Apraxia, Neglect, and Agnosia

H. Branch Coslett, MD, FAAN; Behavioral Neurology and Psychiatry p. 768-782 June 2018, Vol.24, No.3 doi: 10.1212/CON.0000000000000606
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PURPOSE OF REVIEW: In part because of their striking clinical presentations, disorders of higher nervous system function figured prominently in the early history of neurology. These disorders are not merely historical curiosities, however. As apraxia, neglect, and agnosia have important clinical implications, it is important to possess a working knowledge of the conditions and how to identify them.

RECENT FINDINGS: Apraxia is a disorder of skilled action that is frequently observed in the setting of dominant hemisphere pathology, whether from stroke or neurodegenerative disorders. In contrast to some previous teaching, apraxia has clear clinical relevance as it is associated with poor recovery from stroke. Neglect is a complex disorder with many different manifestations that may have different underlying mechanisms. Neglect is, in the author’s view, a multicomponent disorder in which impairment in attention and arousal is a major contributor. Finally, agnosias come in a wide variety of forms, reflecting impairments ranging from low-level sensory processing to access to stored knowledge of the world (semantics).

SUMMARY: The classic behavioral disorders reviewed here were of immense interest to early neurologists because of their arresting clinical phenomenology; more recent investigations have done much to advance the neuroscientific understanding of the disorders and to reveal their clinical relevance.

Address correspondence to Dr H. Branch Coslett, Department of Neurology, 3400 Spruce St, Philadelphia, PA 19104, hbc@pennmedicine.upenn.edu.

RELATIONSHIP DISCLOSURE: Dr Coslett serves on external advisory boards for National Institutes of Health Center grants for the University of Nevada, Reno (R21 NS099645, 1R01 DC013196, R21NS089084, 1R01 NS099061) and for a US Department of Veterans Affairs grant for the VA Boston Healthcare System. Dr Coslett serves on the editorial boards of Brain and Language and Cortex and as an editor for volume 151 of the Handbook of Clinical Neurology (“The Parietal Lobe”).

UNLABELED USE OF PRODUCTS/INVESTIGATIONAL USE DISCLOSURE: Dr Coslett reports no disclosure.

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© 2018 American Academy of Neurology