Subtle extrapyramidal signs can predict the development of dementia in elderly individuals

To assess the significance of mild extrapyramidal signs (EPSs) in aging, we prospectively followed 228 elderly individuals without dementia or major neurologic disease at baseline. Seventy-three (32%) showed mild idiopathic EPSs at baseline assessment and 32 (14%) of these 228 individuals met NINCDS-ADRDA criteria for probable or possible Alzheimer's disease on follow-up. While none of these individuals developed Parkinson's disease, those with more than one EPS at baseline were significantly more likely to become demented during follow-up than were those with one or no EPS, an association not confounded by age, education, or gender. Individuals with more than one EPS and with cognitive impairment (CI) at baseline were at highest risk for dementia. EPSs were also independently associated with incident dementia in the absence of CI at baseline. We conclude that mild EPSs are a significant predictor of dementia in elderly individuals.