Incident parkinsonism in older adults without Parkinson disease

Abstract

Objective: To determine the incidence of parkinsonism in community-dwelling older adults without Parkinson disease.Methods: Four parkinsonian signs were assessed with a modified motor portion of the Unified Parkinson's Disease Rating Scale in 2,001 older adults without parkinsonism. We used Cox proportional hazards models to determine the associations of age and sex with incident parkinsonism (2 or more signs). We calculated the number of events per 1,000 person-years of observation in 3 age strata. Next, we investigated several potential risk factors for incident parkinsonism. Then, we examined longitudinal progression of parkinsonism using discrete-time multistate Markov models.Results: Average age at baseline was 76.8 years (SD 7.62 years). During an average of 5 years of follow-up, 964/2,001 (48.2%) developed parkinsonism. Age (hazard ratio [HR] 1.09, 95% confidence interval [CI] 1.08-1.10) but not male sex (HR 1.06, 95% CI 0.91-1.23) was associated with incident parkinsonism. The incidence of parkinsonism per 1,000 person-years of follow-up was 36.0 for adults ,75 years of age, 94.8 for those 75-84, and 160.5 for those 85 years or older. Depressive symptoms, neuroticism, urinary incontinence, sleep complaints, and chronic health conditions were associated with incident parkinsonism. Secondary analyses suggest that risk factors are linked with incident parkinsonism via early motor signs of parkinsonism and cognitive function. Transition modeling suggests that while parkinsonism may fluctuate, it is progressive in most older adults and its risk factors increase the odds of its progression. Motor impairments such as parkinsonian signs are common in older adults without Parkinson disease (PD) and are associated with a wide range of adverse health outcomes. Cross-sectional studies suggest that parkinsonian signs may affect up to half of older adults. Conclusions:1 Since parkinsonism is strongly associated with age, its incidence is likely to increase in our aging population and could constitute a major public health problem. Nonetheless, little data are available regarding age-and sex-specific incidence rates of parkinsonism.In this study, we employed a previously validated categorical measure of parkinsonism to determine the age-and sex-specific incidence of parkinsonism in 2,000 older communitydwelling older adults.2 Then we examined motor and cognitive measures that might capture early signs of parkinsonism and several possible risk factors to determine which were associated with incident parkinsonism.

Parkinson's Disease in the Very Old - Clinicopathological Observations

“…Old age is the best known risk for PD and PS. Many otherwise normal elderly are known to have some features resembling Parkinsonism [18]. However, old age or premature aging is not the cause of PD.…”

“…In one study, 5.8% cases had Bradykinesia [18]. Bradykinesia is characterized by slowing of motor function which may be confused as normal aging.…”

“…Gait and balance impairment are part of normal aging in some individuals [18,42,43]. The elderly are more likely to have lower limb ailments such as arthritis, joint replacement, etc.…”

“…It can be assessed at the wrist, elbow or shoulder in the upper limbs and the knee in the lower limbs. In one study 0.76% normal elderly had "rigidity" [18]. The passive movement should be performed slowly to appreciate the rigidity.…”

“…Old age is the best known risk for developing PS and the PD [17][18][19][20][21][22]. Individuals over the age of 80 years have been classified as "very old" [20].…”