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Progression of Parkinsonism and Loss of Cognitive Function in Alzheimer Disease
Robert S. Wilson, PhD;
David A. Bennett, MD;
David W. Gilley, PhD;
Laurel A. Beckett, PhD;
Julie A. Schneider, MD;
Denis A. Evans, MD
Arch Neurol. 2000;57:855-860.
Objective To assess the relation between parkinsonism and cognitive function in Alzheimer disease from cross-sectional and longitudinal perspectives.
Design Prospective cohort study with annual clinical evaluations during a 4-year period.
Setting Alzheimer disease clinic in an urban medical center.
Participants Four hundred ten persons with clinically diagnosed Alzheimer disease.
Main Outcome Measures Global and specific measures of cognitive function and parkinsonism.
Results Higher levels of parkinsonism at baseline were reliably associated with lower levels of cognitive function at baseline and with more rapid cognitive decline during the 4-year study period. However, the associations were small, with baseline parkinsonism accounting for less than 10% of the variation either in baseline cognitive function or in the rate of cognitive decline. By contrast, rates of change in parkinsonism and cognitive function were strongly correlated, with 70% or more shared variance in the rates of change in many models. The association was observed with diverse measures of cognition and parkinsonism and was not explained by demographic variables or use of neuroleptic medications.
Conclusion In Alzheimer disease, progressive worsening of parkinsonism is more strongly associated with cognitive decline than previously recognized.
From the Rush Alzheimer's Disease Center and Rush Institute for Healthy Aging, and the Departments of Neurological Sciences (Drs Wilson, Bennett, Gilley, and Schneider) and Medicine (Drs Beckett and Evans), Rush University and Rush-Presbyterian-St Luke's Medical Center, Chicago, Ill.
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