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Reflex Tongue Protrusion as a Novel Release Phenomenon in Dementia in Adulthood

A 79-year-old right-handed man diagnosed with Alzheimer’s dementia nine years prior and living in a nursing home was admitted to hospital with respiratory sepsis. On examination, he was globally aphasic and not obeying commands. Incidentally, when any object was seen to approach his mouth, there was involuntary and immediate anterior protrusion of the tongue followed by withdrawal of the tongue back into the mouth (Video 1). This abnormal movement was stereotypical and highly reproducible. Grasp, snout, and palmomental reflexes were also present. Deep tendon reflexes were present and normal throughout. Plantar reflexes were downgoing. There were no obvious cranial nerve deficits. There was no evidence of extrapyramidal signs (i.e., chorea, dystonia, dyskinesia, myoclonus, bradykinesia or rigidity). Although unable to coordinate the use of a straw, the patient was able to chew and swallow effectively, maintaining a soft diet with regular fluids without overt signs of aspiration or unintentional weight loss. Magnetic resonance imaging of the brain showed generalized atrophy without lobar predominance, and chronic microvascular ischaemia without restricted diffusion or contrast enhancement.