The CamPaIGN study of Parkinson's disease: 10-year outlook in an incident population-based cohort

痴呆 医学 队列 鹿特丹研究 人口 危险系数 比例危险模型 队列研究 疾病 神经心理学 儿科 内科学 精神科 认知 置信区间 环境卫生
作者
Caroline H. Williams‐Gray,Sarah Mason,Jonathan Evans,Thomas Foltynie,Carol Brayne,Trevor W. Robbins,Roger A. Barker
出处
期刊:Journal of Neurology, Neurosurgery, and Psychiatry [BMJ]
卷期号:84 (11): 1258-1264 被引量:596
标识
DOI:10.1136/jnnp-2013-305277
摘要

Background

Prognosis in Parkinson9s disease (PD) remains poorly understood due to a lack of unbiased data on the natural history of treated PD. The CamPaIGN study has been the first to prospectively track disease evolution from diagnosis in an unselected population-representative incident cohort. We now report the 10-year follow-up data, focusing on three key irreversible milestones: postural instability (Hoehn and Yahr 3), dementia and death.

Methods

The cohort was collected between December 2000 and 2002. Those meeting diagnostic criteria (n=142) were followed-up until 1 January 2012. Clinical, neuropsychological and genetic testing were performed. Progression to key milestones was evaluated using Kaplan–Meier and Cox regression survival analyses.

Results

At 10 years, 55% had died, 68% had postural instability and 46% dementia. 23% had a good outcome at 10 years (surviving free of dementia/postural instability). Death rate was comparable with the UK population (standardised mortality ratio 1.29 (0.97–1.61)). Death certificates indicated PD was a substantial contributor in only 20%, with pneumonia being the commonest cause of death. Age, non-tremor-dominant motor phenotype and comorbidity predicted earlier postural instability. Baseline predictors of dementia were age, motor impairment, ‘posterior-cortical’ cognitive deficits and MAPT genotype.

Conclusions

(1) outlook in PD is heterogeneous, with most dying or developing dementia or postural instability by 10 years from diagnosis, but a quarter still doing well, with preserved mobility and intact cognition; (2) death is not directly related to PD in the majority; (3) baseline clinical and genetic variables are predictive of outcome and may be helpful in selecting patients for clinical trials.
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