Medium-term prognosis of an incident cohort of parkinsonian patients compared to controls. (November 2016)

• Record Type: Journal Article
• Authors: Fielding, S.; Macleod, A.D.; Counsell, C.E.
• Is Part Of: Parkinsonism & related disorders. Volume 32(2016)
• Page Start: 36
• Page End: 41
• Publication Date: 2016-11
• Subjects: Parkinson's disease -- Parkinsonian disorders -- Prognosis -- Survival -- Cohort study; Parkinson's disease -- Periodicals; Movement disorders -- Periodicals; Movement Disorders -- Periodicals; Nerve Degeneration -- Periodicals; Nervous System Diseases -- Periodicals; Parkinson Disease -- Periodicals; Tremor -- Periodicals; Parkinson, Maladie de -- Périodiques; Parkinson's disease; 616.833
• DOI: 10.1016/j.parkreldis.2016.08.010
• Languages: English
• ISSNs: 1353-8020

Abstract

Abstract: Background: The best data on prognosis comes from population-based incident cohorts but few such cohorts exist for Parkinson's disease and atypical parkinsonism. Methods: The PINE study is a prospective follow-up study of an incident cohort of people with degenerative or vascular parkinsonism and age-sex matched controls. Participants have annual follow-up from diagnosis until death with review of primary/secondary care records and linkage to the UK death register. Data are collected on survival, disability (dependency on others for activities of daily living) and institutionalization. Research criteria are used to guide the clinical diagnosis, which is updated annually. We compared all-cause mortality, disability and institutionalization in patients (subdivided by diagnosis) and controls, adjusted for important confounders. Results: 323 incident parkinsonian patients (199 Parkinson's disease, 124 atypical parkinsonism, mean age at diagnosis 75yrs) and 262 controls (mean age 75yrs) had 1349 and 1334 person-years follow-up respectively (maximum follow-up 10 years). All outcomes were worse in parkinsonian patients than controls, especially in atypical parkinsonism (adjusted mortality hazards ratios Parkinson's disease 2.49, 95%CI 1.72–3.58, atypical parkinsonism, 6.85, 95%CI 4.78–9.81). Median survival times for Parkinson's disease and atypical parkinsonism were 7.8 and 2.7 years respectively but were very age-dependent. At three years the rates of death or dependency were controls 21%, Parkinson's disease 46%, atypical parkinsonism 96% whilst overall institutionalization rates were 5%, 15% and 55% respectively. Conclusion: The prognosis of Parkinson's disease and atypical parkinsonism in this unselected incident cohort was significantly worse than previously reported. This has important implications for patient management. Highlights: 323 incident parkinsonian patients were followed for up to 10 years. Mortality was 2.5–6.8 times higher in patients compared to controls. After 3 years 46% (PD) and 96% (atypical parkinsonism) were dead or dependent. 14% (PD) and 55% (atypical parkinsonism) were institutionalized during follow-up. Prognosis was significantly worse than in previous non-incident younger cohorts.