title: Palmomental Reflex a Relevant Sign in Early Alzheimer's Disease Diagnosis?
abstract: BACKGROUND
  Sophisticated and expensive biomarkers are proposed for the diagnostic of Alzheimer's disease (AD). The amyloid process seems to be early in AD, and brain amyloid load affects the frontal lobe.
  
  
  OBJECTIVE
  To determine if certain simple clinical signs, especially frontal-related signs, could help reach an earlier and better diagnosis.
  
  
  METHODS
  In the frame of the 3-City cohort, we conducted a nested case-control study comparing incident cases of AD to controls matched for age, gender, and education. The standardized neurological exam included extrapyramidal signs (akinesia, rigidity, rest tremor), pyramidal symptoms (spastic rigidity, Babinski reflex), primitive reflexes (snout, palmomental reflex grasping), and tremor (essential, intentional, head) at the time of diagnosis and two years before.
  
  
  RESULTS
  We compared 106 incident AD subjects (mean age at diagnosis 82.2 (SD = 5.9); median MMSE at diagnosis = 23) to 208 matched controls. In patients younger than 80, palmomental reflexes were more frequent in AD than controls, two years before diagnosis (25.0 versus 7.0% , p = 0.03) and at time of diagnosis (30.3 versus 12.3% , p = 0.02). No difference was observed for other signs two years before diagnosis or for patients older than 80.
  
  
  CONCLUSIONS
  Before diagnosis, the clinical examination of AD patients is not strictly normal; the primitive reflexes appear to be pathological. It might be in connection with the frontal amyloid load at an early stage of the disease. Clinical examination can reveal simple and interesting signs that deserve consideration as well as the other more invasive and expensive biomarkers.
authors.affiliation: Memory Research and Resources Center, CMRR of Montpellier, Department of Neurology, Hospital Gui de Chauliac, Montpellier, France.|INSERM U1183, Saint Eloi Hospital, Montpellier, France.|Montpellier University, Montpellier, France.
authors.forename: Audrey
authors.initials: A
authors.lastname: Gabelle
authors.affiliation: Memory Research and Resources Center, CMRR of Montpellier, Department of Neurology, Hospital Gui de Chauliac, Montpellier, France.|INSERM U1061, La Colombière Hospital, Montpellier, France.|Montpellier University, Montpellier, France.
authors.forename: Laure-Anne
authors.initials: LA
authors.lastname: Gutierrez
authors.affiliation: Memory Research and Resources Center, CMRR de Bordeaux, Bordeaux, France.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Dartigues
authors.affiliation: INSERM U1061, La Colombière Hospital, Montpellier, France.|Montpellier University, Montpellier, France.
authors.forename: Karen
authors.initials: K
authors.lastname: Ritchie
authors.affiliation: Memory Research and Resources Center, CMRR of Montpellier, Department of Neurology, Hospital Gui de Chauliac, Montpellier, France.|INSERM U1061, La Colombière Hospital, Montpellier, France.|Montpellier University, Montpellier, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Touchon
authors.affiliation: Memory Research and Resources Center, CMRR of Montpellier, Department of Neurology, Hospital Gui de Chauliac, Montpellier, France.|INSERM U1061, La Colombière Hospital, Montpellier, France.|Montpellier University, Montpellier, France.
authors.forename: Claudine
authors.initials: C
authors.lastname: Berr
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000175:diagnosis* / Q000503:physiopathology*; D015331:Cohort Studies; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D005602:France; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009483:Neuropsychological Tests; D012018:Reflex
keywords: Alzheimer’s disease; biomarkers; clinical examination; frontal signs; palmomentonal reflex