title: Harm avoidance is associated with progression of parkinsonism in community-dwelling older adults: a prospective cohort study.
abstract: BACKGROUND
  We tested the hypothesis that harm avoidance, a trait associated with behavioral inhibition, is associated with the rate of change in parkinsonism in older adults.
  
  
  METHODS
  At baseline harm avoidance was assessed with a standard self-report instrument in 969 older people without dementia participating in the Rush Memory and Aging Project, a longitudinal community-based cohort study. Parkinsonism was assessed annually with a modified version of the motor section of the Unified Parkinson's Disease Rating Scale (mUPDRS).
  
  
  RESULTS
  Average follow-up was 5 years. A linear mixed-effects model controlling for age, sex and education showed that for an average participant (female, 80 years old at baseline, with 14 years of education and a harm avoidance score of 10), the overall severity of parkinsonism increased by about 0.05 unit/ year (Estimate, 0.054, S.E., 0.007, p <0.001) and that the level of harm avoidance was associated with the progression of parkinsonism (Estimate, 0.004, S.E., 0.001, p <0.001). Thus, for an average participant, every 6 point (~1 SD) increase in harm avoidance score at baseline, the rate of progression of parkinsonism increased about 50% compared to an individual with an average harm avoidance score. This amount of change in parkinsonism over the course of the study was associated with about a 5% increased risk of death. The association between harm avoidance and progression of parkinsonism persisted when controlling for cognitive function, depressive symptoms, loneliness, neuroticism, late-life cognitive, social and physical activities and chronic health conditions.
  
  
  CONCLUSIONS
  A higher level of the harm avoidance trait is associated with a more rapid progression of parkinsonism in older adults.
authors.affiliation: Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA. Aron_S_Buchman@rush.edu.
authors.forename: Aron S
authors.initials: AS
authors.lastname: Buchman
authors.forename: Lei
authors.initials: L
authors.lastname: Yu
authors.forename: Robert S
authors.initials: RS
authors.lastname: Wilson
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Shulman
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Boyle
authors.forename: David A
authors.initials: DA
authors.lastname: Bennett
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D040261:Harm Reduction / Q000502:physiology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D020734:Parkinsonian Disorders / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology*; D011446:Prospective Studies; D012111:Residence Characteristics
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