Objective: To characterize the cognitive and neurologic features of pa
tients with end-stage Alzheimer's disease using a standard neurologic
examination and the Glasgow Coma Scale. Design: Case series. Setting:
Local community nursing homes. Patients: Forty patients with Alzheimer
's disease were drawn from previously enrolled subjects in the Rochest
er Alzheimer's Disease Project with Clinical Denientia Rating scores o
f 3, 4, or 5. Main Outcome Measures: Scores on the Glasgow Coma Scale
and cognitive screening examinations and the prevalence of neurologic
manifestations such as primitive reflexes and extrapyramidal signs wer
e compared across the Clinical Dementia Rating groups. Results: When c
ompared with patients in the Clinical Dementia Rating stages 3 and 4,
patients with a stage 5 scored significantly lower on the Glasgow Coma
Scale, with the discriminating subscales being verbal and motor respo
nses. Primitive reflexes, myoclonus, and dyskinesia were increasingly
prevalent in the more terminal stages. Cognitive screening assessments
did not discriminate between groups.