Ideomotor apraxia in patients with Alzheimer disease: Why do they use their body parts as objects?

Objective: Difficulty in pantomiming the use of tools is observed in patients with Alzheimer disease. Patients with Alzheimer disease tend to use their body parts as objects when they try to pantomime the use of tools. The body-parts-as-objects phenomenon was thought to consist of appropriate gross movement of patients arms despite inappropriate patterns of handling tools with their hands. However, the mechanism has not been investigated fully. Methods: The authors examined 11 healthy individuals and 24 patients with Alzheimer disease for ability to recognize tools, to pantomime the use of tools, to use actual tools, and to select an appropriate photograph of a handling pattern of the tool. Results: In comparison with the patients with Alzheimer disease, the healthy individuals had higher scores for all tasks. The authors classified the patients into group A (patients with higher pantomime scores), group B (patients with middle level scores), and group C (patients with lower scores). Frequency of use of body parts as objects for patients in group B was higher than that of patients in group A and in group C. The mean Mini-Mental State Examination score for patients in group A was higher than that of patients in group B and in group C. In comparison with patients in group A, patients in group B showed lower scores on the hand-posture discrimination task without a tool, even after controlling the Mini-Mental State Examination score. Conclusions: The authors conclude that body-parts-as-objects responses in patients with Alzheimer disease occur because general cognition is lowered or because retrieval ability of the appropriate holding posture for tools is impaired.