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Departments of Neurology (Drs. Stern, Jacobs, Tang, Marder, Bell, and Sano) and Psychiatry (Drs. Stern and Devanand) and the Gertrude H. Sergievsky Center (Drs. Stern, Jacobs, Marder, and Sano), Columbia University College of Physicians and Surgeons, New York, NY; the Department of Psychiatry and Behavioral Sciences (Drs. Brandt and Bylsma), Johns Hopkins University, Baltimore, MD; and the Departments of Psychiatry and Neurology (Drs. Albert and Lafleche), Massachusetts General Hospital, Harvard Medical School, Boston, MA.
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.
Address correspondence and reprint requests to Dr. Yaakov Stern, Sergievsky Center, 630 West 168th Street, New York, NY 10032.
Supported by federal grants AG07370 and RR00645, and the Charles S. Robertson Gift for Alzheimer's Disease from the Banbury Fund.
Received February 3, 1994. Accepted in final form June 8, 1994.
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