Can the 'head-turning sign' be a clinical marker of Alzheimer's disease?

Dement Geriatr Cogn Dis Extra. 2011 Jan;1(1):310-7. doi: 10.1159/000332605. Epub 2011 Oct 11.


Aims: To investigate the incidence and severity of the 'head-turning sign' (HTS), i.e. turning the head back to the caregiver(s) for help, in patients with various dementias and discuss its clinical specificity in Alzheimer's disease (AD).

Methods: WE INVESTIGATED THE INCIDENCE AND SEVERITY OF HTS WHILE ADMINISTERING A SHORT COGNITIVE TEST (THE REVISED HASEGAWA DEMENTIA RATING SCALE: HDSR) in outpatients with AD [125 patients, including 4 with AD + vascular dementia (VaD)], 8 with amnestic mild cognitive impairment (aMCI), 34 with dementia with Lewy bodies (DLB), 8 with progressive supranuclear palsy (PSP) and 6 with VaD.

Results: Significant differences were found among the 5 disease groups in the incidence and severity of HTS, and HDSR scores. Given the significant differences between AD and DLB in post hoc analyses, patients were dichotomized into AD-related (AD and aMCI) and AD-nonrelated (PSP, DLB and VaD) groups. Both incidence (41 vs. 17%, p = 0.002) and severity of HTS (0.80 ± 1.13 vs. 0.21 ± 0.60, p = 0.001) were significantly higher in the AD-related group, while average age and HDSR scores were comparable between both groups. AD-related disease, female gender and low HDSR score contributed significantly to the occurrence and severity of HTS.

Conclusions: HTS can be a clinical marker of AD and aMCI, and may represent a type of excuse behavior as well as a sign of dependency on and trust in the caregivers.

Keywords: Amnestic mild cognitive impairment; Behavioral symptoms; Caregivers; Dementia with Lewy bodies; Excuse behavior; Female preponderance; Head-turning sign; Neuropsychological signs; Progressive supranuclear palsy; Vascular dementia.