Objective: 1. To identify presence and subtypes of apraxia in patients with idiopathic Parkinson’s Disease. 2. To relate praxis deficits in IPD to clinical UPDRS, depression and cognition scores.

Background: Limb apraxia, a disorder of skilled action despite intact elemental motor, sensory functions, comprehension and coordination, has been described in several neurological disorders (Leiguarda and Marsden, 2000). Notable movement disorders in which apraxia has been described include cortico-basal degeneration, progressive supranuclear palsy, and idiopathic Parkinson’s Disease (Leiguarda et al. 1997).

Method: 20 patients with idiopathic Parkinson’s disease (mean age 68.9 [61-78];M9:F11) recruited from the Oxford Parkinson’s Disease Centre, were tested for presence of limb apraxia, measured on a battery of tasks, comparing their performance to deficits measured using the UPDRS, and independent measures of cognition (MOCA), response inhibition on a go-no go task, and dexterity (on nine-hole peg testing). Results were analysed using Pearson’s correlations, with correction for multiple comparisons. All patients were on levodopa treatment; time from levodopa use did not significantly influence performance on praxis and other tasks.

Results: All but one patient made errors in the praxis tasks. Detailed neuropsychological testing revealed that 9 out of 20 patients displayed significant ideomotor deficits, 3 out of 20 patients showed distinct ideational deficits. Both ideational and ideomotor deficits correlated with Part 3 of the UPDRS score and with cognitive performance on the MOCA. Ideomotor deficits also correlated with deficits in dexterity and response inhibition. Whereas deficits in dexterity correlated with PD severity; praxis and cognitive deficits did not.

Conclusion: The study showed we could identify deficits in limb praxis assessed using batteries of tasks in patients with Parkinson’s disease, distinguishing subtypes from other measures such as dexterity. This indicates that praxis deficits might have different underlying mechanisms in this disorder and may provide a useful way for stratifying patients’ impairments and response to treatments.

References: 1. Leiguarda, Pramstaller, Merello, Starkstein, Lees, Marsden. 1997. Apraxia in Parkinson’s disease, progressive supranuclear palsy, multiple system atrophy and neuroleptic-induced parkinsonism. Brain 120 ( Pt 1):75-90. 2. Leiguarda and Marsden. 2000. Limb apraxias: higher-order disorders of sensorimotor integration. Brain 123 ( Pt 5):860-79. 3. Zadikoff, Lang. 2005. Apraxia in movement disorders. Brain 128(Pt 7):1480-97.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/praxis-deficits-in-patients-with-parkinsons-disease-a-neuropsychological-study/