Applause sign in advanced Parkinson's disease

Area of Science:

• Neurology
• Geriatric Medicine
• Cognitive Science

Background:

• The 'applause sign,' characterized by persistent clapping, was initially linked to atypical parkinsonian disorders.
• Its presence in early Parkinson's disease (PD) is documented, but its occurrence and correlation with cognitive decline in late-stage PD remain unclear.

Purpose of the Study:

• To investigate the prevalence of the applause sign in nursing home residents with late-stage Parkinson's disease (PD).
• To determine the correlation between the applause sign and cognitive impairment using standardized tests.

Main Methods:

• Included nursing home residents with PD (MMSE >17).
• Administered the clapping test and assessed cognitive function using the Mini-Mental State Examination (MMSE) and Scopa-cog.
• Utilized t-testing to compare cognitive scores between residents with and without the applause sign.

Main Results:

• The applause sign was identified in 20.5% (15/73) of residents with advanced PD (mean disease duration 10 years, mean age 78.7 years).
• Residents exhibiting the applause sign demonstrated significantly lower mean scores on both the MMSE and Scopa-cog tests.
• Specifically, MMSE scores were 25.1 (applause sign positive) vs. 22.9 (applause sign negative), and Scopa-cog scores were 14.8 vs. 12.0, respectively (p < 0.006 and p < 0.039).

Conclusions:

• The applause sign is a relevant clinical finding in late-stage Parkinson's disease.
• Its presence correlates with a higher degree of cognitive impairment, as measured by established clinimetric tools.
• This association suggests increased frontal lobe dysfunction in PD patients exhibiting the applause sign.