Ideational apraxia: definition, causes and symptoms

Ideational apraxia is a neurological condition that incapacitates the person to think and carry out certain sequences of movements with everyday objects and tools, when asked to do so.

For example, when we tell a patient who suffers from this type of apraxia to communicate out loud the steps to be taken to brush their teeth, it will be impossible for them.

Next, we will see in more detail what ideational apraxia consists of, what are the causes and its main symptoms, as well as the indicated treatment.

• Related article: "The 5 types of Apraxia: differences, symptoms and frequent causes"

What is ideational apraxia?

Ideational apraxia is a neurological disorder characterized by the loss of the ability to conceptualize, plan, and execute. the complex sequences of motor actions involved in the use of tools and objects of daily life.

This condition prevents the subject who suffers from planning movements in which there is some type of interaction with objects, due to which there is a loss of knowledge or perception of the purpose of the same. Characteristics of this disorder include a disturbance in the concept of sequential organization of voluntary actions. The patient seems to have asked for knowledge of what a specific object represents.

It was the psychiatrist Arnold Pick who, a century ago, described the first patient who seemed to have lost the ability to use objects; this person made mistakes such as combing his hair with the wrong end of the comb or brushing his teeth with his finger, mistakes that often occur in ideational apraxia.

Yet it was not until the 1900s that the German neurologist, Hugo Liepman, redefined the term ideational apraxia, specifically describing a series of disorders that involved, above all, problems in motor planning, apart from alterations in visual perception, language or the symbolic capacity of the patients.

Causes

The causes of ideational apraxia are still unknown to most researchers.

Nevertheless, studies conducted with patients who have suffered brain damage indicate that this type of apraxia is related to lesions in the dominant hemisphere, in areas close to those associated with disorders such as aphasia.

It was Liepmann at the beginning of the last century who proposed a hypothesis that implicated the motor processing system, in charge of execute actions, located in the left cerebral hemisphere and responsible for motor planning that guides the movements of the body. However, he was never able to describe the same type of ideational apraxia symptoms in two patients with the same brain damage.

Other researchers have suggested that possibly damage to the lateral sulcus of the brain, also known as sylvian fissure, could contribute to explain the deterioration in the recognition of objects by the subjects. Another possible location that would lead to the typical symptoms of ideational apraxia could be the marginal gyrus, located in the parietal lobe of the brain.

In general, ideational apraxia has been identified with bilateral lesions in the parietooccipital and parietotemporal regions, although lesions frontal and frontotemporal in the left hemisphere have also been proposed as possible locations involved in the causes of this type of apraxia, since this would explain the problems in motor planning observed in this type of patients, as well as the difficulty in distinguishing it from certain aphasias.

In cases where apraxia occurs along with some type of dementia (Alzheimer's either Parkinson's) extensive lesions in the left hemisphere and damage to the corpus callosum have been described.

Signs and symptoms

Patients who present ideational apraxia, as we have previously commented, are incapable of carrying out movements that imply an orderly sequence of acts. Although the person may be able to execute each act that makes up a movement separately, they cannot execute it in an orderly and logical manner.

To verify this, Liepmann ran a series of tests, known as multi-object tasks. Each task requires the patient to use more than one object; the investigator describes the task to the patient and asks him to perform that task as described. Liepmann gave the patients various items, including a candle, a wick, and a box of matches. He then watched to see how they interacted with each object.

In the case of the box of matches, one of the patients brought the box closer to the side of the wick; another opened the box and took out a match, and brought it close to the wick without lighting it; another patient knocked the candle against the matchbox, and so on. The researcher was able to witness the discontinuity of the patients' actions with respect to everyday objects, categorizing the errors they made, such as: a bad location of the actions, misuse of objects, omissions or errors sequential.

In short, the deficit presented by patients with ideational apraxia is not a lack of knowledge of how to use an object, since they fully understand the function of each one of them. The problem is that when they try to interact with multiple objects to execute any of their functions, the execution becomes faulty..

The person is, therefore, capable of carrying out more or less complex actions on a routine basis (turning on a match or open a box), but is unable to do so under verbal command or when asked to do so make. Hence, for some researchers, this type of apraxia is nothing more than a severe ideomotor apraxia, which It implies the inability to perform movements or gestures when these are required verbally or by imitation.

Treatment

Currently, The most common treatment for ideational apraxia, which is still a brain damage disorder, is occupational therapy and neuropsychological rehabilitation, which aim to delay the progression of symptoms and help patients regain their independence and functional autonomy.

In younger patients, after a stroke that causes apraxia of this type, recovery is less complicated because their brains are more plastic than those of an adult or older person, so as new patterns and behaviors during rehabilitation, functional and intact neural areas may assume some of the functions previously performed by damaged regions.

Ideational apraxia has been frequently described in cases of Alzheimer's-type dementia, being an important cause of morbidity and also progressing with the underlying disease. In these contexts, people quickly lose autonomy and become highly dependent, requiring the use of technical aids and, in the most serious cases, transfer to a center where they can cover their needs.

Bibliographic references:

• Ardila, A., & Rosselli, M. (2007). clinical neuropsychology. Editorial The Modern Manual.

• Hanna-Pladdy, B., & González Rothi, L. J. (2001). Ideational apraxia: Confusion that began with Liepmann. Neuropsychological Rehabilitation, 11(5), 539-547.

• Ochipa, C., Rothi, L. J. G, & Heilman, K. m. (1989). Ideational apraxia: a deficit in tool selection and use. Annals of Neurology, 25, 190-193. doi: 10.1002/ana.410250214