Franssen E H, Kluger A, Torossian C L, Reisberg B
Aging and Dementia Research Center, New York University Medical Center, NY 10016.
Arch Neurol. 1993 Oct;50(10):1029-39. doi: 10.1001/archneur.1993.00540100024010.
To assess the possible association between functional decline and noncognitive neurologic signs in the severe stages of Alzheimer's disease (AD).
Case series.
Subjects from a dementia research referral center, longitudinally followed, when necessary, into residential home and nursing home settings.
A consecutive sample of 56 patients (16 men, 40 women; mean age, 74.6 years) with a clinical diagnosis of probable AD in the moderately severe and severe stages.
For global dementia severity, the Global Deterioration Scale and Mini-Mental State examination; for functional assessment, the Functional Assessment Staging Scale; and for assessment of neurologic function, nine release signs (primitive reflexes), 10 measures of extrapyramidal function, and five measures of pyramidal function, including deep-tendon reflexes and plantar signs. Changes in activity or presence of neurologic signs were rated on a seven-point scale. Results were analyzed in terms of prevalence and magnitude of change in relation to functional impairment.
Prevalence and mean scores of certain release signs, certain extrapyramidal measures commonly referred to as bradykinesia, and certain pyramidal signs showed significant associations with the magnitude of functional impairment. Other neurologic measures, for example, the palmomental reflex, and certain extrapyramidal measures commonly seen in Parkinson's disease, including the glabellar blink reflex, cogwheeling, tremor, shuffling gait, and festination, did not show significant increments with continuing functional decline in AD.
Functional decline in the advanced stages of AD appears to be associated with a particular combination of progressive cortical, extrapyramidal, and pyramidal system dysfunction. The characteristics of this neurologic syndrome of the severe stages of AD differ from those of other neurologic disorders. For example, the pattern of extrapyramidal system disease is different from that seen in Parkinson's disease. The neurologic syndrome of the severe stages of AD is amenable to description and deserves further investigation.
评估阿尔茨海默病（AD）重度阶段功能衰退与非认知神经体征之间的可能关联。
病例系列研究。
来自痴呆症研究转诊中心的受试者，必要时进行纵向随访，直至入住养老院和疗养院。
连续抽取56例患者（16例男性，40例女性；平均年龄74.6岁），临床诊断为中度至重度可能的AD。
对于整体痴呆严重程度，采用总体衰退量表和简易精神状态检查；对于功能评估，采用功能评估分期量表；对于神经功能评估，采用9种释放体征（原始反射）、10种锥体外系功能指标和5种锥体功能指标，包括深腱反射和巴宾斯基征。神经体征的活动变化或存在情况采用七点量表进行评分。根据功能损害的患病率和变化幅度对结果进行分析。
某些释放体征、某些通常称为运动迟缓的锥体外系指标以及某些锥体体征的患病率和平均得分与功能损害的程度显示出显著关联。其他神经指标，例如掌颏反射，以及帕金森病中常见的某些锥体外系指标，包括眉间眨眼反射、齿轮样动作、震颤、拖步和慌张步态，在AD患者功能持续衰退时未显示出显著增加。
AD晚期的功能衰退似乎与进行性皮质、锥体外系和锥体系统功能障碍的特定组合有关。AD重度阶段这种神经综合征的特征与其他神经疾病不同。例如，锥体外系疾病的模式与帕金森病不同。AD重度阶段的神经综合征易于描述，值得进一步研究。
