title: Ten year survival and outcomes in a prospective cohort of new onset Chinese Parkinson's disease patients.
abstract: OBJECTIVE
  The 10 year outcomes and impact of motor and non-motor features on survival of a cohort of new onset Chinese Parkinson's disease (PD) patients were prospectively studied.
  
  
  METHODS
  A cohort of new onset PD patients from 1995 to 2002 was recruited from a regional hospital based movement disorder clinic. Subjects were classified into postural instability gait disorder (PIGD), tremor predominant type or mixed subtypes at presentation. All were evaluated yearly for development of sensory complaints, first significant fall, hallucinations, dementia, postural hypotension, speech disturbances, dysphagia and postural instability persisted during 'on' medication state (PIPon). Mortality and predictors of death were determined.
  
  
  RESULTS
  171 new onset PD patients were recruited. After a mean follow-up of 11.3±2.6 years, 50 (29%) patients died. The standardised mortality ratio was 1.1 (CI 0.8 to 1.5, p=0.34). 83 (49%) developed dementia, 81 (47%) had psychosis and 103 (60%) had sensory complaints. Postural hypotension was found in 58 (34%) patients, 108 (63%) had PIPon, 101 (59%) had falls, 102 (60%) had dysphagia, 148 (87%) had freezing of gait and 117 (68%) had speech disturbances. 46 (27%) were institutionalised whereas 54 (32%) lived independently. Dementia (HR 5.0, 95% CI 2.1 to 13.0), PIPon (HR 2.8, 95% CI 1.2 to 6.8), older onset (HR 1.05, 1 year increase in age, 95% CI 1.0 to 1.1) and PIGD type (HR 2.1, 95% CI 1.2 to 3.7) were independent predictors of death.
  
  
  CONCLUSIONS
  10 years into PD, a significant proportion of patients developed dopa resistant motor and non-motor features. Older onset, PIGD type, PIPon and dementia had a negative impact on survival. Standardised mortality ratio was 1.1.
authors.affiliation: Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong, SAR China. auyema@yahoo.com.hk
authors.forename: Man
authors.initials: M
authors.lastname: Auyeung
authors.forename: T H
authors.initials: TH
authors.lastname: Tsoi
authors.forename: Vincent
authors.initials: V
authors.lastname: Mok
authors.forename: C M
authors.initials: CM
authors.lastname: Cheung
authors.forename: C N
authors.initials: CN
authors.lastname: Lee
authors.forename: R
authors.initials: R
authors.lastname: Li
authors.forename: E
authors.initials: E
authors.lastname: Yeung
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People / Q000706:statistics & numerical data; D015331:Cohort Studies; D003680:Deglutition Disorders / Q000150:complications / Q000401:mortality; D003704:Dementia / Q000150:complications / Q000401:mortality; D018450:Disease Progression; D005260:Female; D020233:Gait Disorders, Neurologic / Q000150:complications / Q000401:mortality; D006212:Hallucinations / Q000150:complications / Q000401:mortality; D006801:Humans; D007024:Hypotension, Orthostatic / Q000150:complications / Q000401:mortality; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications / Q000175:diagnosis / Q000401:mortality*; D012307:Risk Factors; D013064:Speech Disorders / Q000150:complications / Q000401:mortality; D016019:Survival Analysis