Developing Parkinson’s disease during a course on diseases related to old age, study finds

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The researchers said they carried out the study with the aim of finding more information about the interplay between age and Parkinson’s disease (PD) with the aim of improving patient management and therapy development. .

Older age at onset of Parkinson’s disease (PD) is primarily related to more severe disease and lower health-related quality of life (HRQOL), although there were exceptions for measures of dyskinesia and dystonia, according to a recent population-based study from Sweden.

Although PD is generally considered a disease of aging, the actual development and appearance of PD can vary widely, and researchers now generally believe that these temporal factors – not just age of onset but duration of the disease – can influence the overall course of the disease and the type of motor and non-motor symptoms that may occur.

The researchers said they carried out the study with the aim of finding more information about the interplay between age and PD with the aim of improving patient management and therapy development.

With this in mind, the researchers sought to analyze how different aspects of PD changed over time, including symptom scores, HRQoL, components of the clinical scale, and medication use as a function of disease. aging and disease duration.

The study, published in Scientific reports, used data from Sweden’s national Parkinson’s registry, called PARKreg, which started in 2011; it includes demographic variables, diagnosis, treatments, physician-reported clinical measures of disease severity, and patient-reported outcomes.

The current study is based on data from 1436 patients with idiopathic PD from the southernmost region of Sweden, Scania; data retrieval occurred in April 2020. Patients were followed longitudinally for approximately 7.5 years from enrollment (3470 visits spanning 2285 patient-years; mean length of follow-up 1.7 years) .

The median age at baseline was 72 years, the median time since PD diagnosis was 4.2 years, and the median duration of motor symptoms was 6.2 years. Ninety percent of patients were on levodopa at the time of their initial visit, and most patients had mild disease and were classified as stage I or II according to the modified Hoehn & Yahr scale.

The researchers also used the Clinical Impression of Severity Index for Parkinson’s Disease, a 6-item scale, and the Non-Motor Symptom Questionnaire (NMSQ), a 30-item scale. Dystonia and daily duration of dystonia were assessed as well as gait freeze and power off fluctuations. Medication use was taken from another linked national database in Sweden. Using a variety of statistical analyses, the researchers examined data on the interactions between age at onset and different outcomes.

In most cases, being diagnosed at a later age was correlated with more rapid worsening of motor symptoms.

This did not apply to dyskinesia and other motor fluctuations associated with levodopa, which tended to worsen when patients were diagnosed at a younger age. OFF periods were more frequent as the disease progressed, but no interaction was observed with age.

For older patients, HRQoL worsened over time, as did some non-motor symptoms including unexplained weight changes, hallucinations, and double vision.

For the NMSQ total score, the researchers found an interaction with time and age in that late onset was related to slightly more non-motor symptoms and more symptoms appearing over time.

The study had several strengths, including its size, population-based cohort, longitudinal study design, and the ability to link patients to the Swedish Prescription Drug Register to capture drug use.

A notable limitation is that it did not include the Unified Parkinson’s Disease Rating Scale. Additionally, the NMSQ only captured the presence of symptoms and not changes in severity or frequency. Finally, the study did not include any analysis of the effect of comorbidities.

Reference

Raket LL, Oudin Åström D., Norlin, JM, Kellerborg Km Martinez-Martin P, Odin P. Impact of age of onset on symptom profiles, treatment characteristics, and health-related quality of life in Parkinson’s disease. Sci Rep. Published online January 11, 2022. doi:10.1038/s41598-021-04356-8

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