title: The applause sign and neuropsychological profile in progressive supranuclear palsy and Parkinson's disease.
abstract: BACKGROUND
  The applause sign has been associated with various neurodegenerative diseases. We investigate its validity in the differential diagnosis of progressive supranuclear palsy and Parkinson's disease, and its relationship with neuropsychological tests.
  
  
  METHODS
  23 patients with progressive supranuclear palsy and 106 patients with Parkinson's disease were included and administered the following scales: progressive supranuclear palsy rating scale, unified Parkinson's disease rating scale (UPDRS), mini-mental state examination (MMSE), frontal assessment battery (FAB), neuropsychiatric inventory and three-clap test.
  
  
  RESULTS
  73.9% with progressive supranuclear palsy and 21.7% with Parkinson's disease showed a positive applause sign. Only a positive applause sign, UPDRS II score and disease duration were found to be predictors of progressive supranuclear palsy. Both patient-groups showed statistically significant correlations between the applause sign and neuropsychological tests: in progressive supranuclear palsy patients MMSE correlation coefficient: 0.62 (p: 0.002) and FAB correlation coefficient: 0.48 (p: 0.02), and in Parkinson's disease patients MMSE correlation coefficient: 0.47 (p<0.001) and FAB correlation coefficient: 0.43 (p<0.001). Verbal fluency and inhibitory control (FAB) and writing and orientation in time (MMSE) discriminated between patients with normal and positive applause sign.
  
  
  CONCLUSIONS
  A positive applause sign is not specific to progressive supranuclear palsy and may also be observed in Parkinson's disease patients with altered cognition, and it's related to cortical frontal abnormalities such as language disorders and inhibitory control.
authors.affiliation: Movement Disorders Unit, Department of Neurology, Cruces University Hospital, University of the Basque Country, Baracaldo, Spain. johannehatteland.somme@osakidetza.net
authors.forename: Johanne
authors.initials: J
authors.lastname: Somme
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Gómez-Esteban
authors.forename: Beatriz
authors.initials: B
authors.lastname: Tijero
authors.forename: Koldo
authors.initials: K
authors.lastname: Berganzo
authors.forename: Elena
authors.initials: E
authors.lastname: Lezcano
authors.forename: Juan Jose
authors.initials: JJ
authors.lastname: Zarranz
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003627:Data Interpretation, Statistical; D003937:Diagnosis, Differential; D005260:Female; D005625:Frontal Lobe / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination / Q000379:methods*; D009483:Neuropsychological Tests; D010300:Parkinson Disease / Q000473:pathology* / Q000523:psychology*; D011597:Psychomotor Performance / Q000502:physiology; D012044:Regression Analysis; D013494:Supranuclear Palsy, Progressive / Q000473:pathology* / Q000523:psychology*