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Prevalence of Primitive Reflexes and Parkinsonian Signs in Dementia

Published online by Cambridge University Press:  02 December 2014

K. A. Links ,
D. Merims ,
M. A. Binns ,
M. Freedman  and
T. W. Chow
K. A. Links
Affiliation:
Baycrest Rotman Research Institute
D. Merims
Affiliation:
Baycrest Rotman Research Institute
M. A. Binns
Affiliation:
Dalla Lana School of Public Health, University Health Network-Mt. Sinai Hospital Baycrest Rotman Research Institute
M. Freedman
Affiliation:
Department of Medicine, Division of Neurology, University Health Network-Mt. Sinai Hospital Division of Neurology, University of Toronto Baycrest Division of Neurology, Toronto, Ontario, Canada
T. W. Chow*
Affiliation:
Department of Medicine, Division of Neurology, University Health Network-Mt. Sinai Hospital Department of Psychiatry, Division of Geriatric Psychiatry, University Health Network-Mt. Sinai Hospital Baycrest Rotman Research Institute Baycrest Division of Neurology, Toronto, Ontario, Canada
*
Baycrest, Rotman Research Institute, 3560 Bathurst Street, 8th Floor Brain Health Complex, Toronto, Ontario, M6A 2E1,Canada.
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Abstract

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Objective:

Primitive reflexes and parkinsonian signs are used by clinicians to differentiate among dementias. We reviewed our clinical sample to determine whether primitive reflexes were more prevalent in frontally-based dementias and whether parkinsonian signs were more common in dementia with Lewy bodies (DLB) than in other types of dementia.

Design:

We retrospectively reviewed charts from 204 patients with dementia who presented for consultation at Baycrest's Ross Memory Clinic between April, 2003, to December, 2007.

Results:

A greater proportion of subjects with DLB and dementia of the Alzheimer type with cardiovascular disease had primitive reflexes than subjects with frontotemporal dementia (FTD). Primitive reflexes were not positively predictive of FTD or vascular dementia (VaD). Dementia with Lewy bodies subjects were more likely to have parkinsonian signs than the other dementias, and bradykinesia and rigidity were positively predictive of FTD. The palmomental reflex was the most common primitive reflex in the sample, and cogwheeling was the most common parkinsonian sign. There was no significant difference between early- and late-stage groups in presence of primitive reflexes or parkinsonian signs.

Conclusions:

Primitive reflexes appear not to be clinically discriminative of frontally-based dementias such as FTD and VaD.

Résumé:

RÉSUMÉ:Objectif:

Les réflexes primitifs et les signes parkinsoniens sont utilisés par les cliniciens pour faire la distinction entre les démences. Nous avons révisé nos observations cliniques pour déterminer si la prévalence des réflexes primitifs était plus élevée dans les démences frontales et si les signes parkinsoniens étaient plus fréquents dans la démence à corps de Lewy (DCL) par rapport aux patients atteints de d’autres types de démence.

Plan de l’étude:

Nous avons révisé rétrospectivement les dossiers de 204 patients atteints de démence qui ont consulté au Baycrest Hospital Ross Memory Clinic entre avril 2003 et décembre 2007.

Résultats:

Une proportion plus élevée de sujets atteints de DCL et de démence de type Alzheimer accompagnée de maladie cardiovasculaire avaient des réflexes primitifs que les patients atteints de démence frontotemporale (DFT). Les réflexes primitifs n’étaient pas des facteurs de prédiction positifs de la DFT ou de la démence vasculaire (DVA). Les sujets atteints de DCL étaient plus susceptibles d’avoir des signes parkinsoniens que les patients atteints d’autres démences et la bradycinésie et la rigidité étaient des facteurs de prédiction positifs de la DFT. Le réflexe palmo-mentonnier était le réflexe primitif le plus frequent et la roue dentée était le signe parkinsonien le plus fréquent. Il n’y avait pas de différence significative entre les groupes en phase précoce et en phase tardive de la maladie quant à la présence des réflexes primitifs ou des signes parkinsoniens.

Conclusions:

Au point de vue clinique, les réflexes primitifs ne semblent pas ètre discriminants dans les démences frontales telles la DFT et la DVA.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 37 , Issue 5 , September 2010 , pp. 601 - 607
Copyright
Copyright © The Canadian Journal of Neurological 2010

References

1. Cummings, J, Miller, B. Conceptual and clinical aspects of the frontal lobes. In: Miller, B, Cummings, J, editors. The human frontal lobes. 2 ed. New York: The Guilford Press; 2007. p. 12–21.Google Scholar
2. Absher, JR, Cummings, JL. Neurobehavioural examination of frontal lobe functions. Aphasiology. 1995;9(2):181–92.Google Scholar
3. Neary, D, Snowden, JS, Gustafson, L, et al. Frontotemporal lobar degeneration: a consensus on clinical diagnostic criteria. Neurology. 1998;51(6):1546–54.Google Scholar
4. Mumenthaler, M. Neurologic differential diagnosis. 2 ed. New York: Thieme Medical Publishers, Inc; 1992.Google Scholar
5. Hogan, DB, Ebly, EM. Primitive reflexes and dementia: results from the Canadian Study of Health and Aging. Age Ageing. 1995;24(5):375–81.Google Scholar
6. van Boxtel, MP, Bosma, H, Jolles, J, Vreeling, FW. Prevalence of primitive reflexes and the relationship with cognitive change in healthy adults: a report from the Maastricht Aging Study. J Neurol. 2006;253(7):935–41.Google Scholar
7. McKeith, IG, Dickson, DW, Lowe, J, et al. Diagnosis and management of dementia with Lewy bodies: third report of the DLB Consortium. Neurology. 2005;65(12):1863–72.Google Scholar
8. Litvan, I, Agid, Y, Calne, D, et al. Clinical research criteria for the diagnosis of progressive supranuclear palsy (Steele-Richardson-Olszewski syndrome): report of the NINDS-SPSP International Workshop. Neurology. 1996;47:1–9.Google Scholar
9. Gilman, S, Low, P, Quinn, N, et al. Consensus statement on the diagnosis of multiple system atrophy. Clin Auton Res. 1998;8(6): 359–62.Google Scholar
10. Kövari, E. Neuropathological spectrum of frontal lobe dementias. Front Neurol Neurosci. 2009;24:149–59.Google Scholar
11. Claassen, DO, Parisi, JE, Giannini, C, Boeve, BF, Dickson, DW, Josephs, KA. Frontotemporal dementia mimicking dementia with Lewy bodies. Cogn Behav Neurol. 2008;21(3):157–63.Google Scholar
12. Diehl-Schmid, J, Schulte-Overberg, J, Hartmann, J, Förstl, H, Kurz, A, Häussermann, P. Extrapyramidal signs, primitive reflexes and incontinence in fronto-temporal dementia. Eur J Neurol. 2007;14 (8):860–4.Google Scholar
13. Mackenzie, IR. The neuropathology and clinical phenotype of FTD with progranulin mutations. Acta Neuropathol. 2007;114(1): 49–54.Google Scholar
14. Leverenz, JB, Yu, CE, Montine, TJ, et al. A novel progranulin mutation associated with variable clinical presentation and tau, TDP43 and alpha-synuclein pathology. Brain. 2007;130:1360–74.Google Scholar
15. Le Ber, I, van der Zee, J, Hannequin, D, et al. Progranulin null mutations in both sporadic and familial frontotemporal dementia. Hum Mutat. 2007;28(9):846–55.Google Scholar
16. Baker, M, Mackenzie, IR, Pickering-Brown, SM, et al. Mutations in progranulin cause tau-negative frontotemporal dementia linked to chromosome 17. Nature. 2006;442(7105):916–9.Google Scholar
17. Hodges, JR, Davies, RR, Xuereb, JH, et al. Clinicopathological correlates in frontotemporal dementia. Ann Neurol. 2004;56(3): 399–406.Google Scholar
18. Yoshita, M, Taki, J, Yamada, M. A clinical role for [123I]MIBG myocardial scintigraphy in the distinction between dementia of the Alzheimer’s-type and dementia with Lewy bodies. J Neurol Neurosurg Psychiatry. 2001;71:574–5.CrossRefGoogle ScholarPubMed
19. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (4th edition, text revision) (DSM-IV-TR). Washington, DC: American Psychiatric Association, 2000.Google Scholar
20. McKhann, G, Drachman, D, Folstein, M, et al. Clinical diagnosis of Alzheimer’s disease: report of the NINCDS-ADRDA work group under the auspices of department of health and human services task force on Alzheimer’s disease. Neurology. 1984;34:939–44.Google Scholar
21. Román, GC, Tatemichi, TK, Erkinjuntti, T, et al. Vascular dementia: diagnostic criteria for research studies: report of the NINDS-AIREN International Workshop. Neurology. 1993;43:250.Google Scholar
22. Folstein, MF, Folstein, SE, McHugh, PR. “Mini-Mental State”: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189–98.Google Scholar
23. Darvesh, S, Leach, L, Black, SE, Kaplan, E. The behavioural neurology assessment. Can J Neurol Sci. 2005;32:167–77.Google Scholar
24. Piguet, O, Hornberger, M, Shelley, BP, Kipps, CM, Hodges, J. Sensitivity of current criteria for the diagnosis of behavioral variant frontotemporal dementia. Neurology. 2009;72:732–7.Google Scholar
25. Funkenstein, HH, Albert, MS, Cook, NR, et al. Extrapyramidal signs and other neurologic findings in clinically diagnosed Alzheimer’s disease: a community-based study. Arch Neurol. 1993;50(1):51–6.Google Scholar
26. Piguet, O, Halliday, GM, Creasey, H, Broe, GA, Kril, JJ. Frontotemporal dementia and dementia with Lewy bodies in a case-control study of Alzheimer’s disease. Int Psychogeriatr. 2009;21(4):688–95.Google Scholar
27. Boeve, BF, Hutton, M. Refining frontotemporal dementia with parkinsonism linked to chromosome 17 introducing FTDP-17 (MAPT) and FTDP-17 (PGRN). Arch Neurol. 2008;65(4):460–4.Google Scholar