Presence Of Primitive Reflexes Research Articles

Long-Term Severe Mental Disorders Preceding Behavioral Variant Frontotemporal Dementia: Frequency and Clinical Correlates in an Outpatient Sample.

The behavioral variant frontotemporal dementia (bvFTD) shares some clinical features with severe mental disorders, such as bipolar affective disorder (BAD), schizophrenia (SCZ), and schizoaffective disorder (SZA), and at least for a small subgroup of patients, these conditions may share similar pathological genetic mutations. To investigate the frequency of a past medical history satisfying diagnostic criteria for BAD, SCZ, and SZA in a bvFTD outpatient sample, and to compare the clinical profile of patients with and without a positive history. Cross-sectional study in which participants were consecutively selected after receiving a diagnosis of probable bvFTD and had a caregiver interviewed with SCID-I. The sample was categorized into two groups: with (bvFTD+) or without (bvFTD-) prior medical history satisfying diagnostic criteria for BAD/SCZ/SZA. Subjects went through cognitive, functional, and neuropsychiatric evaluations. Overall, 46 bvFTD patients were included; bvFTD+ patients accounted for 36.9% of the sample. The main nosology fulfilling criteria was BAD (76.5%). The groups differed in Neuropsychiatric Inventory scores (p = 0.01), use of antipsychotics (p = 0.01), family history of psychosis (p = 0.01), presence of primitive reflexes (p = 0.04), Frontal Assessment Battery performance (p = 0.01), Ekman's facial emotion recognition test (p = 0.03), frequency of apathy (p = 0.03), and stereotyped behavior (p = 0.01). All these parameters were more frequent/worse in the bvFTD+ group. A prior medical history compatible with BAD/SCZ/SZA was found in more than 1/3 of this sample of bvFTD patients and was associated with subtle distinctive clinical features.

Physiological factors contributing to mobility loss over 9 years of follow-up—results from the InCHIANTI study.

Mobility is an essential aspect of everyday life and enables autonomy and participation. Although many risk factors for mobility loss have been previously described, their relative importance and independent contributions to the long-term risk of losing mobility have not been well defined. This study is based on 1,013 men and women aged ≥65 years enrolled in 1998-2000 and followed for 9 years through 2007-2008 in the population-based InCHIANTI (Invecchiare in Chianti, aging in the Chianti area) study. We considered 44 different measures assessed at baseline to explore six subsystems: (i) central nervous system, (ii) peripheral nervous system, (iii) muscles, (iv) bone and joints, (v) energy production and delivery, and (vi) perceptual system. The outcome was incident mobility loss defined as self-report of inability to walk 400 m or climb and descend 10 steps without help from another person. Random survival forest analysis was used to rank the candidate predictors by their importance. The most important physiological markers predicting mobility loss that emerged from the random survival forest modeling were older age among women (81-95 vs 65-68 years, hazard ratio [HR] 9.60 [95% CI 3.35, 27.50]), weaker ankle dorsiflexion strength (lowest vs highest quintile, HR 5.25 [95% CI 2.35, 11.72]), low hip flexion range of motion (lowest vs highest quintile, HR 2.30 [95% CI 1.20, 4.41]), presence of primitive reflexes (yes vs no, HR 1.47 [95% CI 1.03, 2.09]), and tremor (yes vs no, HR 1.91 [95% CI 1.18, 3.07]). Prevention of mobility loss with aging should focus on prevention and treatment of neuromuscular impairments.

Primitive Reflexes Associated with Delirium: A Prospective Trial

The presence of primitive reflexes (PRs) may have diagnostic or prognostic value in the evaluation of cognitive impairment. We hypothesized that the presence of preoperative PRs would predict the development of postoperative delirium and that the emergence of PRs postoperatively would be positively associated with the emergence of delirium. Patients participating in a larger study on the prophylaxis of postoperative delirium were evaluated for the presence of six PRs (grasp reflex [left and right], palmomental reflex [left and right], glabellar tap, and snout reflex), preoperatively and postoperatively. The presence of PRs was then correlated with the development of delirium. Of the 79 patients studied, 29% (n = 23) developed delirium during the postoperative period. The preoperative presence of one PR did not predict the development of delirium, but the only patient with >1 PR preoperatively went on to develop delirium in the postoperative period. Similarly, having one frontal release sign in the postoperative period did not correlate with delirium, while the appearance of more than one PR was associated with a greater likelihood of delirium. Of the 11 patients who had two or more frontal release signs during one postoperative examination, six (55%) developed delirium. Of the five patients who showed three or more frontal release signs, 4 (80%) developed delirium. Our study is the first to investigate the relationship between the appearance of PRs and the development of delirium. We have provided some evidence that PRs are associated with acute CNS dysfunction.

Prevalence of Primitive Reflexes and Parkinsonian Signs in Dementia

Primitive reflexes and parkinsonian signs are used by clinicians to differentiate among dementias. We reviewed our clinical sample to determine whether primitive reflexes were more prevalent in frontally-based dementias and whether parkinsonian signs were more common in dementia with Lewy bodies (DLB) than in other types of dementia. We retrospectively reviewed charts from 204 patients with dementia who presented for consultation at Baycrest's Ross Memory Clinic between April, 2003, to December, 2007. A greater proportion of subjects with DLB and dementia of the Alzheimer type with cardiovascular disease had primitive reflexes than subjects with frontotemporal dementia (FTD). Primitive reflexes were not positively predictive of FTD or vascular dementia (VaD). Dementia with Lewy bodies subjects were more likely to have parkinsonian signs than the other dementias, and bradykinesia and rigidity were positively predictive of FTD. The palmomental reflex was the most common primitive reflex in the sample, and cogwheeling was the most common parkinsonian sign. There was no significant difference between early- and late-stage groups in presence of primitive reflexes or parkinsonian signs. Primitive reflexes appear not to be clinically discriminative of frontally-based dementias such as FTD and VaD.

Sinais neurológicos sutis: uma revisão

O objetivo deste trabalho é discutir o significado dos sinais neurológicos sutis e a relevância para a pesquisa em psiquiatria, com ênfase na esquizofrenia e no transtorno bipolar (TB). Realizou-se uma revisão da literatura nas bases de dados Medline e Bireme. Sinais neurológicos sutis são alterações no exame neurológico que compreendem funções diversas como integração sensorial, coordenação motora, sequenciamento motor e presença de reflexos primitivos. Esses sinais indicam disfunção cerebral não focal, podendo se apresentar como fatores de risco para transtornos psiquiátricos. Podem indicar endofenótipos relacionados a disfunções em circuitos neurais específicos, fornecendo informações relevantes para fisiopatologia desses transtornos. Apesar disso, há poucos trabalhos sobre o tema na literatura nacional. A observação de sinais neurológicos sutis aponta para o potencial de o exame neurológico preencher uma lacuna entre a pesquisa neurobiológica e a prática clínica.

Endemic cretinism in Thailand: a multidisciplinary survey.

Endemic cretinism has been classified into neurological and myxedematous types. Profound mental deficiency, deaf-mutism and cerebral diplegia are predominantly found in the former. The latter have been described as less mentally retarded but with severe growth retardation and myxedematous features. The pathogenesis of different clinical types of endemic cretinism is still unclear. Recently, a unifying hypothesis suggested that iodine deficiency, severe enough to cause maternal and fetal hypothyroxinemia, results in neurological defects in all cretins. We conducted the present study in northern Thailand to determine the validity of this hypothesis in another geographical area. The study consisted of a multidisciplinary survey on 112 endemic cretins aged 2-66 years in Nan. They were categorized clinically into three types of endemic cretins, neurological (n = 57), myxedematous (n = 19) and mixed form (n = 36). The subjects were generally short and the majority had severe mental retardation (mean intellectual quotient (I.Q.) 30.8 +/- 8.8), psychomotor defect and profound sensorineural hearing loss. The I.Q. score and proportion of cretins with sensorineural hearing loss and psychomotor defect were similar among the three types of cretins. The most frequent neurological abnormalities were spasticity, hyper-reflexia, the presence of primitive reflexes and gait disturbance. These abnormalities were distributed equally among the three types of endemic cretins. Delayed skeletal maturation and abnormal epiphysis were also present in all types of cretins. However, myxedematous cretins were shorter (P < 0.01), having more myxedematous features (P < 0.05 to P < 0.001) and less sexual maturation (P < 0.05). Thyroid volume was lower in cretins with hypothyroidism (P < 0.01). In conclusion, our findings support the hypothesis that neurological features are present in all types of cretins, and are the consequence of maternal and fetal hypothyroxinemia due to severe iodine deficiency. The clinical manifestations of the cretins were subsequently modified by the length and severity of postnatal iodine deficiency and hypothyroidism.

SYMPTOMATOLOGICAL CHARACTERISTICS DISTINGUISH BETWEEN FRONTOTEMPORAL DEMENTIA AND VASCULAR DEMENTIA WITH A DOMINANT FRONTAL LOBE SYNDROME

Objective. Our hypothesis was that patients with vascular dementia and a dominating frontal lobe syndrome have a symptomatology that reflects a more widespread lesion compared with patients with frontotemporal dementia. Design. Patients with vascular dementia and a dominating frontal lobe syndrome (VAD-F; N=11) were compared with regard to clinical symptoms and imaging features on CT scans of the brain with patients with frontotemporal dementia (FTD; N=21). Setting. A neuropsychiatric diagnostic ward. Patients. Thirty-two inpatients, aged 48–78 years, with frontotemporal dementia or vascular dementia. Measures. Relatives were questioned about the initial symptoms. At the clinical investigation, mental and neurological symptoms and signs were recorded using the STEP method (stepwise comparative status analysis). CT scan features of the brain were evaluated by a trained neuroradiologist. The GBS-i (Gottfries–Bra3ne–Steen, intellectual variables) scale was used to measure the degree of dementia. Results. At the onset of dementia, loss of memory (p<0.001), sudden onset (p<0.001), confusion (p<0.05) and unspecified neurological signs (p<0.05) had been significantly more frequent in the VAD-F group. At the time of the clinical investigation, lack of social awareness and presence of primitive reflexes were more frequent in the FTD group (p<0.01 and p<0.05, respectively) and visuospatial deficits more frequent in the VAD-F group (p<0.05). CT of the brain showed that, apart from brain infarcts (present only in the VAD-F group), paraventricular leukoaraiosis was significantly more pronounced in the VAD-F group (p<0.05). The groups did not differ with respect to age, age at onset or level of dementia. Conclusion. The findings support our hypothesis.

SYMPTOMATOLOGICAL CHARACTERISTICS DISTINGUISH BETWEEN FRONTOTEMPORAL DEMENTIA AND VASCULAR DEMENTIA WITH A DOMINANT FRONTAL LOBE SYNDROME

Our hypothesis was that patients with vascular dementia and a dominating frontal lobe syndrome have a symptomatology that reflects a more widespread lesion compared with patients with frontotemporal dementia. Patients with vascular dementia and a dominating frontal lobe syndrome (VAD-F; N = 11) were compared with regard to clinical symptoms and imaging features on CT scans of the brain with patients with frontotemporal dementia (FTD; N = 21). A neuropsychiatric diagnostic ward. Thirty-two inpatients, aged 48-78 years, with frontotemporal dementia or vascular dementia. Relatives were questioned about the initial symptoms. At the clinical investigation, mental and neurological symptoms and signs were recorded using the STEP method (stepwise comparative status analysis). CT scan features of the brain were evaluated by a trained neuroradiologist. The GBS-i (Gottfries-Bråne-Steen, intellectual variables) scale was used to measure the degree of dementia. At the onset of dementia, loss of memory (p < 0.001), sudden onset (p < 0.001), confusion (p < 0.05) and unspecified neurological signs (p < 0.05) had been significantly more frequent in the VAD-F group. At the time of the clinical investigation, lack of social awareness and presence of primitive reflexes were more frequent in the FTD group (p < 0.01 and p < 0.05, respectively) and visuospatial deficits more frequent in the VAD-F group (p < 0.05). CT of the brain showed that, apart from brain infarcts (present only in the VAD-F group), paraventricular leukoaraiosis was significantly more pronounced in the VAD-F group (p < 0.05). The groups did not differ with respect to age, age at onset or level of dementia. The findings support our hypothesis.

Primitive (developmental) reflexes, tardive dyskinesia and intellectual impairment in schizophrenia

Primitive reflexes, also known as higher cerebral, developmental or release reflexes, are present in foetal and infant life, and are found in certain organic brain diseases. They are normally regarded as non-localising signs of cerebral immaturity or dysfunction which are uncommon in the normal population. The main aims of this study were to find out whether recent reports of an association between primitive reflexes and severity of cognitive impairment in dementia and between primitive reflexes and tardive dyskinesia in schizophrenia could be replicated in a younger population of schizophrenic patients. Forty-eight schizophrenic patients (mean age 51 years) were assessed for primitive reflexes, involuntary movements and cognitive function, and 58% exhibited at least one primitive reflex and 23% at least two. No association was found between primitive reflexes and cognitive impairment or between primitive reflexes and tardive dyskinesia. These results fail to support the hypothesis that the presence of primitive reflexes in some schizophrenic patients indicates a vulnerability to tardive dyskinesia and intellectual decline with advancing age, but long-term prospective studies would be required to test this hypothesis adequately. Nevertheless, these findings support the notion of neurodevelopmental or neurodegenerative brain disease in at least a proportion of patients with schizophrenia.

Factors involved in the prognosis of walking in cerebral paralysis

With the objective of studying the prognosis for walking in children with cerebral palsy a retrospective survey of 100 children being treated at the Associação de Assistência à Criança Defeituosa was made during the period from 1979 to 1988. The following parameters were analysed: (1) degree of motor dysfunction; (2) age of acquisition of sitting balance; (3) function of upper limbs; (4) degree of mental retardation; (5) presence of primitive reflexes. All the above parameters were analysed with respect to the capability of children acquiring or not walking. The results of our study show that the following factors are indicative of bad prognosis for walking: (1) severity of motor dysfunction; (2) acquisition of sitting posture after 3 years old; (3) precarius function of upper limbs; (4) severe mental retardation associated with severe physical deficiency. Clinical evaluation of primitive reflexes did not reveal direct relation to the walking prognosis.

Clinical Significance of Primitive Reflexes in Alzheimer's Disease

To establish the relationship between cognition, behavior, function, and clinical characteristics on the one hand, and the presence of primitive reflexes (PR) (pout, snout, palmomental and grasp) in patients with Alzheimer's disease (AD). Cross-sectional survey. Secondary care geriatric practice specializing in the assessment of cognitive impairment. 136 consecutive patients presenting with AD. PR were assessed in standardized fashion by a single clinician. Cognitive function was measured using the Standardized Mini-Mental Status Examination, activities of daily living (ADL) and instrumental activities of daily living (IADL) were measured using the Lawton scale, and behavior was measured using the Behavioural Problem Checklist. There was no difference in age or duration of dementia in those with and without PR, nor was there any difference in cognitive function. Despite this, patients with PR showed a greater degree of functional limitation and dysfunctional behavior. There was also a higher incidence of rigidity, gait abnormalities, and apraxia in patients with PR. Patients with primitive reflexes had more severe impairment in ADL function and dysfunctional behavior for an equal level of cognitive function.