What predicts mortality in Parkinson disease? A prospective population-based long-term study
What predicts mortality in Parkinson disease? A prospective population-based long-term study
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DOI：
10.1212/wnl.0b013e3181f61311
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发表时间：
2010-10-05
期刊：
影响因子：
9.9
通讯作者：
Alves, G.
中科院分区：
文献类型：
--
作者：
Forsaa, E. B.;Larsen, J. P.;Alves, G.
目的：确定社区帕金森病(PD)队列中死亡的独立危险因素，并对其进行前瞻性长期随访。方法：对1993年至2005年挪威西南部230例帕金森病患者的社区流行样本进行重复的运动和非运动症状评估。2009年10月20日之前的生命状况信息是从挪威国家人口登记处获得的。应用COX比例风险模型来确定随访期间死亡率的独立预测因素。年龄、统一帕金森病评定量表(UPDRS)运动评分、左旋多巴等效剂量、可能的REM睡眠行为障碍、精神病性症状、痴呆和抗精神病药物的使用作为时间因变量，发病年龄(AAO)和性别作为时间独立变量。结果：230例患者中，211例(92%)在研究期间死亡。运动开始后的中位生存期为15.8年(范围2.2-36.6)。在随访期间死亡率的独立预测因素是AAO(风险比[HR]1.40，10年增长，p=0.029)，年龄(HR 1.51，10年增长，p=0.043)，男性(HR 1.63，P=0.001)，UPDRS运动评分(HR 1.18，10分增长，p<；结论：这项以人群为基础的长期研究表明，除了年龄、运动严重程度和痴呆症之外，精神病症状还独立地预测帕金森病患者死亡率的增加。相反，在我们的PD队列中，没有观察到抗精神病药物或抗帕金森病药物对生存率的显著影响。早期预防运动进展、精神病和痴呆症的发展可能是延长帕金森病患者预期寿命的最有前途的策略。神经病学(R)2010；75：1270-1276
Objective: To identify independent risk factors of mortality in a community-based Parkinson disease (PD) cohort during prospective long-term follow-up.Methods: A community-based prevalent sample of 230 patients with PD from southwestern Norway was followed prospectively with repetitive assessments of motor and nonmotor symptoms from 1993 to 2005. Information on vital status until October 20, 2009, was obtained from the National Population Register in Norway. Cox proportional hazards models were applied to identify independent predictors of mortality during follow-up. Chronological age, Unified Parkinson's Disease Rating Scale (UPDRS) motor score, levodopa equivalent dose, probable REM sleep behavior disorder, psychotic symptoms, dementia, and use of antipsychotics were included as time-dependent variables, and age at onset (AAO) and sex as time-independent variables.Results: Of 230 patients, 211 (92%) died during the study period. Median survival time from motor onset was 15.8 years (range 2.2-36.6). Independent predictors of mortality during follow-up were AAO (hazard ratio [ HR] 1.40 for 10-years increase, p = 0.029), chronological age (HR 1.51 for 10-years increase, p = 0.043), male sex (HR 1.63, p = 0.001), UPDRS motor score (HR 1.18 for 10-point increase, p < 0.001), psychotic symptoms (HR 1.45, p = 0.039), and dementia (HR 1.89, p = 0.001).Conclusions: This population-based long-term study demonstrates that in addition to AAO, chronological age, motor severity, and dementia, psychotic symptoms independently predict increased mortality in PD. In contrast, no significant impact of antipsychotic or antiparkinsonian drugs on survival was observed in our PD cohort. Early prevention of motor progression and development of psychosis and dementia may be the most promising strategies to increase life expectancy in PD. Neurology (R) 2010;75:1270-1276