Motor and Nonmotor Features in Early Parkinson's Disease Predict Increased Mortality Risk
Motor and Nonmotor Features in Early Parkinson's Disease Predict Increased Mortality Risk
Lo RY, Tanner CM, Albers KB, et al
Arch Neurol. 2009;66:1353-1358
Identifying demographic or clinical predictors of survival in early Parkinson's disease (PD) would be useful not only for determining prognosis, but also for clinical trials. In a multiethnic inception cohort started in 1994-1995 at Kaiser Permanente Medical Care Program, northern California, 573 patients with newly diagnosed PD were evaluated for clinical features within 2 years of diagnosis.
Potential predictors studied were age at diagnosis, gender, race/ethnicity, clinical subtype (modified tremor dominant or postural instability gait difficulty), symmetry, cognitive dysfunction, depression, dysphagia, and hallucinations. Using Cox proportional hazards regression analysis, the investigators determined the association of these factors with shorter survival through December 31, 2005.
During follow-up, 352 patients (61.4%) had died. Predictors of increased all-cause mortality, after adjustment for age, gender, and race/ethnicity, were older age at diagnosis (hazard ratio [HR], 1.1; 95% confidence interval [CI], 1.09-1.12), clinical subtype of modified postural instability gait difficulty (HR, 1.8; 95% CI, 1.3-2.7), symmetry of motor signs (HR, 2.0; 95% CI, 1.1-3.7), mild cognitive impairment (HR, 1.7; 95% CI, 1.3-2.2), severe cognitive impairment (HR, 2.7; 95% CI, 1.9-3.9), dysphagia (HR, 1.4; 95% CI, 1.1-1.9), and hallucinations (HR, 2.1; 95% CI, 1.3-3.2).
None of the other potential predictors studied, including depression, was associated with change in survival. An empirical predictive analysis revealed that most significant predictors that were identified previously remained associated with shorter survival.
Factors predicting increased mortality in early PD include both motor and nonmotor clinical features, notably postural instability gait difficulty, cognitive dysfunction and hallucinations. The strongest predictor was severe cognitive impairment within 2 years of PD diagnosis. This is the first report of dysphagia being associated with shorter survival in PD and it suggests that beginning swallowing training early in the course of PD might reduce mortality risk.
In addition to facilitating clinical management, these predictors should be considered in the design of research studies.
Clinical Features in Early Parkinson Disease and Survival
Lo RY, Tanner CM, Albers KB, et al
Arch Neurol. 2009;66:1353-1358
Summary
Identifying demographic or clinical predictors of survival in early Parkinson's disease (PD) would be useful not only for determining prognosis, but also for clinical trials. In a multiethnic inception cohort started in 1994-1995 at Kaiser Permanente Medical Care Program, northern California, 573 patients with newly diagnosed PD were evaluated for clinical features within 2 years of diagnosis.
Potential predictors studied were age at diagnosis, gender, race/ethnicity, clinical subtype (modified tremor dominant or postural instability gait difficulty), symmetry, cognitive dysfunction, depression, dysphagia, and hallucinations. Using Cox proportional hazards regression analysis, the investigators determined the association of these factors with shorter survival through December 31, 2005.
During follow-up, 352 patients (61.4%) had died. Predictors of increased all-cause mortality, after adjustment for age, gender, and race/ethnicity, were older age at diagnosis (hazard ratio [HR], 1.1; 95% confidence interval [CI], 1.09-1.12), clinical subtype of modified postural instability gait difficulty (HR, 1.8; 95% CI, 1.3-2.7), symmetry of motor signs (HR, 2.0; 95% CI, 1.1-3.7), mild cognitive impairment (HR, 1.7; 95% CI, 1.3-2.2), severe cognitive impairment (HR, 2.7; 95% CI, 1.9-3.9), dysphagia (HR, 1.4; 95% CI, 1.1-1.9), and hallucinations (HR, 2.1; 95% CI, 1.3-3.2).
None of the other potential predictors studied, including depression, was associated with change in survival. An empirical predictive analysis revealed that most significant predictors that were identified previously remained associated with shorter survival.
Viewpoint
Factors predicting increased mortality in early PD include both motor and nonmotor clinical features, notably postural instability gait difficulty, cognitive dysfunction and hallucinations. The strongest predictor was severe cognitive impairment within 2 years of PD diagnosis. This is the first report of dysphagia being associated with shorter survival in PD and it suggests that beginning swallowing training early in the course of PD might reduce mortality risk.
In addition to facilitating clinical management, these predictors should be considered in the design of research studies.
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