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Florence Portet, MD, PhD; Nikolaos Scarmeas, MD, MS; Stephanie Cosentino, PhD; Elisabeth P. Helzner, PhD; Yaakov Stern, PhD

Arch Neurol. 2009;66(9):1120-1126.

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).

Main 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.

Author Affiliations: Memory Research Resource Center for Alzheimer's Disease, Neurology Department, U 888 Institut National de la Santé et de la Recherche Médicale, Centre Hospitalier Universitaire de Montpellier, France (Dr Portet); and Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York, New York (Dr Scarmeas, Cosentino, Helzner, and Stern).

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