Extrapyramidal Signs in Patients With Probable Alzheimer Disease

Abstract

In this cohort, the presence or absence of EPSs is related to time to institutionalization, but not to severe cognitive or functional impairment or death. However, when severity of the extrapyramidal phenomenon is taken into account, EPSs are related to functional decline. Further, it appears that a subgroup of patients with AD with EPSs, where cogwheel rigidity and tremors are the core signs, can have a worse outcome.

Motor signs predict poor outcomes in Alzheimer disease

“…This cutoff was chosen because 1) it marks the transition from the moderate to severe stage of the disease and therefore represents a clinically significant landmark and 2) similar outcome scores have been previously used. 2,32 Exploratory analyses of neighboring endpoints (i.e., CMMS ≤ 15) did not change the results.…”

“…This cutoff was chosen because 1) it marks the transition from the moderate to severe stage of the disease and therefore represents a clinically significant landmark and 2) similar outcome scores have been previously used. 2,32 Exploratory analyses of neighboring endpoints (i.e., CMMS ≤ 15) did not change the results.Functional outcome-Functional capacity was assessed using the Blessed Dementia Rating Scale (BDRS) parts I and II. 33 The range is between 0 and 17, with higher scores indicating worse functional status.…”

“…[1][2][3][4] Because their exact mechanism and anatomic location of origin is not clear, in this article we use the term motor Address correspondence and reprint requests to Dr. Nikolaos Scarmeas, Columbia University Medical Center, 622 West 168th street, PH 19th floor, New York, NY 10032; ns257@columbia.edu.…”

“…5 In addition, information about presence of motor signs in AD is important because they may predict cognitive [6][7][8][9] and functional 2,10 decline, institutionalization, 2,10 and death. [10][11][12][13][14][15][16] However, some reports failed to detect significant associations for cognition, 2,[17][18][19] function, 17,18,20 institutionalization, 20 or mortality. 21,22 Many factors contribute to the variability in reported associations between motor signs and AD outcomes.…”

Assessment of Suspected Dementia

“…While a few investigators have claimed that the presence of EPS predicts more rapid decline, 76 others have failed to confirm this finding. 70,110,111 Overall, the main role of the neurological examination is to establish the presence of extrapyramidal and motor abnormalities suggesting an alternative, nonAlzheimer etiology such as vascular disease or DLB. Abnormalities on the neurological exam, particularly lateralizing signs can be a strong indicator of a vascular or mixed dementia.…”