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Multicenter Study
. 2004 Sep 28;63(6):975-82.
doi: 10.1212/01.wnl.0000138440.39918.0c.

Motor signs during the course of Alzheimer disease

N Scarmeas  1 , G M Hadjigeorgiou, A Papadimitriou, B Dubois, M Sarazin, J Brandt, M Albert, K Marder, K Bell, L S Honig, D Wegesin, Y Stern
Affiliations
Multicenter Study

Motor signs during the course of Alzheimer disease

N Scarmeas et al. Neurology. .

Abstract

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.

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Figures

Figure 1
Figure 1. Cumulative risk (1 – cumulative survival) curves of developing individual domain motor signs (MOSIs) and any MOSIs y-axes. The time axes (x) show years from first evaluation until development of signs (or last evaluation)
Figure 2
Figure 2. Mean scores for individual motor sign (MOSI) domains and total MOSIs (y axes) over the course of follow-up in years (x axes). Regression lines are derived from the generalized estimating equation models
See this image and copyright information in PMC

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