This Article  • References  • Full text PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (74)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

Elan D. Louis, MD, MS; Karen Marder, MD, MPH; Lucien Cote, MD; Ming Tang, PhD; Richard Mayeux, MD, MSE

Arch Neurol. 1997;54(3):260-264.

Abstract
Background
Levodopa therapy for Parkinson disease (PD) has improved quality of life, but mortality rates remain high. Although the presence of dementia and severity of extrapyramidal signs (EPSs) influence morbidity in PD, it is not known whether these manifestations contribute to mortality.

Methods
Patients with PD were compared with nondemented and demented elderly subjects. Each underwent annual neurological and neuropsychological examinations. Dementia was diagnosed by Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised criteria, and EPSs were rated with the Unified Parkinson's Disease Rating Scale. Survival rates were compared using Kaplan-Meier analysis and Cox proportional hazards models.

Results
The risk of mortality, when compared with nondemented elderly subjects, was highest among those with both PD and dementia (rate ratio, 4.9; 95% confidence interval, 3.4-7.1), but also was elevated in patients with PD only (rate ratio, 2.7; 95% confidence interval, 1.7-4.4). Dementia in the absence of PD also was associated with an increased risk of mortality (rate ratio, 1.6; 95% confidence interval, 1.1-2.3). A high baseline total EPS score was associated with significantly earlier mortality.

Conclusions
Compared with nondemented elderly people in the same community, patients with PD have a 2- to 5-fold increased risk of mortality. The risk is strongly related to the presence of severe EPSs, especially bradykinesia. Despite the introduction of levodopa and other advances in the treatment of PD, these factors greatly increase mortality.

Author Affiliations
From the Departments of Neurology (Drs Louis, Marder, Cote, and Mayeux) and Psychiatry (Dr Mayeux), the Gertrude H. Sergievsky Center (Drs Louis, Marder, Cote, Tang, and Mayeux), College of Physicians and Surgeons, and the Division of Epidemiology, School of Public Health (Dr Mayeux), Columbia University, New York, NY.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Clinical Features in Early Parkinson Disease and Survival
Lo et al.
Arch Neurol 2009;66:1353-1358.
ABSTRACT | FULL TEXT  

The distinct cognitive syndromes of Parkinson's disease: 5 year follow-up of the CamPaIGN cohort
Williams-Gray et al.
Brain 2009;132:2958-2969.
ABSTRACT | FULL TEXT  

Overview of Results From the Largest Clinical Trial for Dysphagia Treatment Efficacy
Robbins and Hind
Swallowing and Swallowing Disorders (Dysphagia) 2008;17:59-66.
ABSTRACT | FULL TEXT  

Parkinson disease and risk of mortality: A prospective comorbidity-matched cohort study
Driver et al.
Neurology 2008;70:1423-1430.
ABSTRACT | FULL TEXT  

Comparison of 2 Interventions for Liquid Aspiration on Pneumonia Incidence: A Randomized Trial
Robbins et al.
ANN INTERN MED 2008;148:509-518.
ABSTRACT | FULL TEXT  

Estimated life expectancy of Parkinson's patients compared with the UK population
Ishihara et al.
J. Neurol. Neurosurg. Psychiatry 2007;78:1304-1309.
ABSTRACT | FULL TEXT  

PARKINSON DISEASE AT THE END OF LIFE: CAREGIVER PERSPECTIVES
Goy et al.
Neurology 2007;69:611-612.
FULL TEXT  

Survival and mortality differences between dementia with Lewy bodies vs Alzheimer disease
Williams et al.
Neurology 2006;67:1935-1941.
ABSTRACT | FULL TEXT  

Clinical phenotype of Parkinson disease dementia.
Galvin et al.
Neurology 2006;67:1605-1611.
ABSTRACT | FULL TEXT  

Challenges in the design and conduct of a randomized study of two interventions for liquid aspiration
Brandt et al.
Clin Trials 2006;3:457-468.
ABSTRACT  

Cognitive Predictors of Dementia in Parkinson's Disease: A Community-Based, 4-Year Longitudinal Study
Janvin et al.
J Geriatr Psychiatry Neurol 2005;18:149-154.
ABSTRACT  

Prognosis of Parkinson Disease: Risk of Dementia and Mortality: The Rotterdam Study
de Lau et al.
Arch Neurol 2005;62:1265-1269.
ABSTRACT | FULL TEXT  

Donepezil for dementia in Parkinson's disease: a randomised, double blind, placebo controlled, crossover study
Ravina et al.
J. Neurol. Neurosurg. Psychiatry 2005;76:934-939.
ABSTRACT | FULL TEXT  

Evaluation of Movement Speed and Reaction Time as Predictors of All-Cause Mortality in Men
Metter et al.
Journals of Gerontology Series A: Biological Sciences and Medical Sciences 2005;60:840-846.
ABSTRACT | FULL TEXT  

Survival in Parkinson disease: Thirteen-year follow-up of the DATATOP cohort
Marras et al.
Neurology 2005;64:87-93.
ABSTRACT | FULL TEXT  

Mortality and Parkinson disease: A community based study
Herlofson et al.
Neurology 2004;62:937-942.
ABSTRACT | FULL TEXT  

Survival Study of Parkinson Disease in Olmsted County, Minnesota
Elbaz et al.
Arch Neurol 2003;60:91-96.
ABSTRACT | FULL TEXT  

The association of incident dementia with mortality in PD
Levy et al.
Neurology 2002;59:1708-1713.
ABSTRACT | FULL TEXT  

Fluctuations in attention: PD dementia vs DLB with parkinsonism
Ballard et al.
Neurology 2002;59:1714-1720.
ABSTRACT | FULL TEXT  

Medical Services Utilization and Prognosis in Parkinson Disease: A Population-Based Study
Parashos et al.
Mayo Clin Proc. 2002;77:918-925.
ABSTRACT  

Parkinsonism in Ontario: Increased mortality compared with controls in a large cohort study
Guttman et al.
Neurology 2001;57:2278-2282.
ABSTRACT | FULL TEXT  

Prevalence, incidence, and mortality of PD: A door-to-door survey in Ilan County, Taiwan
Chen et al.
Neurology 2001;57:1679-1686.
ABSTRACT | FULL TEXT  

Risk of dementia in Parkinson's disease: A community-based, prospective study
Aarsland et al.
Neurology 2001;56:730-736.
ABSTRACT | FULL TEXT  

Selegiline and mortality in subjects with Parkinson's disease: A longitudinal community study
Donnan et al.
Neurology 2000;55:1785-1789.
ABSTRACT | FULL TEXT  

Parkinson Disease Survival: A Population-Based Study
Morgante et al.
Arch Neurol 2000;57:507-512.
ABSTRACT | FULL TEXT  

The Sydney multicentre study of Parkinson's disease: progression and mortality at 10 years
Hely et al.
J. Neurol. Neurosurg. Psychiatry 1999;67:300-307.
ABSTRACT | FULL TEXT  

Progression of Parkinsonian Signs in Parkinson Disease
Louis et al.
Arch Neurol 1999;56:334-337.
ABSTRACT | FULL TEXT  

Parkinson's Disease- First of Two Parts
Lang and Lozano
NEJM 1998;339:1044-1053.
FULL TEXT