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Key points
- Many routine activities that we consider simple and straightforward are actually multifaceted and complicated.
- Although most dementias start with impairment in memory, language, and other aspects of thinking, they eventually disrupt learned skills.
- Individuals with corticobasal syndrome frequently show loss of skilled movements in one hand, which becomes useless over time.
- Some individuals with corticobasal syndrome experience a limb with a mind of its own.
You wake up in the morning, get out of bed, walk to the bathroom, flip on the light, use the toilet, brush your teeth (wetting your toothbrush, putting on toothpaste, moving the brush across your teeth, rinsing your mouth, rinsing your toothbrush, and putting the brush back), shower (including all of its separate steps), dry yourself, brush your hair, put on your underwear, socks, shirt, pants, and sweater. You slip on your shoes and tie the laces. Walking into the kitchen, you pull out your coffee maker, fill the reservoir with water, put the filter in, add the coffee, and turn it on. While the coffee is brewing, you pop a slice of bread in the toaster. Then you put a little oil in a pan, turn the heat on, crack 2 eggs, and fry them sunny side up. The toaster dings, and the toast pops up. You take out a plate, put the toast on the plate, and slide the eggs from the pan onto the toast. You set the plate on the table, pour yourself some coffee, pull out a knife and fork, and sit down to eat your breakfast.
All of these steps in your morning routine are commonplace, even trivial everyday steps that you do without thinking twice. I outlined them in detail, however, to emphasize just how multifaceted and complicated they actually are.
We commonly think about dementia as disrupting memory, language, and other aspects of thinking. But as dementia progresses and affects other brain regions, the ability to perform these learned, skilled movements deteriorates. It may first be noticeable when performing technical tasks in complicated activities such as woodworking or cooking, and it may progress to difficulty with basic activities such as manipulating buttons and putting on clothes correctly. These problems are generally due to frontal lobe dysfunction either alone or in combination with dysfunction of other brain regions. Some individuals with dementia experience difficulty performing skilled tasks early in their course, and most individuals have these difficulties at some point.
Rarely, a dementia begins with these types of difficulties. When difficulties with skilled movements appear first, it is usually due to corticobasal syndrome. Individuals with this syndrome initially show difficulties with one hand participating in skilled tasks such as buttoning or tying shoelaces, but then progress to limbs that can become useless—or even seemingly acting with a mind of their own. The hand of one patient we cared for didn’t release on its own after grasping a chair arm or doorknob, with predictable consequences when they tried to get out of a chair or open a door. The arm of another patient we cared for tended to slowly rise up and make slow, purposeless movements.
© Andrew E. Budson, MD, 2021, all rights reserved.
References
Budson AE, O’Connor MK. Seven Steps to Managing Your Memory: What’s Normal, What’s Not, and What to Do About It, New York: Oxford University Press, 2017.
Budson AE, O’Connor MK. Six Steps to Managing Alzheimer’s Disease and Dementia: A Guide for Families, New York: Oxford University Press, 2021.
Budson AE, Solomon PR. Memory Loss, Alzheimer’s Disease, & Dementia: A Practical Guide for Clinicians, 3rd Edition, Philadelphia: Elsevier Inc., 2021.
