title: Loss of independence in early Parkinson disease: A 5-year population-based incident cohort study.
abstract: OBJECTIVE
  To determine the risk, predictors, and prognosis of independence loss and institutionalization in patients with early Parkinson disease (PD).
  
  
  METHODS
  We conducted a prospective population-based 5-year longitudinal study following 189 patients with incident PD and 174 controls matched for age, sex, and comorbidity. Health care status was assessed repeatedly with standardized interviews.
  
  
  RESULTS
  More newly diagnosed patients with PD (15.9%) than controls (5.7%) were dependent in activities of daily living at baseline (relative risk [RR] 2.8, p = 0.004). During follow-up, 40.9% of the initially independent patients lost their independence vs 9.1% of controls (RR 4.5, p < 0.001). Higher age, shorter symptom duration, increasing motor severity, and presence of mild cognitive impairment at PD diagnosis independently predicted independence loss during follow-up. Dependency was irreversible in most (>95%) patients. Long-term care facility placement was needed in 8.8% of patients vs 0.6% of controls (RR 15.4, p = 0.001). More patients with PD admitted to long-term care facilities were fallers (RR 4.8, p < 0.001), had hallucinations (RR 4.4, p = 0.001), or had dementia (RR 4.2, p < 0.001) than home-dwelling patients. Once admitted to a long-term care facility, the age-adjusted RR for death during the study period was 5.5 (p = 0.002) vs patients never admitted and 25.1 (p < 0.001) vs controls.
  
  
  CONCLUSIONS
  Patients with early PD face a substantially greater risk of independence loss and institutionalization than well-matched controls. Independence loss is irreversible in most patients and represents a sinister prognostic factor in early PD. These findings have implications for patient management and health care planning.
authors: From The Norwegian Centre for Movement Disorders (A.B., J.P.L., G.A.) and Department of Neurology (A.B., G.A.), Stavanger University Hospital; Department of Neurology (O.-B.T.), Haukeland University Hospital; and Institute of Clinical Medicine (O.-B.T.), University of Bergen, Norway. anders.bjornestad@outlook.com.
authors: Anders
authors: A
authors: Bjornestad
authors: From The Norwegian Centre for Movement Disorders (A.B., J.P.L., G.A.) and Department of Neurology (A.B., G.A.), Stavanger University Hospital; Department of Neurology (O.-B.T.), Haukeland University Hospital; and Institute of Clinical Medicine (O.-B.T.), University of Bergen, Norway.
authors: Ole-Bjorn
authors: OB
authors: Tysnes
authors: From The Norwegian Centre for Movement Disorders (A.B., J.P.L., G.A.) and Department of Neurology (A.B., G.A.), Stavanger University Hospital; Department of Neurology (O.-B.T.), Haukeland University Hospital; and Institute of Clinical Medicine (O.-B.T.), University of Bergen, Norway.
authors: Jan Petter
authors: JP
authors: Larsen
authors: From The Norwegian Centre for Movement Disorders (A.B., J.P.L., G.A.) and Department of Neurology (A.B., G.A.), Stavanger University Hospital; Department of Neurology (O.-B.T.), Haukeland University Hospital; and Institute of Clinical Medicine (O.-B.T.), University of Bergen, Norway.
authors: Guido
authors: G
authors: Alves
mesh_terms: D000058:Accidental Falls; D000368:Aged; D060825:Cognitive Dysfunction / Q000150:complications / Q000453:epidemiology / Q000628:therapy; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006212:Hallucinations / Q000150:complications / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D015994:Incidence; D057187:Independent Living / Q000523:psychology / Q000706:statistics & numerical data; D008134:Long-Term Care; D008137:Longitudinal Studies; D008297:Male; D010300:Parkinson Disease / Q000150:complications / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D016019:Survival Analysis