Weerkamp N J, Tissingh G, Poels P J E, Zuidema S U, Munneke M, Koopmans R T C M, Bloem B R
Bronovo Hospital, The Hague, The Netherlands; Radboud University Nijmegen, Department of Neurology, Nijmegen Center for Evidence Based Practice, The Netherlands.
Bronovo Hospital, The Hague, The Netherlands.
Parkinsonism Relat Disord. 2014 Nov;20(11):1268-9. doi: 10.1016/j.parkreldis.2014.08.012. Epub 2014 Aug 27.
The 'applause sign' a tendency to continue applauding in response to instructions to clap three times was described in 1995 and was considered specific to degenerative disease, especially to atypical parkinsonian disorders. In early phase Parkinson's disease (PD) the sign has been reported positive as well. In late stage PD it is unknown whether and to what extent the sign may be elicited and it remains unknown if and to what degree the sign correlates to cognitive impairment and PD related dementia.
Nursing home residents with PD (MMSE >17) were included. All patients underwent the clapping test and were tested for cognitive disturbance by making use of accepted clinimetrics (MMSE and Scopa-cog). T-testing was performed with the hypothesis that patients expressing the applause sign would score lower on the MMSE or Scopa-cog.
Seventy three nursing home residents (mainly Hoehn and Yahr 4/5) with a mean disease duration of 10 years and a mean age of 78.7 years were included. The applause sign was found positive in 15 of 73 residents (20.5%). Residents expressing the applause sign had significantly lower mean scores on the MMSE (25.1 vs 22.9 points, p < 0.006) and Scopa-cog (14.8 vs 12.0 points, p < 0.039).
The applause sign is present in late stage PD and correlates with a higher degree of cognitive impairment as established with accepted clinimetric tests. A higher degree of frontal lobe involvement explains the presence of the applause sign.
“鼓掌征”是指在被要求鼓掌三次后仍倾向于继续鼓掌的现象，于1995年被描述，被认为是退行性疾病所特有的，尤其是非典型帕金森综合征。在帕金森病（PD）早期也有该体征呈阳性的报道。在PD晚期，尚不清楚该体征是否会出现以及出现的程度，也不清楚该体征与认知障碍及PD相关痴呆是否相关以及相关程度如何。
纳入入住养老院的PD患者（简易精神状态检查表（MMSE）评分>17）。所有患者均接受拍手测试，并采用公认的临床计量学方法（MMSE和Scopa - cog）进行认知障碍检测。进行t检验，假设表现出鼓掌征的患者在MMSE或Scopa - cog测试中得分较低。
纳入73名入住养老院的患者（主要为Hoehn - Yahr 4/5期），平均病程10年，平均年龄78.7岁。73名患者中有15名（20.5%）的鼓掌征呈阳性。表现出鼓掌征的患者在MMSE测试中的平均得分（25.1分对22.9分，p<0.006）和Scopa - cog测试中的平均得分（14.8分对12.0分，p<0.039）显著更低。
鼓掌征在PD晚期存在，并且与公认临床计量学测试所确定的更高程度的认知障碍相关。额叶受累程度更高解释了鼓掌征的出现。
