Limb-kinetic apraxia affects activities of daily living in Parkinson's disease: a multi-center study

作者：Foki T; Vanbellingen T; Lungu C; Pirker W; Bohlhalter S; Nyffeler T; Kraemmer J; Haubenberger D; Fischmeister F Ph S; Auff E; Hallett M; Beisteiner R

来源：European Journal of Neurology, 2016, 23(8): 1301-1307.

DOI：10.1111/ene.13021

<jats:sec><jats:title>Background and purpose</jats:title><jats:p>Impaired dexterity (fine hand movements) is often present in Parkinson's disease (<jats:styled-content style="fixed-case">PD</jats:styled-content>), even at early to moderate disease stages. It has a detrimental impact on activities of daily living (<jats:styled-content style="fixed-case">ADL</jats:styled-content>) such as buttoning, contributing to reduced quality of life. Limb‐kinetic apraxia, a loss of the ability to make precise, independent but coordinated finger and hand movements, may contribute to impaired dexterity even more than bradykinesia <jats:italic>per se</jats:italic>. However, the impact of limb‐kinetic apraxia on <jats:styled-content style="fixed-case">ADL</jats:styled-content> remains controversial. Our aim was to identify the strongest predictor of buttoning and unbuttoning in <jats:styled-content style="fixed-case">PD</jats:styled-content>. It was hypothesized that coin rotation (a surrogate of limb‐kinetic apraxia) represents the most important determinant.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Sixty‐four right‐handed, early to moderate <jats:styled-content style="fixed-case">PD</jats:styled-content> patients were recruited from three movement disorder centers (Hoehn andYahr stages 1–3). Buttoning, unbuttoning and coin rotation (right and left hand) represented the target tasks. Motor impairment was assessed according to the Unified Parkinson's Disease Rating Scale.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Multiple linear regression analysis showed that coin rotation with the right hand was the only significant predictor of buttoning (<jats:italic>P</jats:italic> &lt; 0.001) and unbuttoning (<jats:italic>P</jats:italic> = 0.002). Notably, measures of bradykinesia or overall motor impairment did not represent significant predictors.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Constituting the novel key finding, limb‐kinetic apraxia seems to be particularly relevant for <jats:styled-content style="fixed-case">ADL</jats:styled-content> requiring dexterity skills in <jats:styled-content style="fixed-case">PD</jats:styled-content>, even at early to moderate disease stages. Our results prompt research into the pathophysiological background and therapeutic options to treat limb‐kinetic apraxia. The simple coin rotation test provides valuable information about <jats:styled-content style="fixed-case">ADL</jats:styled-content>‐related dexterity skills.</jats:p></jats:sec>

• 出版日期2016-8