Delirium and High Fever Are Associated with Subacute Motor Deterioration in Parkinson Disease: A Nested Case-Control Study

Umemura, Atsushi; Oeda, Tomoko; Tomita, Satoshi; Hayashi, Rikimaru; Kohsaka, Masayuki; Park, Kwiyoung; Sugiyama, Hiroshi; Sawada, Hideyuki

doi:10.1371/journal.pone.0094944

Cited by 82 publications

(47 citation statements)

References 26 publications

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“…27,28 Heart diseases such as angina and myocardial infraction, 33 respiratory diseases such as emphysema/asthma/COPD, 34 and stroke/brain hemorrhage 35 are known to be leading causes of death. Diabetes 25,36 and Parkinson’s disease 37,38 have been shown to be independently associated with functional deterioration and institutionalization. The effect of additional risk factors, including complete/partial paralysis 39 and mental/psychiatric disorder 40 on functional deterioration, institutionalization, and death may be mitigated by education or clinical management.…”

Section: Discussionmentioning

confidence: 99%

Predictive Indices for Functional Improvement and Deterioration, Institutionalization, and Death Among Elderly Medicare Beneficiaries

Kurichi

Kwong

Xie

et al. 2017

PM&R

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Background Prediction models can help clinicians provide the best and most appropriate care to their patients and can help policy makers design services for groups at highest risk of poor outcomes. Objective The objective was to develop prediction models identifying both risk factors and protective factors for functional deterioration, institutionalization, and death. Design Cohort study using data from the Medicare Current Beneficiary Survey (MCBS) Setting Community survey. Participants This study included 21,264 Medicare beneficiaries 65 years of age and older who participated in the MCBS from the 2001–2008 entry panels and were followed for two years. Methods The index was derived in 60% and validated in the remaining 40%. β-coefficients from a multinomial logistic regression model were used to derive points, which were added together to create scores associated with the outcome. Main outcome measure The outcome was activity of daily living (ADL) stage transitions over two years following entry into the MCBS. Beneficiaries were categorized into one of four outcome categories: stable or improved function, functional deterioration, institutionalization, or death. Results Our model identified 16 factors for functional deterioration (age, gender, education, living arrangement, dual eligibility, proxy use, Alzheimer’s disease/dementia, angina pectoris/coronary heart disease, diabetes, emphysema/asthma/chronic obstructive pulmonary disease, mental/psychiatric disorder, Parkinson’s disease, stroke/brain hemorrhage, hearing impairment, vision impairment, and baseline ADL stage) after backward selection (p<.05). Compared to stable or improved function, the risk of functional deterioration ranged from ≤1 to ≥6, ≤4 to ≥22 for the risk of institutionalization, and ≤3 to ≥16 for the risk of death. Conclusion Predictive indices, or point and scoring systems used to predict outcomes, can identify elderly Medicare beneficiaries at risk of functional deterioration, institutionalization, and death and can aid policy makers, clinicians, and family members in improving care for older adults and supporting successful aging in the community.

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Section: Discussionmentioning

confidence: 99%

Predictive Indices for Functional Improvement and Deterioration, Institutionalization, and Death Among Elderly Medicare Beneficiaries

Kurichi

Kwong

Xie

et al. 2017

PM&R

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“…CRP is synthesized in the liver and is then transported to accumulate, or is synthesized in neurons, in neurodegenerative lesions in the brains of Alzheimer’s disease patients [ 8 ]. Recent evidence suggests that systemic inflammation contributes to the exacerbation of acute symptoms of chronic neurodegenerative disease [ 20 , 42 , 43 ], suggesting that systemic inflammation seems to promote neurodegeneration. Neuroinflammation can also elicit activation of inflammasome and caspase-1 in the brains of patients with Alzheimer disease [ 44 ].…”

Section: Discussionmentioning

confidence: 99%

Baseline C-Reactive Protein Levels and Life Prognosis in Parkinson Disease

et al. 2015

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BackgroundC-reactive protein (CRP) is a biomarker of inflammation, and high levels of CRP correlate with vascular death. Chronic inflammation is considered to be involved in neurodegeneration, although there is no evidence linking it with the process of neurodegenerative diseases.ObjectiveTo determine the role of baseline CRP levels in the prognosis of patients with Parkinson disease (PD).MethodsA cohort of 313 patients with a mean age of 69.1 and mean PD duration of 7.9 years was retrospectively followed for a mean observation time of 1,753 days. CRP was measured when patients were not diagnosed with any infections, and levels were repetitively measured to investigate a tendency of “regression to mean.” The primary outcome measure was a survival time from study enrollment to death.ResultsDuring the observation period 56 patients died. Baseline CRP was log-linearly associated with a risk of death in PD. Mean survival time was 3,149 (95% confidence interval; 3,009-3,289) days in patients with CRP ≤ 0.8mg/L (lower two thirds) and 2,620 (2,343-2,897) days in those with CRP > 0.8 mg/L (top third, p < 0.001, log-rank test). The adjusted hazard ratio (HR) per two-fold higher CRP concentration for all deaths was 1.29 (1.10-1.52), and after excluding PD-unrelated deaths, such as cancer or stroke, HR was 1.23 (1.01-1.49) (adjusted for age, sex, PD duration, modified Hohen-Yahr stages, MMSE scores, and serum albumin).ConclusionsBaseline CRP concentrations were associated with the risk of death and predicted life prognosis of patients with PD. The associations were independent from PD duration, PD severity, cognitive function, ages, and nutritional conditions, suggesting the possibility that subclinical chronic inflammation is associated with a neurodegenerative process in PD.

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“…In animal models of PD, systemic inflammatory stimuli can promote neuroinflammation by accelerating dopaminergic neurodegeneration in the substantia nigra [ 5 – 8 ]. Although we previously demonstrated that acute systemic inflammation can worsen PD motor symptoms [ 9 ], the association between chronic systemic inflammations and neurodegeneration in PD patients has not yet been investigated.…”

Section: Introductionmentioning

confidence: 99%

Baseline Plasma C-Reactive Protein Concentrations and Motor Prognosis in Parkinson Disease

et al. 2015

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BackgroundC-reactive protein (CRP), a blood inflammatory biomarker, is associated with the development of Alzheimer disease. In animal models of Parkinson disease (PD), systemic inflammatory stimuli can promote neuroinflammation and accelerate dopaminergic neurodegeneration. However, the association between long-term systemic inflammations and neurodegeneration has not been assessed in PD patients.ObjectiveTo investigate the longitudinal effects of baseline CRP concentrations on motor prognosis in PD.Design, Setting, and ParticipantsRetrospective analysis of 375 patients (mean age, 69.3 years; mean PD duration, 6.6 years). Plasma concentrations of high-sensitivity CRP were measured in the absence of infections, and the Unified Parkinson’s Disease Rating Scale Part III (UPDRS-III) scores were measured at five follow-up intervals (Days 1–90, 91–270, 271–450, 451–630, and 631–900).Main Outcome MeasureChange of UPDRS-III scores from baseline to each of the five follow-up periods.ResultsChange in UPDRS-III scores was significantly greater in PD patients with CRP concentrations ≥0.7 mg/L than in those with CRP concentrations <0.7 mg/L, as determined by a generalized estimation equation model (P = 0.021) for the entire follow-up period and by a generalized regression model (P = 0.030) for the last follow-up interval (Days 631–900). The regression coefficients of baseline CRP for the two periods were 1.41 (95% confidence interval [CI] 0.21–2.61) and 2.62 (95% CI 0.25–4.98), respectively, after adjusting for sex, age, baseline UPDRS-III score, dementia, and incremental L-dopa equivalent dose.ConclusionBaseline plasma CRP levels were associated with motor deterioration and predicted motor prognosis in patients with PD. These associations were independent of sex, age, PD severity, dementia, and anti-Parkinsonian agents, suggesting that subclinical systemic inflammations could accelerate neurodegeneration in PD.

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Delirium and High Fever Are Associated with Subacute Motor Deterioration in Parkinson Disease: A Nested Case-Control Study

Cited by 82 publications

References 26 publications

Predictive Indices for Functional Improvement and Deterioration, Institutionalization, and Death Among Elderly Medicare Beneficiaries

Predictive Indices for Functional Improvement and Deterioration, Institutionalization, and Death Among Elderly Medicare Beneficiaries

Baseline C-Reactive Protein Levels and Life Prognosis in Parkinson Disease

Baseline Plasma C-Reactive Protein Concentrations and Motor Prognosis in Parkinson Disease

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