Skip to main content
    • Aa
    • Aa
  • Get access
    Check if you have access via personal or institutional login
  • Cited by 2
  • Cited by
    This article has been cited by the following publications. This list is generated based on data provided by CrossRef.

    Choi, Seong Hye and Park, Moon Ho 2016. Three screening methods for cognitive dysfunction using the Mini-Mental State Examination and Korean Dementia Screening Questionnaire. Geriatrics & Gerontology International, Vol. 16, Issue. 2, p. 252.

    Park, Jin Hong Myung, Woojae Choi, Junbae Kim, Sangha Chung, Jae Won Kang, Hyo Shin Na, Duk L. Kim, Seong Yoon Lee, Jae-Hong Han, Seol-Heui Choi, Seong Hye Kim, Sang Yun and Kim, Doh Kwan 2016. Extrapyramidal Signs and Cognitive Subdomains in Alzheimer Disease. The American Journal of Geriatric Psychiatry, Vol. 24, Issue. 7, p. 566.


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

  • Moon Ho Park (a1) (a2), Joo Young Min (a3), Do-Young Kwon (a2), Seung Hwan Lee (a4), Hae Ri Na (a1) (a5), Sung Tae Cho (a6) and Duk L. Na (a1) (a7)
  • DOI:
  • Published online: 29 November 2010

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.

Corresponding author
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:
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

R. W. Baloh , S. H. Ying and K. M. Jacobson (2003). A longitudinal study of gait and balance dysfunction in normal older people. Archives of Neurology, 60, 835839.

D. J. Burn (2003). Extrapyramidal features in Parkinson's disease with and without dementia and dementia with Lewy bodies: a cross-sectional comparative study. Movement Disorders, 18, 884889.

J. M. Burns , J. E. Galvin , C. M. Roe , J. C. Morris and D. W. McKeel (2005). The pathology of the substantia nigra in Alzheimer disease with extrapyramidal signs. Neurology, 64, 13971403.

J. C. de la Torre (2004). Is Alzheimer's disease a neurodegenerative or a vascular disorder? Data, dogma, and dialectics. Lancet Neurology, 3, 184190.

M. Emre (2007). Clinical diagnostic criteria for dementia associated with Parkinson's disease. Movement Disorders, 22, 16891707; quiz 1837.

W. R. Gibb and A. J. Lees (1988). The relevance of the Lewy body to the pathogenesis of idiopathic Parkinson's disease. Journal of Neurology, Neurosurgery, and Psychiatry, 51, 745752.

L. S. Honig , W. Kukull and R. Mayeux (2005). Atherosclerosis and AD: analysis of data from the US National Alzheimer's Coordinating Center. Neurology, 64, 494500.

S. O. Jacobsson and C. J. Fowler (1999). Dopamine and glutamate neurotoxicity in cultured chick telencephali cells: effects of NMDA antagonists, antioxidants and MAO inhibitors. Neurochemistry International, 34, 4962.

J. Jankovic (1990). Variable expression of Parkinson's disease: a base-line analysis of the DATATOP cohort: the Parkinson Study Group. Neurology, 40, 15291534.

K. W. Kim , J. R. MacFall and M. E. Payne (2008). Classification of white matter lesions on magnetic resonance imaging in elderly persons. Biological Psychiatry, 64, 273280.

J. M. Lee (2007). Carotid intima-media thickness in Parkinson's disease. Movement Disorders, 22, 24462449.

R. Maggio (1998). Nicotine prevents experimental parkinsonism in rodents and induces striatal increase of neurotrophic factors. Journal of Neurochemistry, 71, 24392446.

R. Mayeux , Y. Stern and S. Spanton (1985). Heterogeneity in dementia of the Alzheimer type: evidence of subgroups. Neurology, 35, 453461.

I. G. McKeith (1996). Consensus guidelines for the clinical and pathologic diagnosis of dementia with Lewy bodies (DLB): report of the consortium on DLB international workshop. Neurology, 47, 11131124.

G. McKhann , D. Drachman , M. Folstein , R. Katzman , D. Price and E. M. Stadlan (1984). 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, 939944.

M. Merello (1994). Extrapyramidalism in Alzheimer's disease: prevalence, psychiatric, and neuropsychological correlates. Journal of Neurology, Neurosurgery, and Psychiatry, 57, 15031509.

J. C. Morris (1993). The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology, 43, 24122414.

R. C. Petersen (2001). Current concepts in mild cognitive impairment. Archives of Neurology, 58, 19851992.

P. Piccini (1995). White matter hyperintensities in Parkinson's disease: clinical correlations. Archives of Neurology, 52, 191194.

F. Portet , N. Scarmeas , S. Cosentino , E. P. Helzner and Y. Stern (2009). Extrapyramidal signs before and after diagnosis of incident Alzheimer disease in a prospective population study. Archives of Neurology, 66, 11201126.

N. Scarmeas (2004). Motor signs during the course of Alzheimer disease. Neurology, 63, 975982.

W. K. Seo , J. M. Lee , M. H. Park , K. W. Park and D. H. Lee (2008). Cerebral microbleeds are independently associated with arterial stiffness in stroke patients. Cerebrovascular Diseases, 26, 618623.

A. H. Snijders , B. P. van de Warrenburg , N. Giladi and B. R. Bloem (2007). Neurological gait disorders in elderly people: clinical approach and classification. Lancet Neurology, 6, 6374.

Y. Stern (1997). The absence of an apolipoprotein ε4 allele is associated with a more aggressive form of Alzheimer's disease. Annals of Neurology, 41, 615620.

J. Verghese , R. B. Lipton , C. B. Hall , G. Kuslansky , M. J. Katz and H. Buschke (2002). Abnormality of gait as a predictor of non-Alzheimer's dementia. New England Journal of Medicine, 347, 17611768.

C. H. Williams-Gray , T. Foltynie , C. E. Brayne , T. W. Robbins and R. A. Barker (2007). Evolution of cognitive dysfunction in an incident Parkinson's disease cohort. Brain, 130, 17871798.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

International Psychogeriatrics
  • ISSN: 1041-6102
  • EISSN: 1741-203X
  • URL: /core/journals/international-psychogeriatrics
Please enter your name
Please enter a valid email address
Who would you like to send this to? *