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Edward D. Huey, MD; Matteo Pardini, MD; Alyson Cavanagh, BS; Eric M. Wassermann, MD; Dimitrios Kapogiannis, MD; Salvatore Spina, MD; Bernardino Ghetti, MD; Jordan Grafman, PhD

Arch Neurol. 2009;66(10):1274-1280.

Objective  To determine the brain areas associated with specific components of ideomotor apraxia (IMA) in corticobasal syndrome (CBS).

Design  Case-control and cross-sectional study.

Participants  Forty-eight patients with CBS and 14 control subjects.

Intervention  Administration of the Test of Oral and Limb Apraxia.

Main Outcome Measures  Differences between patients with CBS and healthy controls and associations between areas of gray matter volume and IMA determined by voxel-based morphometry in patients with CBS.

Results  Overall, IMA was associated with decreased gray matter volume in the left supplemental motor area, premotor cortex, and caudate nucleus of patients with CBS. The overall degree of apraxia was independent of the side of motor impairment. Praxis to imitation (vs command) was particularly impaired in the patients with CBS. Patients demonstrated equal impairment in transitive and intransitive praxis.

Conclusions  In patients with CBS, IMA is associated with left posterior frontal cortical and subcortical volume loss. Despite showing left frontal volume loss associated with IMA, patients with CBS have particularly impaired imitation of gestures. These findings suggest either that the IMA of CBS affects a route of praxis that bypasses motor engrams or that motor engrams are affected but that they exist in areas other than the inferior parietal cortex.

Author Affiliations: Cognitive Neuroscience Section (Drs Huey, Pardini, Wassermann, Kapogiannis, and Grafman and Ms Cavanagh) and Brain Stimulation Unit (Drs Wassermann and Kapogiannis), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland; Litwin-Zucker Research Center for the Study of Alzheimer's Disease and Memory Disorders, The Feinstein Institute for Medical Research, Manhasset, New York (Dr Huey); Magnetic Resonance Research Centre on Nervous System Diseases and Department of Neurosciences, Ophthalmology, and Genetics, University of Genoa, Genoa, Italy (Dr Pardini); Department of Neurological, Neurosurgical, and Behavioral Sciences, University of Siena, Siena, Italy (Dr Spina); and Indiana Alzheimer Disease Center, Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis (Drs Spina and Ghetti).

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