Neue Erkenntnisse zur Pathophysiologie der Apraxien durch funktionelle Bildgebung

Zusammenfassung

Apraxien sind Störungen der motorischen Kognition, die nicht durch basale sensomotorische Defizite oder Störungen der Kommunikation (Aphasien) erklärt werden können. Durch die Häufigkeit der Apraxien (ca. die Hälfte aller Patienten mit linkshemisphärischem Schlaganfall leiden in der Akutphase an einer Apraxie) und deren prognostische Bedeutung für den Erfolg der rehabilitativen Behandlung ergibt sich die Notwendigkeit, die Pathophysiologie der Apraxien besser zu verstehen, um langfristig neue Therapiestrategien zu entwickeln. In den letzten Jahren konnten mithilfe der funktionellen Bildgebung (PET und fMRT) wichtige neue Erkenntnisse zur Pathophysiologie der ideomotorischen Apraxie (gestörter Bewegungsplan) und der ideatorischen Apraxie (gestörte Bewegungskonzeption) gewonnen werden. In dieser Übersichtsarbeit werden beispielhaft die neuralen Substrate für die klinisch zu beobachtende Dissoziation zwischen der Imitation symbolischer und abstrakter Bewegungen (bei der ideomotorischen Apraxie) und des Objekttrigger-Systems (welches bei der ideatorischen Apraxie gestört ist) vorgestellt. Des Weiteren fassen wir neuere Arbeiten zusammen, die komplementäre Funktionen des rechten bzw. linken Parietalkortex bei der räumlichen bzw. zeitlichen Organisation von komplexen, objektbezogenen Handlungen nachweisen. Die Bedeutung des linken parietalen Kortex für die motorische Kognition wird durch Untersuchungen zur Integration von zeitlicher und räumlicher Bewegungsinformation in einen Bewegungsentwurf und zur Erzeugung von Bewegungsplänen unabhängig von der die Bewegung ausführenden Hand unterstützt.

Abstract

Apraxias are disorders of motor cognition that cannot be explained by basic sensorimotor deficits or aphasia. The relatively high frequency of apraxia (approximately half of all patients with left-hemispheric stroke suffer from apraxia during the acute phase) as well as its prognostic value for determining the outcome of rehabilitative therapy clearly convey the necessity of more comprehensive research into the pathophysiology of apraxia in order to develop new therapeutic strategies. In recent years, functional imaging (PET and fMRI) has helped to provide important new insights into the pathophysiology of ideomotor apraxia (defective movement plan) and ideational apraxia (defective action concept). In this review, the neural bases for the clinically observed dissociations between the imitation of abstract and symbolic movements (as in ideomotor apraxia) and for the object-trigger system (which is disturbed in ideational apraxia) will be exemplified. Furthermore, we will recapitulate recent studies that provide evidence for the complementary functions of the right and left parietal cortices in the spatial and temporal organization of complex, object-related actions. The particular importance of the left parietal cortex for motor cognition is further supported by studies examining the integration of spatial and temporal movement information during the generation of a movement plan as well as by the generation of such movement plans in the left parietal cortex independent from the hand that executes the movement.

Schlüsselwörter

Motorische Kognition - parietaler Cortex - fMRT - PET - Schlaganfall

Key words

motor cognition - parietal cortex - fMRT - PET - stroke

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