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Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 1991 Jan;54(1):34–38. doi: 10.1136/jnnp.54.1.34

Extrapyramidal features in advanced Down's syndrome: clinical evaluation and family history.

P Vieregge 1, G Ziemens 1, M Freudenberg 1, A Piosinski 1, A Muysers 1, B Schulze 1
PMCID: PMC1014295  PMID: 1826326

Abstract

Extrapyramidal, frontal release, and other neurological signs were studied in 54 demented and non-demented patients with Down's syndrome (DS). Fourteen patients were demented and five showed extrapyramidal signs, mainly of the rigid-hypokinetic spectrum and similar to Parkinsonian features in advanced Alzheimer's disease (AD). None of the non-demented patients had Parkinsonian signs. The mean age of the demented DS patients with extrapyramidal signs was significantly higher than that of the patients without. Frontal release signs were present in demented and non-demented patients. A questionnaire showed no increase in either the proportion of early- or senile-onset dementia or Parkinsonism among first- and second-degree relatives of DS patients. Parkinsonian signs appear to be present at a lower frequency in DS than in advanced AD. A speculative hypothesis about a gene dosage effect of Cu/Zn-superoxide dismutase in preventing toxic radical formation in the substantia nigra of DS patients is presented.

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Selected References

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  1. Chandra V., Schoenberg B. S. Inheritance of Alzheimer's disease: epidemiologic evidence. Neuroepidemiology. 1989;8(4):165–174. doi: 10.1159/000110179. [DOI] [PubMed] [Google Scholar]
  2. Chui H. C., Teng E. L., Henderson V. W., Moy A. C. Clinical subtypes of dementia of the Alzheimer type. Neurology. 1985 Nov;35(11):1544–1550. doi: 10.1212/wnl.35.11.1544. [DOI] [PubMed] [Google Scholar]
  3. Cohen G. The pathobiology of Parkinson's disease: biochemical aspects of dopamine neuron senescence. J Neural Transm Suppl. 1983;19:89–103. [PubMed] [Google Scholar]
  4. Dalton A. J., Crapper D. R., Schlotterer G. R. Alzheimer's disease in Down's syndrome: visual retention deficits. Cortex. 1974 Dec;10(4):366–377. doi: 10.1016/s0010-9452(74)80029-8. [DOI] [PubMed] [Google Scholar]
  5. Delwaide P. J., Desseilles M. Spontaneous buccolinguofacial dyskinesia in the elderly. Acta Neurol Scand. 1977 Sep;56(3):256–262. doi: 10.1111/j.1600-0404.1977.tb01431.x. [DOI] [PubMed] [Google Scholar]
  6. Ditter S. M., Mirra S. S. Neuropathologic and clinical features of Parkinson's disease in Alzheimer's disease patients. Neurology. 1987 May;37(5):754–760. doi: 10.1212/wnl.37.5.754. [DOI] [PubMed] [Google Scholar]
  7. Drachman D. A., Stahl S. Letter: Extrapyramidal dementia and levodopa. Lancet. 1975 Apr 5;1(7910):809–809. doi: 10.1016/s0140-6736(75)92479-4. [DOI] [PubMed] [Google Scholar]
  8. Epstein C. J., Avraham K. B., Lovett M., Smith S., Elroy-Stein O., Rotman G., Bry C., Groner Y. Transgenic mice with increased Cu/Zn-superoxide dismutase activity: animal model of dosage effects in Down syndrome. Proc Natl Acad Sci U S A. 1987 Nov;84(22):8044–8048. doi: 10.1073/pnas.84.22.8044. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Gibb W. R., Mountjoy C. Q., Mann D. M., Lees A. J. The substantia nigra and ventral tegmental area in Alzheimer's disease and Down's syndrome. J Neurol Neurosurg Psychiatry. 1989 Feb;52(2):193–200. doi: 10.1136/jnnp.52.2.193. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Goate A. M., Haynes A. R., Owen M. J., Farrall M., James L. A., Lai L. Y., Mullan M. J., Roques P., Rossor M. N., Williamson R. Predisposing locus for Alzheimer's disease on chromosome 21. Lancet. 1989 Feb 18;1(8634):352–355. doi: 10.1016/s0140-6736(89)91725-x. [DOI] [PubMed] [Google Scholar]
  11. Godridge H., Reynolds G. P., Czudek C., Calcutt N. A., Benton M. Alzheimer-like neurotransmitter deficits in adult Down's syndrome brain tissue. J Neurol Neurosurg Psychiatry. 1987 Jun;50(6):775–778. doi: 10.1136/jnnp.50.6.775. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Hofman A., Schulte W., Tanja T. A., van Duijn C. M., Haaxma R., Lameris A. J., Otten V. M., Saan R. J. History of dementia and Parkinson's disease in 1st-degree relatives of patients with Alzheimer's disease. Neurology. 1989 Dec;39(12):1589–1592. doi: 10.1212/wnl.39.12.1589. [DOI] [PubMed] [Google Scholar]
  13. Huff F. J., Auerbach J., Chakravarti A., Boller F. Risk of dementia in relatives of patients with Alzheimer's disease. Neurology. 1988 May;38(5):786–790. doi: 10.1212/wnl.38.5.786. [DOI] [PubMed] [Google Scholar]
  14. Jellinger K. Neuropathological substrates of Alzheimer's disease and Parkinson's disease. J Neural Transm Suppl. 1987;24:109–129. [PubMed] [Google Scholar]
  15. Koller W. C., Wilson R. S., Glatt S. L., Fox J. H. Motor signs are infrequent in dementia of the Alzheimer type. Ann Neurol. 1984 Oct;16(4):514–516. doi: 10.1002/ana.410160418. [DOI] [PubMed] [Google Scholar]
  16. Lai F., Williams R. S. A prospective study of Alzheimer disease in Down syndrome. Arch Neurol. 1989 Aug;46(8):849–853. doi: 10.1001/archneur.1989.00520440031017. [DOI] [PubMed] [Google Scholar]
  17. Leverenz J., Sumi S. M. Parkinson's disease in patients with Alzheimer's disease. Arch Neurol. 1986 Jul;43(7):662–664. doi: 10.1001/archneur.1986.00520070020010. [DOI] [PubMed] [Google Scholar]
  18. Loesch-Mdzewska D. Some aspects of the neurology of Down's syndrome. J Ment Defic Res. 1968 Sep;12(3):237–246. doi: 10.1111/j.1365-2788.1968.tb00263.x. [DOI] [PubMed] [Google Scholar]
  19. Lott I. T., Lai F. Dementia in Down's syndrome: observations from a neurology clinic. Appl Res Ment Retard. 1982;3(3):233–239. doi: 10.1016/0270-3092(82)90017-0. [DOI] [PubMed] [Google Scholar]
  20. Mann D. M., Yates P. O., Marcyniuk B. Dopaminergic neurotransmitter systems in Alzheimer's disease and in Down's syndrome at middle age. J Neurol Neurosurg Psychiatry. 1987 Mar;50(3):341–344. doi: 10.1136/jnnp.50.3.341. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Mann D. M., Yates P. O., Marcyniuk B., Ravindra C. R. Loss of neurones from cortical and subcortical areas in Down's syndrome patients at middle age. Quantitative comparisons with younger Down's patients and patients with Alzheimer's disease. J Neurol Sci. 1987 Aug;80(1):79–89. doi: 10.1016/0022-510x(87)90223-1. [DOI] [PubMed] [Google Scholar]
  22. Marttila R. J., Lorentz H., Rinne U. K. Oxygen toxicity protecting enzymes in Parkinson's disease. Increase of superoxide dismutase-like activity in the substantia nigra and basal nucleus. J Neurol Sci. 1988 Sep;86(2-3):321–331. doi: 10.1016/0022-510x(88)90108-6. [DOI] [PubMed] [Google Scholar]
  23. Mayeux R., Stern Y., Spanton S. Heterogeneity in dementia of the Alzheimer type: evidence of subgroups. Neurology. 1985 Apr;35(4):453–461. doi: 10.1212/wnl.35.4.453. [DOI] [PubMed] [Google Scholar]
  24. Miniszek N. A. Development of Alzheimer disease in Down syndrome individuals. Am J Ment Defic. 1983 Jan;87(4):377–385. [PubMed] [Google Scholar]
  25. Morris J. C., Drazner M., Fulling K., Grant E. A., Goldring J. Clinical and pathological aspects of parkinsonism in Alzheimer's disease. A role for extranigral factors? Arch Neurol. 1989 Jun;46(6):651–657. doi: 10.1001/archneur.1989.00520420071025. [DOI] [PubMed] [Google Scholar]
  26. Mortimer J. A., French L. R., Hutton J. T., Schuman L. M. Head injury as a risk factor for Alzheimer's disease. Neurology. 1985 Feb;35(2):264–267. doi: 10.1212/wnl.35.2.264. [DOI] [PubMed] [Google Scholar]
  27. Mölsä P. K., Marttila R. J., Rinne U. K. Extrapyramidal signs in Alzheimer's disease. Neurology. 1984 Aug;34(8):1114–1116. doi: 10.1212/wnl.34.8.1114. [DOI] [PubMed] [Google Scholar]
  28. Owens D., Dawson J. C., Losin S. Alzheimer's disease in Down's syndrome. Am J Ment Defic. 1971 Mar;75(5):606–612. [PubMed] [Google Scholar]
  29. Pearce J. The extrapyramidal disorder of Alzheimer's disease. Eur Neurol. 1974;12(2):94–103. doi: 10.1159/000114608. [DOI] [PubMed] [Google Scholar]
  30. Pogacar S., Rubio A. Morphological features of Pick's and atypical Alzheimer's disease in Down's syndrome. Acta Neuropathol. 1982;58(4):249–254. doi: 10.1007/BF00688605. [DOI] [PubMed] [Google Scholar]
  31. Rocca W. A. The etiology of Alzheimer's disease: epidemiologic contributions with emphasis on the genetic hypothesis. J Neural Transm Suppl. 1987;24:3–12. [PubMed] [Google Scholar]
  32. Saggu H., Cooksey J., Dexter D., Wells F. R., Lees A., Jenner P., Marsden C. D. A selective increase in particulate superoxide dismutase activity in parkinsonian substantia nigra. J Neurochem. 1989 Sep;53(3):692–697. doi: 10.1111/j.1471-4159.1989.tb11759.x. [DOI] [PubMed] [Google Scholar]
  33. Schapiro M. B., Haxby J. V., Grady C. L., Duara R., Schlageter N. L., White B., Moore A., Sundaram M., Larson S. M., Rapoport S. I. Decline in cerebral glucose utilisation and cognitive function with aging in Down's syndrome. J Neurol Neurosurg Psychiatry. 1987 Jun;50(6):766–774. doi: 10.1136/jnnp.50.6.766. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Schapiro M. B., Kay A. D., May C., Ryker A. K., Haxby J. V., Kaufman S., Milstien S., Rapoport S. I. Cerebrospinal fluid monoamines in Down's syndrome adults at different ages. J Ment Defic Res. 1987 Sep;31(Pt 3):259–269. doi: 10.1111/j.1365-2788.1987.tb01369.x. [DOI] [PubMed] [Google Scholar]
  35. Schellenberg G. D., Bird T. D., Wijsman E. M., Moore D. K., Boehnke M., Bryant E. M., Lampe T. H., Nochlin D., Sumi S. M., Deeb S. S. Absence of linkage of chromosome 21q21 markers to familial Alzheimer's disease. Science. 1988 Sep 16;241(4872):1507–1510. doi: 10.1126/science.3420406. [DOI] [PubMed] [Google Scholar]
  36. Schoenberg B. S., Kokmen E., Okazaki H. Alzheimer's disease and other dementing illnesses in a defined United States population: incidence rates and clinical features. Ann Neurol. 1987 Dec;22(6):724–729. doi: 10.1002/ana.410220608. [DOI] [PubMed] [Google Scholar]
  37. Sturman S. G., Williams A. C. Parkinsonism and Down syndrome. Lancet. 1989 Oct 14;2(8668):920–921. doi: 10.1016/s0140-6736(89)91581-x. [DOI] [PubMed] [Google Scholar]
  38. Sulkava R. Alzheimer's disease and senile dementia of Alzheimer type. A comparative study. Acta Neurol Scand. 1982 Jun;65(6):636–650. doi: 10.1111/j.1600-0404.1982.tb03117.x. [DOI] [PubMed] [Google Scholar]
  39. Thase M. E. Longevity and mortality in Down's syndrome. J Ment Defic Res. 1982 Sep;26(Pt 3):177–192. doi: 10.1111/j.1365-2788.1982.tb00144.x. [DOI] [PubMed] [Google Scholar]
  40. Tyrrell P. J., Rossor M. N. Extrapyramidal signs in dementia of Alzheimer type. Lancet. 1989 Oct 14;2(8668):920–920. doi: 10.1016/s0140-6736(89)91580-8. [DOI] [PubMed] [Google Scholar]
  41. Veall R. M. The prevalance of epilepsy among mongols related to age. J Ment Defic Res. 1974 Jun;18(2):99–106. doi: 10.1111/j.1365-2788.1974.tb01224.x. [DOI] [PubMed] [Google Scholar]
  42. Wisniewski H. M., Rabe A. Discrepancy between Alzheimer-type neuropathology and dementia in persons with Down's syndrome. Ann N Y Acad Sci. 1986;477:247–260. doi: 10.1111/j.1749-6632.1986.tb40344.x. [DOI] [PubMed] [Google Scholar]
  43. Wisniewski K. E., Dalton A. J., McLachlan C., Wen G. Y., Wisniewski H. M. Alzheimer's disease in Down's syndrome: clinicopathologic studies. Neurology. 1985 Jul;35(7):957–961. doi: 10.1212/wnl.35.7.957. [DOI] [PubMed] [Google Scholar]
  44. Wisniewski K. E., French J. H., Rosen J. F., Kozlowski P. B., Tenner M., Wisniewski H. M. Basal ganglia calcification (BGC) in Down's syndrome (DS)--another manifestation of premature aging. Ann N Y Acad Sci. 1982;396:179–189. doi: 10.1111/j.1749-6632.1982.tb26852.x. [DOI] [PubMed] [Google Scholar]
  45. Wisniewski K. E., Wisniewski H. M., Wen G. Y. Occurrence of neuropathological changes and dementia of Alzheimer's disease in Down's syndrome. Ann Neurol. 1985 Mar;17(3):278–282. doi: 10.1002/ana.410170310. [DOI] [PubMed] [Google Scholar]
  46. Wisniewski K., Howe J., Williams D. G., Wisniewski H. M. Precocious aging and dementia in patients with Down's syndrome. Biol Psychiatry. 1978 Oct;13(5):619–627. [PubMed] [Google Scholar]
  47. Yatham L. N., McHale P. A., Kinsella A. Down's syndrome and its association with Alzheimer's disease. Acta Psychiatr Scand. 1988 Jan;77(1):38–41. doi: 10.1111/j.1600-0447.1988.tb05074.x. [DOI] [PubMed] [Google Scholar]
  48. Zemlan F. P., Thienhaus O. J., Bosmann H. B. Superoxide dismutase activity in Alzheimer's disease: possible mechanism for paired helical filament formation. Brain Res. 1989 Jan 2;476(1):160–162. doi: 10.1016/0006-8993(89)91550-3. [DOI] [PubMed] [Google Scholar]

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