Objective: To identify, spectrum of Parkinson variants, clinical features and course of disease in age > 80 year onset cases.

Background: Old age is the best known risk for parkinsonism.  The proportion of the elderly is steadily growing and a higher number of elderly parkinsonian cases are expected in the future.  Additionally, the Parkinson variants in the elderly are reported to be different from those in the younger onset cases and may therefore require different treatment strategies.  However there is no autopsy confirmed study to substantiate that. 

Methods: All residents of Saskatchewan carry provincial tax supported insurance for physician and hospitalization services.  Movement Disorders Clinic Saskatchewan is the only such clinic in the province. Longitudinal clinical follow-up and autopsy study of these cases is the major interest of this program.  Autopsy is performed within 24 hours of death.  One-half brain is frozen at -80^oC and the other half is examined by a neuropathologist.  All patients with clinical diagnosis of parkinsonism assessed at the Movement Disorders Clinic Saskatchewan between 1968 and 2015 who came to autopsy were considered.  

Results: 392 cases with the clinical diagnosis of parkinsonism evaluated at the Movement Disorders Clinic Saskatchewan came to autopsy.  80% of those had Parkinson’s disease.  30 (M15) cases with onset age > 80 years autopsied cases were identified. The largest group was 21 patients with Parkinson’s disease as the only movement disorder.  In two other cases there was Lewy body pathology and another movement disorder.  There were no cases of multiple system atrophy or corticobasal degeneration.  The primary clinical diagnosis of Parkinson’s disease made in 27 cases was confirmed in 21 (78%) cases.  All Parkinson’s disease cases – two cases with Parkinson’s disease plus another movement disorder and three cases without Lewy body pathology improved on levodopa. The rate of progression in Parkinson’s disease was more rapid, there was higher incidence of dementia and higher stroke co-morbidity, than reported in the younger onset patients.

Conclusions: Most very old onset parkinsonian cases have Parkinson’s disease.  Their prognosis is worse than in the younger population.  The majority improve on levodopa and should be tried on the drug. 

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MDS Abstracts - https://www.mdsabstracts.org/abstract/parkinsonism-in-the-very-old-a-clinicopathological-study/