Effect of extrapyramidal signs and Lewy bodies on survival in patients with Alzheimer disease.
BACKGROUND
Patients with Alzheimer disease (AD) who have psychiatric and parkinsonian symptoms experience faster cognitive deterioration and shorter survival vs those without such disease features. Extrapyramidal signs (EPSs) in particular have been associated with the presence of Lewy bodies (LBs) on autopsy and with poorer survival in patients with AD. Lewy bodies found at autopsy are not always correlated with EPSs during late life.


OBJECTIVE
To determine whether the association between LBs and age at death is modified by the presence of EPSs, hallucinations, or delusions.


METHODS
An autopsy series of patients with clinically diagnosed AD.


METHODS
Three AD clinics (San Diego and Sacramento, Calif, and Portland, Ore).


METHODS
Data on 379 patients with a clinical diagnosis of AD who were initially assessed between May 1, 1984, and August 1, 1996, and who were autopsied between January 1, 1990, and April 1, 1998, were pooled from 3 AD centers.


METHODS
Presence of LBs on autopsy and differences in age at death in those with EPSs, LBs, or both.


RESULTS
Individuals with EPSs at initial assessment were more than 3 times as likely to have LBs at autopsy than were those without EPSs. Age at death was younger in those with LBs and EPSs than in those with LBs only and those without EPSs or LBs.


CONCLUSIONS
The presence of EPSs in patients with AD indicates worse prognosis and may be related to underlying LBs. The presence of EPSs is a strong predictor of LBs.
Haan
Mary N
MN
Department of Epidemiology, University of Michigan, School of Public Health, 109 S Observatory St, Ann Arbor, MI 48109-2029, USA. mnhaan@umich.edu
Jagust
William J
WJ
Galasko
Douglas
D
Kaye
Jeffrey
J
D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000150:complications* / Q000401:mortality* / Q000473:pathology; D000704:Analysis of Variance; D001344:Autopsy; D001480:Basal Ganglia Diseases / Q000209:etiology*; D003702:Delusions / Q000209:etiology*; D005260:Female; D006212:Hallucinations / Q000209:etiology*; D006801:Humans; D016631:Lewy Bodies; D016015:Logistic Models; D008297:Male; D012307:Risk Factors; D016019:Survival Analysis