title: Utility of extrapyramidal signs and psychosis as predictors of cognitive and functional decline, nursing home admission, and death in Alzheimer's disease: prospective analyses from the Predictors Study.
abstract: OBJECTIVE
  To examine whether either extrapyramidal signs or psychotic features are associated with more rapid progression of Alzheimer's disease.
  
  
  BACKGROUND
  It has been unclear whether extrapyramidal signs and psychosis are predictors of faster course or are simply late signs.
  
  
  METHODS
  Two hundred thirty-six patients with mild Alzheimer's disease were recruited in three cities and followed semiannually.
  
  
  RESULTS
  Using Cox proportional hazards models that adjusted for age, sex, disease severity, and estimated duration of illness at study entry, the presence of extrapyramidal signs at entry was associated with higher relative risk (RR) of reaching moderate cognitive (RR = 2.35, 95% CI = 1.12 to 4.92) or functional (RR = 2.31, 95% CI = 1.37 to 3.90) severity, nursing home entry (RR = 2.51, 95% CI = 1.32 to 4.76), or death (RR = 3.04, 95% CI = 1.31 to 7.05). Psychosis predicted only the functional end point (RR = 1.85, 95% CI = 1.18 to 2.90). Using regression models, modified Mini-Mental State scores declined 1.30 points (95% CI = 0.16 to 2.44) per 6-month interval, more among patients with than those without extrapyramidal signs; patients with psychosis declined 1.15 (95% CI = 0.52 to 1.77) more mMMS points per interval.
  
  
  CONCLUSIONS
  This study confirms extrapyramidal signs and psychosis as robust predictors of disease end points and rapid progression in Alzheimer's disease.
authors.affiliation: Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY.
authors.forename: Y
authors.initials: Y
authors.lastname: Stern
authors.forename: M
authors.initials: M
authors.lastname: Albert
authors.forename: J
authors.initials: J
authors.lastname: Brandt
authors.forename: D M
authors.initials: DM
authors.lastname: Jacobs
authors.forename: M X
authors.initials: MX
authors.lastname: Tang
authors.forename: K
authors.initials: K
authors.lastname: Marder
authors.forename: K
authors.initials: K
authors.lastname: Bell
authors.forename: M
authors.initials: M
authors.lastname: Sano
authors.forename: D P
authors.initials: DP
authors.lastname: Devanand
authors.forename: F
authors.initials: F
authors.lastname: Bylsma
mesh_terms: D000367:Age Factors; D000368:Aged; D000544:Alzheimer Disease / Q000401:mortality / Q000503:physiopathology* / Q000523:psychology*; D003071:Cognition; D005116:Extrapyramidal Tracts; D005260:Female; D006801:Humans; D008297:Male; D009460:Neurologic Examination; D009735:Nursing Homes; D010343:Patient Admission; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011581:Psychological Tests; D011618:Psychotic Disorders; D015996:Survival Rate