Summary
Occurrence of extrapyramidal signs was investigated in a follow-up study of 32 patients with probable Alzheimer's disease (AD). Bradykinesia and rigidity were observed in 39% and 11% of the neuroleptic-free patients at entry and in 72% and 61% at year 3, respectively. Tremor was not a predominant feature nor did its occurrence increase over time. Use of neuroleptics contributed to extrapyramidal signs; 75–100% of the neuroleptic-treated patients showed bradykinesia, rigidity or orofacial dyskinesia. The homovanillic acid (HVA) concentrations of the cerebrospinal fluid at entry were comparable to those of age-matched controls. Nor did HVA levels correlate with rigidity or bradykinesia in these early AD cases. Presence of bradykinesia or rigidity at the initial evaluation predicted more severe dementia and a poor prognosis over the period of 3 years, although interaction of initial clinical severity of dementia was significant. Of 15 patients with these signs 3 (20%) died and 8 (53%) needed institutional care, while of 17 patients without these signs only 1 (6%) died and 2 (12%) were institutionalized by year 3 (p<0.01).
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Chui HC, Teng EL, Hendersson VW, Moy AC (1985) Clinical subtypes of dementia of the Alzheimer type. Neurology 35: 1544–1550
Ditter SM, Mirra SS (1987) Neuropathological and clinical features of Parkinson's disease in Alzheimer disease patients. Neurology 37: 754–760
Drachman DA, O'Donnel BF, Lew RA, Swearer JM (1990) The prognosis of Alzheimer's disease. “How far” rather than “how fast” best predicts the course. Arch Neurol 47: 851–856
Galasko D, Kwo on Yuen PF, Klauber MR, Thal LJ (1990) Neurological findings in Alzheimer's disease and normal aging. Arch Neurol 47: 625–627
Gotham AM, Brown RG, Marsden CD (1988) “Frontal” cognitive function in patients with Parkinson's disease “on” and “off” levodopa. Brain 111: 299–321
Hansen L, Salmon D, Galasko D, Masliah E, Katzman R, DeTeresa R, Thal L, Pay MM, Hofstetter R, Klauber M, Rice V, Butters N, Alford M (1990) Lewy body variant of Alzheimer's disease. A clinical and pathologic entity. Neurology 40: 1–7
Hartikainen P, Soininen H, Reinikainen KJ, Sirviö J, Soikkeli R, Riekkinen PJ (1991) Neurotransmitter markers in the cerebrospinal fluid of normal subjects. Effects of aging and other confounding factors. J Neural Transm 84: 103–117
Helkala EL, Laulumaa V, Soininen H, Partanen J, Reikkinen PJ (1991) Different patterns of cognitive decline related to normal and deteriorating EEG in three year follow-up study with patients of Alzheimer's disease. Neurology 41: 528–532
Hughes C, Berg P, Danziger L (1982) A new clinical scale for staging dementia. Br J Psychiatry 140: 566–572
Jolkkonen J, Helkala EL, Kutvonen R, Lehtinen M, Riekkinen PJ (1989) Vasopressin levels in CSF of Alzheimer patients: correlations with monoamine metabolites and neuropsychological test performance. Psychoneuroendocrinology 14: 89–95
Kaye JA, May C, Daly E, Atack JR, Sweeney DJ, Luxenberg JS, Kay AD, Kaufman S, Mielstien S, Friedland RP, Rapoport SI (1988) Cerebrospinal fluid monoamine markers are decreased in dementia of the Alzheimer type with extrapyramidal features. Neurology 38: 554–557
Leverenz J, Sumi SM (1986) Parkinson's disease in patients with Alzheimer's disease. Arch Neurol 43: 662–664
Mann DMA, Yates PO, Marcyniuk B (1987) Dopaminergic neurotransmitter systems in Alzheimer's disease and Down syndrome at middle age. J Neurol Neurosurg Psychiatry 50: 341–344
Mayeux R, Stern Y, Spanton S (1985) Heterogeneity in dementia of the Alzheimer type: evidence of subgroups. Neurology 35: 453–461
McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM (1984) Clinical diagnosis of Alzheimer's disease. Report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's disease. Neurology 34: 939–944
Morris JC, Drazner M, Fulling K, Grant EA, Goldring J (1989) Clinical and pathological aspects of parkinsonism in Alzheimer's disease. A role for extranigral factors? Arch Neurol 46: 651–657
Mölsä PK, Marttila RJ, Rinne UK (1984) Extrapyramidal signs in Alzheimer's disease. Neurology 34: 1114–1116
Mölsä PK, Säkö E, Paljärvi L, Rinne JO, Rinne UK (1987) Alzheimer's disease: neuropathological correlates of cognitive and motor disorders. Acta Neurol Scand 75: 376–384
Pearce J (1974) The extrapyramidal disorders of Alzheimer's disease. Eur Neurol 12: 94–103
Perry RH, Irving D, Blessed, Fairbair A, Perry E (1990) Senile dementia of Lewy body type. A clinically and neuropathologically distinct form of Lewy body dementia in the elderly. J Neurol Sci 95: 119–139
Reinikainen KJ, Riekkinen PJ (1990) Noncholinergic neurotransmitter markers in the CSF of patients with dementia of Alzheimer type. In: Fowler CJ, Carlson LA, Gottfries CG, Winbald B (eds) Biological markers in dementia of Alzheimer type. Aging and aging disorders, no 1. Smith-Gordon Nishimura, London, pp 161–178
Reinikainen KJ, Paljärvi L, Halonen T, Malminen O, Kosma VM, Laakso M, Riekkinen PJ (1988) Dopaminergic system and monoamine oxidase-B activity in Alzheimer's disease. Neurobiol Aging 9: 245–252
Reinikainen KJ, Soininen H, Riekkinen PJ (1990) Neurotransmitter changes in Alzheimer's disease: implications to diagnostics and therapy. J Neurosci Res 27: 576–586
Reisberg B, Schneck MK, Ferris SH (1983) The brief cognitive rating scale (BCRS): findings in primary degenerative dementia (PDD). Psychopharmocol Bull 19: 734–739
Rinne JO, Rummukainen J, Paljärvi L, Säkö E, Mölsä P, Rinne UK (1989) Neuronal loss in the substantia nigra in patients with Alzheimer's disease and Parkinson's disease in relation to extrapyramidal symptoms and dementia. Prog Clin Biol Res 317: 325–332
Robbins TW, Giardini V, Jones GH, Reading P, Sahakian BJ (1990) Effects of dopamine depletion from caudate putamen and nucleus accumbens septi on the acquisition and performance of a conditional discrimination task. Behav Brain Res 38: 243–261
Rosen WG, Terry RD, Fuld PA, Katzman R, Beck A (1980) Pathological verification of ischemic score in differentiation of dementias. Ann Neurol 7: 486–488
Rossor MN (1981) Parkinson's disease and Alzheimer's disease as disorders of isodentritic core. Br Med J 283: 1588–1590
Stern Y, Mayeux R, Sano M, Hauser WA, Bush T (1987) Predictors of disease course in patients with probable Alzheimer's disease. Neurology 37: 1649–1653
Stern Y, Hesdorffer D, Sano M, Mayeux R (1990) Measurement and prediction of functional capacity in Alzheimer's disease. Neurology 40: 8–14
Soininen H, MacDonald E, Rekonen M, Riekkinen PJ (1981) Homovanillic acid and 5-hydroxyindoleacetic acid levels in cerebrospinal fluid of patients with senile dementia of Alzheimer type. Acta Neurol Scand 64: 101–107
Soininen H, Partanen J, Laulumaa V, Laakso M, Riekkinen PJ (1989) Longitudinal EEG spectral analysis in early stage of Alzheimer's disease. Electroencephalogr Clin Neurophysiol 72: 290–297
Sulkava R (1982) Alzheimer's disease and senile dementia of Alzheimer type: a comparative study. Acta Neurol Scand 65: 636–650
Webster DD (1968) Clinical analysis of the disability on Parkinson's disease. Mod Treat 5: 257–262
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Soininen, H., Laulumaa, V., Helkala, E.L. et al. Extrapyramidal signs in Alzheimer's disease: A 3-year follow-up study. J Neural Transm Gen Sect 4, 107–119 (1992). https://doi.org/10.1007/BF02251474
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02251474