Summary: A new study reveals information about life expectancy for those with Parkinson’s and other synucleinopathies.
Source: Mayo Clinic.
Faced with a serious disease, patients want to know the answer to a difficult question: “How long will I live?”
A new Mayo Clinic study in today’s JAMA Neurology has some answers for patients with Parkinson’s disease, Lewy body dementia, multiple system atrophy with parkinsonism and Parkinson’s disease dementia.
The population-based study found that patients with these diseases died about two years earlier than the general population. The highest risk of death was seen among patients with multiple system atrophy with parkinsonism at six years earlier. This high-risk group was followed by patients with Lewy body dementia, four years earlier; Parkinson disease dementia, 3½ years earlier; and Parkinson disease, one year earlier.
“As doctors, we want to be able to counsel our patients appropriately when they ask, ‘What will happen to me?'” says Rodolfo Savica, M.D., Ph.D., lead author and a neurologist at Mayo Clinic. “Understanding long-term outcomes can help clinicians better inform patients and their caregivers about what to expect.”
The study used data from the Rochester Epidemiology Project, a collaboration of medical facilities in Minnesota and Wisconsin involving community members who have agreed to share their medical records for research. The researchers reviewed data from 1991 through 2010. They compared 461 patients with these diseases to 452 patients in the general population — all in Olmsted County, Minnesota. Sixty percent of each group was men.
Patients who had synucleinopathies — diseases in which the brain accumulates abnormal amounts of the alpha-synuclein protein — included 309 with Parkinson’s disease, 81 with Lewy body dementia, 55 with Parkinson’s disease dementia, and 16 with multiple system atrophy with parkinsonism. Parkinsonism was defined as having at least two of four signs: resting tremor, slowed movement, rigidity, and impaired reflexes to maintain posture and balance.
Of the 461 patients with synucleinopathies, 316 or 68.6 percent died during follow-up. Of the 452 general population participants, 220 or 48.7 percent died during follow-up.
Cause of death also was compared. Among patients with synucleinopathies, neurodegenerative disease was the most frequent cause of death at 31.5 percent. Cardiovascular disease was the second most common cause of death at 15.7 percent. For the general population, cardiovascular disease was the most common cause of death at 25.5 percent.
“This helps understanding on how these diseases work,” Dr. Savica says, noting that the paper is among the first comprehensive studies of the survival and cause of death of people with synucleinopathies, compared with the general population.
Study co-authors are Brandon Grossardt, M.S.; James Bower, M.D.; Eric Ahlskog, M.D., Ph.D.; Bradley Boeve, M.D.; Jonathan Graff-Radford, M.D., Walter Rocca, M.D.; and Michelle Mielke, Ph.D., all of Mayo Clinic.
Funding: The study was supported by an award from the National Institute on Aging of the National Institutes of Health (grant AG 034676) and the Mayo Foundation for Medical Education and Research. The authors noted study limitations and conflict of interest disclosures.
Source: Susan Barber Lindquist – Mayo Clinic
Image Source: NeuroscienceNews.com image is adapted from the Mayo Clinic news release.
Original Research: Full open access research for “Survival and Causes of Death Among People With Clinically Diagnosed Synucleinopathies With Parkinsonism: A Population-Based Study” by Rodolfo Savica, MD, PhD; Brandon R. Grossardt, MS; James H. Bower, MD, MSc; J. Eric Ahlskog, PhD, MD; Bradley F. Boeve, MD; Jonathan Graff-Radford, MD; Walter A. Rocca, MD, MPH; and Michelle M. Mielke, PhD in JAMA Neurology. Published online May 15 2017 doi:10.1001/jamaneurol.2017.0603
Survival and Causes of Death Among People With Clinically Diagnosed Synucleinopathies With Parkinsonism: A Population-Based Study
Importance To our knowledge, a comprehensive study of the survival and causes of death of persons with synucleinopathies compared with the general population has not been conducted. Understanding the long-term outcomes of these conditions may inform patients and caregivers of the expected disease duration and may help with care planning.
Objective To compare survival rates and causes of death among patients with incident, clinically diagnosed synucleinopathies and age- and sex-matched referent participants.
Design, Setting, and Participants This population-based study used the Rochester Epidemiology Project medical records–linkage system to identify all residents in Olmsted County, Minnesota, who received a diagnostic code of parkinsonism from 1991 through 2010. A movement-disorders specialist reviewed the medical records of each individual to confirm the presence of parkinsonism and determine the type of synucleinopathy. For each confirmed patient, an age- and sex-matched Olmsted County resident without parkinsonism was also identified.
Main Outcomes and Measures We determined the age- and sex-adjusted risk of death for each type of synucleinopathy, the median time from diagnosis to death, and the causes of death.
Results Of the 461 patients with synucleinopathies, 279 (60.5%) were men, and of the 452 referent participants, 272 (60.2%) were men. From 1991 through 2010, 461 individuals received a diagnosis of a synucleinopathy (309 [67%] of Parkinson disease, 81 [17.6%] of dementia with Lewy bodies, 55 [11.9%] of Parkinson disease dementia, and 16 [3.5%] of multiple system atrophy with parkinsonism). During follow-up, 68.6% (n = 316) of the patients with synucleinopathies and 48.7% (n = 220) of the referent participants died. Patients with any synucleinopathy died a median of 2 years earlier than referent participants. Patients with multiple system atrophy with parkinsonism (hazard ratio, 10.51; 95% CI, 2.92-37.82) had the highest risk of death compared with referent participants, followed by those with dementia with Lewy bodies (hazard ratio, 3.94; 95% CI, 2.61-5.94), Parkinson disease with dementia (hazard ratio, 3.86; 95% CI, 2.36-6.30), and Parkinson disease (hazard ratio, 1.75; 95% CI, 1.39-2.21). Neurodegenerative disease was the most frequent cause of death listed on the death certificate for patients, and cardiovascular disease was the most frequent cause of death among referent participants.
Conclusions and Relevance Individuals with multiple system atrophy with parkinsonism, dementia with Lewy bodies, and Parkinson disease dementia have increased mortality compared with the general population. The mortality among persons with Parkinson disease is only moderately increased compared with the general population.
“Survival and Causes of Death Among People With Clinically Diagnosed Synucleinopathies With Parkinsonism: A Population-Based Study” by Rodolfo Savica, MD, PhD; Brandon R. Grossardt, MS; James H. Bower, MD, MSc; J. Eric Ahlskog, PhD, MD; Bradley F. Boeve, MD; Jonathan Graff-Radford, MD; Walter A. Rocca, MD, MPH; and Michelle M. Mielke, PhD in JAMA Neurology. Published online May 15 2017 doi:10.1001/jamaneurol.2017.0603