Imagine waking up in the morning and wanting to pour yourself a cup of coffee. You want to do it. All your muscles are working. And you can’t.
That’s apraxia. It’s a neurological condition that’s often misunderstood and not talked about a lot in dementia, and it can be incredibly frustrating, for the person with dementia and for you as the caregiver.
Up to 52% of people with dementia have it. Below are the two most common types, so you can figure out whether your loved one might have one of them.
What Is Apraxia?
The “a” means without, and “praxia” means action. Put them together and apraxia literally means without action. You might also hear the term dyspraxia, which is similar but a milder form.
Every action we take, like pouring a cup of coffee, starts with the brain sending signals to the body. Signals to start: pick up the pot, pour. And signals to stop: take the pot down and put it away as the cup gets full.
With apraxia, the brain isn’t sending those signals properly.
Apraxia is diagnosed when the person has the physical ability to do the task, their vision and perception are there, and they truly want to do it. They’re trying to cooperate. But the body doesn’t follow.
So this has nothing to do with pain, arthritis or low vision. Everything about them is physically able to do the task. The brain just isn’t communicating the right signals to the body.
How Common Is Apraxia in Dementia?
The risk grows as dementia continues. Only a small share of people with mild cognitive impairment, which is not quite in the dementia range yet, have apraxia: one study found about 5%. By the moderate stages of dementia, it’s over 50%.
Why Apraxia Is Often Missed
Here’s one of the biggest reasons apraxia goes undiagnosed. It’s usually taken as one more symptom of the dementia declining, and it gets overlooked as a separate neurological condition.
I explain why “he could do it if he wanted to” isn’t what’s happening, alongside four other symptoms that get misread, in 5 strange dementia behaviors that actually make perfect sense.
Types of Apraxia in Dementia
There are more types than these two, but ideomotor and ideational apraxia are the most common in dementia. Here’s what each one looks like, and how to help.
Ideomotor Apraxia: When They Can’t Do It on Request
Ideomotor apraxia is the most common type in dementia. The person has a hard time doing or showing an action when they’re asked to.
To check for it, a clinician asks things like: wave goodbye. Show me how you’d brush your teeth. Show me how you’d use a hammer.
What Ideomotor Apraxia Looks Like
In the video, I share a clip of a woman being asked to unlock a door with a key. She just moves her hand back and forth. She can’t figure out the motion.
In another clip, a woman is asked to put on a jacket. She holds it, moves it around, looks at different parts of it, holds it up. She can’t work out the steps to get it on.
Now imagine that showing up in all kinds of ways through the day.
How to Help With Ideomotor Apraxia
With this type, your loved one has the physical ability, but when you tell them to do the task, they can’t. So talk around what you want.
Instead of “put on your jacket,” say, “We’re going outside, it’s cold out,” and hand them the jacket. They might know naturally to put it on.
Instead of “come to the table, it’s time to eat,” which makes them work out what “come to the table” means and what the steps are, just say, “Lunch is ready.” Their brain might be able to bypass the instruction and know that lunch means going in there.
A common dementia tip is to do the task alongside them, like brushing your teeth next to them. With ideomotor apraxia, mirroring likely won’t work. They still can’t figure it out. Instead, say, “It’s time for bed,” walk into the bathroom and start the routine. That might trigger their brain.
Ideational Apraxia: When the Steps Get Out of Order
Ideational apraxia is about sequencing: working out what comes first and what comes next in a task.
Making a peanut butter and jelly sandwich, they might put the two pieces of bread together before putting anything on them. Getting ready to leave the house, they might put on their shoes before their socks.
What Ideational Apraxia Looks Like
In the video, a woman is asked to fold a letter and put it in an envelope. She holds the envelope, flips it, looks at it, and tries a little folding. But she can’t work out how to get the paper into the envelope. She’s struggling with thinking through the steps.
How to Help With Ideational Apraxia
Break it down to one step at a time. Ideally, only put out what they need for that one step.
Back to the sandwich: first, just the two slices of bread are out. Then the peanut butter. Then the jelly. Step by step by step.
It isn’t “make a peanut butter and jelly sandwich.” It’s “take out two pieces of bread.” “Get the peanut butter.” “Get the jelly.” “Put it on the slice of bread.” “Put the other piece of bread on top.”
Apraxia is often why someone with dementia walks into the bathroom and freezes, too. I walk through that in why people with dementia struggle in the bathroom.
Why They Can Do It Sometimes and Not Others
This may explain why your loved one can do something one moment and not the next. They might not be able to do the very same thing they did earlier in the day, and it could be all about how it was presented.
There are many types of apraxia. Understanding the specific type helps you and your loved one’s healthcare team come up with the steps, strategies and support they need to do the things they want and need to do, and to have the best quality of life.
Knowing all this is one thing. Using it in the middle of a hard day is another. Inside the Care Collective, we meet every week, with me and other experts, to work through the moments that feel confusing and overwhelming, so you’re not just collecting information but putting it to use. You can learn more here.
