Primitive Reflexes in Alzheimer's Disease and Vascular Dementia
Identifieur interne : 000250 ( Istex/Corpus ); précédent : 000249; suivant : 000251Primitive Reflexes in Alzheimer's Disease and Vascular Dementia
Auteurs : Fred W. Vreeling ; Peter J. Houx ; Jellemer Jolles ; Frans R. J. VerheySource :
- Journal of Geriatric Psychiatry and Neurology [ 0891-9887 ] ; 1995-04.
Abstract
Data on the prevalence and clinical value of primitive reflexes (PRs) in dementia are controversial, mainly due to a lack of standardization of the methods by which these signs are elicited and scored. A standardized protocol was used to investigate eight PRs in 20 patients with Alzheimer's disease (AD), 20 patients with vascular dementia (VD), and 20 control subjects for each group. Both patient groups showed considerably more PRs than the control groups. The prevalence of PRs was related to the severity of dementia. No single reflex or combination of PR pathognomonic for dementia could be distinguished. The PR profile of AD and VD patients were similar.
Url:
DOI: 10.1177/089198879500800207
Links to Exploration step
ISTEX:C23230D85FFE891440CE5E6833CE6A52A325A4DFLe document en format XML
<record><TEI wicri:istexFullTextTei="biblStruct"><teiHeader><fileDesc><titleStmt><title xml:lang="en">Primitive Reflexes in Alzheimer's Disease and Vascular Dementia</title><author wicri:is="90%"><name sortKey="Vreeling, Fred W" sort="Vreeling, Fred W" uniqKey="Vreeling F" first="Fred W." last="Vreeling">Fred W. Vreeling</name><affiliation><mods:affiliation>Department of Neurology (Dr. Vreeling), and the Department of Neuropsychology and Psychobiology (Drs. Houx, Jolles, and Verhey), University of Limburg, Maastricht, The Netherlands.</mods:affiliation></affiliation></author><author wicri:is="90%"><name sortKey="Houx, Peter J" sort="Houx, Peter J" uniqKey="Houx P" first="Peter J." last="Houx">Peter J. Houx</name><affiliation><mods:affiliation>Department of Neurology (Dr. Vreeling), and the Department of Neuropsychology and Psychobiology (Drs. Houx, Jolles, and Verhey), University of Limburg, Maastricht, The Netherlands.</mods:affiliation></affiliation></author><author wicri:is="90%"><name sortKey="Jolles, Jellemer" sort="Jolles, Jellemer" uniqKey="Jolles J" first="Jellemer" last="Jolles">Jellemer Jolles</name><affiliation><mods:affiliation>Department of Neurology (Dr. Vreeling), and the Department of Neuropsychology and Psychobiology (Drs. Houx, Jolles, and Verhey), University of Limburg, Maastricht, The Netherlands.</mods:affiliation></affiliation></author><author wicri:is="90%"><name sortKey="Verhey, Frans R J" sort="Verhey, Frans R J" uniqKey="Verhey F" first="Frans R. J." last="Verhey">Frans R. J. Verhey</name><affiliation><mods:affiliation>Department of Neurology (Dr. Vreeling), and the Department of Neuropsychology and Psychobiology (Drs. Houx, Jolles, and Verhey), University of Limburg, Maastricht, The Netherlands.</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:C23230D85FFE891440CE5E6833CE6A52A325A4DF</idno><date when="1995" year="1995">1995</date><idno type="doi">10.1177/089198879500800207</idno><idno type="url">https://api.istex.fr/document/C23230D85FFE891440CE5E6833CE6A52A325A4DF/fulltext/pdf</idno><idno type="wicri:Area/Istex/Corpus">000250</idno><idno type="wicri:explorRef" wicri:stream="Istex" wicri:step="Corpus" wicri:corpus="ISTEX">000250</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a" type="main" xml:lang="en">Primitive Reflexes in Alzheimer's Disease and Vascular Dementia</title><author wicri:is="90%"><name sortKey="Vreeling, Fred W" sort="Vreeling, Fred W" uniqKey="Vreeling F" first="Fred W." last="Vreeling">Fred W. Vreeling</name><affiliation><mods:affiliation>Department of Neurology (Dr. Vreeling), and the Department of Neuropsychology and Psychobiology (Drs. Houx, Jolles, and Verhey), University of Limburg, Maastricht, The Netherlands.</mods:affiliation></affiliation></author><author wicri:is="90%"><name sortKey="Houx, Peter J" sort="Houx, Peter J" uniqKey="Houx P" first="Peter J." last="Houx">Peter J. Houx</name><affiliation><mods:affiliation>Department of Neurology (Dr. Vreeling), and the Department of Neuropsychology and Psychobiology (Drs. Houx, Jolles, and Verhey), University of Limburg, Maastricht, The Netherlands.</mods:affiliation></affiliation></author><author wicri:is="90%"><name sortKey="Jolles, Jellemer" sort="Jolles, Jellemer" uniqKey="Jolles J" first="Jellemer" last="Jolles">Jellemer Jolles</name><affiliation><mods:affiliation>Department of Neurology (Dr. Vreeling), and the Department of Neuropsychology and Psychobiology (Drs. Houx, Jolles, and Verhey), University of Limburg, Maastricht, The Netherlands.</mods:affiliation></affiliation></author><author wicri:is="90%"><name sortKey="Verhey, Frans R J" sort="Verhey, Frans R J" uniqKey="Verhey F" first="Frans R. J." last="Verhey">Frans R. J. Verhey</name><affiliation><mods:affiliation>Department of Neurology (Dr. Vreeling), and the Department of Neuropsychology and Psychobiology (Drs. Houx, Jolles, and Verhey), University of Limburg, Maastricht, The Netherlands.</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">Journal of Geriatric Psychiatry and Neurology</title><idno type="ISSN">0891-9887</idno><idno type="eISSN">1552-5708</idno><imprint><publisher>SAGE Publications</publisher><pubPlace>Sage CA: Los Angeles, CA</pubPlace><date type="published" when="1995-04">1995-04</date><biblScope unit="volume">8</biblScope><biblScope unit="issue">2</biblScope><biblScope unit="page" from="111">111</biblScope><biblScope unit="page" to="117">117</biblScope></imprint><idno type="ISSN">0891-9887</idno></series><idno type="istex">C23230D85FFE891440CE5E6833CE6A52A325A4DF</idno><idno type="DOI">10.1177/089198879500800207</idno><idno type="ArticleID">10.1177_089198879500800207</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0891-9887</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Data on the prevalence and clinical value of primitive reflexes (PRs) in dementia are controversial, mainly due to a lack of standardization of the methods by which these signs are elicited and scored. A standardized protocol was used to investigate eight PRs in 20 patients with Alzheimer's disease (AD), 20 patients with vascular dementia (VD), and 20 control subjects for each group. Both patient groups showed considerably more PRs than the control groups. The prevalence of PRs was related to the severity of dementia. No single reflex or combination of PR pathognomonic for dementia could be distinguished. The PR profile of AD and VD patients were similar.</div></front></TEI><istex><corpusName>sage</corpusName><author><json:item><name>Fred W. Vreeling MD, PhD</name><affiliations><json:string>Department of Neurology (Dr. Vreeling), and the Department of Neuropsychology and Psychobiology (Drs. Houx, Jolles, and Verhey), University of Limburg, Maastricht, The Netherlands.</json:string></affiliations></json:item><json:item><name>Peter J. Houx PhD</name><affiliations><json:string>Department of Neurology (Dr. Vreeling), and the Department of Neuropsychology and Psychobiology (Drs. Houx, Jolles, and Verhey), University of Limburg, Maastricht, The Netherlands.</json:string></affiliations></json:item><json:item><name>Jellemer Jolles PhD</name><affiliations><json:string>Department of Neurology (Dr. Vreeling), and the Department of Neuropsychology and Psychobiology (Drs. Houx, Jolles, and Verhey), University of Limburg, Maastricht, The Netherlands.</json:string></affiliations></json:item><json:item><name>Frans R.J. Verhey MD, PhD</name><affiliations><json:string>Department of Neurology (Dr. Vreeling), and the Department of Neuropsychology and Psychobiology (Drs. Houx, Jolles, and Verhey), University of Limburg, Maastricht, The Netherlands.</json:string></affiliations></json:item></author><articleId><json:string>10.1177_089198879500800207</json:string></articleId><language><json:string>eng</json:string></language><originalGenre><json:string>research-article</json:string></originalGenre><abstract>Data on the prevalence and clinical value of primitive reflexes (PRs) in dementia are controversial, mainly due to a lack of standardization of the methods by which these signs are elicited and scored. A standardized protocol was used to investigate eight PRs in 20 patients with Alzheimer's disease (AD), 20 patients with vascular dementia (VD), and 20 control subjects for each group. Both patient groups showed considerably more PRs than the control groups. The prevalence of PRs was related to the severity of dementia. No single reflex or combination of PR pathognomonic for dementia could be distinguished. The PR profile of AD and VD patients were similar.</abstract><qualityIndicators><score>6.784</score><pdfVersion>1.4</pdfVersion><pdfPageSize>612 x 828 pts</pdfPageSize><refBibsNative>true</refBibsNative><abstractCharCount>663</abstractCharCount><pdfWordCount>5049</pdfWordCount><pdfCharCount>30898</pdfCharCount><pdfPageCount>7</pdfPageCount><abstractWordCount>107</abstractWordCount></qualityIndicators><title>Primitive Reflexes in Alzheimer's Disease and Vascular Dementia</title><genre><json:string>research-article</json:string></genre><host><volume>8</volume><publisherId><json:string>JGP</json:string></publisherId><pages><last>117</last><first>111</first></pages><issn><json:string>0891-9887</json:string></issn><issue>2</issue><genre><json:string>journal</json:string></genre><language><json:string>unknown</json:string></language><eissn><json:string>1552-5708</json:string></eissn><title>Journal of Geriatric Psychiatry and Neurology</title></host><categories><wos><json:string>social science</json:string><json:string>psychiatry</json:string><json:string>science</json:string><json:string>geriatrics & gerontology</json:string><json:string>clinical neurology</json:string></wos><scienceMetrix><json:string>health sciences</json:string><json:string>clinical medicine</json:string><json:string>geriatrics</json:string></scienceMetrix></categories><publicationDate>1995</publicationDate><copyrightDate>1995</copyrightDate><doi><json:string>10.1177/089198879500800207</json:string></doi><id>C23230D85FFE891440CE5E6833CE6A52A325A4DF</id><score>0.11414882</score><fulltext><json:item><extension>pdf</extension><original>true</original><mimetype>application/pdf</mimetype><uri>https://api.istex.fr/document/C23230D85FFE891440CE5E6833CE6A52A325A4DF/fulltext/pdf</uri></json:item><json:item><extension>zip</extension><original>false</original><mimetype>application/zip</mimetype><uri>https://api.istex.fr/document/C23230D85FFE891440CE5E6833CE6A52A325A4DF/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/C23230D85FFE891440CE5E6833CE6A52A325A4DF/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a" type="main" xml:lang="en">Primitive Reflexes in Alzheimer's Disease and Vascular Dementia</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>SAGE Publications</publisher><pubPlace>Sage CA: Los Angeles, CA</pubPlace><availability><p>SAGE</p></availability><date>1995</date></publicationStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a" type="main" xml:lang="en">Primitive Reflexes in Alzheimer's Disease and Vascular Dementia</title><author xml:id="author-1"><persName><forename type="first">Fred W.</forename><surname>Vreeling</surname></persName><roleName type="degree">MD, PhD</roleName><affiliation>Department of Neurology (Dr. Vreeling), and the Department of Neuropsychology and Psychobiology (Drs. Houx, Jolles, and Verhey), University of Limburg, Maastricht, The Netherlands.</affiliation></author><author xml:id="author-2"><persName><forename type="first">Peter J.</forename><surname>Houx</surname></persName><roleName type="degree">PhD</roleName><affiliation>Department of Neurology (Dr. Vreeling), and the Department of Neuropsychology and Psychobiology (Drs. Houx, Jolles, and Verhey), University of Limburg, Maastricht, The Netherlands.</affiliation></author><author xml:id="author-3"><persName><forename type="first">Jellemer</forename><surname>Jolles</surname></persName><roleName type="degree">PhD</roleName><affiliation>Department of Neurology (Dr. Vreeling), and the Department of Neuropsychology and Psychobiology (Drs. Houx, Jolles, and Verhey), University of Limburg, Maastricht, The Netherlands.</affiliation></author><author xml:id="author-4"><persName><forename type="first">Frans R.J.</forename><surname>Verhey</surname></persName><roleName type="degree">MD, PhD</roleName><affiliation>Department of Neurology (Dr. Vreeling), and the Department of Neuropsychology and Psychobiology (Drs. Houx, Jolles, and Verhey), University of Limburg, Maastricht, The Netherlands.</affiliation></author></analytic><monogr><title level="j">Journal of Geriatric Psychiatry and Neurology</title><idno type="pISSN">0891-9887</idno><idno type="eISSN">1552-5708</idno><imprint><publisher>SAGE Publications</publisher><pubPlace>Sage CA: Los Angeles, CA</pubPlace><date type="published" when="1995-04"></date><biblScope unit="volume">8</biblScope><biblScope unit="issue">2</biblScope><biblScope unit="page" from="111">111</biblScope><biblScope unit="page" to="117">117</biblScope></imprint></monogr><idno type="istex">C23230D85FFE891440CE5E6833CE6A52A325A4DF</idno><idno type="DOI">10.1177/089198879500800207</idno><idno type="ArticleID">10.1177_089198879500800207</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>1995</date></creation><langUsage><language ident="en">en</language></langUsage><abstract xml:lang="en"><p>Data on the prevalence and clinical value of primitive reflexes (PRs) in dementia are controversial, mainly due to a lack of standardization of the methods by which these signs are elicited and scored. A standardized protocol was used to investigate eight PRs in 20 patients with Alzheimer's disease (AD), 20 patients with vascular dementia (VD), and 20 control subjects for each group. Both patient groups showed considerably more PRs than the control groups. The prevalence of PRs was related to the severity of dementia. No single reflex or combination of PR pathognomonic for dementia could be distinguished. The PR profile of AD and VD patients were similar.</p></abstract></profileDesc><revisionDesc><change when="1995-04">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/document/C23230D85FFE891440CE5E6833CE6A52A325A4DF/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="corpus sage not found" wicri:toSee="no header"><istex:xmlDeclaration>version="1.0" encoding="UTF-8"</istex:xmlDeclaration><istex:docType PUBLIC="-//NLM//DTD Journal Publishing DTD v2.3 20070202//EN" URI="journalpublishing.dtd" name="istex:docType"></istex:docType><istex:document><article article-type="research-article" dtd-version="2.3" xml:lang="EN"><front><journal-meta><journal-id journal-id-type="hwp">spjgp</journal-id><journal-id journal-id-type="publisher-id">JGP</journal-id><journal-title>Journal of Geriatric Psychiatry and Neurology</journal-title><issn pub-type="ppub">0891-9887</issn><publisher><publisher-name>SAGE Publications</publisher-name><publisher-loc>Sage CA: Los Angeles, CA</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.1177/089198879500800207</article-id><article-id pub-id-type="publisher-id">10.1177_089198879500800207</article-id><article-categories><subj-group subj-group-type="heading"><subject>Articles</subject></subj-group></article-categories><title-group><article-title>Primitive Reflexes in Alzheimer's Disease and Vascular Dementia</article-title></title-group><contrib-group><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Vreeling</surname><given-names>Fred W.</given-names></name><degrees>MD, PhD</degrees><aff>Department of Neurology (Dr. Vreeling), and the Department of Neuropsychology and Psychobiology (Drs. Houx, Jolles, and Verhey), University of Limburg, Maastricht, The Netherlands.</aff></contrib></contrib-group><contrib-group><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Houx</surname><given-names>Peter J.</given-names></name><degrees>PhD</degrees><aff>Department of Neurology (Dr. Vreeling), and the Department of Neuropsychology and Psychobiology (Drs. Houx, Jolles, and Verhey), University of Limburg, Maastricht, The Netherlands.</aff></contrib></contrib-group><contrib-group><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Jolles</surname><given-names>Jellemer</given-names></name><degrees>PhD</degrees><aff>Department of Neurology (Dr. Vreeling), and the Department of Neuropsychology and Psychobiology (Drs. Houx, Jolles, and Verhey), University of Limburg, Maastricht, The Netherlands.</aff></contrib></contrib-group><contrib-group><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Verhey</surname><given-names>Frans R.J.</given-names></name><degrees>MD, PhD</degrees><aff>Department of Neurology (Dr. Vreeling), and the Department of Neuropsychology and Psychobiology (Drs. Houx, Jolles, and Verhey), University of Limburg, Maastricht, The Netherlands.</aff></contrib></contrib-group><pub-date pub-type="ppub"><month>04</month><year>1995</year></pub-date><volume>8</volume><issue>2</issue><fpage>111</fpage><lpage>117</lpage><abstract><p>Data on the prevalence and clinical value of primitive reflexes (PRs) in dementia are controversial, mainly due to a lack of standardization of the methods by which these signs are elicited and scored. A standardized protocol was used to investigate eight PRs in 20 patients with Alzheimer's disease (AD), 20 patients with vascular dementia (VD), and 20 control subjects for each group. Both patient groups showed considerably more PRs than the control groups. The prevalence of PRs was related to the severity of dementia. No single reflex or combination of PR pathognomonic for dementia could be distinguished. The PR profile of AD and VD patients were similar.</p></abstract><custom-meta-wrap><custom-meta xlink:type="simple"><meta-name>sagemeta-type</meta-name><meta-value>Journal Article</meta-value></custom-meta><custom-meta xlink:type="simple"><meta-name>search-text</meta-name><meta-value> Primitive Reflexes in Alzheimer's Disease and Vascular Dementia Fred W. Vreeling, MD, PhD, Peter J. HOUX, PhD, Jellemer Jolles, PhD, and Frans R.J. Verhey, MD, PhD ABSTRACT Data on the prevalence and clinical value of primitive reflexes (PRs) in dementia are controversial, mainly due to a lack of standardization of the methods by which these signs are elicited and scored. Astandardized protocol was used to investigate eight PRs in 20 patients with Alzheimer's disease (AD), 20 patients with vascular dementia (VD), 20 control subjects for each group. Both patient groups showed considerably more PRs than the control and groups. The prevalence of PRs was related to the severity of dementia. No single reflex or combination of PR pathognomonic for dementia could be distinguished. The PR profile ofAD and VD patients were similar. (JGeriatr Psychiatry Neurol 1995; 8:111-117). Demented patients may exhibit a number of reflexes that are also present in the earliest stages of ontogenetic development. These developmental or primitive reflexes (PRs), also referred to as release signs, are ubiquitously present in fetal life, in the newborn or infant, and gradually disappear with increasing age. They may reappear in senescence and with neurologic disease. There have been claims that various PRs are strongly correlated with dementing conditions such as Alzheimer's or disease (AD), ‘“vascular dementia (VD), 2, 69 dementia in Parkinson's disease.lOJ1 Several authors have argued that (particular) PRs may be indicators of cognitive dysf u n t i o n. 4. or impaired ADL function and dysfuncJ J tional beha i0r.l Diffuse hemispherical damage' J5J6and focal lesions, notably of frontal areas, have also been mentioned in this res ect.’-‘Some author have found a correlation between the prevalence of PRs and cortical atrophy, whereas others have not.21 Recently, PRS were investigated in community-dwellingAD patients versus nondemented controls? Although PRs occurred with increased prevalence in the patients, they occurred too infrequently early in the course ofAD to serve as diagnostic markers. In another study, release signs occurred Received March 29, 1994. Received revised August 3, 1994. Accepted for publication August 12, 1994. From the Departmentof Neurology (Dr. Vreeling), and the Department of Neuropsychology and Psychobiology (Drs. How, Jolles, and Verhey), University of Limburg, Maastricht. The Netherlands. Reprint requests:Dr. F.Y Vreeling, Department of Neurology, University Bospital, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands. in 55% of patients with AD, but they were also present in 9% of control subjectsz2; patients in a late stage ofAD did not show a significantly increased prevalence of PRs compared with subjects in the early stage ofAD. The conclusion was that these signs were neither sufficiently sensitive nor sufficiently specific to serve as a diagnostic marker for AD. Similar findings and conclusions were drawn in two other studiesF3Z4 However, it was recently found that when combined scores were made for various subgroups of reflexes, patients in a late stage ofAD had a significantly increased prevalence of grasp, root, and suck reflexes (the prehensile signs) compared with control subjects and patients in an early stage of AD, who showed more glabellar, snout, and palmomental reflexes (the nociceptive signsX4 Others qu6stion the clinical value of PR, considering the‘(re-)appearance of PRs as merely a sign of physiologic The potential contribution of PRs to the differential diagnosis of dementing conditions is unclear. This is.because PRs are also prevalent among normal elderly people, 2=O in other neurological diseases such as Parkinson's di ease, 3’-‘psychiatric in and in nondemented patients with vascular abnormalities of the brain.7*34 have been reported to predominate in VD PRs with lacunae, especially in the frontal lobes, 6 and in leuco-araiosis.7The clinical value of PRs in distinguishing AD from VD could not be established by Marterer et al.’ 3 They found no significant difference in prevalence of the glabellar tap and the grasp reflexes in patients with AD and multi-infarct dementia (MID). However, straightforward studies in which a “primitive reflex profile” (PRP) ofAD and VD patients have been compared have not be performed up till now. 111 112 Journal of Geriatric Psychiatry and Neurology I Vol. 8, April 1995 Thus, the literature on PRs in dementing condi Psychiatry and Neurology of the University Hospital in tions is often controversial. This seems to be due to het Maastricht, The Netherlands. Twenty patients (12 females; 8 males) with probable Alzheimer's disease and erogeneity of the patient groups, a lack.ofcompatibility 20 patients (12 males; 8 females) with vascular demenbetween the methods used to elicit and score PRs, and the number of PRs studied. tia were studied. None of the patients received medica The present paper investigates the prevalence oftion that could affect the ability to drive (“yellow sticker eight PRs in a group of community-dwellingAD and VD medication”) andfor that could have a possible influence patients. The first aim of the study was to assess the effect on consciousness. of dementia on the prevalence of PRs, independent of the Probable AD was diagnosed according to the effect of aging. Because of the suggested relation between NINCDS-ADRDA guidelines of Mc Khann et aL50 AD was 4 the prevalence of PR and the severity of dementia, 4*ss35s36 patients whose Hachinski ischemic score (HIS)51 cognitive functioningand the stage of dementia were also or more were excluded from t h e m study cohort. AHIS score above 7 was necessary for a diagnosis of VD. Most assessed. It is not yet known if PRs other than the VD patients also had a history of hypertension and eviglabellar or grasp reflexes or a PRP will be useful in distinguishing between AD and VD. A clinical “primitive dence of cerebrovascular disease on CT. Dementia was reflex profile” consisting of 8 PRs has not been studied diagnosed according to the criteria of the DSM-III-R.52 in demented subjects. Recently, in our methodological All patients underwent a thorough neurologic, neustudy on PRs we found that application of a PR protoropsychologic, and psychiatric examination, routine labcol, in which the instructions to the patient and the oratory investigations, and a CT scan of the brain. The examiner, and the way of elicitating and scoring of the followingrating scales were used: the Hamilton Depression Rating Scale (HDRS), 53 Reisberg‘s Global DeterioPRs are standardized, markedly increased inter- and intra-observer reliability. ration Scale (GDS), 54Blessed Dementia Scale (BDS), 55 Hachinski Ischemic Score (HIS)?‘and the Mini-Mental The second aim was to determine the clinical value of these reflexes, by correlating them to parameters State Examination (MMSE).56 Control subjects were matched to individual patients such as age and sex,-seventy of the disease, cognitive functioning, and depression. The third aim was to invesin the AD group and the VD group for age, sex, and level tigate if the PRP could be used to differentiate between of education. They underwent a routine physical and neuAD andVD. rologic examination and a neuropsychologic investiga The reflex battery consisted of three categories of PRS.tion. All control subjects were healthy and normal The first category consisted of reflexes often mentioned accordingto current criteria in gerontological re earch.5 in relation to brain pathology in adults andfor in a brain The characteristics of patients and controls are given in Table 1. VD patients were more demented than AD aging perspective, namely the glabellar palmar gra p,’. l palm0rnenta1, 3. sn0ut, 3** s u k ‘* patients. and ‘A battery of eight primitive reflexes (BPRs) was reflexes. The second category consisted of PRs that are used to examine patients and controls. All reflexes were not ubiquitously used, but which are mentioned in relation to brain pathology, namely the n u c h c e p h a l i c’ semiquantitatively in a two-cipher score for ampliscores and pollicomenta13 46 reflexes. The mouth open, finger tude and persistence, as proposed by other investigators of PR in a d l t s * - children!? This is in accorand in spread reflex (MOFS) is used in child neurology and ‘. may have potential value in the assessment of a d l t s. 4 *dance with the l i t e r a t r e. A.detailed description of The order in which the PRs are listed in 2A and 2B The snout the grading system is published elsewhere.62 is in accordance with the proposals of Franssen et a1 reflex is described in Table 2 as an example. (v.s.). Reflexes no. 1 to 4 are “nociceptive” signs, reflexes RESULTS no. 5 and 6 are “prehensile” signs (the rooting reflex was not examined in this study), and the remaining reflexes, Figure 1 shows the mean number of positive responses, no. 7 and 8, are categorized as “other” reflexes. The first in patient and control groups, for all PRs as well as group is termed nociceptive because each of them shows three reflex subcategories. a facial contraction to a potentially noxious stimulus. The The overall number of PRs in both patient groups was second category is termed prehensile because they seem higher than in the controls. There were more PRs per to represent part of a prehensile syndrome (as described patient in the VD group than in t h e m group, although by de Ajuriaguerra49, eventually evolving into paraplethis difference was not significant. Individual reflexes gia in flexion, described by Y a k o l e v. were detected more often in the VD group than in t h e m group, except for the left grasp (equal) and the nuchoSUBJECTS AND METHODS cephalic reflexes, which occurred slightly more frequently in the AD group. The average number of PRs per subject We studied 40 community-dwelling patients with dementia. was 4.0 f o r m and 5 8 for VD patients, and in their conenrolled at the Maastricht Memory Clinic, a specialized., trol groups, 1.6 and 1 4 respectively. The combined scores health care facility that is part of the Departments of Primitive Reflexes in AD and Vascular Dementia I Vreeling et a1 113 - Table 1. Characteristics of Patients and Controls Alzheimers's disease Patients Controls Vascular dementia Patients Controls Table 2. Example of How Reflexes were Elicited and Scored – 20 20 No. of subjects 73.8 (5.5) 73.6 (5.7) Age: mean (SO) 62–83 64–83 Age: range 3.5 (1.2) Education: mean (SD) 3.2 (1.0) 8M112F 8M/12F Sex 2.4 (1.5) HIS 7.3 (3.5) EDS 4.6 (0.7) GDS 18.0 (4.9) MMSE 7.7 (4.2) HDRS 20 20 73.3 (6.3) 72.9 (5.4) 61–83 60–84 3.9 (1.6) 4.1 (1.4) 12MI8F 12M/8F 9.7 (2.1) 9.4 (4.7) 4.9 (0.7) 12.9 (5.5) 8.3 (4.3) - Snout Reflex Basic position: Subject sits straight; the eyes are closed. Instruction: Keep your mouth loosely closed and close your eyes. I will tap your lips a few times with my hammer. Stimulus: Slight tap on the middle of the lips with a reflex hammer. 0: no response Response: Amplitude 1: phasic protrusion of the lips 2: tonic protrusion of the lips, with or without extension of the reflex response Persistence 0: no response 1: < 4 consecutive responses 2: 2 4 consecutive responses HIS = Hachinski Ischemic score: BDS = Blessed Dementia Scale; GDS = Reisberg's Global Deterioration Scale; MMSE = Mini-Mental State Examination; HDRS = Hamilton Depression Rating Scale. for the nociceptive reflexes were 2 4 for AD and signifi. cantly higher (P c.01) for VD: 4 3 For the control groups,. these values were 0.9 and 1.1, respectively. The combined scores for the prehensile reflexes were 0.5 for AD and 0 6for VD, and significantlyless (0.1 and 0.0, respec.tively) for the controls (P c.05). The PR scores for the remaining reflexes were 1 2 f o r m, and 1.0 for VD, and. 0.6 and 0.3 for the respective control groups (both nonsignificant). The palmar grasp and right nuchocephalic reflexes were not detected in the control groups. In these groups, correlations with age were observed: r =.48 for total PR, r =.46 for nociceptive reflexes in AD controls. For the VD controls these values were r =.46and r =.45, respectively, all significant by t test (P <.05). In the AD and VD patients, these correlations were not significant. Alzheimer's disease In the AD patients, 338, and in the control group, 12% of all reflexes were positive. The difference between AD patients and their control subjects was particularly evident for the pollico- and palmomental reflexes, and to a lesser extent, for the suck, the nuchocephalic, and the MOFS reflexes (see Figure 2A and B). This was in contrast to the findings for the glabellar tap and snout reflexes. The latter reflex was also present in relatively high frequency in the control group. The palmar grasp reflex was rarely found in the AD patients and was not present in the control subjects. There was only a small difference between the persistence of the PRs: in t h e m group, 34% of the PRs persisted, but 25% persisted in the control group. There was no difference in the ampli: tude of the PRs between the patient and control groups: virtually all PR were weak to moderate. MMSE correlated well with age and BDS, as did GDS with BDS. There was, however, no correlation between these measures, the HDS, and the HIS on the one hand, and the -.total PR or one of the subgroups on the other hand. Vascular dementia In the VD patients, 50%, and in the VD control group, 11% of all reflexes were positive. There was a remarkably high prevalence of the pollicomental and the palmomenta1 reflexes. The glabellar tap and the MOFS were also detected quite often in the VD patients. The snout reflex showed a high prevalence in both the patient and the control groups. The nuchocephalic and the palmar grasp reflexes were infrequently elicited, but the suck reflex was present in one of three VD patients; these signs were not found in the control subjects. There was a slight difference in the persistence of the PRs: 57% and 45% of the PRs persisted in the VD and control groups, respectively (see Figure 3A and B). Again, virtually all responses showed a weak-to-moderate amplitude in both groups. GDS correlated with total PR. GDS, BDS, and MMSE correlated with prehensile signs. Nociceptive signs and total PR were strongly correlated; there was also a correlation between nociceptive signs and education. MMSE correlated well with education, BDs, and GDS. However, there was no correlation between HIS and PRs or any of the subgroups. patients Alzheimer' s disease controls patients.ascular dementia controls 0 I 2 3 4 5 6 Figure 1. Average number of primitive reflexes in patients with Alzheimer's disease, vascular dementia, and healthy control sub Jects who were matched for age, education, and sex. 114 Journal of Geriatric Psychiatry and Neurology I Vol. 8, April 1995 Probable Alzheimers and controls (N= 2 times 20) patients GIab Pa1m.L R P0ll.L R Snout Grasp.L R Suck h1OFS.L Vascular dementia and controls (N= 2 times 20) patients Glab I 1 R Nu6.L R L 0 GI& PalmL R P0ll.L R Snout Grasp.L R Suck h' I0FS.L R Nuch.L 10 20 30 40 50 60 70 controls R 0 10 20 30 40 50 60 70 1 80 R Suck h1OFS.L R Nuch.L R 0 Glab Pa1m.L R P0ll.L R Snout Grasp.L Suck h1OFS.L R h' uch.L R 10 90 IWo A 20 30 40 I 50 1 60 70 80 90 1oor/o controls RI I I score 1 score2 0 1 0 score 1 80 90 100% B 20 30. 40 SO I 60 70 80 90 100% Figure 2A, B. Percentage of patients with Alzheimer's disease and matched healthy control subjects showing a primitive reflex. Score 1: not persistent; score 2: persistent. Figure 3A, B. Percentage of patients with vascular dementia and matched healthy control subjects showing a primitive reflex. Score 1: not persistent; score 2: persistent. DISCUSSION There was no indication of a basically different PR profile in the two patient groups, indicating that-at least in this stage of the disease-no reflex or combination of reflexes has a diagnosticvalue for differentiating between the dementing conditions. This is in accordance with the findings of Marterer et al.34 Franssen et a14found significantly higher scores on summary variables that combined the scores of various individual neurologic measures, including PRs, already in nondemented subjects with mild memory impairment (GDS3). The differences that are found in our series between the prevalence of total PRs, nociceptive, and prehensile signs in AD and VD patients and age-matched controls confirm their findings. The higher mean number of PRs and nociceptive signs in the VD compared to AD patients may be ascribed, in the first place, to the higher degree of dementia in the VD patients. Our findings are similar to those of Ishi et a1, 6 Steigart e t al' and Tweedy et al.63 I n the review by Jenkyn and Reeves,- several papers are mentioned in which PRs were found in diffuse cerebral dysfunction. Whether or not vascular etiology was prominent in these patient groups is not known. A clear difference was observed for the prevalence of the prehensile reflexes between patients (AD and VD)and control subjects. The prehensile reflexes showed a relationship with CDS, BDS, and MMSE in the VD group, with the prevalence increasing with increasing severity of the disease. Franssen4 found that the nociceptive signs were more prevalent in the early stages of dementia, whereas the prevalence of prehensile signs. increased sharply in GDS stages 6 and 7 Galasko et a15 found the grasp and Bakchine et allothe grasp, suck, and snout reflexes associated with the degree of cognitive impairment in AD. No such relation was found for the palmomental and glabellar tap reflexes. Finally, Molloy et all4found no difference in the age or duration of AD in patients with and without PRs, nor was there any difference in cognitive function as measured with the MMSE, ADL, and IADL (Instrumental Abilities of Daily Living). Despite this, patients with PRs showed a greater degree of functional limitation and dysfunctional Primitive Reflexes in AD and Vascular Dementia / Vreeling et a1 115 behavior. Molloy suggestedthat the prevalence of PR could represent a clinical marker for a subgroup ofAD patients with more severe impairment in ADL function. In the present study with community-dwellingpatients, only 2 of the 20 AD patients and 5 of the 20 VD patients were in stage 6. The numbers are small, so no definite conclusion can be drawn. However, our results support the strong indications that PR and cognitive deterioration are correlated. The data cast doubt on earlier suggestions that particular PRs might be of clinical value as indicators of the cerebral area i n v o l e d.PR. should be profiles applied to patients with well-circumscribed focal brain lesions. As far as the individual reflexes, the glabellar blink was present in 21% of the AD patients and in 60% of the VD patients. Pearce68reported that 72% of demented patients showed the reflex, whereas K01ler found that 23% ofAD patients and 8% of controls did. Other studies indicate that the glabellar blink reflex is among the most prominent release i g n s. Occasionally, we. observed it in normal subjects with GDS stages 1 or 2; it was more prominent in GDS stages 3 to 6.4 The available evidence suggests that the glabellar blink is a release sign that develops quite early. Similar conclusions apply to two other nociceptive reflexes: the palmomental and the pollicomental reflex. The palmomental reflex is one of the first PRs to develop in adult life, according to A j r i a g u e r r a Delwaide and. Dijeux70confirmed this in a longitudinal study on AD patients. Various papers have shown that the palmomental reflex, as well as the pollicomental which has been studied only infrequently, occurs with moderate frequency in nondemented elderly people and in the earlier stages of AD.4J4, 22 Basavaraju et all6 found that only the palmomental and grasp reflexes could discriminate between demented and other neurologic patients. Recently, in a group comparison study on ageassociated memory impairment (Vreeling et al, submitted for publication) it was shown that these two reflexes were present significantly more often in the patient group than in age-matched, healthy control subjects. Reis7Idemonstrated that the palmomental reflex is present basically in all normal individuals, but the presence of a clinically evident reflex suggests a diminution of the cerebral inhibition on lower centers. Mc Donald72 found that variability in the palmomental reflex is related to the state of emotionality or anxiety of the subject. More studies are required to assess the relevance of these two reflexes in the elderly. The snout reflex was found in 58% and 85% in AD patients and VD patients, respectively. However, almost half of the control subjects also showed this sign. “weedy6” found a relationship between the snout reflex and cognitive decline. Accordingto Koller, ‘“the snout reflex occurred with equal frequencyin AD patients and in age-matched he nondemented control subjects (54%); also found that the snout was directly correlated with increasing age. Gossman and Jacobd3reported similarfindings for Parkinson's patients and normal subjects. Hildenhagen30showed that the snout reflex can be detected in up to 70% of subjects older than 80 years of age. Thus, the snout reflex, because of its sensitivity to the aging process per se, is not a good predictor of brain pathology. The grasp reflex seemed to be highly specific f o r m and VD in our patient series, since none of the controls showed the reflex. However, the sensitivity was extremely found the sign low: 10 and 15%, respectively. Tweedy63 in 17% ofAD and in 14% of VD patients, and it was correlated with the cognitive score. F O r t l ‘and H u F 2 found an increasing percentage of grasp reflexes (up to 34%)with increasing dementia. Girlingll observed the reflex in 8 of 24 demented 80-year-old people, and Bakchine, 1 who studied AD patients, correlated the reflex to a lower MMSE score. The conclusion is that if a grasp reflex is present and persistent, a hemispherical (frontal?) lesion is probable. The suck reflex was found in one of three patients and in only two control subjects. As with the grasp reflex, Bakchine' O found it correlated with the cognitive decline; however, both reflexes were rarely present (7.7% for the suck and 5.5% for the grasp reflex). Richard75 found this sign to be common in the second of three stages ofAD. Again, if present it may indicate diffuse cerebral (frontal?) damage. The rooting reflex, which was not examined in this study, is of interest in that other prehensile reflexes such as the suck and the grasp reflexes are detected, especially in more severely demented people: The PRs may develop in a particular order, with the rooting reflex developing after the suck and grasp reflexes. This interpretation is in line with the “retrogenesis” theory of de Ajuriaguerra and Hughlings Jackson (see above), and with the findings reported by Delwaide and Dijeux70in a longitudinal study of 104 patients with Alzheimer's disease. We plan to study the rooting reflex in future investigations. Until now, the MOFS has been investigated almost exclusively in h i l d r e n., The prevalence in AD patients was about 40% and in VD patients even higher: 40% on the right side and 60% on the left side. These figures were about 20% for controls. As the pathogenesis and significance of the MOFS reflex are not yet clear, the high prevalence in the various groups motivates further research. The nuchocephalic reflex was elicited in over 20% of our patients and in 4% of the controls. J e n k y n’ found this sign only rarely disinhibited in normal adults, its presence increasing with age, and in patients with parkinsonism and cognitive impairment. It may serve as a nonspecific sign of diffuse hemispherical disease. None of the eight reflexes tested has relevance as a possible pathognomonic sign of the disease. Instead, the data indicate that it is important to use combined scores, in which subgroups of PRs are formed to increase 116 Journal of Geriatric Psychiatry and Neurology I Vol. 8, April 1995 the sensitivity of the measurement. This yields relevant data, even in the earlier stages of Alzheimer's and vascular dementia. A standardized PR protocol is essential in this respect. PRs, measured in a systematic way, may increase our insight into subtle brain dysfunctions that develop in adulthood and senescence. Future application. PRs can be elicited throughout the course of AD and other dementias, including the end stage, when cognitive testing results in uniform low bottom scores. The change in type of PRs elicited during the early and late stages ofAD might make PRs useful as independent markers of disease progression and as indicators of potential therapy.'8 PRs could also be used in clinical practice and research to identify possible subgroups of AD, as was suggested by Molloy14and Nea y; because reliable categorization of AD patients in subgroups is currently only possible by histologic examination; simple clinical tests such as PRs could be helpful in this respect. However, Hamenso found no difference in the prevalence of three PRs between two subgroups of AD patients with and without Lewy bodies. Finally, PRs might be useful in the differentiation ofAD versus other dementing conditions such as depression. References 1. Jenkyn LR, Reeves AG, Warren T et al. Neurologic signs in, senescence. Arch Neurol 1985; 42:1154-1157. , 2. Tavy DLJ, van Woerkom TCAhI, hlorr6 HHE, Slaets JPJ. Alteration of the visual blink reflex in patients with dementia. J Neurol Neurosurg Psychiatry 1985; 48:718. Letter. 3. Constantinidis J, Richard J. Alzheimer's disease. In: Vinken PJ, Bruyn GW, Klawans HL, eds. Handbook ofclinical neurology. Vol 2(46). Neurobehavioural disorders. Amsterdam: Elsevier, 1985:247-282. 4. Franssen EH, Reisberg B, Kluger A, et al. Cognition-independent neurologic symptoms in normal a n d probable Alzheimer's disease. Arch Neurol 1991; 48:148-154. J 5. Galasko D, Kwo-on-Yuen PF, Klauber hfR, Thal L. Neurological findings in Alzheimer's disease and normal aging. Arch Neurol 1990; 47:625-627., 6. Ishi N, Nishihara Y Imamura T. Why do frontal lobe symptoms predominate in vascular dementia with lacunas?Neurology 1986; 36:340-345. 7. Steigart A, Hachinski VC, Lau C, et al. Cognitive and neurologic findings in subjects with diffuse white matter h e n cies on computed tomographic scan (leuko-araiosis). Arch Neurol 1987; 44:32-35. 8. Junqu6 C, Pujol J, Vendrell P, et al. Leuko-araiosis on magnetic resonance imaging and speed of mental processing. Arch Neurol1990; 47151–156. 9. Loeb C, Gandolfo C, Croce R, Conti hl. Dementia associated with lacunar infarction. Stroke 1992; 23:1225-1229. 10. Bakchine S, Lacomblez L, Pallison E, et al. Relationship between primitive reflexes, extrapyramidal signs, reflective apraxia and seventy of cognitive impairment on dementia of the Alzheimer type. Acta Neurol Scand 1989; 79:3846. 11. Girling Dhl, Berrios GE. Extrapyramidal signs, primitive reflexes and frontal lobe function in senile dementia of the Alzheimer type. Br J Psychiatry 1990; 157:888-893. 12. Glatt SL, Wilson RS, Koller WC, Fox JH. Cortical disinhibitory signs. Neurology 1983; 33:1391-1393. 13. hlarterer A, Fischer P, hliiller F, et al. Neurological signs and cognitive decline in the elderly. New Rends Clin Neuropharmacol 1988; 2:277-282. 14. hlolloy DW, Clarnette RhI, h IcIllroy WE, et al. Clinical significance of primitive reflexes in Alzheimer's disease. J Am 1991; 39:1160-1163. Geriatr SOC 15. Paulson GW. The neurological examination in dementia. In: Wells CE, ed. Dementia. Philadelphia: F.A. Davis Company, 1977:169-188. 16. Basavaraju NG, Silverstone FA, Libow LS, Paraskevas K. Primitive reflexes and perceptual sensory tests in the elderlytheir usefulness in dementia. J Chron Dis 1981; 334:367-377. 17. De Renzi E, Barbieri C. The incidence of the grasp reflex following hemispheric lesion and its relation to frontal damage, Brain 1992; 115:293-313. 18. Tiggelen CJhl van. The Bracha reflexes. Neurological indicators of localisation of brain damage. Implications for diagnosis and therapy of organic mental disorders. Acta Gerontologica 1983; 13:195-200. 19. Kobayashi S, Yamaguchi S, Okada K, Yamashita K. Primitive reflexes and hlRI findings, cerebral blood flow in normal elderly. Gerontology 1990; 36199–205. 20. Koller WC, Glatt S, Wilson RS, Fox JH. Primitive reflexes and cognitive function in the elderly. Ann Neumll982; 12:302304. 21. hloylan J J, Saldias CH. Developmental reflexes and cortical atrophy. Ann Neuroll979; 5:499-500. 22. Huff FJ, Boller F, Luchelli F, et al. The neurologic examination in patients with probable Alzheimer's disease. Arch Neurol 1987; 44 929–932. 23. Eastwood hlR, Lautenschlager L, Corbin S. A comparison of clinical methods for assessing dementia. J Am Geriatr Soc 1983; 31 342347. 24. Seltzer B, Shenvin I. A comparison of clinical features in early- and late-onset primary degenerative dementia. Arch Neurol 1983; 40343–146. 25. Landau %. ! Reflex dementia: disinhibited primitive thinking. I Neurology 1989; 39:133-137. 26. Crevel van H. Clinical approach to dementia. Prog Bmin Res 1986; 70:3-13. 27. Koller WC. Primitive reflexes in the evaluation of the aging patient. Clin Gerontologist 1984; 3:19-22. 28. Jacobs L, Grossmann MD. Three primitive reflexes in normal adults. Neurology 1980; 30:184-188. 29. Critchley hl. Neurologic changes in the aged. JChron Dis 1956; 3:459477. 30. Hildenhagen 0, Schiffer R. Neurologische Befunde (insbesondere “Entwicklungsreflexe”) bei uber 75 jahrigen Altenheimbewohnern. J Neuroll976; 213:133-142. 31. Huber SJ, Paulson GW. Relationship between primitive reflexes and severity in Parkinson's disease. J Neurol Neurosurg Psychiatry 1986; 49:1298-1300. 32. Gossmann hID, Jacobs L. Three primitive reflexes in parkinsonism patients. Neurology 1980; 30:189-192. 33. Keshavan his, Vikram Kumar K, Channabasavanna SBl. Primitive reflexes in psychiatry. Lancet 1987; 30:1264. 34. Botvin JG, Keith RA, Johnston hN. Relationship between primitive reflexes in stroke patients and rehabilitation outcome. Stroke 1978; 9:256-258. 35. Huff FJ, Growdon JH. Neurological abnormalities associated with seventy of dementia in Alzheimer's disease. Can JNeurol Sci 1986; 13:403-405. 36. Sinisi L, De Michele G, hfansi D, et al. Relationship of neurological and physiologicalsigns to physical and metabolic risk factors in elderly persons living in retirement facilities: a multidisciplinary approach. Funct Neuroll989; 4:277-282. Primitive Reflexes in AD and Vascular Dementia I Vreeling et a1 117 37. Vreeling FWV, Jolles J, Verhey FRJ, Houx PJ. Primitive reflexes in healthy, adult volunteers and neurological patients: methodological issues. J Neurol 1993; 290:495-504. 38. Iriarte Lhl, Chacon J, hladrazo J, et al. Blink reflex in dyskinetic and nondyskinetic patients with Parkinson's disease. Eur Neurol 1989; 29:67-70. 39. Klawans HL, Paulson GW. Primitive reflexes in parkinsonism. Confin Neuroll971; 33:25-32. 40. Boelhouwer AJK. Investigations on blink reflexes in humans. Thesis. University Tilburg, the Netherlands, 1984. 41. Gelmers HJ. Non-paralytic motor disturbances and speech disorders: the role of the supplementary motor area. J Neurol Neurosurg Psychiatry 1983; 46:1052-1054. 42. hlarti-Vilalta JL, Graus F. The palmomental reflex. Eur Neurol 1984; 23:12-16. 43. Cutler NR, Haxby JV, Duara R, et al. Clinical history, brain metabolism, and neuropsychological function in Alzheimer's disease. A n n Neurol 1985; 18:29& 309. 44. Ajuriaguerra J de, Rego A, Tissot R. Le rkflexe oral et quelques activitids orales dans les syndromes ddmentiels d u grand ige. Enckphale 1963: 52; 189–219. 45. Jenkyn LR, Walsh DB, Walsh BT. The nuchocephalic reflex. J Neurol Neurosurg Psychiatry 1975; 38:561-566. 46. Brakha S. The clinical value of the pollico-mental reflex in neuropathology. J Nerve Ment D s 1958; 127:91-94. i 47. Capute AJ, Palmer FB, Shapiro BK, et al. Primitive reflex profile: a quantitation of primitive reflexes in infancy. Dev hfed Child Neurol 1984; 26:375-383. 48. Alberts hl. ijber das “hlundoffnungs-Fingerspreiz-Phanomen.” Neruenartz 1955; 26:228-232. 49. Yakovlev P Paraplegia in flexion of cerebral origin. J Neuro. pathol Exp Neurol 1954; 13:267-296. 50. hlc Khann G, Drachman D, Folstein hl, et al. Clinical diagnosis of Alzheimer's disease. Neurology 1984; 34:939-945. 51. Hachinski VC, Iliff LD, Zilkha E, et al. Cerebral blood flow in dementia. Arch Neurol 1975; 32:632-637. 52. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 3rd Ed. Rev. Washington, DC: AF' A Press, 1987230–233. 53. Hamilton hl. Development of a rating scale for primary depressive illness. Br J Soc Clin Psycho1 1967; 6:278-296. 54. Reisberg B. Clinical presentation, diagnosis and symptomatology of age-associated cognitive decline and Alzheimer's disease. In: Reisberg B, ed. Alzheimer's disease. New York: The Free Press, 1983:173-183. 55. Blessed G, Tomlinson BE, Roth hf. The association between quantitative measures of dementia and of senile change in the cerebral gray matter of elderly subjects. Br JPsychiatry 1968; 114:797-811. 56. Folstein hlF, Folstein SE, Blc Hugh PR. hlini-hlental State: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12:189-198. 57. H o w PJ, Vreeling FW, Jolles J. Rigomus health screening reduces age effect on memory scanning task. Brain Cognition 1991; 15246–260. 58. Gimenez-Roldan S, Esteban A, Abad YJhl. Reflejo palmomentoniano en enfermedad de Parkinson. Arch Neurobiol IMadr) 1976; 39, 4:233-248. 59. Dalby hfA. The diagnostic value of the palmo-mental reflex. Acta Neurol Scand 1970; 46:601-608. 60. hlaertens de Noordhout A, Delwaide PJ. The palmornental reflex in Parkinson's disease. Arch Neuroll988; 45 425427. 61. Sunohara N, Tomi H, Satoyoshi E, Tachibana S. Glabella tap sign. Is it due to a lack of R2-habituation? J Neurol S i 1985; c 70 257–267. 62. Vreeling FW, Verhey FRJ, Jolles J. Protocol on the examination of primitive reflexes: basic position, instructions elicitation, response and scoring. Protocol 87–0126. State University of Limburg. Neuropsychology & Psychobiology Projeckl-7. 63. Tweedy J, Reding hl, Garcia C, et al. Significance of cortical disinhibition signs. Neurology 1982; 32:169-173. 64. Jenkyn LR, Reeves AG. Signs of cortical disinhibition in neuropsychiatric disorders. Psychiatr nled 1984; 1:389-405. 65. Brakha S. Le M e x e profond de I' orbiculaire oral (le phknomhne de la bouche d' Escherich) signe pr Bcoce et pathognomique des troubles f r o n t a u 21 predominance ant Cro-m6dio-basale. Rev Neuroll968; 124:386-390. 66. Pfeiffer J. Zum lokalisatorischen Wert pathologischer Greifphanomene. Archiu fur Psychiatrie und Zeitschrift f u r die Gesamute Neurologie 1964; 206:406-418. 67. Lohr JB. Transient grasp reflexes in schizophrenia. Biol Psych 1985; 20:172-175. 68. Pearce J. Mental changes in parkinsonism. J Neurol Neurosurg Psychiatry 1968; 31501–508. 69. Ferguson IT. Habituation of the orbicularis oculi reflex in dementia and dyskinetic states. J Neurol Neurosurg Psychiatry 1978; 41:824-828. 70. Delwaide PJ, Dijeux L. RBflexes nkonataux et dykinesies bucco-linguo-faciales dans la dkmence s6nile. Z' Actualitk en Gkrontologie 1980; 6126–133. 71. Reis DJ. The palmomental reflex. Arch Neuroll961; 4:486498. 72. Rlc Donald JK, Kelley JJ, Brock LD, Bartunek EJ. Variability of t h e palmomental reflex. J Nerv Ment Dis 1963; 136207–215. 73. Gossman RID, Jacobs L. Three primitive reflexes in parkinsonism patients. Neurology 1980; 30:189-192. 74. Forstl H, Burns A, Levy R, e t al. Neurologic signs in Alzheimer's disease. Arch Neuroll992; 49:1038-1042. 75. Richard J, Constantinidis J, Bouras C. Symptomatologie clinique. In: Richard J, Constantinidis J, Bouras C, eds. La maladie d' Alzheimer. Pan: PUF, 1988:34. 76. Gott Th. Eine wenig bekannte hlitbew& gung und ihr Sinn. 2 Neurol 1921; 66:93-96. 77. Touwen BLC, Prechtl HFR. The neurological examination of the child with minor nervous dysfunction. In: Touwen BCL, ed. Spastics international medical publication. London: Heinemann, 1970:41-42. 78. Kaye J. Neurochemical aspects of motor impairment. Ann Intern Med 1988; 109:298-311. 79. Neary D, Snowden JS, Northen B, Goulding P Dementia of. frontal lobe type. J Neurol Neurosurg Psychiatry 1988; 51: 353–361. 80. Hansen L, Salmon D, Galasko D, et al. The Lewy body varia n t of Alzheimer's disease: a clinical and pathological entity. Neurology 1990; 4O:l-8. </meta-value></custom-meta></custom-meta-wrap></article-meta></front><back><ref-list><ref><citation citation-type="journal" xlink:type="simple">1. <name name-style="western"><surname>Jenkyn LR</surname></name>, <name name-style="western"><surname>Reeves AG</surname></name>, <name name-style="western"><surname>Warren T</surname></name>, et al. <article-title>Neurologic signs in senescence</article-title>. <source>Arch Neurol</source><year>1985</year>; <volume>42</volume>:<fpage>1154</fpage>–<lpage>1157</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple">2. <name name-style="western"><surname>Tavy DLJ</surname></name>, <name name-style="western"><surname>van Woerkom TCAM</surname></name>, <name name-style="western"><surname>Morré HHE</surname></name>, <name name-style="western"><surname>Slaets JPJ</surname></name>. <article-title>Alteration of the visual blink reflex in patients with dementia</article-title>. <source>J Neurol Neurosurg Psychiatry</source><year>1985</year>; <volume>48</volume>:<fpage>718</fpage>. Letter.</citation></ref><ref><citation citation-type="book" xlink:type="simple">3. <name name-style="western"><surname>Constantinidis J</surname></name>, <name name-style="western"><surname>Richard J.</surname></name><article-title>Alzheimer's disease</article-title>. In: <name name-style="western"><surname>Vinken PJ</surname></name>, <name name-style="western"><surname>Bruyn GW</surname></name>, <name name-style="western"><surname>Klawans HL</surname></name>, Eds. <source>Handbook of clinical neurology. Vol 2(46). Neurobehavioural disorders</source>. <publisher-loc>Amsterdam</publisher-loc>: <publisher-name>Elsevier</publisher-name>, <year>1985</year>:<fpage>247</fpage>–<lpage>282</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple">4. <name name-style="western"><surname>Franssen EH</surname></name>, <name name-style="western"><surname>Reisberg B</surname></name>, <name name-style="western"><surname>Kluger A</surname></name>, et al. <article-title>Cognition-independent neurologic symptoms in normal and probable Alzheimer's disease</article-title>. <source>Arch Neurol</source><year>1991</year>; <volume>48</volume>:<fpage>148</fpage>–<lpage>154</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple">5. <name name-style="western"><surname>Galasko D</surname></name>, <name name-style="western"><surname>Kwo-on-Yuen PF</surname></name>, <name name-style="western"><surname>Klauber MR</surname></name>, <name name-style="western"><surname>Thal LJ</surname></name>. <article-title>Neurological findings in Alzheimer's disease and normal aging</article-title>. <source>Arch Neurol</source><year>1990</year>; <volume>47</volume>:<fpage>625</fpage>–<lpage>627</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple">6. <name name-style="western"><surname>Ishi N</surname></name>, <name name-style="western"><surname>Nishihara Y</surname></name>, <name name-style="western"><surname>Imamura T.</surname></name><article-title>Why do frontal lobe symptoms predominate in vascular dementia with lacunas?</article-title><source>Neurology</source><year>1986</year>; <volume>36</volume>:<fpage>340</fpage>–<lpage>345</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple">7. <name name-style="western"><surname>Steigart A</surname></name>, <name name-style="western"><surname>Hachinski VC</surname></name>, <name name-style="western"><surname>Lau C</surname></name>, et al. <article-title>Cognitive and neurologic findings in subjects with diffuse white matter lucencies on computed tomographic scan (leuko-araiosis)</article-title>. <source>Arch Neurol</source><year>1987</year>; <volume>44</volume>:<fpage>32</fpage>–<lpage>35</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple">8. <name name-style="western"><surname>Junqué C</surname></name>, <name name-style="western"><surname>Pujol J</surname></name>, <name name-style="western"><surname>Vendrell P</surname></name>, et al. <article-title>Leuko-araiosis on magnetic resonance imaging and speed of mental processing</article-title>. <source>Arch Neurol</source><year>1990</year>; <volume>47</volume>:<fpage>151</fpage>–<lpage>156</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple">9. <name name-style="western"><surname>Loeb C</surname></name>, <name name-style="western"><surname>Gandolfo C</surname></name>, <name name-style="western"><surname>Croce R</surname></name>, <name name-style="western"><surname>Conti M.</surname></name><article-title>Dementia associated with lacunar infarction</article-title>. <source>Stroke</source><year>1992</year>; <volume>23</volume>:<fpage>1225</fpage>–<lpage>1229</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple">10. <name name-style="western"><surname>Bakchine S</surname></name>, <name name-style="western"><surname>Lacomblez L</surname></name>, <name name-style="western"><surname>Pallison E</surname></name>, et al. <article-title>Relationship between primitive reflexes, extrapyramidal signs, reflective apraxia and severity of cognitive impairment on dementia of the Alzheimer type</article-title>. <source>Acta Neurol Scand</source><year>1989</year>; <volume>79</volume>:<fpage>38</fpage>–<lpage>16</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple">11. <name name-style="western"><surname>Girling DM</surname></name>, <name name-style="western"><surname>Berrios GE</surname></name>. <article-title>Extrapyramidal signs, primitive reflexes and frontal lobe function in senile dementia of the Alzheimer type</article-title>. <source>Br J Psychiatry</source><year>1990</year>; <volume>157</volume>:<fpage>888</fpage>–<lpage>893</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple">12. <name name-style="western"><surname>Glatt SL</surname></name>, <name name-style="western"><surname>Wilson RS</surname></name>, <name name-style="western"><surname>Roller WC</surname></name>, <name name-style="western"><surname>Fox JH</surname></name>. <article-title>Cortical disinhibitory signs</article-title>. <source>Neurology</source><year>1983</year>; <volume>33</volume>:<fpage>1391</fpage>–<lpage>1393</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple">13. <name name-style="western"><surname>Marterer A</surname></name>, <name name-style="western"><surname>Fischer P</surname></name>, <name name-style="western"><surname>Müller F</surname></name>, et al. <article-title>Neurological signs and cognitive decline in the elderly</article-title>. <source>New Trends Clin Neuropharmacol</source><year>1988</year>; <volume>2</volume>:<fpage>277</fpage>–<lpage>282</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple">14. <name name-style="western"><surname>Molloy DW</surname></name>, <name name-style="western"><surname>Clarnette RM</surname></name>, <name name-style="western"><surname>McIllroy WE</surname></name>, et al. <article-title>Clinical significance of primitive reflexes in Alzheimer's disease</article-title>. <source>J Am Geriatr Soc</source><year>1991</year>; <volume>39</volume>:<fpage>1160</fpage>–<lpage>1163</lpage>.</citation></ref><ref><citation citation-type="book" xlink:type="simple">15. <name name-style="western"><surname>Paulson GW</surname></name>. <article-title>The neurological examination in dementia</article-title>. In: <name name-style="western"><surname>Wells CE</surname></name>, Ed. <source>Dementia</source>. <publisher-loc>Philadelphia</publisher-loc>: <publisher-name>F.A. Davis Company</publisher-name>, <year>1977</year>:<fpage>169</fpage>–<lpage>188</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple">16. <name name-style="western"><surname>Basavaraju NG</surname></name>, <name name-style="western"><surname>Silverstone FA</surname></name>, <name name-style="western"><surname>Libow LS</surname></name>, <name name-style="western"><surname>Paraskevas K.</surname></name><article-title>Primitive reflexes and perceptual sensory tests in the elderly— their usefulness in dementia</article-title>. <source>J Chron Dis</source><year>1981</year>; <volume>334</volume>:<fpage>367</fpage>–<lpage>377</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple">17. <name name-style="western"><surname>De Renzi E</surname></name>, <name name-style="western"><surname>Barbieri C.</surname></name><article-title>The incidence of the grasp reflex following hemispheric lesion and its relation to frontal damage</article-title>. <source>Brain</source><year>1992</year>; <volume>115</volume>:<fpage>293</fpage>–<lpage>313</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple">18. <name name-style="western"><surname>Tiggelen CJM van</surname></name><article-title>The Bracha reflexes. Neurological indicators of localisation of brain damage. Implications for diagnosis and therapy of organic mental disorders</article-title>. <source>Acta Gerontologica</source><year>1983</year>; <volume>13</volume>:<fpage>195</fpage>–<lpage>200</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple">19. <name name-style="western"><surname>Kobayashi S</surname></name>, <name name-style="western"><surname>Yamaguchi S</surname></name>, <name name-style="western"><surname>Okada K</surname></name>, <name name-style="western"><surname>Yamashita K.</surname></name><article-title>Primitive reflexes and MRI findings, cerebral blood flow in normal elderly</article-title>. <source>Gerontology</source><year>1990</year>; <volume>36</volume>:<fpage>199</fpage>–<lpage>205</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple">20. <name name-style="western"><surname>Koller WC</surname></name>, <name name-style="western"><surname>Glatt S</surname></name>, <name name-style="western"><surname>Wilson RS</surname></name>, <name name-style="western"><surname>Fox JH</surname></name>. <article-title>Primitive reflexes and cognitive function in the elderly</article-title>. <source>Ann Neurol</source><year>1982</year>; <volume>12</volume>:<fpage>302</fpage>–<lpage>304</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple">21. <name name-style="western"><surname>Moylan JJ</surname></name>, <name name-style="western"><surname>Saldias CH</surname></name>. <article-title>Developmental reflexes and cortical atrophy</article-title>. <source>Ann Neurol</source><year>1979</year>; <volume>5</volume>:<fpage>499</fpage>–<lpage>500</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple">22. <name name-style="western"><surname>Huff FJ</surname></name>, <name name-style="western"><surname>Boller F</surname></name>, <name name-style="western"><surname>Luchelli F</surname></name>, et al. <article-title>The neurologic examination in patients with probable Alzheimer's disease</article-title>. <source>Arch Neurol</source><year>1987</year>; <volume>44</volume>:<fpage>929</fpage>–<lpage>932</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple">23. <name name-style="western"><surname>Eastwood MR</surname></name>, <name name-style="western"><surname>Lautenschläger L</surname></name>, <name name-style="western"><surname>Corbin S.</surname></name><article-title>A comparison of clinical methods for assessing dementia</article-title>. <source>J Am Geriatr Soc</source><year>1983</year>; <volume>31</volume>:<fpage>342</fpage>–<lpage>347</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple">24. <name name-style="western"><surname>Seltzer B</surname></name>, <name name-style="western"><surname>Sherwin I.</surname></name><article-title>A comparison of clinical features in early- and late-onset primary degenerative dementia</article-title>. <source>Arch Neurol</source><year>1983</year>; <volume>40</volume>:<fpage>143</fpage>–<lpage>146</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple">25. <name name-style="western"><surname>Landau WM</surname></name>. <article-title>Roflex dementia: disinhibited primitive thinking</article-title>. <source>Neurology</source><year>1989</year>; <volume>39</volume>:<fpage>133</fpage>–<lpage>137</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple">26. <name name-style="western"><surname>Crevel van H</surname></name><article-title>Clinical approach to dementia</article-title>. <source>Prog Brain Res</source><year>1986</year>; <volume>70</volume>:<fpage>3</fpage>–<lpage>13</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple">27. <name name-style="western"><surname>Koller WC</surname></name>. <article-title>Primitive reflexes in the evaluation of the aging patient</article-title>. <source>Clin Gerontologist</source><year>1984</year>; <volume>3</volume>:<fpage>19</fpage>–<lpage>22</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple">28. <name name-style="western"><surname>Jacobs L</surname></name>, <name name-style="western"><surname>Grossmann MD</surname></name>. <article-title>Three primitive reflexes in normal adults</article-title>. <source>Neurology</source><year>1980</year>; <volume>30</volume>:<fpage>184</fpage>–<lpage>188</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple">29. <name name-style="western"><surname>Critchley M.</surname></name><article-title>Neurologic changes in the aged</article-title>. <source>J Chron Dis</source><year>1956</year>; <volume>3</volume>:<fpage>459</fpage>–<lpage>477</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple">30. <name name-style="western"><surname>Hildenhagen O</surname></name>, <name name-style="western"><surname>Schiffer R.</surname></name><article-title>Neurologische Befunde (insbesondere “Entwicklungsreflexe”) bei über 75 jährigen Altenheimbewohnern</article-title>. <source>J Neurol</source><year>1976</year>; <volume>213</volume>:<fpage>133</fpage>–<lpage>142</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple">31. <name name-style="western"><surname>Huber SJ</surname></name>, <name name-style="western"><surname>Paulson GW</surname></name>. <article-title>Relationship between primitive reflexes and severity in Parkinson's disease</article-title>. <source>J Neurol Neurosurg Psychiatry</source><year>1986</year>; <volume>49</volume>:<fpage>1298</fpage>–<lpage>1300</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple">32. <name name-style="western"><surname>Gossmann MD</surname></name>, <name name-style="western"><surname>Jacobs L.</surname></name><article-title>Three primitive reflexes in parkinsonism patients</article-title>. <source>Neurology</source><year>1980</year>; <volume>30</volume>:<fpage>189</fpage>–<lpage>192</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple">33. <name name-style="western"><surname>Keshavan MS</surname></name>, <name name-style="western"><surname>Vikram Kumar Y</surname></name>, <name name-style="western"><surname>Channabasavanna SM</surname></name>. <article-title>Primitive reflexes in psychiatry</article-title>. <source>Lancet</source><year>1987</year>; <volume>30</volume>:<fpage>1264</fpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple">34. <name name-style="western"><surname>Botvin JG</surname></name>, <name name-style="western"><surname>Keith RA</surname></name>, <name name-style="western"><surname>Johnston MV</surname></name>. <article-title>Relationship between primitive reflexes in stroke patients and rehabilitation outcome</article-title>. <source>Stroke</source><year>1978</year>; <volume>9</volume>:<fpage>256</fpage>–<lpage>258</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple">35. <name name-style="western"><surname>Huff FJ</surname></name>, <name name-style="western"><surname>Growdon JH</surname></name>. <article-title>Neurological abnormalities associated with severity of dementia in Alzheimer's disease</article-title>. <source>Can J Neurol Sci</source><year>1986</year>; <volume>13</volume>:<fpage>403</fpage>–<lpage>405</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple">36. <name name-style="western"><surname>Sinisi L</surname></name>, <name name-style="western"><surname>De Michele G</surname></name>, <name name-style="western"><surname>Mansi D</surname></name>, et al. <article-title>Relationship of neurological and physiological signs to physical and metabolic risk factors in elderly persons living in retirement facilities: a multidisciplinary approach</article-title>. <source>Funct Neurol</source><year>1989</year>; <volume>4</volume>:<fpage>277</fpage>–<lpage>282</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple">37. <name name-style="western"><surname>Vreeling FW</surname></name>, <name name-style="western"><surname>Jolles J</surname></name>, <name name-style="western"><surname>Verhey FRJ</surname></name>, <name name-style="western"><surname>Houx PJ</surname></name>. <article-title>Primitive reflexes in healthy, adult volunteers and neurological patients: methodological issues</article-title>. <source>J Neurol</source><year>1993</year>; <volume>290</volume>:<fpage>495</fpage>–<lpage>504</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple">38. <name name-style="western"><surname>Iriarte LM</surname></name>, <name name-style="western"><surname>Chacon J</surname></name>, <name name-style="western"><surname>Madrazo J</surname></name>, et al. <article-title>Blink reflex in dyskinetic and nondyskinetic patients with Parkinson's disease</article-title>. <source>Eur Neurol</source><year>1989</year>; <volume>29</volume>:<fpage>67</fpage>–<lpage>70</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple">39. <name name-style="western"><surname>Klawans HL</surname></name>, <name name-style="western"><surname>Paulson GW</surname></name>. <article-title>Primitive reflexes in parkinsonism</article-title>. <source>Confin Neurol</source><year>1971</year>; <volume>33</volume>:<fpage>25</fpage>–<lpage>32</lpage>.</citation></ref><ref><citation citation-type="other" xlink:type="simple">40. Boelhouwer AJK. Investigations on blink reflexes in humans. Thesis. University Tilburg, the Netherlands, 1984.</citation></ref><ref><citation citation-type="journal" xlink:type="simple">41. <name name-style="western"><surname>Gelmers HJ</surname></name>. <article-title>Non-paralytic motor disturbances and speech disorders: the role of the supplementary motor area</article-title>. <source>J Neurol Neurosurg Psychiatry</source><year>1983</year>; <volume>46</volume>:<fpage>1052</fpage>–<lpage>1054</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple">42. <name name-style="western"><surname>Marti-Vilalta JL</surname></name>, <name name-style="western"><surname>Graus F.</surname></name><article-title>The palmomental reflex</article-title>. <source>Eur Neurol</source><year>1984</year>; <volume>23</volume>:<fpage>12</fpage>–<lpage>16</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple">43. <name name-style="western"><surname>Cutler NR</surname></name>, <name name-style="western"><surname>Haxby JV</surname></name>, <name name-style="western"><surname>Duara R</surname></name>, et al. <article-title>Clinical history, brain metabolism, and neuropsychological function in Alzheimer's disease</article-title>. <source>Ann Neurol</source><year>1985</year>; <volume>18</volume>:<fpage>298</fpage>–<lpage>309</lpage>.</citation></ref><ref><citation citation-type="other" xlink:type="simple">44. Ajuriaguerra J de, Rego A, Tissot R. Le réflexe oral et quelques activitiés orales dans les syndromes démentiels du grand age. Encéphale 1963: 52;189–219.</citation></ref><ref><citation citation-type="journal" xlink:type="simple">45. <name name-style="western"><surname>Jenkyn LR</surname></name>, <name name-style="western"><surname>Walsh DB</surname></name>, <name name-style="western"><surname>Walsh BT</surname></name>. <article-title>The nuchocephalic reflex</article-title>. <source>J Neurol Neurosurg Psychiatry</source><year>1975</year>; <volume>38</volume>:<fpage>561</fpage>–<lpage>566</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple">46. <name name-style="western"><surname>Brakha S.</surname></name><article-title>The clinical value of the pollico-mental reflex in neuropathology</article-title>. <source>J Nerve Ment Dis</source><year>1958</year>; <volume>127</volume>:<fpage>91</fpage>–<lpage>94</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple">47. <name name-style="western"><surname>Capute AJ</surname></name>, <name name-style="western"><surname>Palmer FB</surname></name>, <name name-style="western"><surname>Shapiro BK</surname></name>, et al. <article-title>Primitive reflex profile: a quantitation of primitive reflexes in infancy</article-title>. <source>Dev Med Child Neurol</source><year>1984</year>; <volume>26</volume>:<fpage>375</fpage>–<lpage>383</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple">48. <name name-style="western"><surname>Alberts M.</surname></name><article-title>Über das “Mundöffnungs-Fingerspreiz-Phänomen.”</article-title><source>Nervenartz</source><year>1955</year>; <volume>26</volume>:<fpage>228</fpage>–<lpage>232</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple">49. <name name-style="western"><surname>Yakovlev P.</surname></name><article-title>Paraplegia in flexion of cerebral origin</article-title>. <source>J Neuropathol Exp Neurol</source><year>1954</year>; <volume>13</volume>:<fpage>267</fpage>–<lpage>296</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple">50. <name name-style="western"><surname>McKhann G</surname></name>, <name name-style="western"><surname>Drachman D</surname></name>, <name name-style="western"><surname>Folstein M</surname></name>, et al. <article-title>Clinical diagnosis of Alzheimer's disease</article-title>. <source>Neurology</source><year>1984</year>; <volume>34</volume>:<fpage>939</fpage>–<lpage>945</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple">51. <name name-style="western"><surname>Hachinski VC</surname></name>, <name name-style="western"><surname>Iliff LD</surname></name>, <name name-style="western"><surname>Zilkha E</surname></name>, et al. <article-title>Cerebral blood flow in dementia</article-title>. <source>Arch Neurol</source><year>1975</year>; <volume>32</volume>:<fpage>632</fpage>–<lpage>637</lpage>.</citation></ref><ref><citation citation-type="book" xlink:type="simple">52. <name name-style="western"><surname>American Psychiatric Association.</surname></name><source>Diagnostic and statistical manual of mental disorders</source>, <edition>3rd Ed. Rev.</edition><publisher-loc>Washington, DC</publisher-loc>: <publisher-name>APA Press</publisher-name>, <year>1987</year>:<fpage>230</fpage>–<lpage>233</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple">53. <name name-style="western"><surname>Hamilton M.</surname></name><article-title>Development of a rating scale for primary depressive illness</article-title>. <source>Br J Soc Clin Psychol</source><year>1967</year>; <volume>6</volume>:<fpage>278</fpage>–<lpage>296</lpage>.</citation></ref><ref><citation citation-type="book" xlink:type="simple">54. <name name-style="western"><surname>Reisberg B.</surname></name><article-title>Clinical presentation, diagnosis and symptomatology of age-associated cognitive decline and Alzheimer's disease</article-title>. In: <name name-style="western"><surname>Reisberg B</surname></name>, Ed. <source>Alzheimer's disease</source>. <publisher-loc>New York</publisher-loc>: <publisher-name>The Free Press</publisher-name>, <year>1983</year>:<fpage>173</fpage>–<lpage>183</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple">55. <name name-style="western"><surname>Blessed G</surname></name>, <name name-style="western"><surname>Tomlinson BE</surname></name>, <name name-style="western"><surname>Roth M.</surname></name><article-title>The association between quantitative measures of dementia and of senile change in the cerebral gray matter of elderly subjects</article-title>. <source>Br J Psychiatry</source><year>1968</year>; <volume>114</volume>:<fpage>797</fpage>–<lpage>811</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple">56. <name name-style="western"><surname>Folstein MF</surname></name>, <name name-style="western"><surname>Folstein SE</surname></name>, <name name-style="western"><surname>McHugh PR</surname></name>. <article-title>Mini-Mental State: a practical method for grading the cognitive state of patients for the clinician</article-title>. <source>J Psychiatr Res</source><year>1975</year>; <volume>12</volume>:<fpage>189</fpage>–<lpage>198</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple">57. <name name-style="western"><surname>Houx PJ</surname></name>, <name name-style="western"><surname>Vreeling FW</surname></name>, <name name-style="western"><surname>Jolles J.</surname></name><article-title>Rigorous health screening reduces age effect on memory scanning task</article-title>. <source>Brain Cognition</source><year>1991</year>; <volume>15</volume>:<fpage>246</fpage>–<lpage>260</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple">58. <name name-style="western"><surname>Gimenez-Roldan S</surname></name>, <name name-style="western"><surname>Esteban A</surname></name>, <name name-style="western"><surname>Abad YJM</surname></name>. <article-title>Reflejo palmomentoniano en enfermedad de Parkinson</article-title>. <source>Arch Neurobiol (Madr)</source><year>1976</year>; <volume>394</volume>:<fpage>233</fpage>–<lpage>248</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple">59. <name name-style="western"><surname>Dalby MA</surname></name>. <article-title>The diagnostic value of the palmo-mental reflex</article-title>. <source>Acta Neurol Scand</source><year>1970</year>; <volume>46</volume>:<fpage>601</fpage>–<lpage>608</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple">60. <name name-style="western"><surname>Maertens de Noordhout A</surname></name>, <name name-style="western"><surname>Delwaide PJ</surname></name>. <article-title>The palmomental reflex in Parkinson's disease</article-title>. <source>Arch Neurol</source><year>1988</year>; <volume>45</volume>:<fpage>425</fpage>–<lpage>427</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple">61. <name name-style="western"><surname>Sunohara N</surname></name>, <name name-style="western"><surname>Tomi H</surname></name>, <name name-style="western"><surname>Satoyoshi E</surname></name>, <name name-style="western"><surname>Tachibana S.</surname></name><article-title>Glabella tap sign. Is it due to a lack of R2-habituation?</article-title><source>J Neurol Sci</source><year>1985</year>; <volume>70</volume>:<fpage>257</fpage>–<lpage>267</lpage>.</citation></ref><ref><citation citation-type="other" xlink:type="simple">62. Vreeling FW, Verhey FRJ, Jolles J. Protocol on the examination of primitive reflexes: basic position, instructions elicitation, response and scoring. Protocol 87–0126. State University of Limburg, Neuropsychology & Psychobiology Project: 1–7.</citation></ref><ref><citation citation-type="journal" xlink:type="simple">63. <name name-style="western"><surname>Tweedy J</surname></name>, <name name-style="western"><surname>Reding M</surname></name>, <name name-style="western"><surname>Garcia C</surname></name>, et al. <article-title>Significance of cortical disinhibition signs</article-title>. <source>Neurology</source><year>1982</year>; <volume>32</volume>:<fpage>169</fpage>–<lpage>173</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple">64. <name name-style="western"><surname>Jenkyn LR</surname></name>, <name name-style="western"><surname>Reeves AG</surname></name>. <article-title>Signs of cortical disinhibition in neuropsychiatric disorders</article-title>. <source>Psychiatr Med</source><year>1984</year>; <volume>1</volume>:<fpage>389</fpage>–<lpage>405</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple">65. <name name-style="western"><surname>Brakha S.</surname></name><article-title>Le réflexe profond de l'orbiculaire oral (le phénomène de la bouche d'Escherich) signe précoce et pathognomique des troubles frontaux à prédominance antéro-médio-basale</article-title>. <source>Rev Neurol</source><year>1968</year>; <volume>124</volume>:<fpage>386</fpage>–<lpage>390</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple">66. <name name-style="western"><surname>Pfeiffer J.</surname></name><article-title>Zum lokalisatorischen Wert pathologischer Greifphänomene</article-title>. <source>Archiv für Psychiatrie und Zeitschrift für die Gesamute Neurologie</source><year>1964</year>; <volume>206</volume>:<fpage>406</fpage>–<lpage>418</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple">67. <name name-style="western"><surname>Lohr JB</surname></name>. <article-title>Transient grasp reflexes in schizophrenia</article-title>. <source>Biol Psych</source><year>1985</year>; <volume>20</volume>:<fpage>172</fpage>–<lpage>175</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple">68. <name name-style="western"><surname>Pearce J.</surname></name><article-title>Mental changes in parkinsonism</article-title>. <source>J Neurol Neurosurg Psychiatry</source><year>1968</year>; <volume>31</volume>:<fpage>501</fpage>–<lpage>508</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple">69. <name name-style="western"><surname>Ferguson IT</surname></name>. <article-title>Habituation of the orbicularis oculi reflex in dementia and dyskinetic states</article-title>. <source>J Neurol Neurosurg Psychiatry</source><year>1978</year>; <volume>41</volume>:<fpage>824</fpage>–<lpage>828</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple">70. <name name-style="western"><surname>Delwaide PJ</surname></name>, <name name-style="western"><surname>Dijeux L.</surname></name><article-title>Réflexes néonataux et dykinésies bucco-linguo-faciales dans la démence sénile</article-title>. <source>l'Actualité en Gérontologie</source><year>1980</year>; <volume>6</volume>:<fpage>126</fpage>–<lpage>133</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple">71. <name name-style="western"><surname>Reis DJ</surname></name>. <article-title>The palmomental reflex</article-title>. <source>Arch Neurol</source><year>1961</year>; <volume>4</volume>:<fpage>486</fpage>–<lpage>498</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple">72. <name name-style="western"><surname>McDonald JK</surname></name>, <name name-style="western"><surname>Kelley JJ</surname></name>, <name name-style="western"><surname>Brock LD</surname></name>, <name name-style="western"><surname>Bartunek EJ</surname></name>. <article-title>Variability of the palmomental reflex</article-title>. <source>J Nerv Ment Dis</source><year>1963</year>; <volume>136</volume>:<fpage>207</fpage>–<lpage>215</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple">73. <name name-style="western"><surname>Gossman MD</surname></name>, <name name-style="western"><surname>Jacobs L.</surname></name><article-title>Three primitive reflexes in parkinsonism patients</article-title>. <source>Neurology</source><year>1980</year>; <volume>30</volume>:<fpage>189</fpage>–<lpage>192</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple">74. <name name-style="western"><surname>Förstl H</surname></name>, <name name-style="western"><surname>Burns A</surname></name>, <name name-style="western"><surname>Levy R</surname></name>, et al. <article-title>Neurologic signs in Alzheimer's disease</article-title>. <source>Arch Neurol</source><year>1992</year>; <volume>49</volume>:<fpage>1038</fpage>–<lpage>1042</lpage>.</citation></ref><ref><citation citation-type="book" xlink:type="simple">75. <name name-style="western"><surname>Richard J</surname></name>, <name name-style="western"><surname>Constantinidis J</surname></name>, <name name-style="western"><surname>Bouras C.</surname></name><article-title>Symptomatologie clinique</article-title>. In: <name name-style="western"><surname>Richard J</surname></name>, <name name-style="western"><surname>Constantinidis J</surname></name>, <name name-style="western"><surname>Bouras C</surname></name>, Eds. <source>La maladie d'Alzheimer</source>. <publisher-loc>Pari</publisher-loc>: <publisher-name>PUF</publisher-name>, <year>1988</year>:<fpage>34</fpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple">76. <name name-style="western"><surname>Gött Th.</surname></name><article-title>Eine wenig bekannte Mitbewegung und ihr Sinn</article-title>. <source>Z Neurol</source><year>1921</year>; <volume>66</volume>:<fpage>93</fpage>–<lpage>96</lpage>.</citation></ref><ref><citation citation-type="book" xlink:type="simple">77. <name name-style="western"><surname>Touwen BLC</surname></name>, <name name-style="western"><surname>Prechtl HFR</surname></name>. <article-title>The neurological examination of the child with minor nervous dysfunction</article-title>. In: <name name-style="western"><surname>Touwen BCL</surname></name>, Ed. <source>Spastics international medical publication</source>. <publisher-loc>London</publisher-loc>: <publisher-name>Heinemann</publisher-name>, <year>1970</year>:<fpage>41</fpage>–<lpage>42</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple">78. <name name-style="western"><surname>Kaye J.</surname></name><article-title>Neurochemical aspects of motor impairment</article-title>. <source>Ann Intern Med</source><year>1988</year>; <volume>109</volume>:<fpage>298</fpage>–<lpage>311</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple">79. <name name-style="western"><surname>Neary D</surname></name>, <name name-style="western"><surname>Snowden JS</surname></name>, <name name-style="western"><surname>Northen B</surname></name>, <name name-style="western"><surname>Goulding P.</surname></name><article-title>Dementia of frontal lobe type</article-title>. <source>J Neurol Neurosurg Psychiatry</source><year>1988</year>; <volume>51</volume>:<fpage>353</fpage>–<lpage>361</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple">80. <name name-style="western"><surname>Hansen L</surname></name>, <name name-style="western"><surname>Salmon D</surname></name>, <name name-style="western"><surname>Galasko D</surname></name>, et al. <article-title>The Lewy body variant of Alzheimer's disease: a clinical and pathological entity</article-title>. <source>Neurology</source><year>1990</year>; <volume>40</volume>:<fpage>1</fpage>–<lpage>8</lpage>.</citation></ref></ref-list></back></article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Primitive Reflexes in Alzheimer's Disease and Vascular Dementia</title></titleInfo><titleInfo type="alternative" lang="en" contentType="CDATA"><title>Primitive Reflexes in Alzheimer's Disease and Vascular Dementia</title></titleInfo><name type="personal"><namePart type="given">Fred W.</namePart><namePart type="family">Vreeling</namePart><namePart type="termsOfAddress">MD, PhD</namePart><affiliation>Department of Neurology (Dr. Vreeling), and the Department of Neuropsychology and Psychobiology (Drs. Houx, Jolles, and Verhey), University of Limburg, Maastricht, The Netherlands.</affiliation></name><name type="personal"><namePart type="given">Peter J.</namePart><namePart type="family">Houx</namePart><namePart type="termsOfAddress">PhD</namePart><affiliation>Department of Neurology (Dr. Vreeling), and the Department of Neuropsychology and Psychobiology (Drs. Houx, Jolles, and Verhey), University of Limburg, Maastricht, The Netherlands.</affiliation></name><name type="personal"><namePart type="given">Jellemer</namePart><namePart type="family">Jolles</namePart><namePart type="termsOfAddress">PhD</namePart><affiliation>Department of Neurology (Dr. Vreeling), and the Department of Neuropsychology and Psychobiology (Drs. Houx, Jolles, and Verhey), University of Limburg, Maastricht, The Netherlands.</affiliation></name><name type="personal"><namePart type="given">Frans R.J.</namePart><namePart type="family">Verhey</namePart><namePart type="termsOfAddress">MD, PhD</namePart><affiliation>Department of Neurology (Dr. Vreeling), and the Department of Neuropsychology and Psychobiology (Drs. Houx, Jolles, and Verhey), University of Limburg, Maastricht, The Netherlands.</affiliation></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="research-article"></genre><originInfo><publisher>SAGE Publications</publisher><place><placeTerm type="text">Sage CA: Los Angeles, CA</placeTerm></place><dateIssued encoding="w3cdtf">1995-04</dateIssued><copyrightDate encoding="w3cdtf">1995</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><abstract lang="en">Data on the prevalence and clinical value of primitive reflexes (PRs) in dementia are controversial, mainly due to a lack of standardization of the methods by which these signs are elicited and scored. A standardized protocol was used to investigate eight PRs in 20 patients with Alzheimer's disease (AD), 20 patients with vascular dementia (VD), and 20 control subjects for each group. Both patient groups showed considerably more PRs than the control groups. The prevalence of PRs was related to the severity of dementia. No single reflex or combination of PR pathognomonic for dementia could be distinguished. The PR profile of AD and VD patients were similar.</abstract><relatedItem type="host"><titleInfo><title>Journal of Geriatric Psychiatry and Neurology</title></titleInfo><genre type="journal">journal</genre><identifier type="ISSN">0891-9887</identifier><identifier type="eISSN">1552-5708</identifier><identifier type="PublisherID">JGP</identifier><identifier type="PublisherID-hwp">spjgp</identifier><part><date>1995</date><detail type="volume"><caption>vol.</caption><number>8</number></detail><detail type="issue"><caption>no.</caption><number>2</number></detail><extent unit="pages"><start>111</start><end>117</end></extent></part></relatedItem><identifier type="istex">C23230D85FFE891440CE5E6833CE6A52A325A4DF</identifier><identifier type="DOI">10.1177/089198879500800207</identifier><identifier type="ArticleID">10.1177_089198879500800207</identifier><recordInfo><recordContentSource>SAGE</recordContentSource></recordInfo></mods></metadata><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
EXPLOR_STEP=$WICRI_ROOT/Wicri/Psychologie/explor/DanceTherParkinsonV1/Data/Istex/Corpus
HfdSelect -h $EXPLOR_STEP/biblio.hfd -nk 000250 | SxmlIndent | more
Ou
HfdSelect -h $EXPLOR_AREA/Data/Istex/Corpus/biblio.hfd -nk 000250 | SxmlIndent | more
Pour mettre un lien sur cette page dans le réseau Wicri
{{Explor lien
|wiki= Wicri/Psychologie
|area= DanceTherParkinsonV1
|flux= Istex
|étape= Corpus
|type= RBID
|clé= ISTEX:C23230D85FFE891440CE5E6833CE6A52A325A4DF
|texte= Primitive Reflexes in Alzheimer's Disease and Vascular Dementia
}}
| This area was generated with Dilib version V0.6.35. |  |