Mortality in Parkinson's disease: A 20‐year follow‐up study

We determined mortality rates and predictors of survival in 238 consecutive patients with Parkinson's disease (PD) with symptom onset between 1974 and 1984. All patients were regularly followed at the Movement Disorder Clinic (Department of Neurology at the Innsbruck Medical University) until December 31, 2004, or death. As of December 31, 2004, 189 patients had died. Standardized mortality ratios (SMRs) increased over time. SMRs were 0.6 (95% CI 0.4–1.0) by 5 years, 0.9 (95% CI 0.7–1.2) by 10 years, 1.2 (95% CI 1.0–1.4) by 15 years, and 1.3 (95% CI 1.1–1.5) by 20 to 30 years. SMR for male patients was significantly increased to 1.3 (95% CI 1.1–1.6), whereas SMR increase of 1.2 (0.9–1.4) observed in female patients was not significant. Significantly increased SMRs were detected in patients with younger and older age of onset. Male gender, gait disorder, lack of tremor, and lack of asymmetry as presenting clinical features predicted poor survival in a Cox's proportional hazard analysis. This study demonstrates similar survival of patients with PD to the normal control population up to a disease duration of 10 years, followed by a modest rise of mortality with disease duration beyond 10 years compared with the general population. Under regular specialist care using all currently available therapies life expectancy in PD does not appear seriously compromised, but male gender, gait disorder, and absent rest tremor at presentation are associated with poorer long‐term survival. © 2009 Movement Disorder Society     

Motor complications in Parkinson's disease: Ten year follow‐up study

Parkinson's disease (PD) can be symptomatically controlled with standard treatments; however, after a few years, this response typically declines and most patients develop motor complications. We carried out a prospective practice‐based study to evaluate the evolution appearance and evolution of motor complications in 64 de novo PD patients over 5 years and in 38 PD patients over 10 years. We studied untreated patients from initial assessment at basal conditions and evaluated every 6 months thereafter with treatment (levodopa versus other drugs). The follow‐up assessments were performed with the Unified Parkinson's Disease Rating Scale (UPDRS). At each assessment, patients were monitored regarding the development of dyskinesias, motor fluctuations, freezing, loss of postural reflexes, and cognitive impairment. We observed a significant improvement in UPDRS scores during the first year, then a progressive decline, more evident after the third year. Motor complications increased after the third year, and at the end of the survey (tenth year); drug‐induced dyskinesias and motor fluctuations were experienced (71.1 and 94.7%, respectively). After the first decade, many complications arose from the non‐levodopa–responsive features of the disease (cognitive impairment was present in 52.6% and gait freezing in 71.1%). Initial medication may influence medium‐term complications but not long‐term problems. Most long‐term disabling problems of PD were related to non‐levodopa‐responsive features. © 2010 Movement Disorder Society.     

Coping with multiple sclerosis: a 5‐year follow‐up study

Lode K, Bru E, Klevan G, Myhr KM, Nyland H, Larsen JP. Coping with multiple sclerosis: a 5‐year follow‐up study. Acta Neurol Scand: 2010: 122: 336–342. © 2009 The Authors Journal compilation © 2009 Blackwell Munksgaard. Objectives – To examine how coping styles among patients with multiple sclerosis (MS) change over time and how patients’ coping styles after 5 years are associated with disability pension. Materials and methods – Seventy‐six MS patients and 94 healthy controls were included in this study. The patients were examined at baseline and 5 years later. This included a neurological examination and information on disability pension and a questionnaire assessing coping (the COPE scale). Controls were registered at baseline only. Results – Compared to healthy controls, MS patients were more passive in coping with disease related distress. This was even more pronounced 5 years later. Disability pensioned patients employed more social support, venting of emotions and behavioural disengagement at follow‐up. Conclusion – This study shows that patients with MS employ coping styles that may be inadequate and this is not improved by adaption over time. Although patients also use strategies to enhance their lives, these findings suggest that there may be a potential for improving the lives of patients with MS through interventions that may enhance adequate coping with the disease.     

Surgical therapy for multiple sclerosis tremor: a 12‐year follow‐up study

Background and purpose: Severe multiple sclerosis (MS) tremor causes disability poorly responsive to medication. Deep brain stimulation (DBS) or thalamotomy can suppress tremor, but long‐term outcomes are unclear. Methods: Nine patients with MS tremor underwent disability measures at baseline and 12 months post‐surgery (six thalamotomy, three DBS) in 1997–1998 (previously reported, Matsumoto et al., Neurology 2001;57:1876–82). We report the prospective 12‐year follow‐up of this cohort for tremor, disability, and death. Results: Surgery was initially successful in all. Tremor recurred in all patients within median 3 months, although two DBS patients were tremor‐free for 5 years. Median tremor‐free survival (tremor‐free time/survival time) was 4.3%. At 12‐year follow‐up, four survivors (two thalamotomy, two DBS) (Expanded Disability Status Scale scores 8–8.5) were severely disabled. Five patients were dead (four thalamotomy, one DBS) median 5.8 years post‐operative. Conclusions: Surgery benefit for severe tremor was overall short‐lived (median 3 months), with long‐term poor prognosis. Although two DBS patients had sustained 5‐year tremor‐suppression, the observed progressive disability and death in this cohort bear importance for long‐term success in future MS tremor surgery trials.     

Depressive symptoms predispose females to metabolic syndrome: a 7‐year follow‐up study

Objective: To evaluate the risk for developing metabolic syndrome when having depressive symptoms. Method: The prevalence of depressive symptoms and metabolic syndrome at baseline, and after a 7‐year follow‐up as measured with Beck depression inventory (BDI), and using the modified National Cholesterol Education Program – Adult Treatment Panel III criteria for metabolic syndrome (MetS) were studied in a middle‐aged population‐based sample (n = 1294). Results: The logistic regression analysis showed a 2.5‐fold risk (95% CI: 1.2–5.2) for the females with depressive symptoms (BDI ≥10) at baseline to have MetS at the end of the follow‐up. The risk was highest in the subgroup with more melancholic symptoms evaluated with a summary score of the melancholic items in BDI (OR 6.81, 95% CI: 2.09–22.20). In men, there was no risk difference. Conclusion: The higher risks for MetS in females with depressive symptoms at baseline suggest that depression may be an important predisposing factor for the development of MetS.