Motor signs during the course of Alzheimer disease.
ABSTRACT Motor signs (MOSIs) are common in Alzheimer disease (AD) and may be associated with rates of cognitive decline, mortality, and cost of care.
To describe the progression and identify predictors of individual MOSIs in AD.
A cohort of 474 patients with AD at early stages was followed semiannually for up to 13.1 years (mean 3.6 years) in five centers in Europe and the United States. MOSIs were rated using a standardized portion of the Unified Parkinson's Disease Rating Scale. Overall, 3,030 visits/assessments of MOSIs (average 6.4/patient) were performed. Prevalence and incidence rates were calculated, and cumulative risk graphs were plotted for individual non-drug-induced MOSI domains. Rates of change over time taking into account potential covariates were also estimated. With use of each MOSI domain as outcome in Cox models, predictors of MOSI incidence were identified.
At least one MOSI was detected in 13% of patients at first examination and in 36% for the last evaluation. Total MOSI score increased at an annual rate of 3% of total possible score. Rates of annual change for speech/facial expression (4%), rigidity (2.45%), posture/gait (3.9%), and bradykinesia (3.75%) were of similar magnitude, and their occurrence increased from first (3 to 6%) to last (22 to 29%) evaluation. Tremor was less frequent throughout the course of the disease (4% at first and 7% at last evaluation) and worsened less (0.75% increase/year).
Most motor signs occur frequently and progress rapidly in Alzheimer disease. Tremor is an exception in that it occurs less frequently and advances at slower rates.
Article: The association between parkinsonism, Alzheimer's disease, and mortality: a comprehensive approach.[show abstract] [hide abstract]
ABSTRACT: The impact of parkinsonism on survival in older persons independent of dementia is not well understood. Participants in the clinical examination of the Canadian Study of Health and Aging who had parkinsonism and were older than age 65 were identified. The impact of parkinsonism on 5-year survival was determined for a combined cohort with and without dementia, and a stratified analysis was then conducted for the subgroups with Alzheimer's disease (AD) and those without dementia. Subjects with a previous diagnosis of Parkinson's disease and those prescribed drugs causing extrapyramidal side effects were excluded. A total of 721 subjects with AD and 1705 subjects without dementia were examined. After adjusting for age and residential status (community vs institution), parkinsonism was associated with poorer survival in the combined cohort (risk ratio 1.51; 95% CI, 1.22-1.85), in those with AD (risk ratio 1.34; 95% CI, 1.02-1.76), and those without dementia (risk ratio 1.54; 95% CI, 1.11-2.15). In the combined cohort, parkinsonism remained independently associated with higher mortality after adjusting for AD status (risk ratio 1.39; 95% CI, 1.13-1.72). In the subgroup with AD, parkinsonism remained associated with poorer survival after adjusting for severity of cognitive impairment (risk ratio 1.33; 95% CI. 1.04-1.74). Parkinsonism is significantly associated with poorer survival in older persons, regardless of whether they have dementia.Journal of the American Geriatrics Society 05/2000; 48(4):422-5. · 3.74 Impact Factor