THE UPDRS SCALE AS A MEANS OF IDENTIFYING EXTRAPYRAMIDAL SIGNS IN PATIENTS SUFFERING FROM DEMENTIA WITH LEWY BODIES

The study aimed to evaluate the merits of the Unified Parkinson's Dise ase Rating Scale (UPDRS) in the assessment of parkinsonism in patients suffering from Dementia with Lewy Bodies (DLB). Parkinsonian symptoms were assessed in 73 dementia patients using the UPDRS and staged usin g the Hoehn & Yahr system. A staging of 1 or greater was taken to indi cate significant parkinsonism. DLB (n=42) was diagnosed using the McKe ith et al. criteria, Alzheimer's disease (n=30) was diagnosed using th e NINCDS ADRDA criteria. The inability of some patients to comply with some of the more complicated tasks meant that the full UPDRS assessme nt could only be completed in 35 (83%) of the DLB patients, 23 (66%) o f whom had significant parkinsonism. Patients with parkinsonism were s ignificantly younger than those without, A Principal Components Analys is derived a sub-scale including the items tremor al rest, action trem or, bradykinesia, facial expression and rigidity, These items had a sp ecificity of 100% and a sensitivity of 85% for significant parkinsonis m using a cut-off of 7/8. The brief scale had several advantages over the complete UPDS. Unlike the full scale it was independent of the sev erity of cognitive impairment and the 5 key items could be assessed in 41 (98%) of the DLB patients. Autopsies have been completed on 31 pat ients, with a specificity of greater than 90% for the operationalized clinical diagnosis of DLB. It is suggested that a 5 item subscale of t he UPDRS provides a reliable and generally applicable instrument for t ile assessment of parkinsonism In DLB patients.