Impact of Aspiration Pneumonia on the Clinical Course of Progressive Supranuclear Palsy: A Retrospective Cohort Study.
BACKGROUND
Although aspiration pneumonia is the most common complication of progressive supranuclear palsy (PSP), the clinical impact of aspiration pneumonia on disease course and survival has not been fully estimated. Thus, we retrospectively analyzed the prognostic factors and clinical consequences of pneumonia in PSP.


METHODS
The clinical course of patients with aspiration pneumonia was surveyed. The association between baseline clinical features (2 years from disease onset) and latency to the initial development of pneumonia was investigated using survival time and Cox regression analyses.


RESULTS
Ninety patients with a clinical diagnosis of PSP were observed for 5.1±3.8 years (mean±SD), and 22 had aspiration pneumonia. Subsequently, 20 patients (91%) had to discontinue oral feeding entirely and 13 (59%) died, whereas, of 68 patients without pneumonia, only three patients (4%) died. Time to initial development of pneumonia was strongly correlated with survival time (Spearman R = 0.92, P<0.001), with a mean latency of 2.3 years to death. Among baseline clinical features, early fall episodes and cognitive decline were significant predictors of pneumonia (P = 0.001 and P<0.001, respectively, log rank test). Cox regression analysis demonstrated that early fall episodes (adjusted hazard ratio: 3.9, 95% confidence interval: 1.2-12.5, P = 0.03) and cognitive decline (adjusted hazard ratio: 5.2, 95% confidence interval: 1.4-19.3, P = 0.02) independently predicted pneumonia. By contrast, dysphagia was not associated with pneumonia (P = 0.2, log rank test).


CONCLUSIONS
Initial development of pneumonia indicates an unfavorable clinical course and predicts survival time (mean survival time 2.3 years). Patients with early falls and cognitive decline were at high risk of early development of pneumonia.
Clinical Research Center, National Regional Center for Neurological Disorders and Utano National Hospital, Kyoto, Japan; Department of Neurology, National Regional Center for Neurological Disorders and Utano National Hospital, Kyoto, Japan.
Satoshi
S
Tomita
Clinical Research Center, National Regional Center for Neurological Disorders and Utano National Hospital, Kyoto, Japan; Department of Neurology, National Regional Center for Neurological Disorders and Utano National Hospital, Kyoto, Japan.
Tomoko
T
Oeda
Clinical Research Center, National Regional Center for Neurological Disorders and Utano National Hospital, Kyoto, Japan; Department of Neurology, National Regional Center for Neurological Disorders and Utano National Hospital, Kyoto, Japan.
Atsushi
A
Umemura
Clinical Research Center, National Regional Center for Neurological Disorders and Utano National Hospital, Kyoto, Japan; Department of Neurology, National Regional Center for Neurological Disorders and Utano National Hospital, Kyoto, Japan.
Masayuki
M
Kohsaka
Clinical Research Center, National Regional Center for Neurological Disorders and Utano National Hospital, Kyoto, Japan; Department of Neurology, National Regional Center for Neurological Disorders and Utano National Hospital, Kyoto, Japan.
Kwiyoung
K
Park
Clinical Research Center, National Regional Center for Neurological Disorders and Utano National Hospital, Kyoto, Japan; Department of Neurology, National Regional Center for Neurological Disorders and Utano National Hospital, Kyoto, Japan.
Kenji
K
Yamamoto
Department of Neurology, National Regional Center for Neurological Disorders and Utano National Hospital, Kyoto, Japan.
Hiroshi
H
Sugiyama
Department of Neurology, Toneyama National Hospital, Osaka, Japan.
Chiaki
C
Mori
Department of Neurology, Toneyama National Hospital, Osaka, Japan.
Kimiko
K
Inoue
Department of Neurology, Toneyama National Hospital, Osaka, Japan.
Harutoshi
H
Fujimura
Clinical Research Center, National Regional Center for Neurological Disorders and Utano National Hospital, Kyoto, Japan; Department of Neurology, National Regional Center for Neurological Disorders and Utano National Hospital, Kyoto, Japan.
Hideyuki
H
Sawada
D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011015:Pneumonia, Aspiration / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D013494:Supranuclear Palsy, Progressive / Q000150:complications* / Q000401:mortality*; D016019:Survival Analysis; D013997:Time Factors