ObjectiveTo assess dyskinesia frequency in a population-based cohort of patients with Parkinson disease (PD). Dyskinesia complicates levodopa treatment and affects quality of life.MethodsUtilizing the 1991–2010 population-based, parkinsonism-incident cohort of Olmsted County, MN (n = 669), accessed via the Rochester Epidemiology Project, we identified patients with PD and abstracted levodopa-related dyskinesia information.ResultsOf 309 patients with PD (46.2% with parkinsonisms), 279 (90.3%) received levodopa. Most (230/279; 82.4%) had been treated by a Mayo Clinic neurologist. Median age of the 309 patients with PD at the time of diagnosis was 74.1 years (range 33.1–97.8 years). Median-age levodopa initiation in this cohort was 75 years (range 37–98 years), and median-duration levodopa treatment was 6 years (range 2 months to 19.8 years). Dyskinesia was documented in 84 of 279 patients (30.1%). Median time from levodopa initiation to dyskinesia onset was 4 years (range 2 months to 20 years); those with dyskinesia (65.5%; 55/84) developed it within 5 years of levodopa initiation (9 within the first year). Dyskinesia was mild in 57/84 (67.9%), moderate in 16/84 (19.1%), and severe in 9/84 (10.7%); severity was not reported in 2 cases. Dyskinesia severity led to levodopa adjustments or amantadine initiation in 60.7% (51/84 of those with dyskinesia), with improvement in 23/51 (45.1%). Thirteen patients with dyskinesia underwent deep brain stimulation, reporting marked improvement. Postmortem examination confirmed Lewy body disease in 7 autopsied cases.ConclusionsLevodopa-induced dyskinesia affected 30% of the patients with PD in our cohort. Mayo neurologists favoring levodopa dosage optimization treated most patients. Dyskinesia was severe in 3.2% of all levodopa-treated patients with PD (10.7% of all patients with dyskinesia) with marked improvement among those treated with deep brain stimulation.

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Background: Early-onset Parkinson’s disease (EOPD), occurring between ages 40 and 55, carries social, societal, and personal consequences and may progress, with fewer comorbidities than typical, later-onset disease. Objective: To examine the incidence and survival of EOPD and other Parkinsonism occurring before age 55 in the population-based cohort of residents in seven Minnesota counties. Methods: A movement-disorder specialist reviewed all the medical records in a 2010–2015 Parkinsonism-incident cohort to confirm diagnosis and subtypes. Results: We identified 27 patients diagnosed at <  50 years with incident Parkinsonism 2010–15:11 (41%) cases of EOPD, 13 (48%) drug-induced Parkinsonism, and 3 (11%) other Parkinsonism and 69 incident cases of Parkinsonism <  55 years of age. Overall incidence for Parkinsonism <  50 years was 1.98/100,000 person-years, and for EOPD was 0.81/100,000 person-years. In patients <  55 years, Parkinsonism incidence was 5.05/100,000 person-years: in EOPD, 2.05/100,000 person-years. Levodopa-induced dyskinesia was present in 45%of EOPD (both <  50 years and <  55 years). Onset of cardinal motor symptoms was proximate to the diagnosis of EOPD, except for impaired postural reflexes, which occurred later in the course of EOPD. Among the 69 Parkinsonism cases <  55 years, 9 (13%; all male) were deceased (only 1 case of EOPD). Men had a higher mortality risk compared to women (p = 0.049). Conclusion: The incidence of EOPD <  50 years was 0.81/100,000 person-years (1.98 in Parkinsonism all type); prior to 55 years was 2.05/100,000 person-years (5.05 in Parkinsonism all type) with higher incidence in men than women. Men with Parkinsonism, all type, had higher mortality compared to women.

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