Abstract Details

Title A Comparison of Extrapyramidal Signs between Smokers and Non-Smokers with Dementia

Topic Aging and Dementia

Presentation(s) P07 - (-)

Poster/Presentation
Number 153

Objective

Background BACKGROUND: Epidemiological studies suggest that smokers have less Parkinson's disease (PD). However, recent analyses of the Unified Parkinson's Disease Rating Scale (UPDRS) and smoking history have demonstrated that UPDRS motor score increases with higher pack-year history amongst former smokers with dementia.

Design/Methods DESIGN/METHODS: We analyzed data from 4520 individuals (age >50) with dementia from the National Alzheimer's Coordinating Center database, including demographics, smoking history and motor UPDRS scores. Subjects were excluded if they had been exposed to antidopaminergic medications. The UPDRS motor scores were subdivided into 9 EPS, which were dichotomized into present (any item score >2) or absent (0-1 scores). Former smokers were split into tertiles (low, medium and heavy) according to pack-year history.

Results RESULTS: Action/postural tremor was more prevalent amongst former heavy smokers than never-smokers (12.6% vs 7.9%, p<0.001). Current smokers had a lower prevalence of rigidity than former heavy smokers (p<0.005); this was no longer significant after adjusting for age, gender and Mini-Mental State Exam (MMSE) score. Current smokers were the least likely to have masked facies (adjusted OR=0.44, 95%CI 0.25-0.77). They were also more likely to have an action or postural tremor (OR=1.68, 95%CI 1.05-2.71). Former smokers with medium and heavy smoking histories also had similarly elevated odds of action/postural tremor (ORs= 1.41 and 1.51 respectively, p's <0.03). Other cardinal features of PD (e.g., rest tremor and bradykinesia) were not significantly different between the groups.

Conclusions CONCLUSIONS: Current smokers have the highest prevalence of action/postural tremor. Possible explanations include the direct effects of nicotine; however this does not explain the increased odds of action/postural tremor in former smokers with medium-to-heavy past smoking histories. Further research is needed to understand the various mechanisms for parkinsonism in dementia, including those mediated by synucleinopathy and cerebrovascular disease.

Authors/Disclosures
Berneet Kaur, MD PRESENTER	No disclosure on file
	No disclosure on file
	No disclosure on file
Robert Beach, MD, PhD, FAAN (Upstate Medical University)	The institution of Dr. Beach has received research support from Neurona.
	No disclosure on file
Charles S. DeCarli, MD, FAAN (UC Davis Health - Dept of NeurologyAlzheimer's Disease Research Center)	Dr. DeCarli has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Novo Nordisk. The institution of Dr. DeCarli has received research support from NIH.
John M. Olichney, MD (Center for Mind and Brain)	No disclosure on file
	No disclosure on file

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