Theoretical models of praxis have two major components, a praxis conceptual system that includes knowledge of tool use and mechanical knowledge and a praxis production system that includes the information needed to program skilled motor acts. Because patients with Alzheimer's disease may have an impairment of the central conceptual system, we wanted to learn if they had a conceptual apraxia by testing their knowledge of the type of actions associated with tool use, their ability to associate tools with objects that receive their action, their ability to understand the mechanical nature of problems and the mechanical advantages tools may afford. We studied 32 subjects with probable Alzheimer's disease and 32 controls by examining tool-action relationships and tool-object associations. We tested mechanical knowledge by having subjects select alternative tools and solve mechanical puzzles by developing new tools. The Alzheimer's group was subdivided into four groups based on the presence or absence of ideomotor apraxia and a lexical-semantic deficit. Results indicated that each of the four Alzheimer's groups differed from normal controls on at least some measures of conceptual apraxia, suggesting that Alzheimer's patients do have a disturbance of the praxis conceptual system and that impairment of this system is not directly related to language impairment or ideomotor apraxia.
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