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This chapter focuses on apraxia of the upper limbs. Hugo Liepmann described three major forms of apraxia: ideomotor apraxia, which was also called ideo-kinetic apraxia in Liepmann's terminology; ideational apraxia; and limb-kinetic apraxia, also referred to by some investigators as melokinetic or innervatory apraxia. The chapter discusses the signs and pathophysiology of the apraxic disorders but use a processing approach. The Florida Action Recall Test (FLART), developed to assess conceptual apraxia, consists of 45 line drawings of objects or scenes for which an action with a tool is required. Conceptual apraxia is reported among persons with degenerative dementias such as Alzheimer's disease (AD) and in the semantic dementia subtype of frontotemporal lobar degeneration. Limb-kinetic apraxia is characterized by a loss of dexterity or deftness such that patients with this disorder are impaired at making precise, independent but coordinated finger movements.
Background: Early definitions of mild cognitive impairment (MCI) excluded the presence of functional impairment, with preservation of a person's ability to perform activities of daily living (ADL) as a diagnostic criterion. However, recent studies have reported varying degrees of functional impairment associated with MCI. Hence, we aimed to test the potential functional impairment associated with MCI and its predictors.
Methods: Sixty-nine healthy elderly subjects, 115 amnestic single-domain MCI subjects (a-MCI), and 111 amnestic multi-domain MCI subjects (md-MCI) were assessed using a battery of neuropsychological tests including measures of attention, memory, working memory, executive functions, language, and depression. Additionally, functional ability was assessed by both qualitative (WHO-DAS II) and quantitative (CHART) instruments. Cognitive and functional performance was compared between groups, and regression analyses were performed to identify predictors of functional ability.
Results: The md-MCI group was more impaired than the a-MCI group, and both were more impaired than healthy subjects in all cognitive measures, in total CHART score, CHART cognitive and mobility subscores, and WHO-DAS II communication and participation subscales. For the rest of the functional measures, the md-MCI group was more impaired than healthy controls. Prediction of functional ability by cognitive measures was limited to md-MCI subjects and was higher for the CHART than for the WHO-DAS II. The WHO-DAS II was largely influenced by depressive symptoms.
Conclusions: Functional impairment is a defining feature of MCI and is partially dependent on the degree of cognitive impairment. Quantitative measures of functional ability seem more sensitive to functional impairment in MCI than qualitative measures, which seem to be more related to depression.
Adolescents with first-episode psychosis have increased severity of
neurological soft signs when compared with controls, but it is unclear
whether increased severity of neurological soft signs is an expression of
specific structural brain deficits.
To examine whether increased severity of neurological soft signs was
associated with decreased brain volumes in adolescents with first-episode
Brain scans were obtained for 70 adolescents (less than 18 years of age)
with first-episode psychosis (duration of positive symptoms less than 6
months). Volumes were assessed using voxel-based morphometry and through
segmentation of anatomical structures.
Increased severity of sensory integration neurological soft signs
correlated with smaller right and left thalamus volume, whereas increased
severity of sequencing of complex motor acts neurological soft signs
correlated with smaller right caudate volume.
Neurological soft signs may be an easy-to-assess marker of
region-specific structural brain deficits in adolescents with
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