Tuesday, February 21, 2012

Parkinson Disease's Effect on Mortality Eclipses Heart Disease and Other Common Illnesses of the Elderly

This rather sobering study (from the January 2nd edition of Archives of Neurology) is quite sobering, but also helpful, since it points us toward aspects of the illness not fully appreciated by the medical community at large (already suspected by most neurologists who have a concentrated number of Parkinson patients in their clinic), and this is important because it can help us focus our efforts toward prevention.
The study references the average patient over the age of 65.
In summary, it says that the average risk of mortality from Parkinson Disease as an independent diagnosis is equal to that (or greater) than that of stroke, heart disease, or hip fracture....

60 % will die within 6 years.

It also tells us that some degree of dementia affects more than HALF of people over the age of 65 with a diagnosis of DEMENTIA.

Was this a small, obscure study? No. The lead author (Allison W Willis, MD of Wash U.) reviewed the Medicare records of 38 million Americans, identifying 550,000 cases of PD overall among those over the age of 65, and specifically looked at new cases (138,728 patients between the years 2002 and 2008).
It showed a couple trends:
96% were white. 6% were African-American. 2% were Hispanic. 1% were Asian.
The incidence was more common among men.
67% of men also had a diagnosis of dementia or mild cognitive impairment which is often a prelude to dementia.
71% of women also had a diagnosis of dementia or mild cognitive impairment, slightly more common in the African-American population and slightly less among Asians.

So in general, it would tell us that compared to someone else over the age of 65 without a chronic illness, the elderly with Parkinson Disease is 3.87 more likely to die during the 6 year study. Why did they die? Many reasons, which was not part of the study per se, but they did notice some trends such as the fact that they were almost 4 times (3.74) more likely to die of a hip fracture, 3.62 times more likely to die from a heat attack, and 2 times more likely to die from a stroke.

So, the reality is, this doesn't seem to pan out in my experience with patient to be quite so dismal. It probably should tell us that there is at least a trend of poorer outcomes and we should be asking why.

POTENTIAL FLAWS in the study which would affect the reliability in the results:
-Many other illnesses cause "parkinsonism" which are some symptoms similar to Parkinson Disease but not the same. Without an expert exam to confirm the diagnosis code in the computer, we can't be sure how many of these patients were correctly diagnosed. For instance, Lewy Body Dementia is a dementia that has some symptoms like Parkinson Disease but just isn't the same and is commonly misdiagnosed.
-How early were these people really diagnosed. Maybe they were diagnosed later than they should if the early symptoms were missed, which would make them sicker a the time of diagnosis.
-It doesn't identify who has their symptoms controlled well and who poorly

SO, If YOU have Parkinson Disease, what does this mean? Well, it means your risk of dying is definitely greater than someone else your age without the diagnosis.... IF you don't control the illness as well as possible, you are at a greater risk of falls and hip fracture which often leads to death quickly.
And without regular exercise and physical therapy, you are more likely to live a sedentary lifestyle, which sets you up to have a greater risk of stroke and heart disease.

So what should we be doing for you as your physician?
-Screening you more closely for vascular disease which might lead to stroke and heart attack
-Screening you for apnea and sleep disorders which have been shown to lead to cognitive impairment/dementia
-Being more bold about making you do physical therapy, home exercise, stretching
-Being more bold about finding the best combinations of medications to help keep you moving, stable, and limber
-Making sure you have appropriate walkers when needed and making sure your home fall risk is properly assessed.