Effect of extrapyramidal signs and Lewy Bodies on survival in patients with Alzheimer disease

Background: Patients with Alzheimer disease (AD) who have psychiatric and parkinsonian symptoms experience faster cognitive deterioration and shorter survival vs those without such disease features. Extrapyramidal signs (EPSs) in particular have been associated with the presence of Lewy bodies (LBs) on autopsy and with poorer survival in patients with AD. Lewy bodies found at autopsy are not always correlated with EPSs during late life. Objective: To determine whether the association between LBs and age at death is modified by the presence of EPSs, hallucinations, or delusions. Design: An autopsy series of patients with clinically diagnosed AD. Settings: Three AD clinics (San Diego and Sacramento, Calif, and Portland, Ore). Patients: Data on 379 patients with a clinical diagnosis of AD who were initially assessed between May 1, 1984, and August 1, 1996, and who were autopsied between January 1, 1990, and April 1, 1998, were pooled from 3 AD centers. Main Outcome Measures: Presence of LBs on autopsy and differences in age at death in those with EPSs, LBs, or both. Results: Individuals with EPSs at initial assessment were more than 3 times as likely to have LBs at autopsy than were those without EPSs. Age at death was younger in those with LBs and EPSs than in those with LBs only and those without EPSs or LBs. Conclusions: The presence of EPSs in patients with AD indicates worse prognosis and may be related to underlying LBs. The presence of EPSs is a strong predictor of LBs.