Frailty in Patients with Parkinson’s Disease: Associations with Disability and Timed Up and Go

Abstract

Introduction: Aim of this study was identify the prevalence of frailty in patients with idiopathic Parkinson’s disease (PD), to describe the relationship between severity of the disease and frailty, and to evaluate if timed up and go (TUG) is an eligible test for determination of frailty in idiopathic PD patients. Methods: We conducted a cross-sectional study which included 66 patients, aged 60 and over in a tertiary hospital. Frailty was assessed by the Fried Frailty Index (FFI). Severity of the idiopathic PD was detected by the Hoehn and Yahr (H&Y) scale. Mobility was measured by the TUG test. Demographic characteristics and comprehensive geriatric assessments were evaluated. Descriptive statistics and logistic regression were used in analyses. Receiver operating characteristic (ROC) curves were used to identify the discriminative effect of TUG test on frailty. Results: The numbers of frail, prefrail, and robust subjects were 34 (51.5%), 24 (36.4%), and 8 (12.1%), respectively. Dependency in instrumental activities of daily living (IADL) was significantly associated with frailty (Odds ratio (OR): 36.00, Confidence interval (CI): 8.43–153.80). Multivariate logistic regression analysis results yielded, depression (OR: 10.37, CI: 2.82–38.12) and higher levodopa doses (OR: 6.28, CI: 1.77–22.24) were independently associated with frailty. TUG test performance was strongly associated with frailty with high sensitivity (0.806) and specificity (0.826) (Area under the curve (AUC): 0.831). Conclusions: Frailty is highly prevalent in idiopathic PD and is strongly associated with disabilities as well as specific risk factors of the disease. The TUG may be a reliable test for prediction of frailty in patients with idiopathic PD.

Frailty in Parkinson’s disease: A systematic review and meta-analysis

“…Higher daily dose of levodopa carbidopa has been also shown to be associated with frailty [25] . Findings reported in a conference abstract found that frailty was positively associated with levodopa dose ≥400 mg (OR 26.78; 95% CI 1.34–535.45) [20] .…”

“…Fifteen studies employed the frailty phenotype method [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] and 9 studies employed the clinical frailty scale [13] , [14] , [15] , [31] , [32] , [33] , [34] , [35] , [36] . Four studies employed the frailty index, or cumulative deficit model [19] , [27] , [37] , [38] .…”

“…Eight studies were included in meta -analysis using the frailty phenotype [17] , [20] , [22] , [24] , [25] , [27] , [28] , [29] . The prevalence using the FP ranged from 0.03 to 0.64 across included studies.…”

“…Female gender (OR 11.77; 95% CI 1.01–142.91), depression (OR 12.56; 95% CI 1.01–162. 83), and dependency in instrumental activities of daily living (IADLs) (OR 339.18; 95% CI 9.95–11558.97) were significantly associated with frailty [20] . Another study reported similar associations between female gender (OR 3.10; 95% CI 1.53–6.26) and depression (OR 1.12; 95% CI 1.01–1.24) and frailty in a U.K. study [28] .…”

“…The prevalence of frailty in PD using random effects meta -analysis and the frailty phenotype was 0.38 (95% CI 0.24–0.55) [17] , [20] , [22] , [24] , [25] , [27] , [28] , [29] . The heterogeneity of included studies was high and significant (I 2 = 92.6%, p < 0.01) likely a reflection of both clinical and methodological heterogeneity of the included studies, including, sample compositions, age, gender, duration and severity of PD and methodological specifics including features of the study design and the performance of the frailty phenotype evaluation.…”