Natural history and survival of 14 patients with corticobasal degeneration confirmed at postmortem examination
- G K Wenninga,
- I Litvanb,
- J Jankovicc,
- R Granataa,
- C A Mangoneb,
- A McKeed,
- W Poewea,
- K Jellingere,
- K Ray Chaudhurif,
- L D’Olhaberriagueb,
- R K B Pearceg
- aDepartment of Neurology, University Hospital, Innsbruck, Austria, bNeuroepidemiology Branch, National Institute of Neurological Disorders and Stroke, National Institute of Health, Bethesda, Maryland, USA, cDepartment of Neurology, Baylor College of Medicine, Houston, Texas, USA, dDepartment of Neuropathology, Massachusetts General Hospital, Boston,Massachusetts, USA, eLudwig Boltzmann Institute of Clinical Neurobiology, Vienna, Austria, fDepartment of Neurology, Institute of Psychiatry, London, UK, gParkinson’s Disease Society Brain Bank Research Centre, London, UK
- Dr Irene Litvan, Federal Building, Room 714, National Institutes of Health, Bethesda, Maryland 20892, USA.
- Received 30 May 1997
- Revised 28 July 1997
- Accepted 5 August 1997
OBJECTIVE To analyse the natural history and survival of corticobasal degeneration by investigating the clinical features of 14 cases confirmed by postmortem examination.
METHODS Patients with definite corticobasal degeneration were selected from the research and clinical files of seven tertiary medical centres in Austria, the United Kingdom, and the United States. Clinical features were analysed in detail.
RESULTS The sample consisted of eight female and six male patients; mean age at symptom onset was 63 (SD 7.7) years, and mean disease duration was 7.9 (SD 2.6) years. The most commonly reported symptom at onset included asymmetric limb clumsiness with or without rigidity (50%) or tremor (21%). At the first neurological visit, on average 3.0 (SD 1.9) years after symptom onset, the most often encountered extrapyramidal features included unilateral limb rigidity (79%) or bradykinesia (71%), postural imbalance (45%), and unilateral limb dystonia (43%). Ideomotor apraxia (64%), and to a lesser extent cortical dementia (36%), were the most common cortical signs present at the first visit. During the course of the disease, virtually all patients developed asymmetric or unilateral akinetic rigid parkinsonism and a gait disorder. No patient had a dramatic response to levodopa therapy. Median survival time after onset of symptoms was 7.9 (SD 0.7) (range, 2.5–12.5) years, and, after the first clinic visit, 4.9 (SD 0.7) (range, 0.8–10) years. Early bilateral bradykinesia, frontal syndrome, or two out of tremor, rigidity, and bradykinesia, predicted a shorter survival.
CONCLUSION The results confirm that unilateral parkinsonism unresponsive to levodopa and limb ideomotor apraxia are the clinical hallmarks of corticobasal degeneration, and only a minority of patients with corticobasal degeneration present with dementia. The study also suggests that a focal cognitive and extrapyramidal motor syndrome is indicative of corticobasal degeneration. Survival in corticobasal degeneration was shortened by the early presence of (more) widespread parkinsonian features or frontal lobe syndrome.