Are impairments in activities of daily living in patients with Alzheimer´s Disease related to symptoms of apraxia? Leippold K.1, Rohrbach N.1, Armstrong A.1,Diehl-Schmid J.2, Grimmer T.2, Kohl S.2, Hermsdörfer J.1 1 Institute of Human Movement Science, Department of Sport and Health Sciences, Technical University of Munich 2 Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich Contact:
[email protected]
Introduction ➢ Clinical tests have revealed symptoms of apraxia in patients with dementia due to Alzheimer’s Disease (AD)1. ➢ Research shows that deficits in activities of daily living (ADL) are evident in AD patients even at an early stage of the disease². ➢ In this study we investigated whether apraxia directly affects ADL performance in a group of patients with mild AD. ADL tasks: • Filing a document (DF) [Figure 1] • Making a cup of tea with milk and sugar (TM) [Figure 2] Apraxia tests: • Pantomime of object use [Figure 3] • Imitation of meaningless hand gestures [Figure 4] • Imitation of meaningless finger gestures [Figure 5]
Methods • 19 AD patients (mean age = 71.5 years, mean MMSE = 23.3) and 19 healthy controls (mean age = 72.6 years) followed a standardized protocol, including two ADL tasks and three clinical apraxia tests proposed by Goldenberg (1996)³. • Video recording served to identify and classify errors and to measure durations by two independent examiners.
Results Document Filing Task
Tea Making Task
Error Types and Categories Error Categories Sequencing
20
16
16
15
Conceptual Spatio-temporal
10 5 1
0
Fig. 1: Setting for DF task
2
0
2
1
2
Fig.: 2 Setting for TM task
Error types
Error Categories
25
Number of errors
Number of errors
25
5
Error Types and Categories 21
20
Sequencing
17
Conceptual
15
Spatio-temporal
9
10
5
5 0
0
6
4 1
1
8
2
0
Error types
ADL tasks: • AD patients frequently did not achieve the task goal (TM: 26.3 %; DF: 10.5 %). • AD patients committed sig. more sequencing errors in both ADL (TM: z = -3.038, p = .002; DF: z = -1.980, p = .048), more spatiotemporal errors in TM (z = -2.099, p = .036) and more conceptual errors in DF (z = - 3.355, p = .001) • Performance duration was sig. longer for DF, but not for TM in the AD group (DF ∆ 𝒕 (𝒔): 49.2 ± 56.9, z = -2.964, p =.003). • MMSE-scores sig. correlated with sequencing errors of TM (r= -.522, p = .022) Apraxia tests: Correlations between ADL tasks and Apraxia tests All tests revealed signs of apraxia in patients as a high number of patients performed below the normal cut-off: • 15.8 % in pantomime of object use • 36.8 % in hand imitation • 68.4 % in finger imitation
Sequencing Errors DF
r = - .580**, p = .009
Sequencing Errors DF
Finger Imitation Score
r = - .564*, p = .012
Fig. 5: Finger imitation test
Fig. 4: Hand imitation test
Hand Imitation Score
Pantomime Score
Fig. 3: Pantomime of object use
Sig. differences to controls were only found for finger imitation ( z = -4.271, p = .000) Apraxia and ADL tasks: • Scores in finger imitation correlated sig. with conceptual errors in the TM task, although variability was substantial. • Scores in pantomime of object use and hand imitation correlated sig. with sequencing errors in the DF task.
r = - .550*, p = .015
Conceptual Errors TM
Discussion ➢ ➢ ➢ ➢
We confirmed apraxia as a symptom associated with early AD dementia, as well as mild to moderate deficits in the execution of ADL. Even in early AD these deficits may prevent independent living in some patients. We found that apraxia could account for impaired performance in ADL tasks. However, we hypothesize that processes related to the involved objects and sequential task aspects are critical for preserved ADL performance in AD. These aspects of complex ADL tasks may be particularly vulnerable to the core symptoms of AD.
1) Baumard J et al. Cortex (2016) 82, 119-132. 2) Giovannetti T et al. Neuropsychologia (2002) 40(8), 1220-1232. 3) Goldenberg G et al. Journal of Neurology (1996).
This study was funded by the EU EIT Health Project “Active Hands”
