The Sydney multicenter study of Parkinson's disease: The inevitability of dementia at 20 years

After 20 years follow‐up of newly diagnosed patients with Parkinson's disease (PD), 100 of 136 (74%) have died. The mortality rate fell in the first 3 years of treatment, then rose compared to the general population, the standardized mortality ratio from 15 to 20 years reaching 3.1. Drug induce...

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Bibliographic Details
Published in:Movement disorders 2008-04, Vol.23 (6), p.837-844
Main Authors: Hely, Mariese A., Reid, Wayne G.J., Adena, Michael A., Halliday, Glenda M., Morris, John G.L.
Format: Article
Language:English
Subjects:
Activities of Daily Living
Adult
Aged
Antiparkinson Agents - adverse effects
Antiparkinson Agents - therapeutic use
Australia
Biological and medical sciences
Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases
dementia
Dementia - epidemiology
Dementia - etiology
Dyskinesias - epidemiology
Female
Follow-Up Studies
Hallucinations - etiology
Humans
Levodopa - adverse effects
Levodopa - therapeutic use
Male
Medical sciences
Middle Aged
mortality
Neurology
Parkinson Disease - drug therapy
Parkinson Disease - mortality
Parkinson Disease - physiopathology
Parkinson Disease - psychology
Parkinson's disease
progression
Time Factors
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Summary:After 20 years follow‐up of newly diagnosed patients with Parkinson's disease (PD), 100 of 136 (74%) have died. The mortality rate fell in the first 3 years of treatment, then rose compared to the general population, the standardized mortality ratio from 15 to 20 years reaching 3.1. Drug induced dyskinesia and end of dose failure were experienced by most patients, but the main current problems relate to the non‐levodopa responsive features of the disease. Dementia is present in 83% of 20‐year survivors. Dementia correlates with increasing age and probably reflects an interplay of multiple pathologies. Seventeen people with dementia had postmortems. Eight had diffuse Lewy bodies as the only cause of dementia, while others had mixed neuropathology. Only one person lives independently and 48% are in nursing homes. Excessive daytime sleepiness is noted in 70%, falls have occurred in 87%, freezing in 81%, fractures in 35%, symptomatic postural hypotension in 48%, urinary incontinence in 71%, moderate dysarthria in 81%, choking in 48%, and hallucinations in 74%. The challenge is to understand the cellular mechanisms underlying the diverse features of advanced PD that go far beyond a lack of dopamine. © 2008 Movement Disorder Society
ISSN:0885-3185
1531-8257
DOI:10.1002/mds.21956