FRONTAL RELEASE SIGNS IN PARKINSON DISEASE (PD) PATIENTS PRESENTING TO A TERTIARY CARE HOSPITAL IN ISLAMABAD

Abstract

Objective: To determine the frequency of frontal release signs (FRSs) among patients with Parkinson disease and assess their association with disease severity, cognitive performance, and selected clinical characteristics. Study Design and Setting: Cross-sectional study conducted at a tertiary care hospital in Islamabad. Methodology: A total of 102 patients diagnosed with Parkinson disease were included. Demographic and clinical information, including age, sex, disease duration, Hoehn and Yahr stage, Mini-Mental State Examination (MMSE) score, and history of visual hallucinations, was recorded. Frontal release signs were assessed through neurological examination, including the glabellar tap, snout, and palmomental reflexes. The frequency of individual signs and the number of positive signs were determined. Associations between FRSs and selected clinical characteristics were evaluated using appropriate statistical tests, with statistical significance set at p less than 0.05. Results: The mean age of participants was 66.4 ± 8.1 years, and 61 (59.8%) were male. At least one frontal release sign was observed in 77 (75.5%) patients. The glabellar tap reflex was the most frequent sign, present in 58 (56.9%) patients, followed by the palmomental reflex in 49 (48.0%) and the snout reflex in 43 (42.2%). Patients with frontal release signs had lower mean MMSE scores than those without these signs (24.1 ± 3.5 versus 26.9 ± 3.1; p = 0.001). The frequency of FRSs increased across higher Hoehn and Yahr stages (p = 0.04). A significant association was also observed between FRS presence and longer disease duration (p = 0.02). No statistically significant association was found with sex or visual hallucinations. Conclusion: Frontal release signs were frequently observed in patients with Parkinson disease, with the glabellar tap reflex being the most common. Their presence was associated with greater disease severity, longer disease duration, and lower cognitive screening scores. Systematic assessment of these signs may provide supplementary information during neurological evaluation; however, further studies are required to establish their independent clinical significance.