Midline Hand Drift as a Possible Sign of Neurologic Disorder

Movement and maintenance of posture involve many interacting factors that rely on a broad neural network. These factors include proprioception, body schema, and peripersonal and extrapersonal space, all of which may be affected in individuals with neurocognitive disorders. Frontal release signs are a common clinical finding in such individuals, resulting from the disruption of the related neural networks. In this case series, we discuss the potential clinical relevance of midline hand drift (MHD). MHD is a rarely documented physical exam finding in which one or both hands move toward the midline when the individual is seated upright with their eyes open, arms outstretched, and palms facing upwards. Upon examination, 24 individuals with a chief complaint of worsening memory were found to have MHD. All 24 individuals with MHD had at least mild cognitive impairment, and 22 were also diagnosed with a neurodegenerative disorder. The most common diagnoses among these individuals were Parkinson disease dementia, Lewy body dementia, and vascular dementia. Nine of the 24 patients demonstrated no frontal release signs upon examination. MHD may be a useful clinical finding that aids in the diagnosis of an underlying neurocognitive disorder. Assessing for MHD may be most beneficial for individuals who are in the earlier stages of neurocognitive decline. They may show mild impairment on the Mini-Mental State Examination or the Montreal Cognitive Assessment, but no other characteristic findings (eg, frontal release signs).