Objective: To evaluate the association between the premotor symptoms and the prognosis of Parkinson’s disease (PD) by utilizing Taiwan National Health Insurance Research Database.

Background: No study is conducted for the assessment of premotor symptoms served as prognostic indicators for Parkinson’s disease.

Methods: A total of 1213 patients who were diagnosed of PD from January 2001 to December 2008 were selected from National Health Insurance Research Database. Patients were traced back to determine the presence of premotor symptoms, including rapid eye movement sleep behavior disorder (RBD), depression, and constipation. Patients were divided into two groups: patients with and without premotor symptoms. Cox’s regression analysis was used to detect the risks between the occurrence of premotor symptoms and the outcome (including death, psychosis, accidental injury, dementia and aspiration pneumonia) of PD. In addition, the association between premotor symptoms and levodopa equivalent dosage was examined.

Results: Higher occurrence of death, dementia and aspiration pneumonia were identified in PD patients with premotor symptoms than without premotor symptoms (HR 1.69, 95% CI 1.34-2.14, p <0.001 for death; HR 1.63, 95% CI 1.20-2.22, p = 0.002 for dementia; HR 2.45, 95% CI 1.42-4.21, p = 0.001 for aspiration pneumonia). The associations remained statistically significant after adjusting for age, sex, and comorbidities (hypertension, diabetes, hyperlipidemia and ischemic heart disease). In comorbidities-stratified analysis, PD patients with premotor symptoms showed significantly high risks of mortality and morbidity (dementia and aspiration pneumonia), especially in absence of diabetes, hyperlipidemia, and ischemic heart disease. Moreover, the higher age, male sex, constipation, RBD, RBD with constipation and depression, and diabetes were independent predictors of mortality in PD patients. Besides, no significant difference of LED and subsequent accidental injury were noted between PD patient with or without premotor symptoms.

Conclusions: Our study revealed higher risk of mortality, dementia, and aspiration pneumonia in PD patients with premotor symptoms than in control subjects, especially in absence of comorbidities. The premotor symptoms seem not merely risk factors, but also prognostic factors of PD.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/premotor-symptoms-as-prognostic-indicators-of-parkinsons-disease-a-nationwide-population-based-and-case-control-study/