title: Progressive apraxia in clinically discordant monozygotic twins.
abstract: OBJECTIVE
  To determine disease concordancy in the first identical twin with corticobasal degeneration. The patients were 63-year-old, erythrocyte antigen-confirmed monozygotic male twins who were clinically discordant for progressive apraxia caused by corticobasal degeneration.
  
  
  METHODS
  Neuropsychologic and kinesiologic testing, magnetic resonance imaging, and positron emission tomographic measurements of cerebral metabolic rate for glucose.
  
  
  RESULTS
  The affected twin had lower neuropsychologic and kinesiologic test scores than did his brother, particularly on tests sensitive to right-compared with left-hemisphere function; widespread cerebral atrophy, worst in right parietotemporal cortices; and reduced whole-brain cerebral metabolic rate for glucose, worst in right posterior cortices. The clinically asymptomatic twin had normal neuropsychologic and kinesiologic test scores but performed more poorly on tests sensitive to left- compared with right-hemisphere function; had no abnormalities on magnetic resonance imaging; and had left temporoparietal as well as mild whole-brain hypometabolism.
  
  
  CONCLUSIONS
  Corticobasal degeneration may remain clinically discordant in identical twins after 7 years. Positron emission tomography and neuropsychologic findings suggest the possibility of a preclinical stage of corticobasal degeneration. There is generalized cortical atrophy in patients with corticobasal degeneration in addition to focal atrophy.
authors.affiliation: Section of Neurology, Mayo Clinic, Scottsdale (Ariz), USA.
authors.forename: R J
authors.initials: RJ
authors.lastname: Caselli
authors.forename: E M
authors.initials: EM
authors.lastname: Reiman
authors.forename: D
authors.initials: D
authors.lastname: Timmann
authors.forename: G E
authors.initials: GE
authors.lastname: Stelmach
authors.forename: M A
authors.initials: MA
authors.lastname: Lawson
authors.forename: D
authors.initials: D
authors.lastname: Osborne
authors.forename: S B
authors.initials: SB
authors.lastname: Moore
authors.forename: M J
authors.initials: MJ
authors.lastname: Cevette
mesh_terms: D001072:Apraxias / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology / Q000523:psychology; D004200:Diseases in Twins; D006801:Humans; D007698:Kinesis; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D014055:Tomography, Emission-Computed; D014430:Twins, Monozygotic