Association between dominant side of motor symptoms and frontal-cognitive impairments in patients with corticobasal degeneration

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  • Fukui Toshiya
    Division of Neurology, Internal Medicine, Showa University Northern Yokohama Hospital

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  • 皮質基底核変性症における運動障害優位側と前頭葉・認知症状の関係

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Corticobasal degeneration (CBD), once considered a pure motor disorder, is now regarded also as a cognitive and behavioral disease. The purpose of the present article is to discuss the association between the dominant side of motor symptoms and frontal/cognitive impairments, an issue that to date has not been fully clarified.<br>We studied, during the average period of 3.3 ± 2.0 years, the frequency and temporal order of frontal/cognitive symptoms in association with the dominant side of motor impairment in 14 patients who satisfied the diagnostic criteria of CBD. Motor symptoms were more frequent on the right side (right 11, left 3).<br>Frequent frontal symptoms included alien hand signs, psychomotor slowness, abulia, indifference, emotional disturbance, disinhibition and frontal release signs. Frontal signs were more prevalent in patients with left-dominant motor symptoms and tended to appear somewhat later in the clinical course.<br>In contrast, cognitive impairments were more common in patients with right-dominant motor symptoms in the earlier clinical stages, but the difference in prevalence between the groups disappeared within five years after onset. Common impairments included dysarthria, word-finding difficulty, taciturnity, agraphia and apraxia. Speech and writing difficulties were of earlier onset and appeared to be the presenting symptoms in some patients with right-but not left-dominant motor impairments. Apraxia was characterized as a mixture of ideomotor and limb-kinetic apraxia that appeared more common in patients with right-dominant motor symptoms and tended to appear after the first two years.<br>In sum, expressive speech and writing disturbances may be the initial presenting symptoms in patients with right-sided motor symptoms while frontal signs may be of a later presentation and more prevalent in those with left-sided motor symptoms.

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