Extrapyramidal signs in Alzheimer's disease: a 3-year follow-up study.
Occurrence of extrapyramidal signs was investigated in a follow-up study of 32 patients with probable Alzheimer's disease (AD). Bradykinesia and rigidity were observed in 39% and 11% of the neuroleptic-free patients at entry and in 72% and 61% at year 3, respectively. Tremor was not a predominant feature nor did its occurrence increase over time. Use of neuroleptics contributed to extrapyramidal signs; 75-100% of the neuroleptic-treated patients showed bradykinesia, rigidity or orofacial dyskinesia. The homovanillic acid (HVA) concentrations of the cerebrospinal fluid at entry were comparable to those of age-matched controls. Nor did HVA levels correlate with rigidity or bradykinesia in these early AD cases. Presence of bradykinesia or rigidity at the initial evaluation predicted more severe dementia and a poor prognosis over the period of 3 years, although interaction of initial clinical severity of dementia was significant. Of 15 patients with these signs 3 (20%) died and 8 (53%) needed institutional care, while of 17 patients without these signs only 1 (6%) died and 2 (12%) were institutionalized by year 3 (p less than 0.01).
Department of Neurology, University of Kuopio, Finland.
H
H
Soininen
V
V
Laulumaa
E L
EL
Helkala
P
P
Hartikainen
P J
PJ
Riekkinen
D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000134:cerebrospinal fluid / Q000150:complications* / Q000453:epidemiology / Q000401:mortality; D014150:Antipsychotic Agents / Q000009:adverse effects; D001480:Basal Ganglia Diseases / Q000134:cerebrospinal fluid / Q000453:epidemiology / Q000209:etiology*; D004298:Dopamine / Q000378:metabolism; D004409:Dyskinesia, Drug-Induced / Q000134:cerebrospinal fluid / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006719:Homovanillic Acid / Q000134:cerebrospinal fluid; D006801:Humans; D015994:Incidence; D007326:Institutionalization / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009127:Muscle Rigidity / Q000134:cerebrospinal fluid / Q000453:epidemiology / Q000209:etiology; D011237:Predictive Value of Tests; D011379:Prognosis; D012720:Severity of Illness Index
D014150:Antipsychotic Agents; D004298:Dopamine; D006719:Homovanillic Acid