Conceptual apraxia in probable Alzheimer’s disease as demonstrated by the Florida Action Recall Test RONALD L. SCHWARTZ, 1 JOHN C. ADAIR, 2 ANASTASIA M. RAYMER, 3 DAVID J.G. WILLIAMSON, 5 BRUCE CROSSON, 5 LESLIE J.G. ROTHI, 4 STEPHEN E. NADEAU, 4,5 and KENNETH M. HEILMAN 4,5 1 Department of Neurology, University of Florida at Jacksonville, Jacksonville, Florida 2 Department of Neurology, University of New Mexico; Neurology Service, Department of Veterans Affairs Medical Center, Albuquerque, New Mexico 3 Department of Child Study and Special Education, Old Dominion University, Norfolk, Virginia 4 Department of Veterans Affairs Medical Center, Gainesville, Florida 5 Department of Neurology, University of Florida College of Medicine, Neurology Service, Gainesville, Florida (Received October 21, 1997; Revised November 11, 1998; Accepted November 25, 1998) Abstract Patients with probable Alzheimer’s disease (AD) often have difficulties associated with semantic knowledge. Therefore, conceptual apraxia, a defect of action semantics and mechanical knowledge, may be an early sign of this disease. The Florida Action Recall Test (FLART), developed to assess conceptual apraxia, consists of 45 line drawings of objects or scenes. The subject must imagine the proper tool to apply to each pictured object or scene and then pantomime its use. Twelve participants with Alzheimer’s disease (NINCDS–ADRDA criteria) and 21 age- and education-matched controls were tested. Nine Alzheimer’s disease participants scored below a 2-standard- deviation cutoff on conceptual accuracy, and the three who scored above the cutoff were beyond a 2-standard-deviation cutoff on completion time. The FLART appears to be a sensitive measure of conceptual apraxia in the early stages of Alzheimer’s disease. ( JINS, 2000, 6, 265–270.) Keywords: Apraxia, Conceptual apraxia, Ideational apraxia, Alzheimer’s disease, Semantic INTRODUCTION Limb apraxia, hereafter referred to as apraxia, is a loss of ability to perform skilled purposive movements that cannot be attributed to elemental sensory or motor deficits (Heil- man & Rothi, 1993). Liepmann (190501980) posited that voluntary motor actions were initiated by the idea of an ac- tion and the translation of that concept into kinesthetic mo- tor programs. Current models of praxis knowledge posit two major components: productive and conceptual (Roy & Square, 1985). The productive component includes the spa- tial and temporal codes needed for the performance of skilled purposive motor actions, and the impairment of this com- ponent leads to ideomotor apraxia (Rothi et al., 1991). Ideo- motor apraxia leads to errors of spatial or temporal coding. Ideational apraxia refers to deficits in sequential organiza- tion of actions (e.g. prepare a letter for mailing, light a can- dle from a matchbook; Poeck 1983). The conceptual do- main involves associative and mechanical knowledge about tools (i.e., manipulable objects) and actions. The associa- tive realm involves the relationships between tools and their actions (e.g., knife–cut) and between tools and the objects they act upon (e.g., knife–bread). The mechanical realm in- volves understanding the advantage that tools afford in com- pleting certain tasks. Deficits in the mechanical realm include the inability to solve mechanical problems or construct novel tools. Impairments related to the praxis conceptual system lead to conceptual apraxia (Ochipa et al., 1992; Rothi et al., 1991). Conceptual apraxia is most commonly associated with left hemisphere injury (Heilman et al., 1997). Lesion studies in humans support the hypotheses that the productive and con- ceptual components of the praxis system may be anatomi- cally distinct. The productive component includes praxicons or gesture movement representations that may be stored in the supramarginal or angular gyrus of the inferior parietal lobe (Heilman & Rothi, 1993; Rothi et al., 1985), innerva- Reprint requests to: Kenneth M. Heilman, Department of Neurology, Box 100236, University of Florida College of Medicine, Gainesville, FL. E-mail: heilman@medicine.ufl.edu Journal of the International Neuropsychological Society (2000), 6, 265–270. Copyright © 2000 INS. Published by Cambridge University Press. Printed in the USA. 265