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BRIEF RESEARCH REPORT article

Front. Neurol.

Sec. Movement Disorders

This article is part of the Research TopicClinical and Neurophysiological Features of Progressive Supranuclear Palsy and Other Parkinsonism SyndromesView all 4 articles

The Paper-Toss Test: Enhancing Bedside Recognition of Corticobasal Syndrome

Provisionally accepted
Gero LuegGero Lueg1*Thomas DuningThomas Duning2Markus A. HobertMarkus A. Hobert3,4Alexander RöslerAlexander Rösler5Sara PeranovicSara Peranovic1Rainer WirthRainer Wirth1Julia KrämerJulia Krämer6
  • 1Department of Geriatric Medicine, Marien Hospital Herne, Ruhr University Bochum, Herne, Germany
  • 2Department of Neurology, Klinikum Bremen-Ost, Bremen, Germany
  • 3Universitatsklinikum Schleswig-Holstein Campus Kiel, Kiel, Germany
  • 4Universitatsklinikum Schleswig-Holstein Campus Lubeck Klinik fur Neurologie, Lbeck, Germany
  • 5Department of Geriatric Medicine, Bethesda Krankenhaus Hamburg Bergedorf, Hamburg, Germany
  • 6Universitatsklinikum Munster Klinik fur Neurologie mit Institut fur Translationale Neurologie, Mnster, Germany

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Introduction: The diagnosis of corticobasal syndrome (CBS) is challenging due to its clinical overlap with other neurodegenerative disorders. Ideomotor apraxia is a core feature of CBS and often presents asymmetrically, but is often under-recognized in the clinical setting. Methods: The "Paper-Toss Test" (PTT) is administered to a video-based case series of four patients with different CBS pathologies (Alzheimer's disease, progressive supranuclear palsy, and corticobasal degeneration) and involves instructions to throw a paper ball with each hand. A positive test result is indicated by the presence of specific performance deficits of patient's affected side such as an absent or delayed release of the paper ball or an interrupted throwing motion. Results: All patients exhibited a positive PTT, independent of the underlying cause of CBS. Discussion: This study proposes the PPT as a bedside tool for the detection of unilateral ideomotor apraxia, facilitating the diagnosis of CBS. These deficits correspond to the known impairments in transitive gestures and disturbances of the neuronal apraxia network in CBS patients. These results support further investigation and validation of the PPT in clinical practice.

Keywords: Cortocobasal Syndrome, CBS, Psp, cbd, apraxia

Received: 23 May 2025; Accepted: 26 Nov 2025.

Copyright: © 2025 Lueg, Duning, Hobert, Rösler, Peranovic, Wirth and Krämer. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Gero Lueg

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

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