Clinical features in early Parkinson disease and survival.
OBJECTIVE
To examine the association between demographic and clinical features in early Parkinson disease (PD) and length of survival in a multiethnic population.


METHODS
Clinical features within 2 years of diagnosis were determined for an inception cohort established during 1994-1995. Vital status was determined through December 31, 2005. Predictor variables included age at diagnosis, sex, race/ethnicity, as well as clinical subtype (modified tremor dominant, postural instability gait difficulty), symmetry, cognitive impairment, depression, dysphagia, and hallucinations. Cox proportional hazards regression analysis was used to identify factors associated with shorter survival.


METHODS
Kaiser Permanente Medical Care Program, northern California.


METHODS
Five hundred seventy-three men and women with newly diagnosed PD.


RESULTS
Three hundred fifty-two participants in the PD cohort (61.4%) had died in the follow-up period. Older age at diagnosis (hazard ratio [HR], 1.1; 95% confidence interval [CI], 1.09-1.12), modified postural instability gait difficulty subtype (HR, 1.8; 95% CI, 1.3-2.7), symmetry of motor signs (HR, 2.0; 95% CI, 1.1-3.7), mild (HR, 1.7; 95% CI, 1.3-2.2) and severe (HR, 2.7; 95% CI, 1.9-3.9) cognitive impairment, dysphagia (HR, 1.4; 95% CI, 1.1-1.9), and hallucinations (HR, 2.1; 95% CI, 1.3-3.2) were associated with increased all-cause mortality, after adjusting for age, sex, and race/ethnicity. None of the other factors altered mortality risk. In an empirical predictive analysis, most previous significant predictors remained associated with shorter survival.


CONCLUSIONS
Both motor and nonmotor features in early PD predict increased mortality risk, particularly postural instability gait difficulty, cognitive impairment, and hallucinations. These predictors may be useful in clinical practice and when designing clinical trials.
Lo
Raymond Y
RY
The Parkinson's Institute and Clinical Center, Sunnyvale, CA 94085, USA.
Tanner
Caroline M
CM
Albers
Kathleen B
KB
Leimpeter
Amethyst D
AD
Fross
Robin D
RD
Bernstein
Allan L
AL
McGuire
Valerie
V
Quesenberry
Charles P
CP
Nelson
Lorene M
LM
Van Den Eeden
Stephen K
SK
D000328:Adult; D000367:Age Factors; D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000401:mortality* / Q000503:physiopathology*; D012307:Risk Factors; D012737:Sex Factors