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. 2024 Dec;271(12):7471-7488.
doi: 10.1007/s00415-024-12706-5. Epub 2024 Oct 10.

Apraxia phenotypes and frontotemporal lobar degeneration

Tobias C Langheinrich  1   2 , Jennifer C Thompson  3   4 , Matthew Jones  3   5 , Anna M T Richardson  3   5 , David M A Mann  6 , Julie S Snowden  3   6
Affiliations

Apraxia phenotypes and frontotemporal lobar degeneration

Tobias C Langheinrich et al. J Neurol. 2024 Dec.

Abstract

Background: Apraxia has been identified in all clinical forms of frontotemporal lobar degeneration (FTLD). The characteristics of apraxia symptoms and their underlying cognitive/motor basis are not fully understood. This study investigated apraxia in pathological subtypes of FTLD.

Methods: The study constituted a retrospective review of 115 pathologically confirmed cases of FTLD from a single cognitive neurology centre. Patients in whom apraxia had been documented as a notable clinical characteristic were identified. Apraxia features, demographic, cognitive, neurological, and imaging findings were recorded.

Results: Eighteen patients were identified: 12 with FTLD-tau pathology (7 corticobasal degeneration (CBD), four Pick type and one progressive supranuclear palsy (PSP)) and six with FTLD-TDP pathology, all type A and four linked to progranulin gene mutations. Apraxia as a dominant presenting feature was typically associated with tau pathologies, whereas it emerged in the context of aphasia in TDP pathology. Apraxia typically predominated in one body part (face or limb) in tau but not TDP pathology. Relatively preserved activities in daily life were associated with TDP. Apraxia of speech was associated with tau pathology. Pick-type pathology was linked to symmetrical atrophy and late development of limb rigidity.

Conclusion: Apraxia in FTLD subtypes has variable characteristics. Apraxia associated with CBD pathology conformed to criteria for probable corticobasal syndrome (CBS), whereas apraxia with Pick-type pathology did not. Apraxia in patients with TDP-A pathology was interpreted as one manifestation of their generalised communication disorder. Apraxia in FTLD may have distinct cognitive and motor substrates that require prospective investigation.

Keywords: Apraxia; Corticobasal syndrome; Progranulin; Progressive aphasia; TDP pathology; Tau pathology.

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Conflict of interest statement

Declarations. Conflicts of interest: The authors declare that they have no conflicts of interest. Ethical approval and consent: Ethical approval was obtained from the Newcastle and Tyneside Ethics committee ‘Clinical data in research into degenerative brain disease’ Rec ref. 09/H0906/53 + 5, and ‘Manchester Brain Bank’ Rec ref. 09/H0906/52 + 5. Informed written consent was obtained from patients or their consultee (next-of-kin) in accordance with the Declaration of Helsinki.

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