Hospital-based study on emergency admission of patients with Parkinson's disease

Abstract

ObjectiveParkinson's disease (PD) is a progressive neurodegenerative disease. As the severity of disease worsens, patients have lower tolerance for treatments and occasionally need to be hospitalized. This study focuses on characteristics of patients with PD who were emergently admitted to our hospital and evaluates their prognosis during hospitalization.MethodsHospital-based study on emergency admission was conducted in a consecutive series of patients with PD between April 2009 and March 2015.ResultsA total of 164 admissions involving 136 patients with PD with available medical records were identified. Among these, 40 admissions involving 38 patients were emergency admissions. The most common cause of hospitalization was aspiration pneumonia (n = 17) followed by parkinsonism hyperpyrexia syndrome (n = 6), cerebrovascular disease (n = 2), dehydration (n = 2), and others (n = 13). The mean Hoehn and Yahr stage at admission and discharge were 3.5 and 4.2, respectively, with significant differences between time points (p < 0.001). All patients except one presented with either postural instability gait difficulty phenotype (PIGD) or mixed phenotype with PIGD and tremor. All 17 patients with aspiration pneumonia had various combinations of three components: abnormalities seen on videofluoroscopy swallowing study, cognitive impairment, and history of psychiatric symptoms.ConclusionAspiration pneumonia was the most common reason for emergency admission in patients afflicted with PD for more than five years. Abnormalities seen in videofluoroscopy, PIGD and mixed phenotypes, cognitive impairment, and history of psychiatric symptoms could potentially be predictors for aspiration pneumonia in patients with PD.

Factors associated with hospitalisation among people with Parkinson's disease – A systematic review and meta-analysis

“…Infections, mainly UTI and pneumonia were the topmost reason for admission among people with PD. This supports data provided by a number of other studies which identified infectious diseases including aspiration pneumonia, UTI and others as common reasons for emergency admissions [14,31,45,48]. In contrast, falls/fractures are the most reported in other studies.…”

Management of Dysphagia in Patients with Parkinson's Disease and Related Disorders

“…Deteriorated sensitivity and intensity of cough reflex also influence the risk of aspiration pneumonia (63). Aspiration pneumonia was the most common reason for the emergency admission of patients with PD whose disease duration was >5 years (64). Most of them exhibited abnormalities on their VFSS, cognitive impairment, and a history of psychiatric symptoms.…”

Drug-induced Hyperthermic Syndromes in Psychiatry

“…PHS is reported in the context of non-compliance with dopaminergic medications, during severe “off” periods, concurrent illness, dysphagia or changes in diet, and withholding of medications prior to medical or surgical procedures [ 30 , 31 ]. For example, PHS may be observed after surgery in patients with PD instructed to stop dopamine medications prior to surgery and not restarted promptly post-operatively.…”