Ten year survival and outcomes in a prospective cohort of new onset Chinese Parkinson's disease patients
- 1Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong
- 2Department of Medicine, Prince of Wales Hospital (Chinese University of Hong Kong), Hong Kong, SAR China
- Correspondence to Dr M Auyeung, Department of Medicine, Pamela Youde Nethersole Eastern Hospital, 3rd Lok Man Road, Chai Wan, Hong Kong, SAR China;
Contributors Acquisition of the data: MA, CMC, CNL, RL and EY; analysis and interpretation of the data: MA, THT, VM, CMC, CNL, RL and EY; drafting of the manuscript: MA and THT; and critical revision of the manuscript: MA, THT and VM.
- Received 7 October 2011
- Revised 24 January 2012
- Accepted 25 January 2012
- Published Online First 22 February 2012
Objective The 10 year outcomes and impact of motor and non-motor features on survival of a cohort of new onset Chinese Parkinson's disease (PD) patients were prospectively studied.
Method A cohort of new onset PD patients from 1995 to 2002 was recruited from a regional hospital based movement disorder clinic. Subjects were classified into postural instability gait disorder (PIGD), tremor predominant type or mixed subtypes at presentation. All were evaluated yearly for development of sensory complaints, first significant fall, hallucinations, dementia, postural hypotension, speech disturbances, dysphagia and postural instability persisted during ‘on’ medication state (PIPon). Mortality and predictors of death were determined.
Results 171 new onset PD patients were recruited. After a mean follow-up of 11.3±2.6 years, 50 (29%) patients died. The standardised mortality ratio was 1.1 (CI 0.8 to 1.5, p=0.34). 83 (49%) developed dementia, 81 (47%) had psychosis and 103 (60%) had sensory complaints. Postural hypotension was found in 58 (34%) patients, 108 (63%) had PIPon, 101 (59%) had falls, 102 (60%) had dysphagia, 148 (87%) had freezing of gait and 117 (68%) had speech disturbances. 46 (27%) were institutionalised whereas 54 (32%) lived independently. Dementia (HR 5.0, 95% CI 2.1 to 13.0), PIPon (HR 2.8, 95% CI 1.2 to 6.8), older onset (HR 1.05, 1 year increase in age, 95% CI 1.0 to 1.1) and PIGD type (HR 2.1, 95% CI 1.2 to 3.7) were independent predictors of death.
Conclusions 10 years into PD, a significant proportion of patients developed dopa resistant motor and non-motor features. Older onset, PIGD type, PIPon and dementia had a negative impact on survival. Standardised mortality ratio was 1.1.
Competing interests None.
Ethics approval Ethics approval was obtained from the ethics committee of the institution.
Provenance and peer review Not commissioned; externally peer reviewed.