Frontal Release Signs Linked to Future Dementia Risk in Older Adults
Key Clinical Summary
- Older adults with 2 or more frontal release signs (FRS) had a higher risk of developing dementia compared with those without multiple FRS.
- In a cohort of 873 participants aged 70 years and older, FRS positivity was associated with future cognitive decline among individuals with intact cognition at baseline.
- Findings suggest that neurological examination for primitive reflexes may serve as an adjunct to established cognitive screening measures in clinical practice.
The presence of frontal release signs (FRS), primitive reflexes that reemerge with neurodegeneration or brain injury, may help identify older adults at increased risk for future cognitive decline, according to a cohort study published in JAMA Network Open. Researchers at the University of Kentucky Alzheimer Disease Research Center (UK ADRC) found that FRS detected during routine neurological examinations were associated with progression to dementia among older adults with intact cognition.
Study Findings
FRS are primitive reflexes, including the snout, grasp, and palmomental reflexes, that normally disappear during brain maturation but may reappear in the setting of neurological disease. While previous studies have linked these signs to dementia, their prognostic value in early cognitive decline has remained uncertain.
To address this question, investigators analyzed longitudinal data collected between 2005 and 2024 through the Uniform Data Set at the UK ADRC. The study included 873 research participants aged 70 years or older who were classified at baseline as either cognitively intact or mildly impaired. All participants underwent at least 2 annual assessments, including standardized neurological examinations evaluating FRS.
The primary analysis examined whether the presence of multiple FRS predicted future cognitive decline. Researchers defined participants with 2 or more frontal release signs as FRS positive.
At baseline, 59 of 672 participants (8.8%) with intact cognition and 48 of 201 participants (23.9%) with mild impairment were FRS positive. Among individuals who were cognitively intact at baseline, FRS positivity was associated with an increased risk of developing dementia during follow-up (hazard ratio, 1.78; 95% CI, 1.02-3.09). More participants who were FRS positive progressed to dementia (25.4%) compared with participants who were not FRS positive (14.5%).
Clinical Implications
The study highlights the potential value of incorporating assessment of frontal release signs into routine neurological examinations of older adults. Because FRS testing is simple, noninvasive, and can be performed during a standard clinical evaluation, it may offer clinicians another method for identifying patients who warrant closer cognitive surveillance.
However, the authors do not suggest replacing established cognitive assessments with FRS evaluation. Rather, the findings support using these neurological signs as a complementary tool alongside cognitive screening measures.
For patients who are cognitively normal but demonstrate multiple frontal release signs, clinicians may consider more careful longitudinal follow-up and heightened awareness of potential cognitive changes.
Expert Commentary
“Ultimately, this cohort study’s findings suggest that the widespread examination of FRS in the aging population has ecological validity as a tool to augment preclinical detection of impending cognitive decline,” wrote Lauren G. Bojarski, DO, University of Kentucky Sanders-Brown Center on Aging, Lexington, Kentucky, and study coauthors.
“While not supplanting neuropsychological testing or the use of diagnostic biomarkers, FRS may serve as accessory evidence heightening clinical suspicion of imminent cognitive decline as we search for more effective and practical methods to screen the aging population at risk for development of a degenerative dementia,” they concluded.
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