Dysphagia predicts poor outcome in late-stage Parkinson's disease

Margherita Fabbri, Miguel Coelho, Daisy Abreu, Leonor Correia Guedes, Mario M. Rosa, Catarina Godinho, Rita Cardoso, Isabel Guimaraes, Angelo Antonini, Maurizio Zibetti, Leonardo Lopiano, Joaquim J. Ferreira

Research output: Contribution to journalArticlepeer-review

33 Citations (Scopus)

Abstract

Background: Few data exist on the rate of clinical progression for Parkinson's disease (PD) patients who have entered a late stage of the disease. Objective: Study the clinical progression of a late-stage PD (LSPD) population over one year follow-up. Methods: 50 LSPD patients (Schwab and England ADL Scale <50 or Hoehn Yahr Stage >3 in MED ON) underwent an extensive clinical assessment at baseline and after one year and an acute levodopa test at baseline. Results: Mean age of LSPD patients (female 46%) was 77.5 ± 5.9 years and mean disease duration was 15.5 ± 6.5 years. At baseline, 76% had levodopa-induced motor complications (MC), usually non-troublesome, 68% were demented, 54% had psychosis and 68% depression. Caregiver distress was high. L-dopa responsiveness was mild (18% ± 12 of improvement on MDS-UPDRS-III). After one-year, 20% of the patients were dead, institutionalized or HY 5. MDS-UPDRS-motor mean score worsened 7.2 ± 10.3 points although there was heterogeneity between patients, and there was a global worsening of non-motor symptoms, mostly in cognition/mood, urinary and gastrointestinal domains. Nevertheless, MC improved despite similar levodopa equivalent dose. Functional independence and quality of life worsened. Dysphagia severity at baseline predicted a poor outcome (death, institutionalization or HY 5) (Hazard ratio 2.3, 95% CI 1.12–4.4; p = 0.01), whereas magnitude of L-dopa response of LSPD patients did not. Conclusions: LSPD patients still present a significant, although heterogeneous, motor and non-motor progression over 1 year. Dysphagia severity predicts the occurrence of additional disease severity milestones and its management must be prioritized.

Original languageEnglish
Pages (from-to)73-81
Number of pages9
JournalParkinsonism and Related Disorders
Volume64
DOIs
Publication statusPublished - Jul 2019

Keywords

  • Dementia
  • Dysphagia
  • Late stage
  • Mortality
  • Parkinson's disease

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