CoChat
Sign Up
Cited by 79Dementia and Cognitive Impairment ResearchAlzheimer's disease research and treatmentsParkinson's Disease Mechanisms and Treatments

Extrapyramidal Signs Before and After Diagnosis of Incident Alzheimer Disease in a Prospective Population Study

Open access
Portet, Florence, Scarmeas, Nikolaos, Cosentino, Stephanie, Helzner, Elisabeth P., Stern, Yaakov·2009·Archives of Neurology
DOI 10.1001/archneurol.2009.196PMC PMC2896248
Open this paper in CoChat — free account

Abstract

BACKGROUND: Extrapyramidal signs (EPSs) are commonly accepted as a feature of Alzheimer disease (AD) and may influence both the profile of impairment and prognosis. OBJECTIVE: To examine rates of occurrence and risk factors for all types of EPSs and to describe the impact of EPSs over time on the clinical course of AD. DESIGN: Longitudinal study. SETTING: The Washington Heights Hamilton Heights Inwood Columbia Aging Project. Patients A total of 388 patients with incident AD (mean age, 79 years; 71.4% female). MAIN OUTCOME MEASURES: Extrapyramidal signs rated by means of a standardized portion of the Unified Parkinson's Disease Rating Scale; prevalence and incidence rates and cumulative risk for non-drug-induced EPSs; and rates of change in EPSs over time, taking into account potential covariates. RESULTS: Extrapyramidal signs were detected in 12.3% of patients at first evaluation and 22.6% at last evaluation. In a multivariate-adjusted generalized estimating equation model of change, total EPS score increased at an annual rate of 1.3%. Women (relative risk [RR], 1.57; P = .03), older patients (RR, 1.03; P = .02), and those with EPSs at baseline (RR, 2.07; P = .001) had greater rates of cognitive decline. CONCLUSIONS: Extrapyramidal signs occur frequently and progress significantly in AD. Patients with incident AD and concomitant EPSs have a greater rate of cognitive decline than do patients with incident AD but without EPSs.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1001/archneurol.2009.196

Cites

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Parkinsonian features may be present in up to 30% of patients with AD, and these appear later in the disease course.

    “While parkinsonian features may be present in up to 30% of patients with AD, [32] these appear later in the disease course [32].”

    From Diagnosing the frontal variant of Alzheimer’s disease: a clinician’s yellow brick road (2017) · cites this paper as [32]

    The Discussion says extrapyramidal signs were present in very early AD, even before the diagnosis was confirmed, contrary to the claim that they appear later in the disease course. The Abstract Results report 12.3% at first evaluation and 22.6% at last evaluation, supporting their presence in a substantial minority but not the claimed timing. Our copy provides no page numbers for these passages. (LLM, conf=0.87)

    Checked by a reasoning model — may be wrong.

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

No citation lists for this paper

No citation lists for this paper yet — checked again daily.

References 36 · Cited by 79

Research works printed but not linked: 27

  1. [1]Ellis RJ Caligiuri M Galasko D Thal LJ Extrapyramidal motor signs in clinically diagnosed Alzheimer disease Alzheimer Dis Assoc Disord 1996 10 2 103 114 8727172
  2. [2]Soininen H Helkala EL Laulumaa V Soikkeli R Hartikainen P Riekkinen PJ Cognitive profile of Alzheimer patients with extrapyramidal signs: a longitudinal study J Neural Transm Park Dis Dement Sect 1992 4 3 241 254 1627257
  3. [3]Richards M Stern Y Mayeux R Subtle extrapyramidal signs can predict the development of dementia in elderly individuals Neurology 1993 43 11 2184 2188 8232926
  4. [4]Stern Y Albert M Brandt J Jacobs DM Tang MX Marder K Bell K Sano M Devanand DP Bylsma F Utility of extrapyramidal signs and psychosis as predictors of cognitive and functional decline, nursing home admission, and death in Alzheimer’s disease: prospective analyses from the Predictors Study Neurology 1994 44 12 2300 2307 7991116
  5. [5]Chui HC Lyness SA Sobel E Schneider LS Extrapyramidal signs and psychiatric symptoms predict faster cognitive decline in Alzheimer’s disease Arch Neurol 1994 51 7 676 681 8018040
  6. [6]Richards M Stern Y Mayeux R Subtle extrapyramidal signs and incident dementia: a follow-up analysis Neurology 1995 45 10 1942 7478001
  7. [7]Stern Y Liu X Albert M Brandt J Jacobs DM Del Castillo-Castaneda C Marder K Bell K Sano M Bylsma F Modeling the influence of extrapyramidal signs on the progression of Alzheimer disease Arch Neurol 1996 53 11 1121 6 8912485
  8. [8]Lopez OL Wisnieski SR Becker JT Boller F DeKosky ST Extrapyramidal signs in patients with probable Alzheimer disease Arch Neurol 1997 54 8 969 975 9267971
  9. [9]Scarmeas N Albert M Brandt J Blacker D Hadjigeorgiou G Papadimitriou A Dubois B Sarazin M Wegesin D Marder K Bell K Honig L Stern Y Motor signs predict poor outcomes in Alzheimer disease Neurology 2005 64 10 1696 1703 15911793 PMC3028937
  10. [10]Wilson RS Bennett DA Gilley DW Beckett LA Schneider JA Evans DA Progression of parkinsonian signs in Alzheimer’s disease Neurology 2000 54 6 1284 1289 10746599
  11. [11]Scarmeas N Hadjigeorgiou GM Papadimitriou A Dubois B Sarazin M Brandt J Albert M Marder K Bell K Honig LS Wegesin D Stern Y Motor signs during the course of Alzheimer disease Neurology 2004 63 6 975 982 15452286 PMC3028531
  12. [12]Tang MX Cross P Andrews H Jacobs DM Small S Bell K Merchant C Lantigua R Costa R Stern Y Mayeux R Incidence of AD in African-Americans, Caribbean Hispanics, and Caucasians in northern Manhattan Neurology 2001 56 1 49 56 11148235
  13. [13]Buschke H Fuld PA Evaluating storage, retention, and retrieval in disordered memory and learning Neurology 1974 24 11 1019 1025 4473151
  14. [14]Benton AL A multiple choice type of the visual retention test AMA Arch Neurol Psychiatry 1950 64 5 699 707 14770617
  15. [15]Williams BW Mack W Henderson VW Boston Naming Test in Alzheimer’s disease Neuropsychologia 1989 27 8 1073 1079 2797414
  16. [16]Stern Y Andrews H Pittman J Sano M Tatemichi T Lantigua R Mayeux R Diagnosis of dementia in a heterogeneous population. Development of a neuropsychological paradigm-based diagnosis of dementia and quantified correction for the effects of education Arch Neurol 1992 49 5 453 460 1580806
  17. [17]Richards M Marder K Bell K Dooneief G Mayeux R Stern Y Interrater reliability of extrapyramidal signs in a group assessed for dementia Arch Neurol 1991 48 11 1147 1149 1953399
  18. [19]Chen JY Stern Y Sano M Mayeux R Cumulative risks of developing extrapyramidal signs, psychosis, or myoclonus in the course of Alzheimer’s disease Arch Neurol 1991 48 11 1141 1143 1953398
  19. [20]Louis ED Schupf N Manly J Marder K Tang MX Mayeux R Association between mild parkinsonian signs and mild cognitive impairment in a community Neurology 2005 12 64(7) 1157 1161 15824340
  20. [21]Liu Y Stern Y Chun MR Jacobs DM Yau P Goldman JE Pathological correlates of extrapyramidal signs in Alzheimer’s disease Ann Neurol 1997 41 3 368 74 9066358
  21. [22]Burns JM Galvin JE Roe CM Morris JC McKeel DW The pathology of the substantia nigra in Alzheimer disease with extrapyramidal signs Neurology 2005 26 64(8) 1397 1403 15851730
  22. [23]Boyle PA Wilson RS Aggarwal NT Arvanitakis Z Kelly J Bienias JL Bennett DA Parkinsonian signs in subjects with mild cognitive impairment Neurology 2005 27 65(12) 1901 1906 16380610
  23. [24]Richards M Touchon J Ledesert B Ritchie K Mild extrapyramidal signs and functional impairment in ageing Int J Geriatr Psychiatry 2002 17 2 150 153 11813278
  24. [25]Katzman R Brown T Fuld P Thal L Davies P Terry R Significance of neurotransmitter abnormalities in Alzheimer’s disease Res Publ Assoc Res Nerv Ment Dis 1986 64 279 286 2873637
  25. [26]Wilson JA MacLennan WJ Review: drug-induced parkinsonism in elderly patients Age Ageing 1989 18 3 208 210 2675581
  26. [27]Stern Y Albert S Tang MX Tsai WY Rate of memory decline in AD is related to education and occupation: cognitive reserve? Neurology 1999 10 53(9) 1942 7 10599762
  27. [31]Bennett DA Postmortem indices linking risk factors to cognition: results from the Religious Order Study and the Memory and Aging Project Alzheimer Dis Assoc Disord 2006 20 3 Suppl 2 S63 68 16917198

Authors
Portet, F., Scarmeas, N., Cosentino, S., Helzner, E. P., & Stern, Y.
Affiliations
Inserm (FR)
ORCID
Venue
Archives of Neurology
Publisher
American Medical Association (AMA)
Published
2009-09-01
Volume
66
Issue
9
Pages
1120-6
ISSN
0003-9942 (ISSN-L)
DOI
10.1001/archneurol.2009.196
PMC
PMC2896248
OpenAlex
W2134181639
Cited by
79
References
36
Citations by year
2025: 1 · 2024: 1 · 2023: 1 · 2022: 3 · 2021: 15 · 2020: 2 · 2019: 9 · 2018: 7 · 2017: 7 · 2016: 3 · 2015: 6 · 2014: 5 · 2013: 4 · 2012: 1
FWCI
3.09
Type
journal article
Language
en
Open access
Locations
  • Archives of Neurology (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • JAMA Neurology
Funders
  • National Institute on Aging (P01AG007232, AG 07232, P01AG07232)
  • National Institute of Neurological Disorders and Stroke (T32NS007153)
  • National Center for Research Resources (RR 00645, M01RR000645)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
  • Health Sciences › Medicine › Physiology › Alzheimer's disease research and treatments
  • Health Sciences › Medicine › Neurology › Parkinson's Disease Mechanisms and Treatments
Keywords
extrapyramidal signs, Alzheimer's disease, cognitive decline, Unified Parkinson's Disease Rating Scale, disease progression, risk factors, sex differences, older adults
MeSH terms
Alzheimer Disease, Basal Ganglia Diseases, Brain, Cognition Disorders, Disability Evaluation, Neuropsychological Tests, Prospective Studies, Severity of Illness Index, Time Factors, Cohort Studies, Comorbidity, Incidence, Prevalence, Multivariate Analysis, Age Distribution, Sex Distribution, Disease Progression, Risk Assessment

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review