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Vascular risk factors and the effect of white matter lesions on extrapyramidal signs in Alzheimer's disease

Published online by Cambridge University Press:  29 November 2010

Moon Ho Park*
Affiliation:
Clinical Research Center for Dementia (CRCD), Seoul, Republic of Korea Departments of Neurology, Korea University Medical College and Korea University Ansan Hospital, Ansan, Republic of Korea
Joo Young Min
Affiliation:
Fiona Clinic Hospital, Seoul, Republic of Korea
Do-Young Kwon
Affiliation:
Departments of Neurology, Korea University Medical College and Korea University Ansan Hospital, Ansan, Republic of Korea
Seung Hwan Lee
Affiliation:
Department of Neurology, Kangwon National University, Chuncheon, Republic of Korea
Hae Ri Na
Affiliation:
Clinical Research Center for Dementia (CRCD), Seoul, Republic of Korea Department of Neurology, Bobath Memorial Hospital, Seongnam, Republic of Korea
Sung Tae Cho
Affiliation:
Department of Urology, Hallym University, Seoul, Republic of Korea
Duk L. Na
Affiliation:
Clinical Research Center for Dementia (CRCD), Seoul, Republic of Korea Department of Neurology, Sungkyunkwan University School of Medicine and Samsung Medical Center, Seoul, Republic of Korea
*Corresponding
Correspondence should be addressed to: Moon Ho Park, MD, PhD, Department of Neurology, Korea University College of Medicine, 516, Gojan-1-dong, Danwon-gu, Ansan-si, Gyeonggi-do 425-707, Republic of Korea. Phone: +82-31-412-5150; Fax:+82-31-412-5154. Email: parkmuno@yahoo.co.kr.

Abstract

Background: Extrapyramidal signs (EPSs), which are important characteristics of Parkinson's disease (PD), occur frequently in Alzheimer's disease (AD). Although AD and PD share common clinical features such as EPSs, these diseases vary with respect to vascular risk factors. The presence of vascular risk factors increases the risk of AD; however, these factors have been known to be inversely associated with PD. We aimed to assess the effect of vascular risk factors and white matter lesions (WMLs) on EPSs in AD.

Methods: We recruited 1,187 AD patients and 333 controls with neither cognitive impairment nor EPSs. All participants underwent detailed clinical evaluations which included assessments of vascular risk factors, cognitive function, and EPSs, as well as WMLs on brain MRIs. EPS subtypes were classified into tremor-dominant, postural instability gait difficulty, or indeterminate; WMLs subtypes were classified into periventricular WML (pvWML) or deep WML (dWML).

Results: EPSs were present in 17.9% of subjects with AD and were significantly associated with vascular risk factors such as age, male gender, diabetes mellitus, and WMLs. Additionally, a multivariate logistic regression analysis showed that EPSs in AD were associated with pvWML (odds ratio (OR), 1.61–2.52), not with dWML. With respect to EPS subtypes, the majority (78.4%) of EPSs in AD were postural instability gait difficulty, which was also associated with WMLs (OR 1.84–2.41), pvWML (OR 2.09–3.14), and dWML (OR 1.83–3.42).

Conclusions: EPSs in AD are associated with selected vascular risk factors as well as WMLs.

Type
Research Article
Copyright
Copyright © International Psychogeriatric Association 2010

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