Contractures and loss of function in patients with Alzheimer's disease.
OBJECTIVE
To investigate the prevalence of contractures in patients with Alzheimer's disease and to assess possible associations between contractures and cognitive and functional decline in Alzheimer's disease.


METHODS
Case series.


METHODS
Subjects from an outpatient, university-based, dementia research center, followed, when necessary, into residential home and nursing home settings.


METHODS
A consecutive sample of 161 patients (48 men, 113 women; mean age 75.3 +/- 8.6 years) with a clinical diagnosis of probable Alzheimer's disease and with deficits in basic activities of daily living or more severe functional impairment.


METHODS
For cognition, the Mini-Mental State Examination (MMSE); for functioning, the Functional Assessment Staging Scale (FAST); contracture is defined as a decrease of 50% or more of the normal passive range of motion of the joint.


RESULTS
Prevalence of contractures was correlated highly with degree of functional impairment (r = .70, P < .001). More than three quarters of patients who had lost the ability to walk manifested contractures; however, contractures were found in fewer than 11% of all ambulatory patients examined. When present, contractures involved more than one extremity in 97% of cases and involved all four extremities in more than two-thirds of patients.


CONCLUSIONS
Joint contractures are very common in the severe stages of Alzheimer's disease. More than a quarter of a million institutionalized residents in US nursing homes are likely to be afflicted by this potentially painful and disfiguring condition. Possible pathophysiology and contributing factors and possible means of intervention for this major source of disability are discussed.
Souren
L E
LE
Aging and Dementia Research Center, NYU Medical Center, NY 10016, USA.
Franssen
E H
EH
Reisberg
B
B
D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000453:epidemiology* / Q000503:physiopathology / Q000523:psychology; D003071:Cognition / Q000502:physiology; D003286:Contracture / Q000453:epidemiology* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007592:Joint Diseases / Q000453:epidemiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009069:Movement Disorders / Q000453:epidemiology / Q000503:physiopathology; D009735:Nursing Homes; D015995:Prevalence; D011597:Psychomotor Performance / Q000502:physiology; D016059:Range of Motion, Articular / Q000502:physiology; D012044:Regression Analysis; D012111:Residence Characteristics; D012737:Sex Factors; D016138:Walking / Q000502:physiology