Apraxia profile differentiates behavioural variant frontotemporal from Alzheimer's dementia in mild disease stages

Johnen, Andreas; Tokaj, Amelie; Kirschner, Anne; Wiendl, Heinz; Lueg, Gero; Duning, Thomas; Lohmann, Hubertus

doi:10.1136/jnnp-2014-308773

Cited by 31 publications

(36 citation statements)

References 40 publications

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“…11 A more recent study found that patients with amnestic AD performed significantly worse than patients with bvFTD on tests of limb apraxia, examining both ideational and ideomotor gestures. 14 It is widely held that the left parietal lobe plays a central role in limb apraxia, originating in Leipmann's early model describing a posterior to anterior stream that converts mental images of actions into a motor response, 2 and subsequent models have equally attributed a central role to the left parietal regions. 1 15 In conjunction with apraxia, left parietal dysfunction produces a range of other cognitive symptoms, including deficits in reading, writing and arithmetic, and there is suggestion in the literature that these clinical features may also be of relevance to the diagnosis of dementia syndromes, particularly in the AD spectrum.…”

Section: Introductionmentioning

confidence: 99%

Utility of testing for apraxia and associated features in dementia

Ahmed

Baker

Thompson

et al. 2016

J Neurol Neurosurg Psychiatry

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IntroductionExisting literature suggests that the presence or absence of apraxia and associated parietal deficits may be clinically relevant in differential diagnosis of dementia syndromes.AimThis study investigated the profile of these features in Alzheimer's disease (AD) and frontotemporal dementia (FTD) spectrum disorders, at first presentation.MethodsRetrospective 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.ResultsThe 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.DiscussionDisease-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.

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Section: Introductionmentioning

confidence: 99%

Utility of testing for apraxia and associated features in dementia

Ahmed

Baker

Thompson

et al. 2016

J Neurol Neurosurg Psychiatry

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“…Recently, we demonstrated that patients with typical amnestic AD and patients with bvFTD present with distinct apraxia profiles15: the former were shown to have pronounced deficits in imitation of hand and finger postures (CAS subscore 2.2), while imitation of face postures (CAS subscore 2.1) was spared. In contrast, patients with typical bvFTD had relatively preserved imitation of hand and finger postures but pronounced deficits in imitation of face postures 15. Therefore, we calculated a limb (CAS 2.2) minus face (CAS 2.1) functional score for differential diagnosis of AD versus FTD praxis impairment.…”

Section: Methodsmentioning

confidence: 99%

“…Recently, we have demonstrated that patients with typical AD and patients with bvFTD present with distinct forms of praxis impairment 15. Apraxia denotes the inability to perform specific predefined actions or to carry out learnt and purposeful movements due to acquired brain lesions 16 17.…”

Section: Introductionmentioning

confidence: 99%

Apraxia screening predicts Alzheimer pathology in frontotemporal dementia

Pawlowski

Joksch

Wiendl

et al. 2018

J Neurol Neurosurg Psychiatry

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ObjectivesFrontotemporal dementia (FTD) is a heterogeneous clinical syndrome linked to diverse types of underlying neuropathology. Diagnosis is mainly based on clinical presentation and accurate prediction of underlying neuropathology remains difficult.MethodsWe present a large cohort of patients with FTD spectrum diseases (n=84). All patients were thoroughly characterised by cerebrospinal fluid (CSF) Alzheimer’s disease (AD) biomarkers, neuroimaging, neuropsychological testing and standardised apraxia screening.ResultsA potential AD pathology was found in 43% of patients with FTD. CSF AD biomarker levels positively correlated with AD-typical apraxia scores in patients with FTD. The discriminative power of apraxia test results indicative of AD pathology was high (sensitivity: 90%, specificity: 66%).ConclusionsApraxia is common in neurodegenerative dementias but under-represented in clinical workup and diagnostic criteria. Standardised apraxia screening may serve as bedside test to objectify an AD-typical apraxia profile as an early and robust sign of AD pathology in patients with FTD.

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“…As a higher‐order disorder of sensorimotor integration, apraxia is commonly seen in neurological diseases, such as Alzheimer disease (AD) and stroke, and may contribute to dementia diagnosis in early stages . Among subtypes of apraxia, ideomotor apraxia is believed to reflect an impaired action production system.…”

mentioning

confidence: 99%

“…A s a higher-order disorder of sensorimotor integration, apraxia is commonly seen in neurological diseases, such as Alzheimer disease (AD) and stroke, and may contribute to dementia diagnosis in early stages. [1][2][3][4][5][6] Among subtypes of apraxia, ideomotor apraxia is believed to reflect an impaired action production system. Due to insufficient conversion to execution of motor programming, individuals with ideomotor apraxia exhibit deficits in the spatial organization, timing, and sequencing of gestural movements.…”

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confidence: 99%

Bimanual Gesture Imitation Links to Cognition and Olfaction

Tian

Chastan

Thambisetty

et al. 2019

J American Geriatrics Society

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OBJECTIVES Given the need to detect subclinical changes in brain health that sometimes occur with aging in apparently healthy older adults, we assessed whether bimanual gesture imitation performance, simple to assess clinically, can detect age effects and alterations in cognition, olfaction, and movement. DESIGN Cross‐sectional study. SETTING Baltimore Longitudinal Study of Aging. PARTICIPANTS Men and women, aged 22 to 101 years, without cognitive impairment, dementia, stroke, Parkinson disease, resting tremor, abnormal muscle tone, or abnormal coordination (N = 507). MEASUREMENTS Bimanual gesture imitation was measured using a test validated in older adults. We assessed (1) cognition, including verbal memory, executive function, attention, visuospatial ability, visuoperceptual speed, and language; (2) manual dexterity with the Purdue Pegboard Test; (3) olfaction, using the 16‐item Sniffin' Sticks Identification Test; (4) upper extremity motor function, using a computer‐based finger tapping test; and (5) lower extremity motor function, including 6‐meter usual and rapid gait speeds, 400‐meter walk time, Health ABC Physical Performance Battery, and total standing balance time. Cross‐sectional associations between bimanual gesture imitation performance and each measure were examined using linear regression after adjustment for age, sex, race, education, and body mass index. Models with mobility measures also adjusted for height. RESULTS Higher gesture imitation performance was associated with younger age. After adjustment, a worse score was associated with worse olfaction, executive function, and visuospatial ability. Gesture imitation score was not associated with other cognitive measures or motor function. CONCLUSION In persons without clinically detectable neurological conditions, poor bimanual gesture imitation is associated with other indicators of brain health, including olfaction and selected cognitive function domains. Bimanual gesture imitation may be useful clinically to detect subtle brain changes in apparently healthy older adults. J Am Geriatr Soc 67:2581–2586, 2019

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Apraxia profile differentiates behavioural variant frontotemporal from Alzheimer's dementia in mild disease stages

Cited by 31 publications

References 40 publications

Utility of testing for apraxia and associated features in dementia

Utility of testing for apraxia and associated features in dementia

Apraxia screening predicts Alzheimer pathology in frontotemporal dementia

Bimanual Gesture Imitation Links to Cognition and Olfaction

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