Mortality in Parkinson's disease: a 38-year follow-up study.

BACKGROUND: In this study we report on the outcome including overall and cause-specific mortality of Parkinson's disease (PD) patients subsequent to 38 years of surveillance. This is an extension study of our previous report on mortality. METHODS: Two hundred thirty-seven patients with a symptom onset between 1974 and 1984 were followed until the date of December 31, 2012 or death, representing a follow-up period of up to 38 years. Overall and cause-specific standardized mortality ratios (SMRs) were calculated, and predictors for survival at disease onset were estimated. RESULTS AND CONCLUSION: Two hundred thirty patients had died by December 31, 2012; a total of 3,489 person-years were available for observation. The SMR at 38 years of follow-up was 2.02 (1.76-2.29). Employing Cox's proportional hazard modeling, male sex, gait disorder, absence of classical rest tremor, and absence of asymmetry predicted poor survival in this cohort. Increased cause-specific SMRs were found for pneumonia and cerebrovascular and cardiovascular diseases.

Mortality in Parkinson's disease: a 20-year follow-up study.

We determined mortality rates and predictors of survival in 238 consecutive patients with Parkinson's disease (PD) with symptom onset between 1974 and 1984. All patients were regularly followed at the Movement Disorder Clinic (Department of Neurology at the Innsbruck Medical University) until December 31, 2004, or death. As of December 31, 2004, 189 patients had died. Standardized mortality ratios (SMRs) increased over time. SMRs were 0.6 (95% CI 0.4-1.0) by 5 years, 0.9 (95% CI 0.7-1.2) by 10 years, 1.2 (95% CI 1.0-1.4) by 15 years, and 1.3 (95% CI 1.1-1.5) by 20 to 30 years. SMR for male patients was significantly increased to 1.3 (95% CI 1.1-1.6), whereas SMR increase of 1.2 (0.9-1.4) observed in female patients was not significant. Significantly increased SMRs were detected in patients with younger and older age of onset. Male gender, gait disorder, lack of tremor, and lack of asymmetry as presenting clinical features predicted poor survival in a Cox's proportional hazard analysis. This study demonstrates similar survival of patients with PD to the normal control population up to a disease duration of 10 years, followed by a modest rise of mortality with disease duration beyond 10 years compared with the general population. Under regular specialist care using all currently available therapies life expectancy in PD does not appear seriously compromised, but male gender, gait disorder, and absent rest tremor at presentation are associated with poorer long-term survival.