The Three Clap Test: a Window into Cognitive and Frontal Lobe Dysfunction

Overview

Journal Neurol Sci

Specialty Neurology

Date 2024 Nov 28

PMID 39607617

Authors

Zuzana Brezna

Katarina durcova Typcukova

Jan Necpal

Affiliations

Soon will be listed here.

Abstract

The three clap test (TCT) is a simple bedside test that can elicit the so-called applause sign (AS), manifesting with more than three claps after the examiner's instruction to clap three times. Although the AS was originally described as a useful sign differentiating patients with progressive supranuclear palsy (PSP) from patients with Parkinson's disease (PD) and frontotemporal dementia (FTD), it is also known to be present in PD, Alzheimer's disease and several other diseases. It reflects the so-called stopping impulsivity and cognitive and frontal lobe dysfunction. In addition to the AS, the TCT can also elicit the non-applause sign, linked with the apathy subtype of behavioural variant of FTD and the jumping the gun sign, a sign of waiting impulsivity, also seen in PSP. This review summarizes the up-to-date clinical aspects and pathophysiology of all these signs and discuss the benefit of using the TCT in the routine clinical praxis.

References

Dubois B, Defontaines B, Deweer B, Malapani C, Pillon B . Cognitive and behavioral changes in patients with focal lesions of the basal ganglia. Adv Neurol. 1995; 65:29-41. View

Dubois B, Slachevsky A, Pillon B, Beato R, Villalponda J, Litvan I . "Applause sign" helps to discriminate PSP from FTD and PD. Neurology. 2005; 64(12):2132-3. DOI: 10.1212/01.WNL.0000165977.38272.15. View

Wu L, Sitburana O, Davidson A, Jankovic J . Applause sign in Parkinsonian disorders and Huntington's disease. Mov Disord. 2008; 23(16):2307-11. DOI: 10.1002/mds.22090. View

Anneser J, Krzovska M, Borasio G, Danek A . Occurrence of the "applause sign" in patients with amyotrophic lateral sclerosis. Clin Neurol Neurosurg. 2015; 137:8-10. DOI: 10.1016/j.clineuro.2015.06.005. View

Abdo W, van Norden A, de Laat K, de Leeuw F, Borm G, Verbeek M . Diagnostic accuracy of the clapping test in Parkinsonian disorders. J Neurol. 2007; 254(10):1366-9. DOI: 10.1007/s00415-007-0551-6. View

Luzzi S, Fabi K, Pesallaccia M, Silvestrini M, Provinciali L . Applause sign: is it really specific for Parkinsonian disorders? Evidence from cortical dementias. J Neurol Neurosurg Psychiatry. 2011; 82(8):830-3. DOI: 10.1136/jnnp.2010.224394. View

Isella V, Rucci F, Traficante D, Mapelli C, Ferri F, Appollonio I . The applause sign in cortical and cortical-subcortical dementia. J Neurol. 2012; 260(4):1099-103. DOI: 10.1007/s00415-012-6767-0. View

Somme J, Gomez-Esteban J, Tijero B, Berganzo K, Lezcano E, Zarranz J . The applause sign and neuropsychological profile in progressive supranuclear palsy and Parkinson's disease. Clin Neurol Neurosurg. 2012; 115(8):1230-3. DOI: 10.1016/j.clineuro.2012.11.013. View

Tomic S, Vladetic M, Solic K, Misevic S, Butkovic Soldo S . The applause sign in Parkinson's disease patients is related to dysexecutive syndrome. J Clin Neurosci. 2013; 20(12):1734-6. DOI: 10.1016/j.jocn.2013.02.024. View

10.

Luzzi S, Fabi K, Pesallaccia M, Silvestrini M, Provinciali L . Applause sign in Alzheimer's disease: relationships to cognitive profile and severity of illness. J Neurol. 2012; 260(1):172-5. DOI: 10.1007/s00415-012-6608-1. View

11.

Schonecker S, Hell F, Botzel K, Wlasich E, Ackl N, Sussmair C . The applause sign in frontotemporal lobar degeneration and related conditions. J Neurol. 2018; 266(2):330-338. DOI: 10.1007/s00415-018-9134-y. View

12.

Ahn J, Kwon J, Won J, Byeon K, Youn J, Park H . Waiting impulsivity in progressive supranuclear palsy-Richardson's syndrome. Front Neurosci. 2023; 17:1240709. PMC: 10560850. DOI: 10.3389/fnins.2023.1240709. View

13.

Luzzi S, Fabi K, Pesallaccia M, Cafazzo V, Silvestrini M, Provinciali L . To clap or not to clap? Applause sign in apathetic and disinhibited/stereotypical behavioural variants of FTD. J Neurol Neurosurg Psychiatry. 2014; 85(7):823-4. DOI: 10.1136/jnnp-2013-307116. View

14.

Slachevsky A, Pillon B, Fourneret P, Pradat-Diehl P, Jeannerod M, Dubois B . Preserved adjustment but impaired awareness in a sensory-motor conflict following prefrontal lesions. J Cogn Neurosci. 2001; 13(3):332-40. DOI: 10.1162/08989290151137386. View

15.

Partiot A, Verin M, Pillon B, Agid Y, Dubois B . Delayed response tasks in basal ganglia lesions in man: further evidence for a striato-frontal cooperation in behavioural adaptation. Neuropsychologia. 1996; 34(7):709-21. DOI: 10.1016/0028-3932(95)00143-3. View

16.

Rubia K, Smith A, Brammer M, Taylor E . Right inferior prefrontal cortex mediates response inhibition while mesial prefrontal cortex is responsible for error detection. Neuroimage. 2003; 20(1):351-8. DOI: 10.1016/s1053-8119(03)00275-1. View

17.

Caligiore D, Mannella F, Arbib M, Baldassarre G . Dysfunctions of the basal ganglia-cerebellar-thalamo-cortical system produce motor tics in Tourette syndrome. PLoS Comput Biol. 2017; 13(3):e1005395. PMC: 5373520. DOI: 10.1371/journal.pcbi.1005395. View

18.

Brass M, Derrfuss J, Forstmann B, von Cramon D . The role of the inferior frontal junction area in cognitive control. Trends Cogn Sci. 2005; 9(7):314-6. DOI: 10.1016/j.tics.2005.05.001. View

19.

Buccino G, Vogt S, Ritzl A, Fink G, Zilles K, Freund H . Neural circuits underlying imitation learning of hand actions: an event-related fMRI study. Neuron. 2004; 42(2):323-34. DOI: 10.1016/s0896-6273(04)00181-3. View

20.

Iacoboni M, Woods R, Brass M, Bekkering H, Mazziotta J, Rizzolatti G . Cortical mechanisms of human imitation. Science. 2000; 286(5449):2526-8. DOI: 10.1126/science.286.5449.2526. View