Constructional apraxia refers to the inability of patients to copy accurately drawings or three-dimensional constructions. It is a common disorder after right. Abstract. Constructional apraxia refers to the inability of patients to copy accurately drawings or three-dimensional constructions. It is a common. Constructional apraxia. Article (PDF Available) ยท January with Reads. Export this citation. Sharon Cermak at University of Southern California.

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June 09, ; Accepted date: June 23, ; Published ocnstructional J Alzheimers Dis Parkinsonism 6: This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. There have been suggestions that different cognitive mechanisms could account for CA in different forms of dementia, but this hypothesis has not been directly verified.

Our findings suggest that CA could be ascribed to distinctive cognitive defects in the different forms of dementia. In visuo-constructional copying tasks demented patients may perform poorly on drawing, producing simplified figures, alterations in spatial relationships among the parts, lack of perspective, or failure in constrictional integrating single elements in a coherent whole.

In the subsequent years, copying drawing performances have received revamped attention in literature being used increasingly for the identification of cognitive impairments especially in elderly [ 23 ].

Indeed, the occurrence of constructional impairments in copying drawing tasks has been often considered as a neuropsychological marker for diffuse cognitive deterioration, after lesions in either left or right hemisphere [ 45 ]. Drawing disorders have been observed in focal brain-damaged patients [ 6 – 8 ], and more often described and investigated in patients with progressive mental deterioration [ 9 – 15 ].

However, no converging data would seem clarify the cognitive mechanisms underlying constructional impairment in AD patients. Indeed, some neuropsychological and neuroimaging findings ascribe a crucial spraxia to the spatial-constructional processing and bilateral parietal atrophy on a hand, or planning abilities and fronto-temporal-parietal atrophy, on the other hand [ 1316 ]. A few studies explored constructional impairments in individuals with Fronto-temporal dementia FTD. These studies compared performances on copying figures in FTD and AD patients, but reported contrasting findings.

Some authors [ 11 ] observed that FTD and AD patients showed similar scores in copying geometrical figures, but more recently other authors [ 1217 ] reported that FTD patients were more accurate in copying figures compared to AD patients. Similar conflicting results concern patients with Vascular dementia VADwhere performances have been reported similar [ 18 ] or poorer than AD patients [ 19 ].

It has been reported that that early impairment of pentagon drawing is a predictor of faster cognitive decline in patients with Parkinson disease [ 20 ]. Based on the literature above reported, it would appear that no univocal findings are available on the constructional impairments across the different forms of dementia. Moreover, we tried to assess whether specific cognitive dysfunctions could be associated with graphic constructional defects in the different forms of dementia.


Thus, the present study could contribute to clarify the cognitive mechanisms underlying visuo-constructional copying performances in demented patients. To qualify for the present study we included individuals who met the following inclusion criteria: A total of patients satisfied the inclusion and exclusion criteria.

AD sample included 72 patients mean age: FAB includes six subtests assessing conceptualization, mental flexibility, motor planning, sensitivity to interference, inhibitory control, and environmental independency, and provides a global measure of cognitive and motor frontal control score range: Visuo-spatial functions were assessed by means of the Corsi span forward [ 31 ] and by Clock drawing task [ 32 ].

A deficit of spatial remapping in constructional apraxia after right-hemisphere stroke.

Corsi span requires reproducing block-tapping sequences of increasing length, and provides a measure of visuo-spatial memory score range: The Clock drawing task requires completing a shape of a clock by putting in all the numbers and setting the hands for 2 and 45 and requires a wide range of visuo-spatial skills score range: Anterograde memory was assessed by means of the immediate and delayed recall of Word learning test [ 30 ] for the verbal domain score range: Visuo-constructional performances were assessed for in response at a copying drawings test [ 31 ].

This task required patients to reproduce seven black-and-white geometrical figures e. Subjects were required to copy each stimulus in the lower half of the sheet-model. For each graphic response, drawing accuracy was scored assigning 2 points in case of correct reproduction, 1 point in case of partially correct reproduction i.

Constructional apraxia – Wikipedia

Since copying drawing test comprised seven models the score range was points. PDD as independent between-subject variable, and the accuracy on constructiobal drawing test as dependent variable.

Moreover, in AD patients the accuracy on drawing copying task significantly and positively correlated with performances on Corsi span forward, Clock drawing task, and delayed recall of the Rey Complex figure. In PDD patients, accuracy of graphic performances significantly correlated with Corsi span forward and Clock drawing task. To this aim we employed a visuoconstructional copying task that would have high sensibility for detecting visuo-constructional defects [ 216 ].

These findings would confirm that in FTD patients the visuo-constructional copying performances would be better than AD patients as reported in some previous studies [ 1217 ], and clarified that drawing abilities do not significantly differ constructiojal AD and VAD patients [ 18 ].

However, our results additional revealed that visuo-constructional copying abilities would be relatively preserved in FTD patients compared with the other forms of dementia. In our study, we also tried to explore possible correlates of constructional impairments in our demented patients. Results from correlation analysis revealed that there was a strong correlation of accuracy on drawing copying task with MMSE.

However, when we statistically weighted out the individual contribution of the cognitive variables on the accuracy of graphic reproduction, by adopting the logistic regression analysis, we observed specific pattern of findings according to the specific form of dementia.


Indeed, we found that in AD patients constructional impairments were strongly related to visuo-spatial defects. Moreover, correlation analysis also showed a positive association between scores on Corsi span forward, Clock drawing test, and delayed recall of the Rey Complex figure. All these tasks involved visuo-perceptual and visuo-spatial working memory skills that are early defective in AD patients [ 16 ]. Similarly, we observed that visuo-spatial dysfunctions were associated to visuo-constructional accuracy in PDD patients too.

In these patients scores on Corsi span forward and Clock drawing test were positively correlated with a;raxia on copying drawing task. Taken together, these results would suggest that constructjonal in AD and PDD patients, the cognitive defects underlying constructional impairment could involve the visuospatial cognitive domain and in particular the spatial-constructional processing, likely exploration and judgment of spatial relationship.

Indeed, our results from correlation analysis showed that scores on FAB, and PVF test were significantly and positively correlated to graphic accuracy. Moreover, drawing abilities were also correlated to scores on Clock drawing test in VAD patients, and delayed recall of the Word learning test in FTD patients.

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These findings would suggest that in VAD and FTD patients the drawing defects would be prevalently ascribed to frontal control processes requiring planning, organization, and attention skills in addition to problem-solving strategies. Some limitations of the present study should be taken into account. First, we enrolled patients with mild-to-moderate level of dementia to select comparable samples but this choice did not allow to fully exploring the effect of construftional severity on visuo-constructional impairments; further studies are needed to elucidate the relationships between drawing performances and progression of cognitive impairments.

Second, although we used apraxa clinical criteria for the clinical diagnosis of our participants, these criteria might be insufficient to identify patients; thus inclusion of neuroimaging data in future studies will increase the likelihood of creating strongly homogeneous patient samples. Finally, it seems worthy to explore whether the different pathological pattern of constructional apraxia could play a predictive role in pre-dementia state.

Inclusion in cconstructional studies of patients with initial cognitive impairment i.

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