Survival in Parkinson's disease. Relation with motor and non-motor features

https://doi.org/10.1016/j.parkreldis.2014.02.030Get rights and content

Abstract

Background

Survival in patients with Parkinson's disease is reduced as compared to the general population. We aimed to identify motor and non-motor features that predict mortality in Parkinson's disease.

Methods

A broad range of motor and non-motor features were assessed in a hospital-based cohort of 414 patients with Parkinson's disease, who underwent five annual follow-up examinations including vital status assessment. Multivariable Cox's proportional hazards regression analysis was used to evaluate the association between baseline characteristics and mortality risk. Stepwise regression with backward elimination was carried out to determine the best model to predict mortality in Parkinson's disease.

Results

After a mean follow-up period of 4.3 years, 49 (11.8%) patients had died. In the stepwise regression model, predictors of mortality in Parkinson's disease were higher age, male sex, cognitive impairment, higher postural instability gait disorder score, and the presence of psychotic symptoms.

Conclusions

Higher age, male sex, cognitive impairment, higher postural instability gait disorder score, and the presence of psychotic symptoms are independent predictors of decreased survival in Parkinson's disease. Mortality in Parkinson's disease thus seems to be affected mainly by non-dopaminergic and non-motor features.

Introduction

Survival in patients with Parkinson's disease (PD) is reduced as compared to the general population, with mortality hazard ratios ranging from 1.5 to 2.7 [1], [2], [3], [4], [5], [6], [7]. Knowledge on factors associated with increased mortality in PD may provide more insight in the pathophysiology and course of the disease and will allow clinicians to inform individual patients more adequately about their prognosis. Several studies have sought to determine which factors predict mortality in PD. Older age, male sex, severity of motor symptoms, dementia, and gait dysfunction were found to be associated with reduced survival in previous studies [1], [2], [6], [7], [8], [9], [10], [11], [12], [13]. However, most of these studies individually investigated only a limited number of variables, and focused mainly on demographic, motor, and cognitive features. Therefore, knowledge of the influence on mortality of non-motor symptoms other than dementia (including depression, daytime sleepiness, psychotic symptoms, and autonomic dysfunction) is scarce.

We aimed to identify predictors of mortality in a prospective study among 414 PD patients who underwent extensive, standardized assessment of a large number of motor and non-motor symptoms.

Section snippets

Study design

The current study was carried out within the ‘PROfiling PARKinson's disease’ (PROPARK) study, a longitudinal hospital-based cohort study of 414 patients with PD with extensive annual evaluation of different clinical domains. All patients fulfilled the United Kingdom Parkinson's Disease Society Brain Bank criteria for idiopathic PD [14]. Patients were recruited from both university and regional hospitals from the western part of The Netherlands. The recruitment procedure of the PROPARK study has

Results

Table 1 displays the baseline characteristics of the study population. The total number of person years of follow-up for the cohort was 1790.51. During a mean follow up per patient of 4.32 (range 0.23–6.28) years, 49 patients (11.8%) died. In the course of the study period 56 patients (13%) were lost to follow-up. Reported causes of death were malignancy (n = 9), cardiac disease (n = 9), infection or sepsis (n = 7), stroke (n = 4), accident (n = 2), pulmonary embolism (n = 1), suicide (n = 1),

Discussion

In this prospective study among a hospital-based cohort of 414 PD patients we found that higher age, male sex, cognitive impairment, higher PIGD score, and psychotic symptoms were independent predictors of decreased survival in PD patients. Depression and disease severity were associated with mortality in the models adjusted for age, sex, and disease duration, but were no longer statistically significant in the multivariable stepwise regression model.

Methodological strengths of this study are

Acknowledgements

This work was supported by a grant from the Dutch Parkinson's Disease Society (JJvH). The funding source had no role in the study design, collection, analysis, and interpretation of data, or writing of the report.

None of the authors has potential conflicts of interest that relate to the manuscript.

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