[Progressive severity of left unilateral apraxia in 2 cases of Alzheimer disease]

Two patients presented with progressive left unilateral motor apraxia and progressive visuo-spatial difficulties, including constructional apraxia, dressing apraxia, spatial dysgraphia and dyslexia, spatial acalculia and neglect of the left side, without significant changes in the other cognitive functions. In both patients, radiological tests demonstrated cortical atrophy, more marked in the retrorolandic areas. A diagnosis of Alzheimer's disease was made in the first patient by cortical biopsy and in the second patient by post-mortem examination. The second patient died from an intercurrent neoplastic condition early in the course. Post-mortem examination of her brain showed the atrophy to be predominantly in the superior parietal gyri. In these areas, in addition to neuritic plaques and neurofibrillary tangles, these was also severe gliosis and superficial spongiosis. These two cases were clinically different from cortico-basal degeneration, where the motor difficulties are associated with occulo-motor problems, extrapyramidal signs and involuntary movements of the "alien hand" type. These data confirm the presence of focal forms of Alzheimer's disease. The motor apraxia seen in our patients resembles the kinesthesic apraxia described by Luria.