2009 Articles

Extrapyramidal Signs Before and After Diagnosis of Incident Alzheimer Disease in a Prospective Population Study

Portet, Florence; Scarmeas, Nikolaos; Cosentino, Stephanie; Helzner, Elizabeth P.; Stern, Yaakov

Background: Extrapyramidal signs (EPSs) are commonly accepted as a feature of Alzheimer disease (AD) and may influence both the profile of impairment and prognosis. Objective: To examine rates of occurrence and risk factors for all types of EPSs and to describe the impact of EPSs over time on the clinical course of AD. Design: Longitudinal study. Setting: The Washington Heights Hamilton Heights Inwood Columbia Aging Project. Patients: A total of 388 patients with incident AD (mean age, 79 years; 71.4% female). Outcome Measures: Extrapyramidal signs rated by means of a standardized portion of the Unified Parkinson's Disease Rating Scale; prevalence and incidence rates and cumulative risk for non–drug-induced EPSs; and rates of change in EPSs over time, taking into account potential covariates. Results: Extrapyramidal signs were detected in 12.3% of patients at first evaluation and 22.6% at last evaluation. In a multivariate-adjusted generalized estimating equation model of change, total EPS score increased at an annual rate of 1.3%. Women (relative risk [RR], 1.57; P = .03), older patients (RR, 1.03; P = .02), and those with EPSs at baseline (RR, 2.07; P = .001) had greater rates of cognitive decline. Conclusions: Extrapyramidal signs occur frequently and progress significantly in AD. Patients with incident AD and concomitant EPSs have a greater rate of cognitive decline than do patients with incident AD but without EPSs.