Applause sign (clap test) – updated research

Here’s some new research that probably speaks to the results that Dubois got in ’05 when he and other French researchers said that the “applause sign helps to discriminate PSP from FTD and PD.”

This newly-published research looks at those with PD and “various forms of atypical parkinsonism.” (I’ll have to get the full article to know which forms were included.) These Dutch researchers found: “Although the proportion with an abnormal clapping test was significantly higher in atypical parkinsonism, the clapping test did not discriminate well between Parkinson’s disease and atypical parkinsonism.”

Journal of Neurology. 2007 Oct 15; [Epub ahead of print] Diagnostic accuracy of the clapping test in Parkinsonian disorders.

Abdo WF, van Norden AG, de Laat KF, de Leeuw FE, Borm GF, Verbeek MM, Kremer PH, Bloem BR.
Parkinson Centre Nijmegen (ParC), Institute of Neurology, Radboud University Nijmegen Medical Centre, The Netherlands.

BACKGROUND : To determine the diagnostic value of the clapping test, which has been proposed as a reliable measure to differentiate between progressive supranuclear palsy (where performance is impaired) and Parkinson’s disease (where performance should be normal).

METHODS : Our study group included a large cohort of consecutive outpatients including 44 patients with Parkinson’s disease, 48 patients with various forms of atypical parkinsonism and 149 control subjects. All subjects performed the clapping test according to a standardized protocol.

RESULTS : Clapping test performance was normal in all control subjects, and impaired in 63% of the patients with atypical parkinsonism. Unexpectedly, we also found an impaired clapping test in 29% of the patients with Parkinson’s disease.

CONCLUSION : Although the proportion with an abnormal clapping test was significantly higher in atypical parkinsonism, the clapping test did not discriminate well between Parkinson’s disease and atypical parkinsonism.

PubMed ID#: 17934886

The “applause sign” is where you ask someone who might have PSP to clap. While clapping, you tell them to stop. The person with PSP continues to clap; it takes them awhile to stop.

In a study done by Dubois, 30 out of 42 patients diagnosed with PSP could not stop applauding immediately after being told to stop. Interestingly, none of those with FTD or PD had trouble stopping.

Here’s the abstract of the Dubois article (published 6/05 in Neurology):

*Neurology. 2005 Jun 28;64(12):2132-3.

“Applause sign” helps to discriminate PSP from FTD and PD.

Dubois B, Slachevsky A, Pillon B, Beato R, Villalponda JM, Litvan I.
INSERM, Fédération de Neurologie, Hôpital de la Salpêtrière, Paris, France.

“Applause sign” helps to discriminate PSP from FTD and PD
The “applause sign” is a simple test of motor control that helps to differentiate PSP from frontal or striatofrontal degenerative diseases. It was found in 0/39 controls, 0 of 24 patients with frontotemporal dementia (FTD), 0 of 17 patients with Parkinson disease (PD), and 30/42 patients with progressive supranuclear palsy (PSP). It discriminated PSP from FTD (p < 0.001) and PD (p < 0.00). The “three clap test” correctly identified 81.8% of the patients in the comparison PSP and FTD and 75% of the patients in the comparison of PSP and PD.

PubMed ID#: 15985587 (see

“Taking Care of Your Parents — and Yourself”

This post may be of interest to adult children caregivers.

An article titled “Taking Care of Your Parents — and Yourself” was recently published in MORE magazine. It addresses “how to play family caregiver to an aging parent without sacrificing your own wellbeing.” Support group member Linda mentioned this article to me.

The “sanity-saving measures” suggested include:

* Find a Sympathetic Ear
* Acknowledge the Past
* Assemble a Team
* Make Your Limits Clear
* Be Fair About Work, Money, and Power
* Consult an Elder Lawyer

I think this article would be a good basis for a family discussion (with all siblings there) about caring for a parent with a neurodegenerative disorder.



Editor’s Note: Article is no longer available

Taking Care of Your Parents — and Yourself
By Katy Butler
MORE magazine
May 2007

How to play family caregiver to an aging parent without sacrificing your own well-being.

With “medical miracles” extending life spans, people over 85 are America’s fastest-growing age group. Half of them have Alzheimer’s disease or some other type of brain impairment, a quarter are in nursing homes, and many others need help with such practical activities as bill-paying, yardwork, driving, laundry, cooking, dressing, and showering.

While men pitch in more than they used to, 60 percent of America’s 50 million unpaid family caregivers are women. Typical, according to a recent survey conducted by the American Association of Retired Persons and the National Family Caregivers Association, is a married, employed, 46-year-old woman looking after a widowed mother who doesn’t live in the same house.

Sound familiar? Think this might be you someday? Here are some sanity-saving measures.

Find a Sympathetic Ear
Don’t kid yourself. Honored as you may be to help, this work takes its toll. Long-term caregivers struggle with anger and guilt, and are unusually vulnerable to insomnia, depression, anxiety, neck and back pain, and even illness and premature death. Vent to a friend, partner, therapist, or online. bulletin board or support group, such as those run by local Alzheimer’s associations (800-272-3900 or or the Family Caregiver Alliance (

“Ambivalence is natural,” says psychologist Barry J. Jacobs, a medical family therapist and author of The Emotional Survival Guide for Caregivers. “I’m sure there are people out there who are happily selfless, but more commonly, people adopt that stance because they think they’re supposed to. They wind up burning out.”

Acknowledge the Past
Were you the family’s black sheep? Its quiet martyr? Did you feel slighted in favor of a sibling? “Caregiving gives you the opportunity to repeat the same patterns and feel just as angry and disappointed as ever, or to do things differently and finally resolve issues that have gone unresolved,” says psychotherapist Roberta Satow, who interviewed 50 midlife adults for Doing the Right Thing: Taking Care of Your Elderly Parents Even If They Didn’t Take Care of You. “Unless you deal with your old feelings, you can’t cope with the demands being put on you now.”

Assemble a Team
If you have siblings, Jacobs and Satow recommend convening meetings, either face-to-face or via e-mail or conference call. Make a list of tasks, and find out what each person is willing to do. Those living far away may give money or handle paperwork or medical advocacy, while those close by offer hands-on care. Don’t let brothers off the hook.

Make Your Limits Clear
“Taking care of an elderly parent is an important priority, but it’s not the only one,” Satow says. Balance commitments. Don’t sacrifice your relationships or your kids’ welfare. Do what you can when you can, and say no when you must. It’s better to do a little consistently than to exhaust yourself and withdraw altogether. If you can’t afford to hire help, check out local agencies on aging, which often offer respite services for lower-income families.

Be Fair About Work, Money, and Power
Family therapist Terry Hargrave has seen daughters sacrifice a decade or more to caring for a parent and then receive the same inheritance as siblings who did nothing but micromanage from afar. In other cases, daughters provided daily hands-on care while a sibling who provided no other help controlled — and sometimes withdrew from — the parent’s bank account.

Hargrave, author of Loving Your Parents When They Can No Longer Love You, suggests radical ground rules. First, give the money and power to whoever is doing the active caretaking. Second, if funds are available, pay the primary caretaker for time and lost wages, either via a regular paycheck or a bigger share of the inheritance. The payments, Hargrave says, should be at below-market rates for the work provided, and all family members should know about them up front.

“Taking on the caregiving burden alone is unfair, and compensation helps with that sense of injustice,” he says. Although caregivers often strongly resist being paid, “It’s about fairness,” he says. “People can be dishonest about this all they want to, but when they have some extra money to go out to dinner, they feel better.”

Consult an Elder Lawyer
If you plan ahead, inheritances can sometimes be structured to reduce the bite from the I.R.S. A power-of-attorney-in-fact document (revocable by your parents as long as they’re competent) gives you the right to handle their finances without formal conservatorship. A durable power-of-attorney for healthcare is crucial when it’s time to shift from high-tech, life-extending medicine to palliative care.

Originally published in MORE magazine, May 2007.