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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 State Examination [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 < or = 20/57 [ approximately MMSE < or = 10/30]), functional endpoint (Blessed Dementia Rating Scale > or = 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.

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  • Authors+Show Affiliations

    ,

    Cognitive Neuroscience Division of the Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, NY 10032, USA. ns257@columbia.edu

    , , , , , , , , , , ,

    Source

    Neurology 64:10 2005 May 24 pg 1696-703

    MeSH

    Aged
    Aged, 80 and over
    Alzheimer Disease
    Brain
    Cognition Disorders
    Cohort Studies
    Disease Progression
    Dysarthria
    Female
    Follow-Up Studies
    Gait Disorders, Neurologic
    Humans
    Hypokinesia
    Male
    Middle Aged
    Movement Disorders
    Muscle Rigidity
    Neurologic Examination
    Neuropsychological Tests
    Predictive Value of Tests
    Prognosis
    Proportional Hazards Models

    Pub Type(s)

    Journal Article
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

    Language

    eng

    PubMed ID

    15911793

    Citation

    Scarmeas, N, et al. "Motor Signs Predict Poor Outcomes in Alzheimer Disease." Neurology, vol. 64, no. 10, 2005, pp. 1696-703.
    Scarmeas N, Albert M, Brandt J, et al. Motor signs predict poor outcomes in Alzheimer disease. Neurology. 2005;64(10):1696-703.
    Scarmeas, N., Albert, M., Brandt, J., Blacker, D., Hadjigeorgiou, G., Papadimitriou, A., ... Stern, Y. (2005). Motor signs predict poor outcomes in Alzheimer disease. Neurology, 64(10), pp. 1696-703.
    Scarmeas N, et al. Motor Signs Predict Poor Outcomes in Alzheimer Disease. Neurology. 2005 May 24;64(10):1696-703. PubMed PMID: 15911793.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Motor signs predict poor outcomes in Alzheimer disease. AU - Scarmeas,N, AU - Albert,M, AU - Brandt,J, AU - Blacker,D, AU - Hadjigeorgiou,G, AU - Papadimitriou,A, AU - Dubois,B, AU - Sarazin,M, AU - Wegesin,D, AU - Marder,K, AU - Bell,K, AU - Honig,L, AU - Stern,Y, PY - 2005/5/25/pubmed PY - 2006/2/9/medline PY - 2005/5/25/entrez SP - 1696 EP - 703 JF - Neurology JO - Neurology VL - 64 IS - 10 N2 - 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 State Examination [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 < or = 20/57 [ approximately MMSE < or = 10/30]), functional endpoint (Blessed Dementia Rating Scale > or = 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. SN - 1526-632X UR - https://www.unboundmedicine.com/medline/citation/15911793/Motor_signs_predict_poor_outcomes_in_Alzheimer_disease_ L2 - http://www.neurology.org/cgi/pmidlookup?view=long&amp;pmid=15911793 DB - PRIME DP - Unbound Medicine ER -