Loss of independence in early Parkinson disease: A 5-year population-based incident cohort study

The things that cause patients to be admitted to long term care facilities are not surprising... each of these are considered independent outcomes in their own right. An important observation here is the irreversible nature of dependency... I suspect that relatively small changes can prompt a switch from independence to dependence, such as prolonged hospital admission or long bone fracture...

Neurology. 2016 Sep 2. pii: 10.1212/WNL.0000000000003213. [Epub ahead of print]

Bjornestad A, Tysnes OB, Larsen JP, Alves G.

OBJECTIVE:

To determine the risk, predictors, and prognosis of independence loss and institutionalization in patients with early Parkinson disease (PD).

METHODS:

We conducted a prospective population-based 5-year longitudinal study following 189 patients with incident PD and 174 controls matched for age, sex, and comorbidity. Health care status was assessed repeatedly with standardized interviews.

RESULTS:

More newly diagnosed patients with PD (15.9%) than controls (5.7%) were dependent in activities of daily living at baseline (relative risk [RR] 2.8, p = 0.004). During follow-up, 40.9% of the initially independent patients lost their independence vs 9.1% of controls (RR 4.5, p < 0.001). Higher age, shorter symptom duration, increasing motor severity, and presence of mild cognitive impairment at PD diagnosis independently predicted independence loss during follow-up. Dependency was irreversible in most (>95%) patients. Long-term care facility placement was needed in 8.8% of patients vs 0.6% of controls (RR 15.4, p = 0.001). More patients with PD admitted to long-term care facilities were fallers (RR 4.8, p < 0.001), had hallucinations (RR 4.4, p = 0.001), or had dementia (RR 4.2, p < 0.001) than home-dwelling patients. Once admitted to a long-term care facility, the age-adjusted RR for death during the study period was 5.5 (p = 0.002) vs patients never admitted and 25.1 (p < 0.001) vs controls.

CONCLUSIONS:

Patients with early PD face a substantially greater risk of independence loss and institutionalization than well-matched controls. Independence loss is irreversible in most patients and represents a sinister prognostic factor in early PD. These findings have implications for patient management and health care planning.