Differential lesion patterns associated with stroke-induced apraxia in women and men

The motor-cognitive syndrome apraxia is a common stroke sequela and severely affects the outcome after stroke by impairing activities of daily living. Notably, like in many health conditions, there is a massive backlog regarding studies on sex differences in patients with apraxia despite common knowledge that sex influences praxis performance in healthy participants. We investigated putative sex differences in apraxic stroke patients at the behavioral and neural levels.

We retrospectively analysed the data of a cohort of 102 left-hemisphere stroke patients in the (sub)acute phase who were apraxic according to the Cologne Apraxia Screening (KAS). We conducted voxel-based lesion–symptom mapping (VLSM) to elucidate the lesion patterns. Further, in an age-matched subsample (tolerance of 5 years) with equal numbers of men and women, behavioral comparisons and a VLSM analysis were conducted to explore differential sex-related lesion patterns.

Overall, apraxic deficits were associated with lesions in the parietal, temporal, and frontal regions in the cohort of 102 left-hemisphere stroke patients (Fig. A). The age-matched cohort consisted of 30 women and 30 men and showed no significant differences in demographic and clinical characteristics. There were no performance differences between men and women at the behavioral level regarding praxis functions. In contrast, VLSM revealed differential lesion patterns by sex. Male compared to female apraxic stroke patients significantly more often showed lesions that affected the left inferior frontal gyrus (Fig. B).

Differential lesion patterns associated with stroke-induced apraxia in women and men
Fig. Results of the statistical lesion analyses. (A) Results of the VLSM analysis: Lesion correlates are shown that were significantly associated with poorer performance in the Cologne Apraxia Screening (KAS), that is, with more severe apraxic deficits in the sample of 102 apraxic patients after left-hemisphere stroke. Only voxels lesioned in at least 10% of the patients were included in the VLSM analysis. Voxels are thresholded at p < 0.05 (FDR-corrected, t-test). (B) Lesion correlates of male versus female apraxic stroke patients in the age-matched cohort with equal sex distribution. All voxels were included in this analysis, and voxels are thresholded at p < 0.05 (FDR-corrected, Liebermeister test). (C) Overlap of the specific lesion correlates for men versus women with apraxia (2B, here in red) with the lesion correlates associated with apraxic deficits (2A, here in green) in the 102 LH stroke patients. The overlap is shown in yellow. Axial slices with MNI z-coordinates from −17 to +58 are shown.

The data suggest a differential organization of the praxis system in men and women, warranting further exploration.

Publication:

Kleineberg NN, Schmidt CC, Fink GR, Weiss PH (2025). Differential lesion patterns associated with stroke-induced apraxia in women and men. European Journal of Neurology, 32(5), e70201. doi: 10.1111/ene.70201

Last Modified: 31.07.2025