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October 14, 2021Research

Primitive Reflexes and Dementia in Adults With Down Syndrome

Jordan Harp, Lisa Koehl, Kathryn Van Pelt, Elizabeth Head, Gregory Jicha, William Robertson, Donita Lightner, Ira Lott, Frederick Schmitt
First published October 14, 2021, DOI: https://doi.org/10.1212/CPJ.0000000000001135
Jordan Harp
1Department of Neurology, University of Kentucky, Lexington, KY
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Lisa Koehl
1Department of Neurology, University of Kentucky, Lexington, KY
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Kathryn Van Pelt
2Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY
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Elizabeth Head
3Department of Pathology & Laboratory Medicine, University of California--Irvine, Irvine, CA
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Gregory Jicha
1Department of Neurology, University of Kentucky, Lexington, KY
2Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY
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William Robertson
1Department of Neurology, University of Kentucky, Lexington, KY
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Donita Lightner
1Department of Neurology, University of Kentucky, Lexington, KY
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Ira Lott
4Department of Neurology, University of California--Irvine, Irvine, CA
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Frederick Schmitt
1Department of Neurology, University of Kentucky, Lexington, KY
2Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY
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Citation
Primitive Reflexes and Dementia in Adults With Down Syndrome
Jordan Harp, Lisa Koehl, Kathryn Van Pelt, Elizabeth Head, Gregory Jicha, William Robertson, Donita Lightner, Ira Lott, Frederick Schmitt
Neurol Clin Pract Oct 2021, 10.1212/CPJ.0000000000001135; DOI: 10.1212/CPJ.0000000000001135

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ABSTRACT

Objective: To determine whether primitive reflexes serve as an indicator of dementia in adults with Down syndrome (DS), we collected neurologic examination data, cognitive and behavioral assessments, and clinical consensus diagnoses of dementia from 92 adults with DS.

Methods: In a cross-sectional, observational study of a regional cohort, chi-square and Fisher’s exact tests examined individual reflexes across diagnostic group (No, Possible, or Probable Dementia). In 64 participants with all 8 reflexes assessed, the number of primitive reflexes was assessed as a predictor of diagnosis using age-controlled multinomial logistic regression and of performance on clinical assessments (Brief Praxis Test [BPT], Severe Impairment Battery [SIB], and the Dementia Questionnaire for People with Learning Disabilities [DLD] using age-adjusted linear regression.

Results: Primitive palmomental, grasp, snout, and suck reflexes were more frequent in individuals with probable dementia, but all participants showed at least one primitive reflex. Multiple primitive reflexes in combination served as a better indicator of dementia, with each additional abnormal reflex tripling probability of Probable Dementia group membership controlling for age. Abnormal reflex count was not associated with direct assessment of cognition and praxis (SIB and BPT) but associated with informant ratings of cognitive and behavioral functioning (DLD).

Conclusions: The presence of multiple reflexes serves as an indicator of dementia status in DS as a supplement to direct assessment of cognition and praxis. The reflex examination may serve as a tool in the multimethod evaluation for dementia in DS, as it appears unaffected by intellectual disability and language mastery.

  • Received November 20, 2020.
  • Accepted September 1, 2021.
  • © 2021 American Academy of Neurology

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