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Gesture deficits and apraxia in schizophrenia
Cortex ( IF 3.6 ) Pub Date : 2020-10-03 , DOI: 10.1016/j.cortex.2020.09.017
Sebastian Walther 1 , Vijay A Mittal 2 , Katharina Stegmayer 1 , Stephan Bohlhalter 3
Affiliation  

Aberrant performance of skilled action has long been noted in schizophrenia and relatedly, recent reports have demonstrated impaired use, performance, and perception of hand gestures in this group. Still, this deficit is not acknowledged as apraxia, which to the broader medical field, characterizes impairments in skilled actions. Understanding the relationship between apraxia and schizophrenia may shed an invaluable new perspective on disease mechanism, and highlight novel treatment opportunities as well. To examine this potential link, we reviewed the evidence for the types of praxis errors, associated psychopathology, and cerebral correlates of the praxis deficit in schizophrenia. Notably, the review indicated that gesture deficits are severe enough to be considered genuine apraxia in a substantial proportion of patients (about 25%). Further, other potential contributors (e.g., hypokinetic motor abnormalities, cognitive impairment) are indeed associated with gesture deficits in schizophrenia, but do not sufficiently explain the abnormality. Finally, patients with praxis deficits have altered brain structure and function including the left parieto-premotor praxis network and these neural correlates are specific to the praxis deficit. Therefore, we argue that the gestural disorder frequently observed in schizophrenia shares both the clinical and neurophysiological features of true apraxia, as in other neuropsychiatric disorders with impaired higher order motor control, such as Parkinson's disease.



中文翻译:

精神分裂症的手势缺陷和失用症

长期以来,精神分裂症患者的熟练动作的异常表现一直被注意到,相关地,最近的报告表明,该组的手势使用、表现和感知受损。尽管如此,这种缺陷并没有被认为是失用症,对于更广泛的医学领域来说,这是熟练操作障碍的特征。了解失用症和精神分裂症之间的关系可能会为疾病机制提供宝贵的新视角,并突出新的治疗机会。为了检查这种潜在的联系,我们审查了精神分裂症实践错误类型、相关的精神病理学和大脑相关性的证据。值得注意的是,该审查表明,相当大比例的患者(约 25%)手势缺陷严重到足以被认为是真正的失用症。更远,其他潜在因素(例如,运动机能减退异常、认知障碍)确实与精神分裂症的手势缺陷有关,但不能充分解释异常。最后,有实践缺陷的患者的大脑结构和功能发生了改变,包括左侧顶叶-前运动神经网络,这些神经关联是特定于实践缺陷的。因此,我们认为精神分裂症中经常观察到的手势障碍具有真正的失用症的临床和神经生理学特征,就像在其他高级运动控制受损的神经精神疾病中一样,例如帕金森病。但没有充分解释异常。最后,有实践缺陷的患者的大脑结构和功能发生了改变,包括左侧顶叶-前运动神经网络,这些神经关联是特定于实践缺陷的。因此,我们认为精神分裂症中经常观察到的手势障碍具有真正的失用症的临床和神经生理学特征,就像在其他高级运动控制受损的神经精神疾病中一样,例如帕金森病。但没有充分解释异常。最后,有实践缺陷的患者的大脑结构和功能发生了改变,包括左侧顶叶-前运动神经网络,这些神经关联是特定于实践缺陷的。因此,我们认为精神分裂症中经常观察到的手势障碍具有真正的失用症的临床和神经生理学特征,就像在其他高级运动控制受损的神经精神疾病中一样,例如帕金森病。

更新日期:2020-10-30
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