Apraxia and Motor Dysfunction in Corticobasal Syndrome

• Published in: PloS one Vol. 9; no. 3; p. e92944
• Main Authors: Burrell, James R., Hornberger, Michael, Vucic, Steve, Kiernan, Matthew C., Hodges, John R.
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 24.03.2014; Public Library of Science (PLoS)
• Subjects: Age; Aged; Agnosia - pathology; Agnosia - physiopathology; Alzheimer's disease; Amyotrophic lateral sclerosis; Apraxia; Apraxias - pathology; Apraxias - physiopathology; Atrophy; Biology and Life Sciences; Brain research; Cognition; Cognitive ability; Cognitive disorders; Cognitive tasks; Correlation; Cortex (motor); Cortex (parietal); Dementia; Female; Humans; Magnetic fields; Male; Medicine and Health Sciences; Middle Aged; Morphometry; Motor Cortex - pathology; Motor Cortex - physiopathology; Motor task performance; Neurosciences; Parkinson's disease; Pathology; Patients; Research and Analysis Methods; Stroke; Syndrome; Thalamus; Thalamus - pathology; Thalamus - physiopathology; Transcranial magnetic stimulation; Australia; New South Wales Australia
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0092944

Corticobasal syndrome (CBS) is characterized by multifaceted motor system dysfunction and cognitive disturbance; distinctive clinical features include limb apraxia and visuospatial dysfunction. Transcranial magnetic stimulation (TMS) has been used to study motor system dysfunction in CBS, but the relationship of TMS parameters to clinical features has not been studied. The present study explored several hypotheses; firstly, that limb apraxia may be partly due to visuospatial impairment in CBS. Secondly, that motor system dysfunction can be demonstrated in CBS, using threshold-tracking TMS, and is linked to limb apraxia. Finally, that atrophy of the primary motor cortex, studied using voxel-based morphometry analysis (VBM), is associated with motor system dysfunction and limb apraxia in CBS. Imitation of meaningful and meaningless hand gestures was graded to assess limb apraxia, while cognitive performance was assessed using the Addenbrooke's Cognitive Examination - Revised (ACE-R), with particular emphasis placed on the visuospatial subtask. Patients underwent TMS, to assess cortical function, and VBM. In total, 17 patients with CBS (7 male, 10 female; mean age 64.4+/- 6.6 years) were studied and compared to 17 matched control subjects. Of the CBS patients, 23.5% had a relatively inexcitable motor cortex, with evidence of cortical dysfunction in the remaining 76.5% patients. Reduced resting motor threshold, and visuospatial performance, correlated with limb apraxia. Patients with a resting motor threshold <50% performed significantly worse on the visuospatial sub-task of the ACE-R than other CBS patients. Cortical function correlated with atrophy of the primary and pre-motor cortices, and the thalamus, while apraxia correlated with atrophy of the pre-motor and parietal cortices. Cortical dysfunction appears to underlie the core clinical features of CBS, and is associated with atrophy of the primary motor and pre-motor cortices, as well as the thalamus, while apraxia correlates with pre-motor and parietal atrophy.