Apraxia in Individuals With Cognitive Impairment: Evidence From Familiar Tool Use.

OBJECTIVE

To evaluate the action selection, production, and execution of familiar tool use in patients with cognitive impairment, and to report the prevalence of Familiar Tool-Use Impairment (FTUI) and its association with cognitive impairment and functional disability.

DESIGN

Cross-sectional, observational study.

SETTING

The outpatient memory clinic in a tertiary care hospital.

PARTICIPANTS

A total of 66 patients with mild cognitive impairment and 80 patients with dementia were consecutively recruited, along with 85 healthy controls.

INTERVENTION: Not applicable.

MAIN OUTCOME MEASURES: Familiar tool test (FTT) and their association with multiple cognitive domains and basic activity of daily living in patients with cognitive impairment.

RESULTS

Early signs of FTUI were observed in the mild cognitive impairment stage, with an FTUI rate of 6.0%. The prevalence of FTUI increased significantly from the healthy controls to the dementia group to approximately 65.0% (P<.001). Canonical correlation analysis (r=0.529, P=.006) indicated that semantic and visuospatial impairment contributed substantially to the canonical variables and showed a prominent association with the Selection Scale in FTT deficits. Multiple linear regression analyses revealed that tool selection was associated with the degree of bathing dependency (R²=0.471; 95% CI, -0.49 to -0.13) and dressing (R²=0.429; 95% CI, -0.35 to -0.05).

CONCLUSIONS

This study characterized the prevalence of FTUI in patients with cognitive impairment and its underlying cognitive factors, based on the FTT. The findings provided a new perspective for understanding the cognitive impairment and functional disability, suggesting that FTUI may serve as an early warning indicator of functional decline, and offer a practical clinical tool for individualized cognitive rehabilitation in apraxia.