China
Africa
Explore chapters and articles related to this topic
Diagnosis and differential diagnosis of Parkinson’s disease
Published in Jeremy Playfer, John Hindle, Andrew Lees, Parkinson's Disease in the Older Patient, 2018
The commonest presenting complaint is clumsiness of one hand and arm.109 Classically, patients develop a unilateral jerky, tremulous, akinetic rigid and apraxic extremity, usually the arm, with accompanying dystonia. The posture is often of a flexed hand and forearm with adduction of the arm. Cortical sensory signs develop concurrently in the form of agraphesthesia, astereognosis and tactile sensory extinction. Ideomotor apraxia110 (difficulty initiating voluntary movements, making fine finger movements and copying hand postures) is a key finding in CBD.106 Apraxia can be masked by concurrent rigidity and immobility as the limb progresses to functional uselessness with a dystonic clenched fist. Examining the opposite limb may reveal an abnormality even if asymptomatic, indicating early involvement of the contralateral cortex.
ENTRIES A–Z
Published in Philip Winn, Dictionary of Biological Psychology, 2003
The ability to recognize symbols (numbers or letters most typically) traced on the SKIN, using only the sensation of TOUCH (the HAPTIC sense)—that is, one does not see the tracing being done, or detect it in any other way. The loss of this ability is of course agraphesthesia.
Posterior cortical atrophy: clinical, neuroimaging, and neuropathological features
Published in Expert Review of Neurotherapeutics, 2023
John Best, Marianne Chapleau, Gil D. Rabinovici
The neurologic exam in individuals with PCA frequently demonstrates dyspraxia or apraxia. Upon initial observation, patients may have trouble orienting themselves properly in the exam room, sometimes bumping into objects. They may have difficulty seeing the examiner and maintaining adequate eye contact due to loss of visual fixation. The examiner should assess a patient’s ability to perform movements under visual guidance, locate objects in the room, copy hand positions, draw and copy geometric figures, and read and write. A careful exam can uncover subtle visual field deficits or extinction to simultaneous bilateral visual stimuli. Gait is hesitant in the context of poor vision. There may be evidence of Balint’s syndrome, specifically oculomotor apraxia (inability to intentionally move eyes toward an object) or optic ataxia (difficulty reaching for an object they are looking at). The motor exam is variable and can sometimes show evidence of parkinsonism, myoclonus, or tremor. Sensory exam shows normal primary sensory function but can show evidence of impaired cortical sensory function, such as inability to identify an object by touch (astereognosis) or inability to perceive written numbers or letters on their skin (agraphesthesia). The gait exam is typically normal; however, evidence of a parkinsonian gait could suggest co-morbid or primary Lewy body pathology.