Extrapyramidal signs, primitive reflexes and incontinence in fronto‐temporal dementia

Abstract

According to the diagnostic consensus criteria [1] akinesia, rigidity and tremor as well as primitive reflexes and incontinence support the diagnosis of fronto-temporal dementia (FTD). However, the prevalence of extrapyramidal signs (EPMS), primitive reflexes and incontinence in FTD has not yet been systematically studied. In the present study, thirty-one patients with mild or moderate FTD without previous or present antipsychotic medication underwent a detailed neurological exam including the motor part of the Unified Parkinson's Disease Rating Scale (UPDRS). The average total score on the motor subscale of the UPDRS was 14.0 points. Akinesia and Parkinsonian gait or posture were found frequently but were mild in most instances. Rigidity was found in 36% of the patients. Resting tremor was a rare symptom. The only primitive reflex that occurred was a positive palmomental that was found in 7% of the patients. Urinary incontinence was present in 26%. The results have to be confirmed with larger or pooled patient samples from different ascertainment scenarios. If the results of the present study can be replicated, a revision of the consensus criteria from 1998 might be considered.

Quantitative Measurements of Motor Function in Alzheimer’s Disease, Frontotemporal Dementia, and Dementia with Lewy Bodies: A Proof-of-Concept Study

“…No previously published studies contained the pronation/supination task in the Q-Motor protocol. The mean values of the clinical ratings in the UPDRS are similar to previous studies using UPDRS on AD, FTD, and DLB patients [3, 12, 17-19]. …”

“…The prevalence of extrapyramidal symptoms in behavioral variant FTD patients has been associated with lower psychomotor speed, greater memory deficits and increased incidence of psychotic symptoms [11]. Different motor symptoms, such as akinesia and tremor have shown different prevalence, the first found in the majority of FTD patients, the latter rarely reported [12]. Finally, in DLB patients, parkinsonism is one of the core diagnostic criteria [13] and although motor symptoms are described in the literature [14], it is still challenging to differentiate DLB from AD and Parkinson’s disease (PD) in early disease stages [3, 4, 15].…”

“…The Unified Parkinson Disease Rating Scale Part-III (UPDRS) [16], a categorical clinical rating scale providing a subjective visual clinical evaluation of motor dysfunction, has been used to examine motor symptoms in AD, FTD, and DLB with varying results [3, 12, 17-20]. Further, both the MDS-UPDRS and the Unified Huntington Disease Rating Scale-Total Motor Score (UHDRS-TMS) [21] are subject to rater bias and risk of consecutive intra- and interrater variability and error [16, 22].…”

A 6‐month, open‐label study of memantine in patients with frontotemporal dementia

“…Impairments of executive functions, memory and language invariably occur. Neurological signs include incontinence and extrapyramidal motor symptoms (EPMS) (Diehl-Schmid et al, 2007). FvFTD is a progressive and malignant disorder, with a median survival time from symptom onset of 6 (Hodges et al, 2003) to 14 (Diehl-Schmid et al, 2006) years.…”

Neurological signs of possible diagnostic value in the cognitive disorders clinic: Table 1

“…Limb rigidity typical of parkinsonism may develop in the classical parkinsonian disorders and also in later stages of Alzheimer's disease, in vascular dementia as a consequence of small vessel disease,18 and in frontotemporal dementia 19. Some patients with dementia with Lewy bodies have no extrapyramidal signs at the time of cognitive presentation 20…”