This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (10)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in this journal  Topic Collections  • Alzheimer Disease  • Lewy Body Disease  • Alert me on articles by topic  Social Bookmarking   What's this?

Mary N. Haan, MPH, DrPH; William J. Jagust, MD; Douglas Galasko, MD; Jeffrey Kaye, MD

Arch Neurol. 2002;59:588-593.

Background  Patients with Alzheimer disease (AD) who have psychiatric and parkinsonian symptoms experience faster cognitive deterioration and shorter survival vs those without such disease features. Extrapyramidal signs (EPSs) in particular have been associated with the presence of Lewy bodies (LBs) on autopsy and with poorer survival in patients with AD. Lewy bodies found at autopsy are not always correlated with EPSs during late life.

Objective  To determine whether the association between LBs and age at death is modified by the presence of EPSs, hallucinations, or delusions.

Design  An autopsy series of patients with clinically diagnosed AD.

Settings  Three AD clinics (San Diego and Sacramento, Calif, and Portland, Ore).

Patients  Data on 379 patients with a clinical diagnosis of AD who were initially assessed between May 1, 1984, and August 1, 1996, and who were autopsied between January 1, 1990, and April 1, 1998, were pooled from 3 AD centers.

Main Outcome Measures  Presence of LBs on autopsy and differences in age at death in those with EPSs, LBs, or both.

Results  Individuals with EPSs at initial assessment were more than 3 times as likely to have LBs at autopsy than were those without EPSs. Age at death was younger in those with LBs and EPSs than in those with LBs only and those without EPSs or LBs.

Conclusions  The presence of EPSs in patients with AD indicates worse prognosis and may be related to underlying LBs. The presence of EPSs is a strong predictor of LBs.

From the Department of Epidemiology, University of Michigan, School of Public Health, Ann Arbor (Dr Haan); the Department of Neurology, University of California, School of Medicine, Davis (Dr Jagust) and San Diego (Dr Galasko); and the Department of Neurology, Oregon Health Sciences University, and Portland Veterans Affairs Medical Center, Portland (Dr Kaye).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED ARTICLE

Archives of Neurology Reader's Choice: Continuing Medical Education
Arch Neurol. 2002;59(4):655-656.
FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Parkinsonian signs in subjects with mild cognitive impairment
Boyle et al.
Neurology 2005;65:1901-1906.
ABSTRACT | FULL TEXT  

Motor signs predict poor outcomes in Alzheimer disease
Scarmeas et al.
Neurology 2005;64:1696-1703.
ABSTRACT | FULL TEXT  

The pathology of the substantia nigra in Alzheimer disease with extrapyramidal signs
Burns et al.
Neurology 2005;64:1397-1403.
ABSTRACT | FULL TEXT  

Motor signs during the course of Alzheimer disease
Scarmeas et al.
Neurology 2004;63:975-982.
ABSTRACT | FULL TEXT  

Influence of Alzheimer pathology on clinical diagnostic accuracy in dementia with Lewy bodies
Merdes et al.
Neurology 2003;60:1586-1590.
ABSTRACT | FULL TEXT