Predictors of functional dependency in Parkinson's disease

Abstract

BackgroundFunctional dependency, the need for help in basic activities of daily living, is an important patient‐oriented outcome. We aimed to describe the development of dependency in Parkinson's disease (PD) and identify independent prognostic factors for this outcome.MethodsWe analyzed data from the Parkinsonism Incidence in North‐East Scotland (PINE) study, a prospective, community‐based incident cohort of PD with ongoing follow‐up. We described the development of dependency defined by a Schwab & England score of < 80% and a Barthel Index of <19. We identified the baseline predictors of dependency using multivariable Cox regression.ResultsIn 198 patients with PD, the rate of development of dependency was 14 per 100 person years. Older age at diagnosis (hazard ratio for 10‐year increase 2.23 [95% confidence interval 1.66‐2.98]), greater smoking history (hazard ratio for 10‐pack‐year increase, 1.15 [1.04‐1.26]), more severe axial impairment (hazard ratio for 5‐point increase in sum of axial items from UPDRS scale, 1.78 [1.30‐2.44]), and lower MMSE score (hazard ratio 0.88 [0.79‐0.98]) were independently associated with a higher risk of dependency as defined by Schwab & England. Only older age (hazard ratio for 10‐year increase 1.35 [1.04‐1.76]) and severity of axial impairment (hazard ratio for 5‐point increase 1.85 [1.31‐2.62]) were associated with a higher risk of dependency as defined by the Barthel Index. Sex, deprivation, comorbidity, overall UPDRS motor score, and disease stage were not independently associated with dependency.ConclusionThis is the first community‐based study of dependency in PD. There was a high rate of dependency development. Older age, more smoking, more axial impairment, and poorer cognition were independent predictors. © 2016 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.

Bringing light into the darkness: Dependence in Parkinson's disease

“…This proportion increased to 46.8% among patients with a disease duration of 10 years or more. These figures are clearly in contrast with the high incidence of functional dependency as reported in this issue of Movement Disorders , suggesting a substantial underestimation of the sequelae of motor impairments in PD …”

“…These figures are clearly in contrast with the high incidence of functional dependency as reported in this issue of Movement Disorders, suggesting a substantial underestimation of the sequelae of motor impairments in PD. 7 Third, comorbidities were not associated with functional dependency. At first, this appears to be a counterintuitive result because the potential impact of comorbidity on functional status has been intensively (yet also controversially) discussed previously, and many other parameters relevant to public health (eg, utilization of health care resources) are usually reported to be increased in comorbid patients.…”

“…In this issue of Movement Disorders , Macleod and Counsell present the results of a remarkable study that aimed at closing some of these gaps . The authors investigated the incidence of sustained functional dependency in terms of decreased capabilities of performing the basic activities of daily living (ADLs) and associated risk factors in patients with Parkinson's disease.…”

“…6 In this issue of Movement Disorders, Macleod and Counsell present the results of a remarkable study that aimed at closing some of these gaps. 7 The authors investigated the incidence of sustained functional dependency in terms of decreased capabilities of performing the basic activities of daily living (ADLs) and associated risk factors in patients with Parkinson's disease. Dependency was operationalized by 2 established rating scales (Schwab & England scale, Barthel index), and the authors employed a sophisticated methodology, including a cohort design based on a comprehensive ascertainment strategy, regression modeling, and survival analyses.…”

Development and validation of prognostic survival models in newly diagnosed Parkinson's disease

“…We do not here discuss particular prognostic factors for dependency outcomes as we have done so previously . The finding that comorbidity was associated with mortality but not the dependency outcomes may be because many deaths, particularly early deaths, were related to comorbid disease, whereas most disability was related to PD itself.…”