Apraxia in Parkinson's disease and multiple system atrophy

Objective: To determine praxis function in patients with Parkinson’s disease (PD)

and multiple system atrophy (MSA).

Methods: Nineteen patients with PD and 16 patients with probable MSA were re-

cruited into study. Twenty-five age-matched, healthy subjects were included as con-

trols. The Mayo Clinic praxis test battery was applied. Pantomime tasks, including

oral/facial, trunk, and upper extremity movement, were used to evaluate ideomotor

apraxia (IMA). Sequential tasks, including Luria test for ideational apraxia (IDA) and

use of actual objects, were also tested. In addition, Standardized Mini Mental Test

(MMSE), Hamilton Depression (HAM-D), and Anxiety (HAM-A) Scales were used.

Results: Mean ages of the study participants were 66 ± 7, 68 ± 5, and 65 ± 7 years

in PD, MSA, and control groups, respectively. Mean total praxis score was signifi-

cantly lower for patients with PD (92.4 ± 4) and MSA (75.9 ± 18) than for controls

(97.4 ± 2) (P= 0.000). Transitive performances of upper extremities and sequential

tasks were significantly impaired in patients with PD compared to control subjects

(P< 0.05). There was no correlation between total praxis scores and sum scores of

tremor, bradykinesia, and rigidity of both of the upper limbs of patients with PD.

Subgroup praxis scores were substantially worse in MSA group (P< 0.0001).

Compared to control subjects, mean scores for MMSE, HAM-D, and HAM-A tests

were significantly worse in MSA group, but, for PD patient group, only HAM-A

scores were worse.

Conclusion: Our results indicate that although not a presenting symptom, IMA and

IDA may be features of MSA and, to a lesser degree, of PD. Also, it seems to be

unrelated to the motor features of patients with PD.