Extrapyramidal Signs and Risk of Progression from Mild Cognitive Impairment to Dementia: A Clinical Research Center for Dementia of South Korea Study
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Objective: Extrapyramidal signs (EPS) are common in patients with mild cognitive impairment (MCI). However, few studies have assessed the effect of EPS on the clinical course of MCI. We aimed to evaluate whether patients with EPS show more frequent progression from MCI to Alzheimer’s disease (AD) and to other types of dementia. Methods: Participants (n=882) with MCI were recruited, and were followed for up to 5 years. The EPS positive group was defined by the presence of at least one EPS based on a focused neurologic examination at baseline. Results: A total of 234 converted to dementia during the follow-up period. The risk of progression to AD was lower in the patients with EPS after adjusting for potential confounders [hazard ratio (HR)=0.70, 95% confidence interval (CI)=0.53–0.93, p=0.01]. In contrast, the patients with EPS had a six-fold elevated risk of progression to dementia other than AD (HR=6.33, 95%CI=2.30–17.39, p<0.001). Conclusion: EPS in patients with MCI is a strong risk factor for progression of MCI to non-Alzheimer dementia. The careful neurologic examination for EPS in patients with MCI can yield important clinical information for prognosis.
Abstract
Objective: Extrapyramidal signs (EPS) are common in patients with mild cognitive impairment (MCI). However, few studies have assessed the effect of EPS on the clinical course of MCI. We aimed to evaluate whether patients with EPS show more frequent progression from MCI to Alzheimer’s disease (AD) and to other types of dementia. Methods: Participants (n=882) with MCI were recruited, and were followed for up to 5 years. The EPS positive group was defined by the presence of at least one EPS based on a focused neurologic examination at baseline. Results: A total of 234 converted to dementia during the follow-up period. The risk of progression to AD was lower in the patients with EPS after adjusting for potential confounders [hazard ratio (HR)=0.70, 95% confidence interval (CI)=0.53–0.93, p=0.01]. In contrast, the patients with EPS had a six-fold elevated risk of progression to dementia other than AD (HR=6.33, 95%CI=2.30–17.39, p<0.001). Conclusion: EPS in patients with MCI is a strong risk factor for progression of MCI to non-Alzheimer dementia. The careful neurologic examination for EPS in patients with MCI can yield important clinical information for prognosis.
참고문헌 (47)
- Petersen RC, "Mild cognitive impairment as a diagnostic entity", J Intern Med, 256, pp.183~194 (2004)
- Artero S, "Risk profiles for mild cognitive impairment and progression to dementia are gender specific", J Neurol Neurosurg Psychiatry, 79, pp.979~984 (2008)
- Manly JJ, "Frequency and course of mild cognitive impairment in a multiethnic community", Ann Neurol, 63, pp.494~506 (2008)
- Luck T, "Prediction of incident dementia: impact of impairment in instrumental activities of daily living and mild cognitive impairment-results from the German study on ageing, cognition, and dementia in primary care patients", Am J Geriatr Psychiatry, 20, pp.943~954 (2012)
- Palmer K, "Mild cognitive impairment in the general population : occurrence and progression to Alzheimer disease", Am J Geriatr Psychiatry, 16, pp.603~611 (2008)
- Busse A, "Mild cognitive impairment : long-term course of four clinical subtypes", Neurology, 67, pp.2176~2185 (2006)
- Petersen RC, "Prevalence of mild cognitive impairment is higher in men. The Mayo Clinic Study of Aging", Neurology, 75, pp.889~897 (2010)
- Ganguli M, "Prevalence of mild cognitive impairment by multiple classifications : The Monongahela-Youghiogheny Healthy Aging Team(MYHAT)project", Am J Geriatr Psychiatry, 18, pp.674~683 (2010)
- Mitchell AJ, "Rate of progression of mild cognitive impairment to dementia--meta-analysis of 41 robust inception cohort studies", Acta Psychiatr Scand, 119, pp.252~265 (2009)
- Farias ST, "Progression of mild cognitive impairment to dementia in clinic-vs community-based cohorts", Arch Neurol, 66, pp.1151~1157 (2009)
- Potter GG, "Neuropsychological predictors of dementia in late-life major depressive disorder", Am J Geriatr Psychiatry, 21, pp.297~306 (2013)
- Turner AD, "Depressive symptoms and cognitive decline in older african americans : two scales and their factors", Am J Geriatr Psychiatry, 23, pp.568~578 (2015)
- Louis ED, "Association between mild parkinsonian signs and mild cognitive impairment in a community", Neurology, 64, pp.1157~1161 (2005)
- Louis ED, "Functional correlates and prevalence of mild parkinsonian signs in a community population of older people", Arch Neurol, 62, pp.297~302 (2005)
- Choi J, "Association between functional impairment, depression, and extrapyramidal signs in neuroleptic-free patients with Alzheimer disease", J Geriatr Psychiatry Neurol, 26, pp.144~150 (2013)
- Richards M, "Subtle extrapyramidal signs can predict the development of dementia in elderly individuals", Neurology, 43, pp.2184~2188 (1993)
- Stern Y, "Utility of extrapyramidal signs and psychosis as predictors of cognitive and functional decline, nursing home admission, and death in Alzheimer’s disease: prospective analyses from the Predictors Study", Neurology, 44, pp.2300~2307 (1994)
- Bennett DA, "Prevalence of parkinsonian signs and associated mortality in a community population of older people", N Engl J Med, 334, pp.71~76 (1996)
- Louis ED, "Parkinsonian signs in older people in a community-based study : risk of incident dementia", Arch Neurol, 61, pp.1273~1276 (2004)
- Wilson RS, "Parkinsonianlike signs and risk of incident Alzheimer disease in older persons", Arch Neurol, 60, pp.539~544 (2003)
- 박희경, "Clinical Characteristics of a Nationwide Hospital-based Registry of Mild-to-Moderate Alzheimer’s Disease Patients in Korea: A CREDOS (Clinical Research Center for Dementia of South Korea) Study", Journal of Korean Medical Science, 26(9), pp.1219~1226 (2011), 대한의학회
- Kim S, "Gender differences in risk factors for transition from mild cognitive impairment to Alzheimer’s disease : A CREDOS study", Compr Psychiatry, 62, pp.114~122 (2015)
- 안현정, "Seoul Neuropsychological Screening Battery-Dementia Version (SNSB-D): A Useful Tool for Assessing and Monitoring Cognitive Impairments in Dementia Patients", Journal of Korean Medical Science, 25(7), pp.1071~1076 (2010), 대한의학회
- Morris JC, "The Clinical Dementia Rating(CDR) : current version and scoring rules", Neurology, 43, pp.2412~2414 (1993)
- American Psychiatric Association, "Diagnostic and Statistical Manual of Mental Disorders Text Revision: DSM-IV-TR", American Psychiatric Association, ~ (2000)
- Moon SY, "Impact of white matter changes on activities of daily living in mild to moderate dementia", Eur Neurol, 65, pp.223~230 (2011)
- Noh Y, "A new classification system for ischemia using a combination of deep and periventricular white matter hyperintensities", J Stroke Cerebrovasc Dis, 23, pp.636~642 (2014)
- Ye BS, "The heterogeneity and natural history of mild cognitive impairment of visual memory predominant type", J Alzheimers Dis, 43, pp.143~152 (2015)
- Folstein MF, "“Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician", J Psychiatr Res, 12, pp.189~198 (1975)
- Bae JN, "Development of the Korean version of the Geriatric Depression Scale and its short form among elderly psychiatric patients", J Psychosom Res, 57, pp.297~305 (2004)
- McKhann G, "Clinical diagnosis of Alzheimer’s disease : report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer’s Disease", Neurology, 34, pp.939~944 (1984)
- Roman GC, "Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop", Neurology, 43, pp.250~260 (1993)
- Erkinjuntti T, "Research criteria for subcortical vascular dementia in clinical trials", Neural Transm Suppl, 59, pp.23~30 (2000)
- Grambsch PM, "Proportional hazards tests and diagnostics based on weighted residuals", Biometrika, 81, pp.515~526 (1994)
- Bae JB, "Incidence of and risk factors for Alzheimer’s disease and mild cognitive impairment in Korean elderly", Dement Geriatr Cogn Disord, 39, pp.105~115 (2015)
- Israeli-Korn SD, "Mild cognitive impairment is associated with mild parkinsonian signs in a door-to-door study", J Alzheimers Dis, 22, pp.1005~1013 (2010)
- Kim KW, "A nationwide survey on the prevalence of dementia and mild cognitive impairment in South Korea", J Alzheimers Dis, 23, pp.281~291 (2011)
- Solfrizzi V, "Vascular risk factors, incidence of MCI, and rates of progression to dementia", Neurology, 63, pp.1882~1891 (2004)
- Burns JM, "The pathology of the substantia nigra in Alzheimer disease with extrapyramidal signs", Neurology, 64, pp.1397~1403 (2005)
- Baba M, "Aggregation of alpha-synuclein in Lewy bodies of sporadic Parkinson’s disease and dementia with Lewy bodies", Am J Pathol, 152, pp.879~884 (1998)
- Kish SJ, "Progressive supranuclear palsy: relationship between extrapyramidal disturbances, dementia, and brain neurotransmitter markers", Ann Neurol, 18, pp.530~536 (1985)
- Stern Y, "Cognitive reserve in ageing and Alzheimer’s disease", Lancet Neurol, 11, pp.1006~1012 (2012)
- Stern Y, "Rate of memory decline in AD is related to education and occupation: cognitive reserve?", Neurology, 53, pp.1942~1947 (1999)
- Ye BS, "Effects of education on the progression of early-versus late-stage mild cognitive impairment", Int Psychogeriatr, 25, pp.597~606 (2013)
- O’Brien JT, "Clinical significance of white matter changes", Am J Geriatr Psychiatry, 22, pp.133~137 (2014)
- Satagopan JM, "A note on competing risks in survival data analysis", Br J Cancer, 91, pp.1229~1235 (2004)
- Lopez OL, "The apolipoprotein E epsilon 4 allele is not associated with psychiatric symptoms or extrapyramidal signs in probable Alzheimer’s disease", Neurology, 49, pp.794~797 (1997)
