Extrapyramidal signs in cognitively intact elderly people

Aim: to investigate the prevalence of extrapyramidal signs in elderly people and their relationship to disease. Setting and subjects: 151 non-demented subjects age 65 and over living within a defined geographical area in Nottingham who were participating in the MRC multicentre Cognitive Function and Ageing Study. Measurements: subjects were assessed at home. Extrapyramidal signs were rated according to a standardized neurological examination using items from the Unified Parkinson's Disease Rating Scale. Results: bradykinetic and hypokinetic abnormalities are a frequent finding, especially in the oldest old. Over 50% of subjects aged 80 or over demonstrated at least one such sign. Only 10% of subjects had any recorded neurological disease. Conclusions: the frequency of recognized neurological and other disease is insufficient to account for the rate of subtle extrapyramidal abnormalities found. These findings may thus represent intrinsic age-related changes in neurological functioning, this being consistent with previously described pathological changes in the substantia nigra and striatum in normal ageing.