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Research paper
Utility of testing for apraxia and associated features in dementia
  1. Samrah Ahmed1,
  2. Ian Baker2,
  3. Sian Thompson3,
  4. Masud Husain1,4,
  5. Christopher R Butler1
  1. 1Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
  2. 2Russell Cairns Unit, Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, UK
  3. 3Department of Clinical Neurology, Oxford University Hospitals NHS Trust, Oxford, UK
  4. 4Department of Experimental Psychology, University of Oxford, John Radcliffe Hospital, Oxford, UK
  1. Correspondence to Dr Samrah Ahmed, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK; samrah.ahmed{at}ndcn.ox.ac.uk

Abstract

Introduction Existing literature suggests that the presence or absence of apraxia and associated parietal deficits may be clinically relevant in differential diagnosis of dementia syndromes.

Aim This study investigated the profile of these features in Alzheimer's disease (AD) and frontotemporal dementia (FTD) spectrum disorders, at first presentation.

Methods Retrospective 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.

Results The 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.

Discussion Disease-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.

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

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Footnotes

  • Contributors SA conceptualised the study, conducted the statistical analysis of the data and prepared the initial manuscript. IB, ST, MH and CRB conducted the clinical examination of the patients described in the study, and edited and revised the manuscript. All authors contributed equally to the study design and approval of the final manuscript.

  • Funding SA is supported by the Oxford Biomedical Research Centre and Alzheimer's Research UK. MH is supported by the Wellcome Trust. CB is supported by the Medical Research Council (MR/K010395/1).

  • Competing interests None declared.

  • Ethics approval South Central Oxford Research Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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