel use (oral or gestural) and efficiency (time to complete the task and intelligibility) were analysed in relation to the score obtained by the subject in a formal examination of ideomotor apraxia. Use of gestures was found to be negatively correlated with the severity apraxia score: more gestures were produced by the more apraxic subjects, who also suffered from more severe forms of aphasia. These messages were understood in a reasonable proportion of cases, so it is suggested that the spontaneous production of gestures can be used in therapy to establish efficient gestural communication.

Using Luria's motor sequence test, we studied the learning ability of 34 right-handed patients with unilateral hemisphere lesions. Patients with ideomotor apraxia needed 4 to 6 trials in the test, while the remainder needed only 1 or 2. Ideomotor apraxics also required more time to complete the test. The lesions of patients who failed to master this test were not always found in the frontal lobes. These results suggest that the ability to learn motor sequences is impaired in apraxic patients and that the left hemisphere of the brain plays the major role in learning a new motor sequence. Patients with ideomotor apraxia are impaired not only when performing previously learned motor tasks but also when learning a new motor task.