Pyramidal and extrapyramidal scale (PEPS): a new scale for the assessment of motor impairment in vascular cognitive impairment associated with small vessel disease

Clin Neurol Neurosurg. 2011 Apr;113(3):181-7. doi: 10.1016/j.clineuro.2010.11.001. Epub 2010 Nov 30.


Objective: Vascular cognitive impairment associated with small vessel disease (sVCI) may manifest as both cognitive and motor dysfunctions. However, few instruments exist for systematically assessing motor symptoms in sVCI, even though many neuropsychological tests exist to evaluate cognitive function. We developed a new scale for assessing motor impairments and evaluated the reliability and validity of the scale in patients with sVCI.

Methods: A new motor scale, called the PEPS (Pyramidal and Extra Pyramidal Scale for sVCI), consisted of 34 items (for 60 total points) with 5 subdomains: corticospinal, corticobulbar, extrapyramidal signs, gait abnormalities, and gait severity. The PEPS was compared between 75 patients with sVCI and 73 control patients who had dementia or mild cognitive impairment (MCI) without ischemia.

Results: The PEPS had good interrater and test-retest reliability, and it was moderately to highly correlated with the UPDRS, NIHSS, MMSE, CDR, and ADL scales. An optimal cut-off score of PEPS to discriminate dementia or MCI patients with ischemia from those without ischemia was 6.5 with a sensitivity of 88% and a specificity of 100%.

Conclusion: The PEPS is a reliable and valid scale that can be used to assess and monitor motor impairment in patients with vascular cognitive impairment due to small vessel disease.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Brain Ischemia / complications
  • Brain Ischemia / physiopathology
  • Brain Ischemia / psychology
  • Cerebrovascular Disorders / diagnosis*
  • Cerebrovascular Disorders / physiopathology
  • Cerebrovascular Disorders / psychology
  • Cognition Disorders / diagnosis*
  • Cognition Disorders / physiopathology
  • Cognition Disorders / psychology
  • Dementia, Vascular / diagnosis*
  • Dementia, Vascular / physiopathology
  • Dementia, Vascular / psychology
  • Extrapyramidal Tracts / physiopathology*
  • Female
  • Gait Disorders, Neurologic / etiology
  • Gait Disorders, Neurologic / physiopathology
  • Humans
  • Male
  • Movement Disorders / diagnosis*
  • Movement Disorders / physiopathology
  • Neurologic Examination
  • Observer Variation
  • Pyramidal Tracts / physiopathology*
  • ROC Curve
  • Reproducibility of Results
  • Socioeconomic Factors