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J Alzheimers Dis. 2016;49(4):1085-93. doi: 10.3233/JAD-150244.

Progression of Extrapyramidal Signs in Alzheimer's Disease: Clinical and Neuropathological Correlates.

Author information

1
The Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, NY, USA.
2
Sergievsky Center, College of Physiciansand Surgeons, Columbia University New York, NY, USA.
3
National Alzheimer's Coordinating Center, University of Washington, WA, USA.
4
Department of Epidemiology, University of Washington, WA, USA.
5
Department of Neurology and Psychiatry, University "Sapienza", Rome, Italy.
6
Department of Neurology, College of Physiciansand Surgeons, Columbia University and the New York, Presbyterian Hospital, New York, NY, USA.

Abstract

BACKGROUND:

Extrapyramidal signs (EPS) are frequent in Alzheimer's disease (AD) and core manifestation of related diseases, i.e., dementia with Lewy bodies and Parkinson's disease; furthermore, Lewy bodies and AD-type pathology occur in all three conditions.

OBJECTIVE:

To identify clusters of EPS progression over time and their clinical and neuropathological correlates.

METHODS:

3,502 AD patients with longitudinal assessment from the National Alzheimer's Coordinating Center database were included; 394 provided neuropathological data. k-means algorithm was employed to identify clusters of EPS progression and those were compared in terms of cognitive profile, neuropsychiatric features and neuropathological findings.

RESULTS:

Three clusters of EPS progression were identified: no/low (n = 1,583), medium (n = 1,259), and high (n = 660) EPS burden. Compared to those with no/low and medium EPS, those with high EPS had greater cognitive and neuropsychiatric impairment, specifically hallucinations. Despite similar AD-pathology across the three clusters, the high EPS cluster had a significantly number of subjects diagnosed with dementia with Lewy bodies.

CONCLUSIONS:

Cluster analysis of EPS progression over time identified different subgroups of AD patients with distinct clinical and neuropathological features.

KEYWORDS:

Alzheimer’s disease; K-means clustering; Lewy bodies; extrapyramidal signs; longitudinal studies

PMID:
26599050
PMCID:
PMC4779642
DOI:
10.3233/JAD-150244
[Indexed for MEDLINE]
Free PMC Article

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