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Neuropathological basis for drawing disability (constructional apraxia) in Alzheimer's disease

Published online by Cambridge University Press:  09 July 2009

H. Förstl ,
A. Burns ,
R. Levy  and
N. Cairns
H. Förstl*
Affiliation:
Section of Old Age Psychiatry and Department of Neuropathology, Institute of Psychiatry, London
A. Burns
Affiliation:
Section of Old Age Psychiatry and Department of Neuropathology, Institute of Psychiatry, London
R. Levy
Affiliation:
Section of Old Age Psychiatry and Department of Neuropathology, Institute of Psychiatry, London
N. Cairns
Affiliation:
Section of Old Age Psychiatry and Department of Neuropathology, Institute of Psychiatry, London
*
1Address for correspondence: Dr Hans Förstl, Central Institute of Mental Health, PO Box 122 120, I 5, W-6800 Mannheim 1, Germany.
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Synopsis

The performance on four drawing tasks was studied in a sample of patients with verified Alzheimer's disease in order to examine the relationship of ‘constructional apraxia’ to neuropathological changes in the parietal lobe and in other brain areas. Twenty-three patients were able to attempt to copy pentagons, a spiral and a three-dimensional drawing of a house, 22 patients were able to draw a clock-face spontaneously. The results were rank-ordered by two independent raters. The values obtained in the different drawing tasks were correlated significantly with each other, with global estimates of cognitive performance (CAMCOG, Mini-Mental State), with a shorter duration of illness, higher brain weight (in the subsample of female patients), higher counts of large neurons in the parahippocampal gyrus and hippocampus, but not in the parietal lobe. This suggests that there is no specific relationship between ‘constructional apraxia’ and neuropathological changes in the parietal lobes of patients with advanced Alzheimer's disease, but that there is a correlation between widespread brain changes and several neuropsychological deficits, one of them being drawing disability.

Type
Original Articles
Information
Psychological Medicine , Volume 23 , Issue 3 , August 1993 , pp. 623 - 629
Copyright
Copyright © Cambridge University Press 1993

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References

Arrigoni, G. & de Renzi, E. (1961). Constructional apraxia and hemispheric locus of lesion. Cortex 1, 180–197.Google Scholar
Berg, L. (1984). Clinical dementia rating. British Journal of Psychiatry 145, 339.CrossRefGoogle ScholarPubMed
Burns, A., Jacoby, R. & Levy, R. (1990). Psychiatric phenomena in Alzheimer's disease. British Journal of Pyschiatry 157, 72–94.Google Scholar
Critchley, M. (1953). The Parietal Lobes. E. Arnold: London.Google Scholar
Crystal, H. A., Horoupian, D. S., Katzman, R. & Jotkowitz, S. (1982). Biopsy-proven Alzheimer disease presenting as a right parietal lobe syndrome. Annals of Neurology 12, 186–188.CrossRefGoogle Scholar
Damasio, A. R. (1985). Disorders of complex visual processing: agnosias, achromatopsia, Balint's syndrome, and related difficulties of orientatation and construction. In Principles of Behavioral Neurology (ed. Mesulam, M. M.), pp. 259–288. F.A. Davis Co: Philadelphia.Google Scholar
de Renzi, E. (1986). Slowly progressive visual agnosia or apraxia without dementia. Cortex 22, 171–180.CrossRefGoogle ScholarPubMed
Förstl, H., Burns, A., Luthert, P., Cairns, N., Lantos, P. & Levy, R. (1992 a). Clinical and neuropathological correlates of depression in Alzheimer's disease. Psychological Medicine 22, 877–884.CrossRefGoogle ScholarPubMed
Förstl, H., Burns, A., Levy, R., Cairns, N., Luthert, P. & Lantos, P. (1992 b). Neurological signs in Alzheimer's disease: results of a prospective clinical and neuropathological study. Archives of Neurology 49, 1038–1042.CrossRefGoogle Scholar
Folstein, M. F., Folstein, S. E. & McHugh, P. R. (1975). Mini-Mental State: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research 12, 189–198.Google Scholar
Gainotti, G. (1985). Constructional apraxia. In Cinical Neuropsychology, Handbook of Clinical Neurology, vol. 45 (ed. Vinken, P. J., Bruyn, G. W. and Klawans, H. L.), pp. 491–506. Elsevier: Amsterdam.Google Scholar
Huff, F. J., Becker, J. T., Belle, S. H., Nebes, R. D., Holland, A. L. & Boller, F. (1987). Cognitive deficits and clinical diagnosis of Alzheimer's disease. Neurology 37, 1119–1124.CrossRefGoogle ScholarPubMed
Hughes, C. P., Berg, L., Danziger, W. L., Coben, L. A. & Martin, R. L. (1982). A new clinical rating scale for the staging of dementia. British Journal of Psychiatry 140, 566–572.CrossRefGoogle ScholarPubMed
Khachaturian, Z. S. (1985). Diagnosis of Alzheimer's disease. Archives of Neurology 42, 1097–1105.CrossRefGoogle ScholarPubMed
Kleist, K. (1914/1918). Kriegsverletzungen des Gehirns in ihrer Bedeutung für die Hirnlokalisation und Hirnpathologie. In Handbuch der ärztlichen Erfahrung im Weltkrieg 1914/1918 (ed. von Schjerning, O.), Vol. IV: Geistes- und Nervenkrankheiten. Barth: Leipzig.Google Scholar
Leger, J. M., Levasseur, M., Benoit, N., Baron, J. C., Tran Dinh, S., Bolgert, F., Cohen, L., Brunet, P. & Signoret, J. L. (1991). Apraxie d'aggravation lentement progressive: étude par IRM et tomographie à positrons dans 4 cas. Revue Neurologique 147, 183–191.Google Scholar
Moore, V. & Wyke, M. A. (1984). Drawing disability in patients with senile dementia. Psychological Medicine 14, 97–105.Google Scholar
Morris, J. C., Heyman, A., Mohs, R. C., Hughes, J. P., van Belle, G., Fillenbaum, G., Mellits, E. D., Clark, C. & CERAD-group (1989). The consortium to establish a registry for Alzheimer's disease (CERAD). Part I. Cinical and neuropsychological assessement of Alzheimer's disease. Neurology 39, 1159–1165.Google Scholar
Norusis, M. J. (1988). SPSS V2.0. Chicago, IL: SPSS.Google Scholar
Robbins, T. W. (1984). Cortical noradrenaline, attention and arousal. Psychological Medicine 14, 13–21.Google Scholar
Roth, M., Tym, E., Mountjoy, C., Huppert, F., Hendrie, H., Verma, S. & Goddard, R. (1986). CAMDEX: a standardized instrument for the diagnosis of mental disorder in the elderly with special reference to the early detection of dementia. British Journal of Psychiatry 149, 698–709.Google Scholar
Shulman, K. I., Shedletsky, R. & Silver, I. (1986). The challenge of time: clock drawing and cognitive function in the elderly. International Journal of Geriatric Psychiatry 1, 135–140.Google Scholar
Siegel, S. (1956). Nonparametric Statistics for the Behavioral Sciences. McGraw Hill: New York.Google Scholar
Squire, L. R. & Zola-Morgan, S. (1988). Memory brain systems and behaviour. Trends in Neuroscience 11, 170–175.Google Scholar
Sunderland, T., Hill, J. L., Mellow, A. M., Lawlor, B. A., Gundersheimer, J., Newhouse, P. A. & Grafman, J. (1989). Clock drawing in Alzheimer's disease: a novel measure of dementia severity. Journal of the American Geriatric Society 37, 725–729.Google Scholar
Villa, G., Gainotti, G. & de Bonis, C. (1986). Constructive disabilities in focal brain-damaged patients. Influence of the hemispheric side, locus of lesion and coexistent mental deterioration. Neuropsychologia 24, 497–510.Google Scholar
Wolf-Klein, G. P., Silverstone, F. A., Levy, A. P., Brod, M. S. & Breuer, J. (1989). Screening for Alzheimer's disease by clock drawing. Journal of the American Geriatric Society 37, 730–734.Google Scholar
Zangwill, O. L. (1964). Psychopathology of dementia. Proceedings of the Royal Society of Medicine 57, 914–917.Google Scholar
Zilles, K. (1990). Cortex. In The Human Nervous System (ed. Paxinos, I. G.), pp. 757–802. Academic Press: San Diego.Google Scholar