Objective: To assess the value of motor (MS), non-motor symptoms (NMS), HAQL and activities of daily living (ADL) for predicting mortality in PD.

Background: Parkinson’s Disease (PD) is a progressive neurodegenerative disorder that results in significant incapacity and reduced HAQL. It is still not clear in which way do the different disease related symptoms influence mortality and wether baseline HAQL and ADL can predict mortality.

Method: A cross-sectional study was performed during 2014 (T0), involving 134 non-selected patients with PD [1]. MS were assessed with the Hohen and Yahr (HY) and UPDRSIII scales and NMS with the Non-Motor Symptom Scale (NMSS). HAQL was assessed with Euro-Qol and ADL with UPDRSII and Schwab and England Scales. Cognitive function was objectively assessed with Montreal Cognitive Assessment scale (MoCA). Mortality was determined during a 4 year period. Predictors of mortality were determined by backward logistic regression analysis, using HY, UPDRS III, Euro-QOL, UPDRS II, SE, the different NMSS itens, HAQL, age and gender as covariates and vital status a the end of the follow-up period as the dependent variable.

Results: Vital status could not be ascertained in 3 patients. 25 patients died during the 4 years follow-up period. Age, HY, NMS8 (sexual dysfunction), NMSS3 (humor/cognition complaints) and Euro-Qol visual analog scale score were retained in the final model. NMSS3 (B=.041; p=0.009; Exp(B)=1.042; CI=1.010-1.075) and Euro-Qol  (B=0.053; p=0.020; Exp(B)=1.055, CI=1.009-1.103) were significantly related with a higher probability of death.

Conclusion: Our results suggest that HAQL and cognitive/humor complaints (but not MoCA scores) are related to a higher probability of dying during a follow-up of 4 years in a non selected cohort of PD patients. Cognitive dysfunction has been previously reported as a predictor of mortality in PD, but this dissociation between objective and subjective cognitive dysfunction  was not and requires further investigation. A strong relation between humor, cognition and HAQL has been suggested in previous studies, which could explain the significant predictive value of HAQL found in our study. On the other hand, the relation between mortality, HAQL and Humor could be biased by preexisting comorbidity, which could simultaneously determine a higher probability of dying, more depressive symptoms and worst HAQL.

References: Bugalho, P. et al. Non-Motor symptoms in Portuguese Parkinson’s Disease patients: correlation and impact on Quality of Life and Activities of Daily Living. Sci. Rep. 6, 32267; doi: 10.1038/srep32267 (2016).

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MDS Abstracts - https://www.mdsabstracts.org/abstract/health-associated-quality-of-life-haql-and-humor-cognitive-complaints-predict-mortality-in-parkinsons-disease-pd/