Skip to main content Accessibility help
Hostname: page-component-848d4c4894-xfwgj Total loading time: 0 Render date: 2024-06-22T00:58:00.252Z Has data issue: false hasContentIssue false

12 - Disorders of visuoconstructive ability

Published online by Cambridge University Press:  10 October 2009

Diane Dupuy
University Hospital, Amiens, France
Olivier Godefroy
University Hospital, Amiens, France
Olivier Godefroy
Université de Picardie Jules Verne, Amiens
Julien Bogousslavsky
Université de Lausanne, Switzerland
Get access


General presentation of visuoconstructive disorders

This chapter deals with the inability to assemble the elements of a two- or three-dimensional object, respecting their orientations and spatial relationships. This disorder is generally known as “constructional apraxia,” a term introduced by Kleist (1934) and frequently used in clinical practice. According to Benton's definition (1967), “constructional apraxia denotes an impairment in combinatory or organizing activity, in which details must be clearly perceived and in which the relationships among the component parts of the entity must be apprehended if the desired synthesis of them is to be achieved.” Since the term apraxia introduces some confusion with other varieties of apraxia, the term “disorders of visuoconstructive ability” is frequently preferred and will be used here.

Impairment of visuoconstructive ability is easily demonstrated in a patient with abnormalities in drawings (either free or copied) not explained by low visual acuity or motor disorders. Drawing difficulties related to purely motor, cerebellar, proprioceptive or extrapyramidal disorders are not considered to be apraxic. In addition, gestural apraxia per se does not induce visuoconstructive impairment (Ajuriaguerra et al., 1960). Drawing disturbances related to visual agnosia, simultagnosia and Bálint's syndrome are usually considered to be secondary to perceptual disorders and are not classified as apraxic. From a practical point of view, the examiner must ensure that the patient's ability to identify the figure to be copied is spared before concluding a disorder of visuoconstructive ability. Finally, visuoconstructive disorders are frequently associated with hemineglect, especially in right brain damage.

Publisher: Cambridge University Press
Print publication year: 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


Adunsky, A., Fleissig, Y., Levenkrohn, S., Arad, M. and Noy, S. (2002). Clock drawing task, mini-mental state examination and cognitive-functional independence measure: Relation to functional outcome of stroke patients. Arch. Gerontol. Geriatr., 45, 153–60.CrossRef
Ajuriaguerra, J., Hécaen, H. and Anguelergues, R. (1960). Les apraxies: Variétés cliniques et latéralisation lésionnelle. Rev. Neurol., 102, 566–94.
Andrews, K., Brocklehurst, J. C., Richards, B. and Laycock, P. J. (1980). The prognostic value of picture drawings by stroke patients. Rheumatol. Rehabil., 19, 180–8.CrossRef
Arena, R. and Gainotti, G. (1978). Constructional apraxia and visuoperceptive disabilities in relation to laterality of cerebral lesions. Cortex, 14, 463–73.CrossRef
Arrigoni, G. and Renzi, E. (1964). Constructional apraxia and hemispheric locus of lesion. Cortex, 1, 180–97.CrossRef
Benton, A. L. (1967). Constructional apraxia and the minor hemisphere. Confinia Neurologica, 29, 1–16.
Benton, A. L. (1968). Differential effects in frontal lobe disease. Neuropsychologia, 6, 53–60.CrossRef
Binder, L. M. (1982). Constructional strategies on complex figure drawings after unilateral brain damage. J. Clin. Neuropsychol., 4, 51–8.CrossRef
Renzi, E. and Faglioni, P. (1967). The relationship between visuospatial impairment and constructional apraxia. Cortex, 3, 227–342.
Dérouesné, J., Seron, X. and Signoret, J. L. (1975). La rééducation de patients avec lésion frontale. Rev. Neurol., 131, 677–89.
Duensing, F. (1953). Raumagnostische und ideatorisch-apraktische storung des gestaltenden handelns. Deutsch Zietschrift Nervenheilkd, 170, 72–94.
Engstad, T., Almkvist, O., Viitanen, M. and Arnesen, E. (2003). Impaired motor speed, visuospatial episodic memory and verbal fluency characterize cognition in long-term stroke survivors: The Tromso Study. Neuroepidemiology, 22, 326–31.CrossRef
Freedman, M., Leach, L., Kaplan, E., et al. (1994). Clock Drawing: A Neuropsychological Analysis, New York: Oxford University Press.Google Scholar
Friedman, P. J. (1991). Clock drawing in acute stroke. Age Ageing, 20, 140–5.CrossRef
Fushimi, H., Inoue, T., Yamada, Y., Udaka, F. and Kameyama, M. (1996). Asymptomatic cerebral small infarcts (lacunae), their risk factors and intellectual disturbances. Diabetes, 45 (Suppl. 3), S98–S100.CrossRef
Gainotti, G. (1972). A quantitative study of the ‘closing in’ phenomenon symptom in children and in brain damaged patients. Neuropsychologia, 10, 429–36.CrossRef
Gainotti, G. (1985). Constructional apraxia. In Frederiks, J. A. M., ed., Handbook of Clinical Neurology Vol 1. Amsterdam: Elsevier, pp. 491–506.
Gainotti, G., D'Erme, P. and Diodato, S. (1985). Are drawing errors differed in right-sided and left-sided constructional apraxics? Ital. J. Neurol. Sci., 6, 495–501.CrossRef
Hécaen, H., Ajuriaguerra, J. and Massonet, J. (1951). Les troubles visuoconstructifs par lésions pariéto-occipitales droites. Rôle des perturbations vestibulaires. Encéphale. 122–79.Google Scholar
Hécaen, H. and Assal, G. (1970). A comparison of constructive deficits following right and left hemispherics lesions. Neuropsychologia, 8, 289–303.CrossRef
Hier, D. B., Mondlock, J. and Caplan, L. R. (1983). Recovery of behavioral abnormalities after right hemisphere stroke. Neurology, 33, 345–50.CrossRef
Hochstenbach, J., Mulder, T., Limbeek, J., Donders, R. and Schoonderwaldt, H. (1998). Cognitive decline following stroke: A comprehensive study of cognitive decline following stroke. J. Clin. Exp. Neuropsychol., 20, 503–17.
Hochstenbach, J. B., Otter, R. and Mulder, T. W. (2003). Cognitive recovery after stroke: A 2-year follow-up. Arch. Phys. Med. Rehabil., 84, 1499–504.CrossRef
Ishiai, S., Sugishita, M., Ichikawa, T., Gono, S. and Watabiki, S. (1993). Clock drawing test and unilateral spatial neglect. Neurology, 43, 106–10.CrossRef
Kirk, A. and Kertesz, A. (1989). Hemispheric contributions to drawing. Neuropsychologia, 27, 881–6.CrossRef
Kirk, A. and Kertesz, A. (1993). Subcortical contribution to drawing. Brain Lang., 21, 57–70.
Kleist, K. (1934). Gehirnpathologie, Leipzig: Barth.Google Scholar
Kreiter, K. T., Copeland, D., Bernardini, G. L., et al. (2002). Predictors of cognitive dysfunction after subarachnoid hemorrhage. Stroke, 33, 200–8.CrossRef
Lhermitte, F., Dérouesné, J. and Signoret, J. L. (1972). L'analyse neuropsychologique du syndrome frontal. Rev. Neurol., 127, 415–40.
Luria, A. R. and Tsvetkova, L. S. (1964). The programming of constructive activity in local brain injury. Neuropsychologia, 2, 95–108.CrossRef
Marshall, R. S., Lazar, R. M., Binder, J. R., et al. (1994). Intrahemispheric localization of drawing dysfunction. Neuropsychologia, 32, 493–501.CrossRef
Mayer, S. A., Kreiter, K. T., Copeland, D., et al. (2002). Global and domain-specific cognitive impairment and outcome after subarachnoid hemorrhage. Neurology, 59, 1750–8.CrossRef
Mendez, M., Ala, T. and Underwood, K. (1992). Development of scoring criteria for the clock drawing task in Alzheimer's disease. J. Am. Geriatr. Soc., 40, 1095–99.CrossRef
Ogden, J. A., Mee, E. W. and Henning, M. (1993). A prospective study of impairment of cognition and memory and recovery after subarachnoid hemorrhage. Neurosurgery, 33, 572–86.
Pillon, B. (1981). Troubles visuoconstructifs et méthodes de compensation: Résultats de 85 patients atteints de lésions cérébrales. Neuropsychologia, 19, 375–83.CrossRef
Rey, A. (1959). Test de Copie d'une Figure Complexe. Paris: Edition du Centre de Psychologie Appliquée.Google Scholar
Rosen, W. (1983). The Rosen drawing Test. New York: Veterans Administration Medical Center.Google Scholar
Rouleau, I., Salmon, D., Butters, N., Kennedy, C. and McGuife, K. (1992). Quantitative and qualitative analyses of clock drawings in Alzheimer's and Huntington's disease. Brain Cogn., 18, 70–87.CrossRef
Sachdev, P. S., Brodaty, H., Valenzuela, M. J., et al. (2004). The neuropsychological profile of vascular cognitive impairment in stroke and TIA patients. Neurology, 62, 912–19.CrossRef
Shallice, T. (1989). From Neuropsychology to Mental Structures. Cambridge, UK: Cambridge University Press.Google Scholar
Suhr, J., Grace, J., Allen, J., Nadler, J. and McKenna, M. (1998). Quantitative and qualitative performance of stroke versus normal elderly on six clock drawing systems. Arch. Clin. Neuropsychol., 13, 495–502.CrossRef
Sunderland, T., Hill, J. L.Mellow, A. M., et al. (1989). Clock drawing in Alzheimer's disease. A novel measure of dementia severity. J. Am. Geriatr. Soc., 37(8), 725–29.CrossRef
Sunderland, A., Tinson, D. and Bradley, L. (1994). Differences in recovery from constructional apraxia after right and left hemisphere stroke? J. Clin. Exp. Neuropsychol., 16, 916–20.CrossRef
Swindell, C. S., Holland, A. L., Fromm, D. and Greenhouse, J. B. (1988). Characteristics of recovery of drawing ability in left and right brain-damaged patients. Brain Cogn., 7, 16–30.CrossRef
Tatemichi, T. K., Desmond, D. W., Stern, Y., et al. (1994). Cognitive impairement after stroke: Frequency, patterns, and relationship to functional abilities. J. Neurol. Neurosurg. Psychiatry, 57, 202–7.CrossRef
Warrington, E. K., James, M. and Kinsbourne, M. (1966). Drawing disability in relation to laterality of cerebral lesion. Brain, 89, 53–82.CrossRef
Watson, Y. I., Arfken, C. L. and Birge, S. J. (1993). Clock completion: An objective screening test for dementia. J. Am. Geriatr. Soc., 41, 1235–40.CrossRef

Save book to Kindle

To save this book to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the or variations. ‘’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats