Assessment for apraxia in Mild Cognitive Impairment and Alzheimer's disease

We evaluated 136 subjects with an average age of 75.74 years (minimum 60 years old, maximum 92 years old) and average schooling of 9 years (minimum of 7 and a maximum of 12 years), using the Mini-Mental State examination (MMSE), Cambridge Cognitive Examination (CAMCOG) and the Clock Drawing Test. For the analysis of the presence of apraxia, eight subitems from the CAMCOG were selected: the drawings of the pentagon, spiral, house, clock; and the tasks of putting a piece of paper in an envelope; the correct one hand waiving "Goodbye" movements; paper cutting using scissors; and brushing teeth.

RESULTS:

Elder controls had an average score of 11.51, compared to MCI (11.13), and AD patients, whose average apraxia test scores were the lowest (10.23). Apraxia scores proved able to differentiate the three groups studied (p=0.001). In addition, a negative correlation was observed between apraxia and MMSE scores.

CONCLUSION:

We conclude that testing for the presence of apraxia is important in the evaluation of patients with cognitive impairments and may help to differentiate elderly controls, MCI and AD.

apraxia; neuropsychometric tests; elder; Alzheimer's disease; mild cognitive impairment; diagnosis

Apraxia	Score
Drawing of the pentagon	1 point
Drawing of the spiral	1 point
Drawing the house	1 point
Drawing a clock	3 points
Putting a sheet of paper in an envelope	3 points
“Goodbye” – correct movement	1 point
Scissors – correct movement	1 point
Brushing teeth – correct movement	1 point
Total	12 points

		MCI	AD	CG	p
Age years (range)		76.60±7.06 (63-92)	77.92±6.97 (64-91)	71.82±6.89 (60-89)	0.185*
Gender (%)	Female	27 (60)	33 (63.5%)	29 (74.4%)	0.358 **
Gender (%)	Male	18 (40)	19 (36.5%)	10 (25.6%)
Schooling	5 to 8 years	23 (51.1%)	21 (40.4%)	12 (30.8%)	0.040**
Schooling	> 9 years	22 (48.9%)	31 (59.6%)	27 (69.2%)

Test	CG Mean±SD (Min-Max)	MCI Mean±SD (Min-Max)	AD Mean±SD (Min-Max)	p
MMSE	29.10±1.16 (26-30)	26.93±2.07 (21-30)	23.40±3.87 (14-29)	0.0001
CAMCOG	97.74±5.36 (82-107)	88.40±6.63 (73-100)	77.2±11.53 (52-96)	0.0001
Apraxia	11.51±0.72 (10-12)	11.13±1.08 (8-12)	10.23±1.98 (2-12)	0.001

		Age	PFAQ	MMSE	CAMCOG	Mendez	Shulman
Apraxia	Pearson correlation	–0.145	–0.182	0.312	0.627	0.310	0.216
	Sig. (2-tailed)	0.378	0.268	0.053	0.000	0.055	0.187
	N	39	39	39	39	39	39
Apraxia controlled by schooling	Correlation	–0.172	–0.108	0.234	0.578	0.207	0.097
	Significance (2-tailed)	0.301	0.517	0.157	0.000	0.212	0.561
	Df	36	36	36	36	36	36

		Age	PFAQ	MMSE	CAMCOG	Mendez	Shulman
Apraxia	Pearson correlation	–0.193	–0.001	0.191	0.472	0.160	0.377
	Sig. (2-tailed)	0.204	0.997	0.208	0.001	0.293	0.011
	N	45	45	45	45	45	45
Apraxia controlled by schooling	Correlation	–0.321	0.010	0.165	0.466	0.083	0.307
	Significance (2-tailed)	0.034	0.947	0.285	0.001	0.594	0.043
	Df	42	42	42	42	42	42

		Age	PFAQ	MMSE	CAMCOG	Mendez	Shulman
Apraxia	Pearson Correlation	0.135	0.073	0.289*	0.214	0.539	0.537
	Sig. (2-tailed)	0.340	0.605	0.040	0.135	0.000	0.000
	N	52	52	51	50	51	51
Apraxia controlled by schooling	Correlation	0.171	0.043	0.288	0.203	0.525	0.519
	Significance (2-tailed)	0.239	0.770	0.044	0.162	0.000	0.000
	Df	47	47	47	47	47	47

Academia Brasileira de Neurologia, Departamento de Neurologia Cognitiva e Envelhecimento R. Vergueiro, 1353 sl.1404 - Ed. Top Towers Offices, Torre Norte, São Paulo, SP, Brazil, CEP 04101-000, Tel.: +55 11 5084-9463 | +55 11 5083-3876 - São Paulo - SP - Brazil
E-mail: revistadementia@abneuro.org.br | demneuropsy@uol.com.br

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[1] Juliana F. Cecato. Instituto de Geriatria e Gerontologia de Jundiaí. Rua Prudente de Moraes 111- 13201-004 Jundiaí SP - Brazil. E-mail: cecatojuliana@hotmail.com.