Loss of independence in early Parkinson disease A 5-year population-based incident cohort study
Loss of independence in early Parkinson disease A 5-year population-based incident cohort study
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DOI：
10.1212/wnl.0000000000003213
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发表时间：
2016-10-11
期刊：
影响因子：
9.9
通讯作者：
Alves, Guido
中科院分区：
文献类型：
--
作者：
Bjornestad, Anders;Tysnes, Ole-Bjorn;Alves, Guido
目的：为了确定早期帕金森病（PD）患者独立性丧失和制度化的风险、预测因素和预后，我们进行了一项前瞻性的基于人群的5年纵向研究，随访189例PD患者和174例年龄、性别和合并症相匹配的对照组。结果：新诊断的PD患者（15.9%）比对照组（5.7%）在基线时依赖于日常生活活动（相对危险度[RR] 2.8，p = 0.004）。在随访期间，40.9%的最初独立的患者失去了独立性，而对照组为9.1%（RR 4.5，p < 0.001）。较高的年龄，较短的症状持续时间，增加运动的严重程度，并在PD诊断存在轻度认知功能障碍独立预测在随访期间的独立性损失。大多数（>95%）患者的依赖性是不可逆的。8.8%的患者需要长期护理机构安置，对照组为0.6%（RR 15.4，p = 0.001）。长期护理机构收治的PD患者中，跌倒（RR 4.8，p < 0.001）、幻觉（RR 4.4，p = 0.001）或痴呆（RR 4.2，p < 0.001）的比例高于居家患者。一旦入住长期护理机构，研究期间死亡的年龄调整RR为5.5（p = 0.002）与从未入住的患者和25.1（p < 0.001）与controls.Conclusions：早期PD患者面临的独立性丧失和机构化的风险大大高于匹配良好的对照组。在大多数患者中，独立性丧失是不可逆的，并且是早期PD的不利预后因素。这些发现对患者管理和医疗保健规划具有重要意义。
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 followup. 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.