The cause of death in idiopathic Parkinson’s disease

doi:10.1016/j.parkreldis.2010.04.010

Parkinsonism & Related Disorders

Volume 16, Issue 7, August 2010, Pages 434-437

https://doi.org/10.1016/j.parkreldis.2010.04.010 Get rights and content

Abstract

Objectives

To identify the cause of death in patients with idiopathic Parkinson’s disease (IPD)

Background

Current literature provides little data relating to cause of death in IPD and much is based on the recording of IPD on death certificates.

Methods

All patients under the care of a Parkinson’s disease (PD) service who had died between 1999 and 2006 inclusive were identified and further classified into those with IPD according to the UK PD Society Brain Bank Criteria. Details were extracted from the service database and medical notes and further information obtained from the Office for National Statistics (ONS). Corrections were made for data classified using the International Classification of Diseases (ICD) 9 classification (prior to 2001) in order to compare accurately with data classified using ICD 10. Trends in cause of death were identified. Comparative data was obtained from the ONS for a control population.

Results

Of 219 patients on the database who had died, 143 were identified as having IPD. They were more likely to be classified as dying from pneumonia, and less likely as malignancy or ischaemic heart disease, than the control population. Pneumonia was a terminal event in 45%. IPD was recorded on the death certificate in only 63% of patients.

Conclusion

As expected, pneumonia is very often the terminal event. As previously demonstrated, malignancy is uncommon. Death certificate documentation is inadequate in one third of certificates; this has implications for research.

Introduction

According to most previous studies of standardized mortality ratio (SMR), idiopathic Parkinson’s disease (IPD) does appear to affect life expectancy, but this varies depending on the age at onset [1]. It has been suggested that people with IPD are less likely to die of malignant conditions or ischaemic heart disease but it is unclear how many die as a direct result of the IPD or its complications.

There are few data evaluating the cause of death in Parkinson’s disease (PD) with some previous studies limited due to smaller sample sizes [2], or with samples arguably based on unrepresentative populations (e.g. tertiary referral clinics) [3]. Other studies have less clearly defined inclusion criteria [4], [5].

The aim of this study, therefore, was to identify the cause of death in patients with IPD in a prospective cohort of patients under the care of a PD service with a representative community-based population.

Section snippets

Methods

Ethical approval was obtained from the NHS National Research Ethics Service (Gateshead and South Tyneside Local Research Ethics Committee) in April 2007.

Patients under the care of the North Tyneside PD Service (NTPDS) who died between January 1st 1999 and January 1st 2007 were identified from service records as has been previously described [6]. Patients with IPD under the NTPDS are not discharged and are therefore followed up life-long.

Results

Of the 219 patients registered with the NTPDS during the study period, 143 patients had IPD, 26 had Vascular Parkinsonism, 17 had Lewy Body Disease, 7 had progressive supranuclear palsy (PSP) and 5 had multi-system atrophy (MSA). Of the remainder, 8 were excluded due to insufficient data, and 12 were excluded because they were documented as not having features of Parkinsonism. One further patient was excluded as they had emigrated and died abroad, and therefore ONS data were not available.

For

Discussion

In this study we have demonstrated that the most common cause of death classified using the ICD-10 data is IPD (29%) followed by malignancy (12%), ischaemic heart disease (12%), pneumonia (11%), and cerebrovascular disease (9%). Our study includes patients with clearly established IPD, as defined by the UK PD Society Brain Bank Criteria, based on follow up and assessment, including response to dopaminergic treatment, during life. A previously published prevalence study has demonstrated that the

Conclusion

The most commonly ascribed cause of death in this study was IPD followed by malignancy, ischaemic heart disease, pneumonia and cerebrovascular disease in decreasing order. However, pneumonia was a terminal event in 45% of patients. One potential way of reducing pneumonia risk would be to have more frequent formal swallowing assessments in people with PD to identify aspiration risk, in people who are potentially “asymptomatic” for swallowing problems. This might involve a speech and language

Ethical approval

Ethical approval was obtained from the NHS National Research Ethics Service (Gateshead and South Tyneside Local Research Ethics Committee) in April 2007.

Conflicts of interest

There are no competing interests for any of the authors.

References (26)

A. Diem-Zangerl et al.
Mortality in Parkinson’s disease: a 20-year follow-up study
Mov Disord
(2009)
M. D’Amelio et al.
Long-term survival of Parkinson’s disease: a population-based study
J Neurol
(2006)
P.A. Fall et al.
Survival time, mortality, and cause of death in elderly patients with Parkinson’s disease: a 9-year follow-up
Mov Disord
(2003)
U. Nath et al.
Population based mortality and quality of death certification in progressive supranuclear palsy (Steele–Richardson–Olszewski syndrome)
J Neurol Neurosurg Psychiatr
(2005)
D.A. Bennett et al.
Prevalence of parkinsonian signs and associated mortality in a community population of older people
N Engl J Med
(1996)
K. Snell et al.
The place of death in Parkinson’s disease
Age Ageing
(2009)
A.J. Hughes et al.
Accuracy of clinical diagnosis of idiopathic Parkinson’s disease – a clinicopathological study of 100 cases
J Neurol Neurosurg Psychiatr
(1992)
World Health Organization
International classification of diseases
(1977)
World Health Organization
International statistical classification of diseases and related health problems
(1992)
C. Rooney et al.
Implementation of ICD-10 for morality data in England and Wales from January 2001
Health Stat Q
(2000)

B. Porter et al.

The prevalence of Parkinson’s disease in an area of North Tyneside in the North-East of England

Neuroepidemiology

(2006)

NHS end of life care

Advance care planning: a guide for health & social care staff

(2008)

H. Woodford et al.

Emergency hospital admissions in idiopathic Parkinson’s disease

Mov Disord

(2005)

Cited by (98)

Risk of Parkinson's disease-related death in cancer survivors: A population-based study in Japan
2024, Parkinsonism and Related Disorders
The risk of Parkinson's disease (PD)-related death in patients with cancer largely unexplored.
We analyzed data from the Neoplasms ANd other causes of DEath (NANDE) study, which investigates the causes of death in patients with cancer in Japan. Standardized mortality ratios (SMRs) were calculated to compare the risk of PD-related deaths in patients with cancer to that of the general population. Poisson regression models were employed to estimate the relative risk of PD-related death in the subgroups.
The cohort included 548,485 patients with cancer, yielding 2,047,398 person-years at risk from 1995 to 2013. During the study period, 242,250 patients died and 145 deaths were attributable to PD. The SMR for PD-related death was 2.34 (95% confidence interval [CI]: 1.99–2.75). Patients who were diagnosed with cancer before 70 years of age had a high SMR (>5) for PD-related deaths. The SMR of patients with mouth-to-stomach cancers (lip, oral cavity, pharynx, esophagus, and stomach cancers) was 3.72 (95% CI: 2.84–4.86), while that of those with other cancers was 1.93 (95% CI: 1.57–2.37). The multivariate Poisson regression model revealed that patients with mouth-to-stomach cancers were more likely to die of PD than those without (relative risk 2.07, 95 % CI; 1.46–2.93).
Patients with cancer are at a high risk of PD-related death; particularly, mouth-to-stomach cancers and potentially obstructing medication for PD are attributable to a high mortality risk. Careful management, including adequate PD treatment, would benefit cancer survivors with PD and reduce the risk of PD-related death.
Incidence of cardiovascular morbidity among Parkinson's disease patients; a large-scale cohort study in a 16-year time window around disease onset
2023, Parkinsonism and Related Disorders
To examine the risk of any or specific types of cardiovascular diseases (CVDs) in patients with Parkinson's disease (PD), in the 16 years around disease onset, and to compare it to that in the general population.
This is a large-scale population-based retrospective cohort study of newly diagnosed PD patients, members of Maccabi Health Services (MHS), who started taking anti-parkinsonian drugs (APD) between 1/1/2000-31/12/2019 (study period). We collected information about CVD incidence (Congestive heart failure-CHF, Myocardial infarction-MI, Stroke) from MHS-CVD registry. We applied Cox regression to estimate adjusted-HR and 95%CI of CVD risks. We calculated Standardized-Incidence-Ratio (SIR) comparing CVD risks in the PD cohort to that of MHS population.
The PD cohort comprised 10,840 patients. During a mean follow up of 16.3 ± 4.3y around disease onset, 20.7% (n = 2241) were diagnosed with any CVD: 7.9% with CHF; 6.7% with MI, and 10.5% with stroke. Risks were higher for men: HR = 1.95 (95%CI 1.58–2.40), and for above age 75y at first APD treatment, HR = 2.00 (95% CI 1.65–2.43). Compared to the MHS population, the PD cohort exhibited a significantly lower risk for CVDs, especially for men: SIRmen = 0.21 (95%CI 0.20–0.22), SIRwomen = 0.29 (95% CI 0.27–0.31). These trends were similar for the specific CVDs.
The findings suggest that the risks that PD patients and particularly men, will develop any type of CVD are lower than those of the general population. Further studies are needed to confirm this finding and examine the underlying mechanisms.
What Special Considerations Are Needed for Individuals with Amyotrophic Lateral Sclerosis, Parkinson’s Disease, and Multiple Sclerosis?
2023, Evidence-Based Practice of Palliative Medicine, Second Edition
Although unique diseases with diverse pathophysiology and disease trajectories, amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), and Parkinson’s disease (PD) share numerous characteristics and care needs. All are associated with complex physical and neuropsychiatric symptoms, progressive functional impairments, and high levels of prolonged personal suffering and caregiver burden. Palliative care is underused for neurodegenerative diseases, particularly for long-term chronic diseases such as MS and PD. Coordinated, interdisciplinary care that incorporates palliative care throughout the disease trajectory is essential for relieving suffering and improving quality of life.
The dilemma between milestones of progression versus clinical scales in Parkinson's disease
2023, Handbook of Clinical Neurology
There are significant challenges in accurately documenting the progression of Parkinson's disease (PD). The disease course is highly heterogeneous, there are no validated biomarkers, and we are reliant on repeated clinical measures to assess disease state over time. Yet, the ability to chart disease progression accurately is vital in both observational and interventional study designs, where reliable measures are critical to determine whether an outcome has been met. In this chapter, we first discuss the natural history of PD, including the spectrum of clinical presentation and expected developments through the course of the disease. We then explore in detail the current strategies for measuring disease progression, which can be broadly divided into: (i) the use of quantitative clinical scales; and (ii) determination of the onset time of key milestones. We discuss the strengths and limitations of these approaches for use in clinical trials, with a particular focus on disease modification trials. The selection of outcome measures for a particular study will depend on multiple factors, but trial duration is an important determinant. Milestones are reached over a course of years rather than months, and hence clinical scales with sensitivity to change are needed for short-term studies. However, milestones represent important markers of disease stage which are not confounded by symptomatic therapies and are of critical relevance to the patient. Prolonged but low intensity follow-up beyond a limited period of treatment with a putative disease-modifying agent may allow milestones to be incorporated into evaluation of efficacy in a practical and cost-effective way.
Deep brain stimulation in neurological diseases and other pathologies
2022, Neurology Perspectives
Deep brain stimulation (DBS) is a surgical procedure used to treat various neurological pathologies, being its greatest use in movement disorders. The FDA first approved deep brain stimulation in 1997 to treat essential tremor, in 2002 it was approved for Parkinson's disease, in 2003 for dystonia and in 2009 for obsessive compulsive disorder. However, until recently this technique began to be implemented for the treatment of other neurological diseases. To conduct research on the different neurological diseases where deep brain stimulation is used articles were chosen from Pubmed, Google Scholar, Redalyc and Scielo databases, references from the last 10 years to date were taken. The keywords that were written in the search engine were ECP/ECP + the required pathology. 75 references were found on the use of DBS in the following pathologies: Parkinson's disease, Alzheimer's, refractory epilepsy, depression, obsessive–compulsive disorder, Gilles Tourette syndrome, aggressiveness, addictions, anorexia nervosa, restless legs syndrome, headache, dystonia, essential tremor and obesity. The use of DBS is growing as technology advances, increasingly focused on neurological diseases, psychosurgery and even systemic diseases, however, its use is only approved by the FDA for some movement disorders, including Parkinson's disease, Dystonia, essential tremor and OCD.
La estimulación cerebral profunda (ECP) es un procedimiento quirúrgico utilizado para tratar diversas patologías neurológicas, siendo su mayor uso en los trastornos del movimiento. La FDA aprobó por primera vez la estimulación cerebral profunda en 1997 para tratar el temblor esencial, en 2002 fue aprobada para la enfermedad de Parkinson, en 2003 para la distonía y en 2009 para el trastorno obsesivo compulsivo. No obstante, hasta hace poco tiempo se empezó a implementar esta técnica para el tratamiento de otras enfermedades neurológicas. Para realizar esta investigación sobre las diferentes enfermedades neurológicas en las que se utiliza la estimulación cerebral profunda se eligieron artículos de las bases de datos Pubmed, Google Scholar, Redalyc y Scielo, se tomaron referencias de los últimos 10 años a la fecha. Las palabras claves que se escribieron en el buscador fueron ECP/ECP + + la patología requerida. Se encontraron 75 referencias sobre el uso de ECP en las siguientes patologías: enfermedad de Parkinson, Alzheimer, epilepsia refractaria, depresión, trastorno obsesivo-compulsivo, síndrome de Gilles Tourette, agresividad, adicciones, anorexia nerviosa, síndrome de piernas inquietas, cefalea, distonía, temblor esencial y obesidad. El uso de ECP crece a medida que avanza la tecnología, cada vez más enfocado en enfermedades neurológicas, psicocirugía e incluso enfermedades sistémicas, sin embargo, su uso solo está aprobado por la FDA para algunos trastornos del movimiento, incluida la enfermedad de Parkinson, la distonía, el temblor esencial y TOC.
The risk of Parkinson's disease according to diabetic kidney disease status in a Korean population
2022, Parkinsonism and Related Disorders
Citation Excerpt :
Some studies have reported an increasing prevalence of CVD in PD patients [20], whereas others have reported similar prevalence rates of CVD in patients with and without PD [21]. One study has examined the cause of death in PD and reported a lower risk of ischemic heart disease-related death in PD patients than patients without PD [22]. Regarding cerebral small vessel disease (SVD), it has been reported that SVD can increase the risk of incident parkinsonism [23].
Type 2 diabetes is a risk factor for Parkinson's disease (PD). Recently, it has been reported that proteinuria without reduced estimated glomerular filtration rate (eGFR) can increase the risk of PD development. The objective of this study was to evaluate the risk of PD among Korean adults with type 2 diabetes stratified by proteinuria (PU) and eGFR levels.
Using the Korean National Health Insurance Service database, a total of 2,217,326 patients with type 2 diabetes who underwent regular health check-ups from 2009 to 2012 were included. These patients were classified into four groups (no-diabetic kidney disease (DKD) (PU⁻GFR^-), proteinuric DKD with normal eGFR (PU⁺GFR⁻), nonproteinuric DKD (PU⁻GFR⁺), and proteinuric DKD with reduced eGFR (PU⁺GFR⁺) and followed up until 2018. PD was defined using International Classification of Diseases, 10th revision.
The prevalence of PU⁻GFR^-, PU⁺GFR⁻, PU⁻GFR⁺, or PU⁺GFR⁺ phenotype was 83.3%, 5.0%, 10.1%, or 1.6%, respectively. During a median follow-up of 7.2 years, 16,079 participants developed PD. Hazard ratios for PD were 1.10 (95% confidence interval [CI]: 1.01–1.21, p = 0.0091), 1.15 (95% CI: 1.09–1.21, p < 0.0001), and 1.23 (95% CI: 1.09–1.39, p < 0.0001) for participants in PU⁺GFR⁻, PU⁻GFR⁺, and PU⁺GFR⁺ groups relative to those in the PU⁻GFR^- group, respectively. Effects of DKD on PD were more pronounced in those aged less than 65 years.
Reduced eGFR and/or proteinuria might be independent risk factors for boosting PD development among patients with type 2 diabetes. More attention should be paid to PD in patients with DKD, even in a younger aged population.

View all citing articles on Scopus

^☆: The review of this paper was entirely handled by the Co-Editor-in-Chief, Ronald Pfeiffer.

View full text

The cause of death in idiopathic Parkinson’s disease☆

Abstract

Objectives

Background

Methods

Results

Conclusion

Introduction

Section snippets

Methods

Results

Discussion

Conclusion

Ethical approval

Conflicts of interest

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

Mov Disord

Long-term survival of Parkinson’s disease: a population-based study

J Neurol

Survival time, mortality, and cause of death in elderly patients with Parkinson’s disease: a 9-year follow-up

Mov Disord

Population based mortality and quality of death certification in progressive supranuclear palsy (Steele–Richardson–Olszewski syndrome)

J Neurol Neurosurg Psychiatr

Prevalence of parkinsonian signs and associated mortality in a community population of older people

N Engl J Med

The place of death in Parkinson’s disease

Age Ageing

Accuracy of clinical diagnosis of idiopathic Parkinson’s disease – a clinicopathological study of 100 cases

J Neurol Neurosurg Psychiatr

International classification of diseases

International statistical classification of diseases and related health problems

Implementation of ICD-10 for morality data in England and Wales from January 2001

Health Stat Q

The prevalence of Parkinson’s disease in an area of North Tyneside in the North-East of England

Neuroepidemiology

Advance care planning: a guide for health & social care staff

Emergency hospital admissions in idiopathic Parkinson’s disease

Mov Disord