title: The Profile of Long-term Parkinson's Disease Survivors with 20 Years of Disease Duration and Beyond.
abstract: BACKGROUND
  Parkinson's disease (PD) patients with 20 years or more survival (PD-20) are not well characterized.
  
  
  OBJECTIVE
  To evaluate PD-20 patient characteristics and identify areas for improvement of their health care.
  
  
  METHODS
  The international, multicenter National Parkinson's Foundation Quality Improvement Initiative (NPF-QII) study database was queried to identify PD-20 subjects. Demographic and clinical data were analyzed.
  
  
  RESULTS
  We identified 187 PD-20 subjects (55% men) representing 4% (187/4,619) of all NPF-QII participants. Subjects were mean age 69.5 years; mean age at PD onset was 44.0 years. The majority (75% ) had 20-25 years of PD duration, the longest duration being 49 years. They were median Hoehn and Yahr stage 3, and 75% had motor fluctuations. Half (54% ) reported exercising. The majority (89% ) were living at home and required a caregiver (88% ). They were mildly cognitively impaired for age (Montreal Cognitive Assessment estimate 22.6±3.7), with most deficits in verbal fluency and delayed recall. Quality of life (Parkinson's Disease Quality of Life Questionnaire index 36±15% ) was mild to moderately impaired, with most impairment in mobility and activities of daily living. Caregiver strain measured by the Multidimensional Caregiver Strain Index (27±16% ), recorded highest subscores in social constraint. PD-20 subjects aged <70 years versus ≥70 only differed significantly by worse cognition (P <  0.0001).
  
  
  CONCLUSIONS
  PD-20 subjects reflect an elite group of PD survivors with early-onset disease and relatively mild cognitive disability despite long disease duration. Interventions for caregivers, mobility, and activities of daily living are areas that could improve caregiver burden and patient quality of life.
authors.affiliation: Center for Movement Disorders & Neurorestoration, University of Florida, Gainesville, Florida, USA.|Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Anhar
authors.initials: A
authors.lastname: Hassan
authors.affiliation: Department of Statistics, University of Florida, Gainesville, Florida, USA.
authors.forename: Samuel S
authors.initials: SS
authors.lastname: Wu
authors.affiliation: National Parkinson's Foundation, Miami, Florida, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Schmidt
authors.affiliation: Parkinson's Disease and Movement Disorders Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Tanya
authors.initials: T
authors.lastname: Simuni
authors.affiliation: Movement Disorders Unit, Department of Neurology, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Nir
authors.initials: N
authors.lastname: Giladi
authors.affiliation: The Movement Disorders Centre, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Janis M
authors.initials: JM
authors.lastname: Miyasaki
authors.affiliation: Radboud University Nijmegen Medical Center, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Nijmegen, Netherlands.
authors.forename: Bastiaan R
authors.initials: BR
authors.lastname: Bloem
authors.affiliation: Center for Movement Disorders & Neurorestoration, University of Florida, Gainesville, Florida, USA.
authors.forename: Irene A
authors.initials: IA
authors.lastname: Malaty
authors.affiliation: Center for Movement Disorders & Neurorestoration, University of Florida, Gainesville, Florida, USA.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Okun
mesh_terms: D000368:Aged; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000453:epidemiology* / Q000523:psychology; D011788:Quality of Life; D011795:Surveys and Questionnaires; D017741:Survivors
keywords: Advanced; Parkinson’s disease; complications; quality-of-life