TY - JOUR
T1 - Motor signs in Alzheimer's disease and vascular dementia
T2 - Detection through natural language processing, co-morbid features and relationship to adverse outcomes
AU - Al-Harrasi, Ahmed M
AU - Iqbal, Ehtesham
AU - Tsamakis, Konstantinos
AU - Lasek, Judista
AU - Gadelrab, Romayne
AU - Soysal, Pinar
AU - Kohlhoff, Enno
AU - Tsiptsios, Dimitrios
AU - Rizos, Emmanouil
AU - Perera, Gayan
AU - Aarsland, Dag
AU - Stewart, Robert
AU - Mueller, Christoph
N1 - Copyright © 2021 Elsevier Inc. All rights reserved.
PY - 2021/4
Y1 - 2021/4
N2 - BACKGROUND: Motor signs in patients with dementia are associated with a higher risk of cognitive decline, institutionalisation, death and increased health care costs, but prevalences differ between studies. The aims of this study were to employ a natural language processing pipeline to detect motor signs in a patient cohort in routine care; to explore which other difficulties occur co-morbid to motor signs; and whether these, as a group and individually, predict adverse outcomes.METHODS: A cohort of 11,106 patients with dementia in Alzheimer's disease, vascular dementia or a combination was assembled from a large dementia care health records database in Southeast London. A natural language processing algorithm was devised in order to establish the presence of motor signs (bradykinesia, Parkinsonian gait, rigidity, tremor) recorded around the time of dementia diagnosis. We examined the co-morbidity profile of patients with these symptoms and used Cox regression models to analyse associations with survival and hospitalisation, adjusting for twenty-four potential confounders.RESULTS: Less than 10% of patients were recorded to display any motor sign, and tremor was most frequently detected. Presence of motor signs was associated with younger age at diagnosis, neuropsychiatric symptoms, poor physical health and higher prescribing of psychotropics. Rigidity was independently associated with a 23% increased mortality risk after adjustment for confounders (p = 0.014). A non-significant trend for a 15% higher risk of hospitalisation was detected in those with a recorded Parkinsonian gait (p = 0.094).CONCLUSIONS: With the exception of tremor, motor signs appear to be under-recorded in routine care. They are part of a complex clinical picture and often accompanied by neuropsychiatric and functional difficulties, and thereby associated with adverse outcomes. This underlines the need to establish structured examinations in routine clinical practice via easy-to-use tools.
AB - BACKGROUND: Motor signs in patients with dementia are associated with a higher risk of cognitive decline, institutionalisation, death and increased health care costs, but prevalences differ between studies. The aims of this study were to employ a natural language processing pipeline to detect motor signs in a patient cohort in routine care; to explore which other difficulties occur co-morbid to motor signs; and whether these, as a group and individually, predict adverse outcomes.METHODS: A cohort of 11,106 patients with dementia in Alzheimer's disease, vascular dementia or a combination was assembled from a large dementia care health records database in Southeast London. A natural language processing algorithm was devised in order to establish the presence of motor signs (bradykinesia, Parkinsonian gait, rigidity, tremor) recorded around the time of dementia diagnosis. We examined the co-morbidity profile of patients with these symptoms and used Cox regression models to analyse associations with survival and hospitalisation, adjusting for twenty-four potential confounders.RESULTS: Less than 10% of patients were recorded to display any motor sign, and tremor was most frequently detected. Presence of motor signs was associated with younger age at diagnosis, neuropsychiatric symptoms, poor physical health and higher prescribing of psychotropics. Rigidity was independently associated with a 23% increased mortality risk after adjustment for confounders (p = 0.014). A non-significant trend for a 15% higher risk of hospitalisation was detected in those with a recorded Parkinsonian gait (p = 0.094).CONCLUSIONS: With the exception of tremor, motor signs appear to be under-recorded in routine care. They are part of a complex clinical picture and often accompanied by neuropsychiatric and functional difficulties, and thereby associated with adverse outcomes. This underlines the need to establish structured examinations in routine clinical practice via easy-to-use tools.
KW - Alzheimer Disease/diagnosis
KW - Dementia, Vascular
KW - Humans
KW - Hypokinesia
KW - London
KW - Natural Language Processing
U2 - 10.1016/j.exger.2020.111223
DO - 10.1016/j.exger.2020.111223
M3 - Article
C2 - 33450346
SN - 0531-5565
VL - 146
SP - 111223
JO - Experimental Gerontology
JF - Experimental Gerontology
ER -