From the Department of Experimental Biomedicine and Clinical Neurosciences,University of Palermo,Palermo,Italy.
Department of Clinical and Experimental Medicine,University of Parma,Parma,Italy.
Can J Neurol Sci. 2019 Mar;46(2):199-208. doi: 10.1017/cjn.2018.388. Epub 2019 Feb 14.
To assess the prevalence of three nociceptive primitive reflexes (nPR), i.e., glabellar tap, snout reflex, and palmomental reflex, in neurologically and cognitively healthy (NCH) aging subjects.
To investigate whether nPR are cross-sectionally associated with white matter hyperintensities (WMH), lacunes, atrophy of the caudate nuclei, and global brain atrophy.
A total of 1246 NCH subjects aged 45-91 years were included in the study and underwent standard brain MRI. Atrophy of the caudate nuclei and global brain atrophy were assessed through the bicaudate ratio (BCr) and lateral ventricles to brain ratio (LVBr), respectively. WMH were assessed through visual rating scales. Lacunes were also rated. Association of nPR with vascular risk factors/diseases and imaging findings was evaluated using logistic regression analysis.
nPR were exhibited by 33.1% of subjects and increased with age. Subjects with nPR performed less than subjects without nPR in tests evaluating global cognition, executive functions, attention, and language. Snout reflex was the most common nPR, followed by glabellar tap and palmomental reflex. Glabellar tap was associated with parieto-temporal WMH, BCr, and LVBr; snout reflex was associated with frontal lacunes, temporal WMH, BCr, and LVBr; palmomental reflex was associated with parieto-occipital WMH, basal ganglia lacunes, BCr, and LVBr.
This study demonstrates that in NCH aging individuals, nPR are associated with WMH, lacunes, BCr, and LVBr and are probably a warning sign of incipient cognitive decline. Therefore, NCH subjects presenting nPR should manage their vascular risk factors/vascular diseases rigorously in order to prevent or delay progression of small vessel disease, and future neurological and cognitive disabilities.
评估三种伤害性原始反射（nPR），即眶额轻敲反射、鼻反射和手掌心-口反射，在神经认知健康（NCH）的老年人群中的发生率。
研究 nPR 是否与脑白质高信号（WMH）、腔隙、尾状核萎缩和全脑萎缩存在横断面关联。
共纳入 1246 名年龄在 45-91 岁之间的 NCH 受试者，并进行了标准的脑部 MRI 检查。通过双尾核比（BCr）和侧脑室与脑比值（LVBr）评估尾状核萎缩和全脑萎缩。通过视觉评分量表评估 WMH。同时也对腔隙进行评分。采用逻辑回归分析评估 nPR 与血管危险因素/疾病和影像学发现的相关性。
33.1%的受试者出现 nPR，且随年龄增长而增加。与无 nPR 的受试者相比，有 nPR 的受试者在评估整体认知、执行功能、注意力和语言的测试中表现较差。鼻反射是最常见的 nPR，其次是眶额轻敲反射和手掌心-口反射。眶额轻敲反射与顶颞部 WMH、BCr 和 LVBr 相关；鼻反射与额部腔隙、颞部 WMH、BCr 和 LVBr 相关；手掌心-口反射与顶枕部 WMH、基底节腔隙、BCr 和 LVBr 相关。
本研究表明，在 NCH 的老年个体中，nPR 与 WMH、腔隙、BCr 和 LVBr 相关，可能是认知能力下降的早期预警信号。因此，出现 nPR 的 NCH 受试者应严格控制其血管危险因素/血管疾病，以预防或延缓小血管疾病以及未来的神经和认知障碍的进展。
