Motor signs predict poor outcomes in Alzheimer disease

Abstract

Objective-To examine whether the presence of motor signs has predictive value for important outcomes in Alzheimer disease (AD). Methods-A total of 533 patients with AD at early stages (mean Folstein Mini-Mental StateExamination [MMSE] 21/30 at entry) were recruited and followed semiannually for up to 13.1 years (mean 3) in five University-based AD centers in the United States and European Union. Four outcomes, assessed every 6 months, were used in Cox models: cognitive endpoint (Columbia Mini-Mental State Examination ≤ 20/57 [∼MMSE ≤ 10/30]), functional endpoint (Blessed Dementia Rating Scale ≥ 10), institutionalization equivalent index, and death. Using a standardized portion of the Unified PD Rating Scale (administered every 6 months for a total of 3,149 visit-assessments, average 5.9 per patient), the presence of motor signs, as well as of individual motor sign domains, was examined as time-dependent predictor. The models controlled for cohort, recruitment center, sex, age, education, a comorbidity index, and baseline cognitive and functional performance.Results-A total of 39% of the patients reached the cognitive, 41% the functional, 54% the institutionalization, and 47% the mortality endpoint. Motor signs were noted for 14% of patients at baseline and for 45% at any evaluation. Their presence was associated with increased risk for cognitive decline (RR, 1.72; 95% CI, 1.24 to 2.38), functional decline (1.80 [1.33 to 2.45]), institutionalization (1.68 [1.26 to 2.25]), and death (1.38 [1.05 to 1.82]). Tremor was associated with increased risk for reaching the cognitive and bradykinesia for reaching the functional endpoints. Postural-gait abnormalities carried increased risk for institutionalization and mortality. Faster rates of motor sign accumulation were associated with increased risk for all outcomes.Conclusions-Motor signs predict cognitive and functional decline, institutionalization, and mortality in Alzheimer disease. Different motor sign domains predict different outcomes.Motor signs are commonly observed in Alzheimer disease (AD). [1][2][3][4] Because their exact mechanism and anatomic location of origin is not clear, in this article we use the term motor Address correspondence and reprint requests to Dr. Nikolaos Scarmeas, Columbia University Medical Center, 622 West 168th street, PH 19th floor, New York, NY 10032; ns257@columbia.edu. NIH Public Access Author ManuscriptNeurology. Author manuscript; available in PMC 2011 January 27. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript signs to refer to what is usually described in the literature as extrapyramidal signs or parkinsonian signs or parkinsonism.As compared to patients with AD without motor signs, patients with AD with motor signs have higher annual total cost of care. 5 In addition, information about presence of motor signs in AD is important because they may predict cognitive 6-9 and functional 2,10 decline, institutionalization, 2,10 and death. [10][11][12][13][14][15][16] However, some reports failed to d...

Mediterranean diet and Alzheimer disease mortality

“…25,26,[36][37][38][39][40][41][42][43][44] Many studies have reported shorter survival for men with dementia as compared with women. 42, 45-48 Regarding ethnic differences, the literature is mixed, with some studies finding higher mortality for Caucasians with AD 26,49 and some others reporting no race differences.…”

Risk Factors for Disease Progression in Alzheimer's Disease

“…Among those are especially early signs of the motor system. They are predictors of fast decline as well as poor outcome (Mangone, 2004;Portet et al, 2009;Scarmeas et al, 2005). Another potential indicator / predictor of a rapid disease course might be the presence of psychotic symptoms (Wilkosz et al 2010).…”

Quantitative Measurements of Motor Function in Alzheimer’s Disease, Frontotemporal Dementia, and Dementia with Lewy Bodies: A Proof-of-Concept Study

“…Presence of extrapyramidal symp toms in studies with AD patients has been found to increase with disease progression [6, 7], and to predict faster cognitive and functional decline, institutionalization, and eventually death [7, 8]. Different motor symptoms have been associated with different outcomes, and the presence and rating of motor symptoms have varied among studies.…”

“…Different motor symptoms have been associated with different outcomes, and the presence and rating of motor symptoms have varied among studies. Tremor, for instance, has been associated with increased risk of cognitive decline [8] while it in other studies has been found to be the least frequent motor sign to develop in AD patients [6-9]. In the heterogeneous group of FTD, parkinsonism has been reported in up to 20% of patients suffering from the behavioral variant FTD, less often in patients with the non-fluent variant primary progressive aphasia FTD, and in the semantic variant FTD [10].…”