title: Incident parkinsonism in older adults without Parkinson disease.
abstract: OBJECTIVE
  To determine the incidence of parkinsonism in community-dwelling older adults without Parkinson disease.
  
  
  METHODS
  Four parkinsonian signs were assessed with a modified motor portion of the Unified Parkinson's Disease Rating Scale in 2,001 older adults without parkinsonism. We used Cox proportional hazards models to determine the associations of age and sex with incident parkinsonism (2 or more signs). We calculated the number of events per 1,000 person-years of observation in 3 age strata. Next, we investigated several potential risk factors for incident parkinsonism. Then, we examined longitudinal progression of parkinsonism using discrete-time multistate Markov models.
  
  
  RESULTS
  Average age at baseline was 76.8 years (SD 7.62 years). During an average of 5 years of follow-up, 964/2,001 (48.2%) developed parkinsonism. Age (hazard ratio [HR] 1.09, 95% confidence interval [CI] 1.08-1.10) but not male sex (HR 1.06, 95% CI 0.91-1.23) was associated with incident parkinsonism. The incidence of parkinsonism per 1,000 person-years of follow-up was 36.0 for adults <75 years of age, 94.8 for those 75-84, and 160.5 for those 85 years or older. Depressive symptoms, neuroticism, urinary incontinence, sleep complaints, and chronic health conditions were associated with incident parkinsonism. Secondary analyses suggest that risk factors are linked with incident parkinsonism via early motor signs of parkinsonism and cognitive function. Transition modeling suggests that while parkinsonism may fluctuate, it is progressive in most older adults and its risk factors increase the odds of its progression.
  
  
  CONCLUSIONS
  Parkinsonism is common in older adults and increases with age. Identifying modifiable risk factors may decrease the magnitude of this growing public health problem.
authors.affiliation: From Rush Alzheimer's Disease Center (A.S.B., S.E.L., L.Y., R.S.W., B.D.J., D.A.B.); Departments of Neurological Sciences (A.S.B., S.E.L., D.A.B.), Behavioral Sciences (R.S.W.), and Internal Medicine (B.D.J.), Rush University Medical Center, Chicago, IL; Department of Neurology (A.S.L.), University of Toronto, Canada; Departments of Neurology, Molecular and Human Genetics, Neuroscience, and Program in Developmental Biology (J.M.S.), Baylor College of Medicine; and Jan and Dan Duncan Neurological Research Institute (J.M.S.), Texas Children's Hospital, Houston. Aron_S_Buchman@rush.edu.
authors.forename: Aron S
authors.initials: AS
authors.lastname: Buchman
authors.affiliation: From Rush Alzheimer's Disease Center (A.S.B., S.E.L., L.Y., R.S.W., B.D.J., D.A.B.); Departments of Neurological Sciences (A.S.B., S.E.L., D.A.B.), Behavioral Sciences (R.S.W.), and Internal Medicine (B.D.J.), Rush University Medical Center, Chicago, IL; Department of Neurology (A.S.L.), University of Toronto, Canada; Departments of Neurology, Molecular and Human Genetics, Neuroscience, and Program in Developmental Biology (J.M.S.), Baylor College of Medicine; and Jan and Dan Duncan Neurological Research Institute (J.M.S.), Texas Children's Hospital, Houston.
authors.forename: Sue E
authors.initials: SE
authors.lastname: Leurgans
authors.affiliation: From Rush Alzheimer's Disease Center (A.S.B., S.E.L., L.Y., R.S.W., B.D.J., D.A.B.); Departments of Neurological Sciences (A.S.B., S.E.L., D.A.B.), Behavioral Sciences (R.S.W.), and Internal Medicine (B.D.J.), Rush University Medical Center, Chicago, IL; Department of Neurology (A.S.L.), University of Toronto, Canada; Departments of Neurology, Molecular and Human Genetics, Neuroscience, and Program in Developmental Biology (J.M.S.), Baylor College of Medicine; and Jan and Dan Duncan Neurological Research Institute (J.M.S.), Texas Children's Hospital, Houston.
authors.forename: Lei
authors.initials: L
authors.lastname: Yu
authors.affiliation: From Rush Alzheimer's Disease Center (A.S.B., S.E.L., L.Y., R.S.W., B.D.J., D.A.B.); Departments of Neurological Sciences (A.S.B., S.E.L., D.A.B.), Behavioral Sciences (R.S.W.), and Internal Medicine (B.D.J.), Rush University Medical Center, Chicago, IL; Department of Neurology (A.S.L.), University of Toronto, Canada; Departments of Neurology, Molecular and Human Genetics, Neuroscience, and Program in Developmental Biology (J.M.S.), Baylor College of Medicine; and Jan and Dan Duncan Neurological Research Institute (J.M.S.), Texas Children's Hospital, Houston.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Wilson
authors.affiliation: From Rush Alzheimer's Disease Center (A.S.B., S.E.L., L.Y., R.S.W., B.D.J., D.A.B.); Departments of Neurological Sciences (A.S.B., S.E.L., D.A.B.), Behavioral Sciences (R.S.W.), and Internal Medicine (B.D.J.), Rush University Medical Center, Chicago, IL; Department of Neurology (A.S.L.), University of Toronto, Canada; Departments of Neurology, Molecular and Human Genetics, Neuroscience, and Program in Developmental Biology (J.M.S.), Baylor College of Medicine; and Jan and Dan Duncan Neurological Research Institute (J.M.S.), Texas Children's Hospital, Houston.
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Lim
authors.affiliation: From Rush Alzheimer's Disease Center (A.S.B., S.E.L., L.Y., R.S.W., B.D.J., D.A.B.); Departments of Neurological Sciences (A.S.B., S.E.L., D.A.B.), Behavioral Sciences (R.S.W.), and Internal Medicine (B.D.J.), Rush University Medical Center, Chicago, IL; Department of Neurology (A.S.L.), University of Toronto, Canada; Departments of Neurology, Molecular and Human Genetics, Neuroscience, and Program in Developmental Biology (J.M.S.), Baylor College of Medicine; and Jan and Dan Duncan Neurological Research Institute (J.M.S.), Texas Children's Hospital, Houston.
authors.forename: Bryan D
authors.initials: BD
authors.lastname: James
authors.affiliation: From Rush Alzheimer's Disease Center (A.S.B., S.E.L., L.Y., R.S.W., B.D.J., D.A.B.); Departments of Neurological Sciences (A.S.B., S.E.L., D.A.B.), Behavioral Sciences (R.S.W.), and Internal Medicine (B.D.J.), Rush University Medical Center, Chicago, IL; Department of Neurology (A.S.L.), University of Toronto, Canada; Departments of Neurology, Molecular and Human Genetics, Neuroscience, and Program in Developmental Biology (J.M.S.), Baylor College of Medicine; and Jan and Dan Duncan Neurological Research Institute (J.M.S.), Texas Children's Hospital, Houston.
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Shulman
authors.affiliation: From Rush Alzheimer's Disease Center (A.S.B., S.E.L., L.Y., R.S.W., B.D.J., D.A.B.); Departments of Neurological Sciences (A.S.B., S.E.L., D.A.B.), Behavioral Sciences (R.S.W.), and Internal Medicine (B.D.J.), Rush University Medical Center, Chicago, IL; Department of Neurology (A.S.L.), University of Toronto, Canada; Departments of Neurology, Molecular and Human Genetics, Neuroscience, and Program in Developmental Biology (J.M.S.), Baylor College of Medicine; and Jan and Dan Duncan Neurological Research Institute (J.M.S.), Texas Children's Hospital, Houston.
authors.forename: David A
authors.initials: DA
authors.lastname: Bennett
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D020734:Parkinsonian Disorders / Q000150:complications / Q000453:epidemiology* / Q000503:physiopathology / Q000523:psychology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors