August 7, 2017 E-Pearl of the Week: Applause sign

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August 7, 2017

Applause sign

Applause sign helps to differentiate progressive supranuclear palsy (PSP) from frontotemporal dementia (FTD) and Parkinson disease (PD). To elicit applause sign, patients are asked to clap three times. If the patient claps greater than three times, that is considered a positive sign. In one study, the applause sign was positive only in the PSP group.1 However, another study does not confirm the specificity of applause sign for PSP, FTD or PD. This suggests that applause sign should be interpreted as a sign of frontal lobe dysfunction rather than a form of apraxia.2


  1. Dubois B, Slachevsky A, Pillon B, et al. Applause sign helps to discriminate PSP from FTD and PD. Neurology 2005; 64: 2132-2133.
  2. Luzzi S1, 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: 830-833.

Submitted by Malik M. Adil, MD, Neurology Resident - Ochsner Clinic Foundation.

Dr. Adil is a member of the Resident & Fellow section of Neurology.

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