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Raymond Y. Lo, MD; Caroline M. Tanner, MD, PhD; Kathleen B. Albers, MPH; Amethyst D. Leimpeter, MSc; Robin D. Fross, MD; Allan L. Bernstein, MD; Valerie McGuire, PhD; Charles P. Quesenberry, PhD; Lorene M. Nelson, PhD; Stephen K. Van Den Eeden, PhD

Arch Neurol. 2009;66(11):1353-1358.

Objective  To examine the association between demographic and clinical features in early Parkinson disease (PD) and length of survival in a multiethnic population.

Design  Clinical features within 2 years of diagnosis were determined for an inception cohort established during 1994-1995. Vital status was determined through December 31, 2005. Predictor variables included age at diagnosis, sex, race/ethnicity, as well as clinical subtype (modified tremor dominant, postural instability gait difficulty), symmetry, cognitive impairment, depression, dysphagia, and hallucinations. Cox proportional hazards regression analysis was used to identify factors associated with shorter survival.

Setting  Kaiser Permanente Medical Care Program, northern California.

Patients  Five hundred seventy-three men and women with newly diagnosed PD.

Results  Three hundred fifty-two participants in the PD cohort (61.4%) had died in the follow-up period. Older age at diagnosis (hazard ratio [HR], 1.1; 95% confidence interval [CI], 1.09-1.12), modified postural instability gait difficulty subtype (HR, 1.8; 95% CI, 1.3-2.7), symmetry of motor signs (HR, 2.0; 95% CI, 1.1-3.7), mild (HR, 1.7; 95% CI, 1.3-2.2) and severe (HR, 2.7; 95% CI, 1.9-3.9) cognitive impairment, dysphagia (HR, 1.4; 95% CI, 1.1-1.9), and hallucinations (HR, 2.1; 95% CI, 1.3-3.2) were associated with increased all-cause mortality, after adjusting for age, sex, and race/ethnicity. None of the other factors altered mortality risk. In an empirical predictive analysis, most previous significant predictors remained associated with shorter survival.

Conclusions  Both motor and nonmotor features in early PD predict increased mortality risk, particularly postural instability gait difficulty, cognitive impairment, and hallucinations. These predictors may be useful in clinical practice and when designing clinical trials.

Author Affiliations: The Parkinson's Institute and Clinical Center, Sunnyvale, California (Drs Lo and Tanner); Division of Research, Kaiser Permanente, Oakland, California (Mss Albers and Leimpeter and Drs Quesenberry and Van Den Eeden); Department of Neurology, Kaiser Hayward Medical Center, Hayward, California (Dr Fross); Department of Neurology, Kaiser Santa Rosa Medical Center, Santa Rosa, California (Dr Bernstein); and Department of Health Research and Policy, Stanford University, Stanford, California (Drs McGuire and Nelson).

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