Apraxia is a neurological disorder where people lose the ability to carry out certain actions due to damage to the brain. This includes dressing, eating, writing, speaking, and even walking. It affects about 1% of the population.

Dressing apraxia is the inability to dress oneself (e.g., sticking one’s head down one’s sleeve or putting one’s pants right side up). 

This type of apraxia is seen in late forms of Alzheimer’s disease.

This difficulty is not explained by a primary motor or sensory deficit or by an attention deficit (as can be observed in patients with delirium or severe frontal syndrome). 

Assessment of dress apraxia

The clinical assessment consists of asking the patient to dress himself or to dress a doll or a mannequin, or to indicate the correct sequence of the steps of dressing.

When dressing apraxia is related to a lesion of the posterior parietal right hemisphere (tumor or stroke), the disease is usually associated with attentional or spatial motor difficulties with the left limbs. 

However, dysfunction in executive functions, motor deficits or constructive apraxia can also contribute. 

Associated with lesions of the parietal lobe of the left hemisphere, dressing apraxia seems more related to general deficits in gesture planning with both limbs.

Case study

A 56-year-old right-handed man developed persistent dressing apraxia following a cerebral infarction. On examination, he showed a considerable difficulty in dressing that did not get better even after many tries. 

He also showed impaired judgement of orientation, difficulties with constructive task completion, and an apparent impairment in right-left object discrimination when objects were placed in front of him. Interestingly, his right left orientation about his own body was not impaired.  No other neuropsychological signs including aphasia, apraxia, agnosia, asomatognosia and anosognosia were present. His visual imagery and mental operation were impaired in the experimental investigations. For instance, he was unable to rotate an imagery object in his mind. Medical staff concluded that his dressing impairment was related with this difficulty in rotating an imagery object in the mind.