title: The CamPaIGN study of Parkinson's disease: 10-year outlook in an incident population-based cohort.
abstract: BACKGROUND
  Prognosis in Parkinson's disease (PD) remains poorly understood due to a lack of unbiased data on the natural history of treated PD. The CamPaIGN study has been the first to prospectively track disease evolution from diagnosis in an unselected population-representative incident cohort. We now report the 10-year follow-up data, focusing on three key irreversible milestones: postural instability (Hoehn and Yahr 3), dementia and death.
  
  
  METHODS
  The cohort was collected between December 2000 and 2002. Those meeting diagnostic criteria (n=142) were followed-up until 1 January 2012. Clinical, neuropsychological and genetic testing were performed. Progression to key milestones was evaluated using Kaplan-Meier and Cox regression survival analyses.
  
  
  RESULTS
  At 10 years, 55% had died, 68% had postural instability and 46% dementia. 23% had a good outcome at 10 years (surviving free of dementia/postural instability). Death rate was comparable with the UK population (standardised mortality ratio 1.29 (0.97-1.61)). Death certificates indicated PD was a substantial contributor in only 20%, with pneumonia being the commonest cause of death. Age, non-tremor-dominant motor phenotype and comorbidity predicted earlier postural instability. Baseline predictors of dementia were age, motor impairment, 'posterior-cortical' cognitive deficits and MAPT genotype.
  
  
  CONCLUSIONS
  (1) outlook in PD is heterogeneous, with most dying or developing dementia or postural instability by 10 years from diagnosis, but a quarter still doing well, with preserved mobility and intact cognition; (2) death is not directly related to PD in the majority; (3) baseline clinical and genetic variables are predictive of outcome and may be helpful in selecting patients for clinical trials.
authors.affiliation: John Van Geest Centre for Brain Repair, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
authors.forename: Caroline H
authors.initials: CH
authors.lastname: Williams-Gray
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Mason
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Evans
authors.forename: Thomas
authors.initials: T
authors.lastname: Foltynie
authors.forename: Carol
authors.initials: C
authors.lastname: Brayne
authors.forename: Trevor W
authors.initials: TW
authors.lastname: Robbins
authors.forename: Roger A
authors.initials: RA
authors.lastname: Barker
mesh_terms: D000328:Adult; D000368:Aged; D002423:Cause of Death; D015331:Cohort Studies; D003704:Dementia / Q000175:diagnosis; D018450:Disease Progression; D004739:England; D005260:Female; D005838:Genotype; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000175:diagnosis* / Q000235:genetics / Q000401:mortality; D004856:Postural Balance; D011379:Prognosis; D016016:Proportional Hazards Models; D016019:Survival Analysis
keywords: DEMENTIA; EPIDEMIOLOGY; GENETICS; PARKINSON'S DISEASE