title: Delirium and high fever are associated with subacute motor deterioration in Parkinson disease: a nested case-control study.
abstract: BACKGROUND
  In Parkinson disease (PD), systemic inflammation caused by respiratory infections such as pneumonia frequently occurs, often resulting in delirium in the advanced stages of this disease. Delirium can lead to cognitive and functional decline, institutionalization, and mortality, especially in the elderly. Inflammation causes rapid worsening of PD motor symptoms and signs, sometimes irreversibly in some, but not all, patients.
  
  
  OBJECTIVE
  To identify factors associated with subacute motor deterioration in PD patients with systemic inflammation.
  
  
  METHODS
  The association of clinical factors with subacute motor deterioration was analyzed by a case-control study. Subacute motor deterioration was defined as sustained worsening by one or more modified Hoehn and Yahr (H-Y) stages. Using multivariable logistic regression incorporating baseline characteristics (age, sex, PD duration, modified H-Y stage, dementia, and psychosis history) and statistically selected possible predictors (peak body temperature, duration of leukocytosis, and presence of delirium), the odds ratios for these factors were estimated as relative risks.
  
  
  RESULTS
  Of 80 PD patients with systemic inflammation, 26 with associated subacute motor deterioration were designated as cases and the remainder as controls. In the 26 cases, 6 months after its onset the motor deterioration had persisted in 19 patients and resolved in four (three were lost for follow-up). Multivariable logistic regression analysis showed that delirium and body temperature are significantly associated with motor deterioration after systemic inflammation (P = 0.001 for delirium and P = 0.026 for body temperature), the adjusted odds ratios being 15.89 (95% confidence interval [CI]: 3.23-78.14) and 2.78 (95% CI: 1.13-6.83), respectively.
  
  
  CONCLUSIONS
  In patients with PD and systemic inflammation, delirium and high body temperature are strong risk factors for subsequent subacute motor deterioration and such deterioration can persist for over 6 months.
authors.affiliation: Clinical Research Center, National Hospital of Utano, Kyoto, Japan; Department of Neurology, National Hospital of Utano, Kyoto, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Umemura
authors.affiliation: Clinical Research Center, National Hospital of Utano, Kyoto, Japan; Department of Neurology, National Hospital of Utano, Kyoto, Japan.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Oeda
authors.affiliation: Clinical Research Center, National Hospital of Utano, Kyoto, Japan; Department of Neurology, National Hospital of Utano, Kyoto, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Tomita
authors.affiliation: Clinical Research Center, National Hospital of Utano, Kyoto, Japan; Department of Neurology, National Hospital of Utano, Kyoto, Japan.
authors.forename: Ryutaro
authors.initials: R
authors.lastname: Hayashi
authors.affiliation: Clinical Research Center, National Hospital of Utano, Kyoto, Japan; Department of Neurology, National Hospital of Utano, Kyoto, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Kohsaka
authors.affiliation: Clinical Research Center, National Hospital of Utano, Kyoto, Japan; Department of Neurology, National Hospital of Utano, Kyoto, Japan.
authors.forename: Kwiyoung
authors.initials: K
authors.lastname: Park
authors.affiliation: Department of Neurology, National Hospital of Utano, Kyoto, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Sugiyama
authors.affiliation: Clinical Research Center, National Hospital of Utano, Kyoto, Japan; Department of Neurology, National Hospital of Utano, Kyoto, Japan.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Sawada
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D003693:Delirium / Q000150:complications* / Q000503:physiopathology*; D005260:Female; D005334:Fever / Q000150:complications* / Q000503:physiopathology*; D006801:Humans; D007249:Inflammation / Q000209:etiology; D008297:Male; D009043:Motor Activity; D016017:Odds Ratio; D010300:Parkinson Disease / Q000150:complications* / Q000503:physiopathology*