@article {211,
	title = {Motor signs predict poor outcomes in Alzheimer disease.},
	journal = {Neurology},
	volume = {64},
	year = {2005},
	month = {2005 May 24},
	pages = {1696-703},
	abstract = {OBJECTIVE: To examine whether the presence of motor signs has predictive value for important outcomes in Alzheimer disease (AD).

METHODS: A total of 533 patients with AD at early stages (mean Folstein Mini-Mental State Examination [MMSE] 21/30 at entry) were recruited and followed semiannually for up to 13.1 years (mean 3) in five University-based AD centers in the United States and European Union. Four outcomes, assessed every 6 months, were used in Cox models: cognitive endpoint (Columbia Mini-Mental State Examination < or = 20/57 [ approximately MMSE < or = 10/30]), functional endpoint (Blessed Dementia Rating Scale > or = 10), institutionalization equivalent index, and death. Using a standardized portion of the Unified PD Rating Scale (administered every 6 months for a total of 3,149 visit-assessments, average 5.9 per patient), the presence of motor signs, as well as of individual motor sign domains, was examined as time-dependent predictor. The models controlled for cohort, recruitment center, sex, age, education, a comorbidity index, and baseline cognitive and functional performance.

RESULTS: A total of 39\% of the patients reached the cognitive, 41\% the functional, 54\% the institutionalization, and 47\% the mortality endpoint. Motor signs were noted for 14\% of patients at baseline and for 45\% at any evaluation. Their presence was associated with increased risk for cognitive decline (RR, 1.72; 95\% CI, 1.24 to 2.38), functional decline (1.80 [1.33 to 2.45]), institutionalization (1.68 [1.26 to 2.25]), and death (1.38 [1.05 to 1.82]). Tremor was associated with increased risk for reaching the cognitive and bradykinesia for reaching the functional endpoints. Postural-gait abnormalities carried increased risk for institutionalization and mortality. Faster rates of motor sign accumulation were associated with increased risk for all outcomes.

CONCLUSIONS: Motor signs predict cognitive and functional decline, institutionalization, and mortality in Alzheimer disease. Different motor sign domains predict different outcomes.},
	keywords = {Aged, Aged, 80 and over, Alzheimer Disease, Brain, Cognition Disorders, Cohort Studies, Disease Progression, Dysarthria, Female, Follow-Up Studies, Gait Disorders, Neurologic, Humans, Hypokinesia, Male, Middle Aged, Movement Disorders, Muscle Rigidity, Neurologic Examination, Neuropsychological Tests, Predictive Value of Tests, Prognosis, Proportional Hazards Models},
	issn = {1526-632X},
	doi = {10.1212/01.WNL.0000162054.15428.E9},
	author = {Scarmeas, N. and Albert, M and Brandt, J and Blacker, D and Hadjigeorgiou, G and Papadimitriou, A and Dubois, B and Sarazin, M and Wegesin, D and Marder, K and Bell, K and Honig, L and Stern, Y}
}
