Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
J Geriatr Psychiatry Neurol. 2013 Sep;26(3):144-50. doi: 10.1177/0891988713490993. Epub 2013 Jun 3.
Extrapyramidal signs (EPSs) are commonly observed in patients with Alzheimer disease (AD). We report here the base rate of EPS in a large cohort of patients with AD who were not receiving neuroleptic drugs, and the associations of EPS with functional outcomes and depressive symptoms.
In a consortium involving 56 clinics, we recruited 2614 patients with AD. We estimated basic activities of daily living (ADL) and instrumental ADL by the Barthel index and the Seoul-Instrumental Activities of Daily Living (S-IADL) scales, respectively. Depressive symptoms were assessed using the 15-item Geriatric Depression Scale (GDS-15). The EPS group was defined by the presence of at least 1 EPS based on a focused neurologic examination.
The prevalence of EPS-positive patients was 12%. These had lower Korean version of the Mini-Mental State Examination (K-MMSE) scores than the EPS-negative cases (P < .001). After controlling for demographic, medical, radiological, genetic, and cognitive (K-MMSE) factors, the proportion of patients with impaired ADL was significantly higher in the EPS group than in the non-EPS group (P < .001, odds ratio = 1.90, 95% confidence interval, 1.45-2.48, and logistic regression). The S-IADL scores were significantly higher in the EPS group than this in the non-EPS group (P < .001, regression coefficient = 3.19, and median regression). The GDS-15 scores were higher in the EPS group (P = .04, regression coefficient = 0.89, and median regression).
The presence of EPS in patients with AD who were not receiving neuroleptic drugs was associated with more impaired basic and instrumental ADL functioning and with greater depression symptoms.
锥体外系症状（EPS）在阿尔茨海默病（AD）患者中很常见。我们在此报告了一大群未接受神经安定药治疗的 AD 患者中 EPS 的基础发生率，以及 EPS 与功能结局和抑郁症状的关系。
在一个涉及 56 个诊所的联盟中，我们招募了 2614 名 AD 患者。我们分别使用巴氏指数和首尔工具性日常生活活动量表（S-IADL）来估计基本日常生活活动（ADL）和工具性 ADL。使用 15 项老年抑郁量表（GDS-15）评估抑郁症状。根据重点神经检查，将 EPS 阳性患者定义为至少存在 1 种 EPS。
EPS 阳性患者的患病率为 12%。与 EPS 阴性病例相比，这些患者的韩国版简易精神状态检查（K-MMSE）评分较低（P <.001）。在控制人口统计学、医学、影像学、遗传学和认知（K-MMSE）因素后，EPS 组患者的 ADL 受损比例明显高于非 EPS 组（P <.001，优势比= 1.90，95%置信区间为 1.45-2.48，和逻辑回归）。与非 EPS 组相比，EPS 组的 S-IADL 评分明显较高（P <.001，回归系数= 3.19，和中位数回归）。EPS 组的 GDS-15 评分较高（P =.04，回归系数= 0.89，和中位数回归）。
在未接受神经安定药治疗的 AD 患者中出现 EPS 与基本和工具性 ADL 功能受损更严重以及抑郁症状更严重有关。
