NEUROLOGY 2004;63:975-982
© 2004 American Academy of Neurology
Motor signs during the course of Alzheimer disease
N. Scarmeas, MD,
G. M. Hadjigeorgiou, MD,
A. Papadimitriou, MD,
B. Dubois, MD,
M. Sarazin, MD,
J. Brandt, PhD,
M. Albert, PhD,
K. Marder, MD MPH,
K. Bell, MD,
L. S. Honig, MD PhD,
D. Wegesin, PhD and
Y. Stern, PhD
From the Cognitive Neuroscience Division, Taub Institute for Research in Alzheimer’s Disease and the Aging Brain, Gertrude H. Sergievsky Center, and Department of Neurology (Drs. Scarmeas, Marder, Bell, Honig, Wegesin, and Stern), Columbia University Medical Center, New York, Department of Psychiatry and Behavioral Sciences (Dr. Brandt), Johns Hopkins University, Baltimore, MD; Departments of Psychiatry and Neurology (Dr. Albert), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (Drs. Dubois and Sarazin), Hospital de la Salpetriere, Paris, France; and Department of Neurology (Drs. Scarmeas, Hadjigeorgiou and Papadimitriou), University of Thessaly, Larissa, Greece.
Address correspondence and reprint requests to Dr. N. Scarmeas, Taub Institute PH, Columbia Presbyterian Medical Center, 622 W. 168 St., 19th fl., New York, NY, 10032; e-mail: ns257{at}columbia.edu
Background: Motor signs (MOSIs) are common in Alzheimer disease (AD) and may be associated with rates of cognitive decline, mortality, and cost of care.
Objective: To describe the progression and identify predictors of individual MOSIs in AD.
Methods: A cohort of 474 patients with AD at early stages was followed semiannually for up to 13.1 years (mean 3.6 years) in five centers in Europe and the United States. MOSIs were rated using a standardized portion of the Unified Parkinson’s Disease Rating Scale. Overall, 3,030 visits/assessments of MOSIs (average 6.4/patient) were performed. Prevalence and incidence rates were calculated, and cumulative risk graphs were plotted for individual non-drug-induced MOSI domains. Rates of change over time taking into account potential covariates were also estimated. With use of each MOSI domain as outcome in Cox models, predictors of MOSI incidence were identified.
Results: At least one MOSI was detected in 13% of patients at first examination and in 36% for the last evaluation. Total MOSI score increased at an annual rate of 3% of total possible score. Rates of annual change for speech/facial expression (4%), rigidity (2.45%), posture/gait (3.9%), and bradykinesia (3.75%) were of similar magnitude, and their occurrence increased from first (3 to 6%) to last (22 to 29%) evaluation. Tremor was less frequent throughout the course of the disease (4% at first and 7% at last evaluation) and worsened less (0.75% increase/year).
Conclusions: Most motor signs occur frequently and progress rapidly in Alzheimer disease. Tremor is an exception in that it occurs less frequently and advances at slower rates.
Received November 19, 2003.
Accepted in final form May 18, 2004.
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