Psychology Department, Sapienza Rome University, Via dei Marsi 78, Rome, Italy.
Neuropsychologia. 2010 May;48(6):1574-82. doi: 10.1016/j.neuropsychologia.2010.01.026. Epub 2010 Feb 6.
It is still a matter of debate whether constructive apraxia (CA) should be considered a form of apraxia or, rather, the motor expression of a more pervasive impairment in visuo-spatial processing. Constructive disorders were linked to visuo-spatial disorders and to deficits in appreciating spatial relations among component sub-parts or problems in reproducing three-dimensionality. We screened a large population of brain-damaged patients for CA. Only patients with constructive disorders and no signs of neglect and/or aphasia were selected. Five apractic subjects were tested with both visuo-spatial and verbal tasks requiring constructive abilities. The former ones were tests such as design copying, while the latter were experimental tasks built to transpose into the linguistic domain the constructive process as phrasing by arranging paper scraps into a sentence. A first result showed a constructive impairment in both the visuo-spatial and the linguistic domain; this finding challenges the idea that CA is confined to the visuo-spatial domain. A second result showed a systematic association between CA and unawareness for constructive disorders. Third, lack of awareness was always associated with a lesion in the right dorsolateral prefrontal cortex, a region deemed as involved in managing a conflict between intentions and sensory feed-back. Anosognosia for constructive disorders and the potential role of the right prefrontal cortex in generating the impairment, are discussed in the light of current models of action control. The core of CA could be the inability to detect any inconsistency between intended and executed action rather than a deficit in reproducing spatial relationship.
是否将建设性失用症（CA）视为失用症的一种形式，或者更确切地说，是视空间加工中更普遍的损伤的运动表现，这仍然存在争议。建设性障碍与视空间障碍以及欣赏部件之间空间关系的缺陷或再现三维性的问题有关。我们对大量脑损伤患者进行了 CA 筛查。仅选择有建设性障碍且无忽视和/或失语症迹象的患者。对 5 名失用症患者进行了视空间和语言任务的测试，这些任务需要建设性能力。前者是设计复制等测试，而后者是构建语言领域的实验任务，即将碎纸片排列成句子来转换构建过程。第一个结果表明，在视空间和语言领域都存在建设性损伤；这一发现挑战了 CA 仅限于视空间领域的观点。第二个结果表明，CA 与对建设性障碍的无意识之间存在系统关联。第三，缺乏意识总是与右背外侧前额叶皮层的损伤有关，该区域被认为参与管理意图和感官反馈之间的冲突。我们根据当前的行动控制模型讨论了对建设性障碍的认知不足和右前额叶皮层在产生损伤中的潜在作用。CA 的核心可能是无法检测到意图和执行动作之间的任何不一致，而不是再现空间关系的缺陷。
