{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T23:40:36Z","timestamp":1792798836056,"version":"4.5.0"},"reference-count":10,"publisher":"Georg Thieme Verlag KG","issue":"11","license":[{"start":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T00:00:00Z","timestamp":1792713600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arq Neuropsiquiatr"],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Parkinson's disease (PD) is a well-known neurodegenerative disease characterized by tremors, rigidity, and bradykinesia. In 1943, Frederic Hanes described the whistle-smile reflex (WSR), noting its absence in PD patients due to reduced facial movements.<\/jats:p>\n                  <jats:p>To assess the WSR's diagnostic performance.<\/jats:p>\n                  <jats:p>In the current cross-sectional study, we selected PD patients and healthy controls. They were filmed while asked to whistle, and a blinded physician assessed if the individuals smiled or not. Absence of smiling after whistling was considered a positive test. We stratified the smiling intensity into 4 groups. We calculated the odds ratio (OR) of the positive WSR in PD and asymptomatic patients, which was reported with CIs, sensitivity (SE), specificity (SP), positive predictive value (PPV), negative predictive value (NPV), and we plotted a receiver operating characteristic (ROC) curve.<\/jats:p>\n                  <jats:p>We identified 43 patients with PD (mean age\u2009=\u200963\u2009\u00b1\u200910 years; 30% of female subjects) and 44 asymptomatic controls (mean age\u2009=\u200964\u2009\u00b1\u200910 years; 51% of female subjects). The WSR test was positive in 35\/43 PD cases versus 7\/44 in the asymptomatic group (OR\u2009=\u200923.1; 95%CI\u2009=\u20097.6\u201370.5; SE\u2009=\u200981.4%; SP\u2009=\u200984.1%; PPV\u2009=\u200983.3%; NPV\u2009=\u200982.2%). When stratified considering the group with the least intense smile as a positive test, the test was positive in 42\/43 PD cases versus 23\/44 in the asymptomatic group (OR\u2009=\u200938.3; 95%CI\u2009=\u20094.8\u2013303.7; SE\u2009=\u200997.7%; SP\u2009=\u200947.7%; PPV\u2009=\u200964.6%; NPV\u2009=\u200995.4%).<\/jats:p>\n                  <jats:p>The WSR test showed a good performance in identifying PD patients; it may complement the physical examination, and its result may be a useful finding during the assessment of a patient with PD.<\/jats:p>","DOI":"10.1055\/s-0046-1829023","type":"journal-article","created":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T23:15:21Z","timestamp":1792797321000},"page":"001-005","source":"Crossref","is-referenced-by-count":0,"title":["The whistle-smile reflex in Parkinson's disease: an exploratory case-control study"],"prefix":"10.1055","volume":"84","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5754-3522","authenticated-orcid":false,"given":"Mateus","family":"Damiani Monteiro","sequence":"additional","affiliation":[{"name":"Universidade Federal de Ci\u00eancias da Sa\u00fade de Porto Alegre, Departamento de Neurologia, Porto Alegre RS, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5124-7877","authenticated-orcid":false,"given":"Eur\u00edpedes Gomes de","family":"Carvalho Neto","sequence":"additional","affiliation":[{"name":"Universidade Federal de Ci\u00eancias da Sa\u00fade de Porto Alegre, Departamento de Neurologia, Porto Alegre RS, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6740-4021","authenticated-orcid":false,"given":"Liana Lisboa","family":"Fernandez","sequence":"additional","affiliation":[{"name":"Universidade Federal de Ci\u00eancias da Sa\u00fade de Porto Alegre, Departamento de Neurologia, Porto Alegre RS, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1476-2105","authenticated-orcid":false,"given":"Arlete","family":"Hilbig","sequence":"additional","affiliation":[{"name":"Universidade Federal de Ci\u00eancias da Sa\u00fade de Porto Alegre, Departamento de Neurologia, Porto Alegre RS, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2950-7211","authenticated-orcid":false,"given":"Carlos Roberto de Mello","family":"Rieder","sequence":"additional","affiliation":[{"name":"Universidade Federal de Ci\u00eancias da Sa\u00fade de Porto Alegre, Departamento de Neurologia, Porto Alegre RS, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,10,23]]},"reference":[{"issue":"S 03","key":"ref1","doi-asserted-by":"publisher","first-page":"S497","DOI":"10.1002\/mds.22028","article-title":"The history of dopamine and levodopa in the treatment of Parkinson's disease","volume":"23","author":"S Fahn","year":"2008","journal-title":"Mov Disord"},{"issue":"9996","key":"ref2","doi-asserted-by":"publisher","first-page":"896","DOI":"10.1016\/S0140-6736(14)61393-3","article-title":"Parkinson's disease","volume":"386","author":"L V Kalia","year":"2015","journal-title":"Lancet"},{"issue":"06","key":"ref3","doi-asserted-by":"publisher","first-page":"681","DOI":"10.1136\/jnnp-2012-303993","article-title":"Facial bradykinesia","volume":"84","author":"M Bologna","year":"2013","journal-title":"J Neurol Neurosurg Psychiatry"},{"issue":"12","key":"ref4","doi-asserted-by":"publisher","first-page":"1591","DOI":"10.1002\/mds.26424","article-title":"MDS clinical diagnostic criteria for Parkinson's disease","volume":"30","author":"R B Postuma","year":"2015","journal-title":"Mov Disord"},{"issue":"14","key":"ref5","doi-asserted-by":"publisher","first-page":"1152","DOI":"10.1001\/jama.1943.62840140003007a","article-title":"TWO CLINICALLY USEFUL SIGNS: 1. THE WHISTLE-SMILE REFLEX IN THE PARKINSONIAN SYNDROME 2. THE \u2018NEPHRITIC STARE\u2019 IN CHRONIC NEPHRITIS","volume":"121","author":"F M Hanes","year":"1943","journal-title":"J Am Med Assoc"},{"issue":"10","key":"ref6","doi-asserted-by":"publisher","first-page":"1075","DOI":"10.1055\/s-0042-1758396","article-title":"The whistle-smile reflex: a missed sign","volume":"80","author":"M D Monteiro","year":"2022","journal-title":"Arq Neuropsiquiatr"},{"issue":"10","key":"ref7","doi-asserted-by":"publisher","first-page":"1314","DOI":"10.1002\/mdc3.14175","article-title":"The Whistle-Smile Reflex in Parkinson's Disease: A Cross-Sectional Study","volume":"11","author":"G Paparella","year":"2024","journal-title":"Mov Disord Clin Pract"},{"issue":"05","key":"ref8","doi-asserted-by":"publisher","first-page":"e0251057","DOI":"10.1371\/journal.pone.0251057","article-title":"Laughter and smiling facial expression modelling for the generation of virtual affective behavior","volume":"16","author":"M Mascar\u00f3","year":"2021","journal-title":"PLoS One"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1860","DOI":"10.1093\/brain\/aws093","article-title":"How does parkinsonism start? Prodromal parkinsonism motor changes in idiopathic REM sleep behaviour disorder","volume":"135","author":"R B Postuma","year":"2012","journal-title":"Brain"},{"issue":"13","key":"ref10","doi-asserted-by":"publisher","first-page":"1176","DOI":"10.1056\/NEJMoa2312323","article-title":"Trial of Lixisenatide in Early Parkinson's Disease","volume":"390","author":"W G Meissner","year":"2024","journal-title":"N Engl J Med"}],"container-title":["Arquivos de Neuro-Psiquiatria"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0046-1829023.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T23:15:23Z","timestamp":1792797323000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0046-1829023"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,23]]},"references-count":10,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2026,8,13]]},"published-print":{"date-parts":[[2026,11]]}},"alternative-id":["s00461829023"],"URL":"https:\/\/doi.org\/10.1055\/s-0046-1829023","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0004-282X","1678-4227"],"issn-type":[{"value":"0004-282X","type":"print"},{"value":"1678-4227","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,23]]}}}