Objective: To elucidate the influence of age, disease duration, and complicated medical and social conditions as the risk factors to predict disease progression. To this end, we determined the duration and reason why PD patients became bed ridden.

Background: The condition of patients with Parkinson’s disease (PD) worsens over time. Putative risk factors for disease progression may include age, sex, genetic factors, disease duration, disease phenotypes, degree of motor and cognitive impairment, and comorbid diseases.

Methods: PD patients who visited our institute between April and December 2015, met the criteria of the UK brain bank, and were Hoehn and Yahr stage 5 for more than 3 months were enrolled in the present study. Exclusion criteria included patients with serious medical conditions causing immobility, such as malignancies. Clinometric characteristics of patients including age at onset, sex, disease duration to become Hoehn and Yahr stage 5, MMSE scores examined around the time to develop stage 5, comorbid diseases, and reason why stage 5 developed, if any, were asked to patients or obtained from medical records.

Results: Sixty-one PD patients (21 men and 40 women) met criteria for the present study. The mean age at disease onset was 70.5 years, and disease duration until stage 5 was 10.2 years. The age at disease onset and disease duration until stage 5 showed a significant, negative correlation (Figure). Cognitive state at the time of stage 5 was not correlated with the duration until stage 5. However, almost every patient showed cognitive impairment upon becoming Hoehn and Yahr stage 5. Of the 61 patients, 28 reported no reason apart from natural course for becoming stage 5. Forteen reported trauma (bone fracture 9, subdural hematoma 2). Other medical conditions to induce stage 5 include pneumonia. For PD patients who became stage 5 by natural course, the mean age at disease onset was 68.9, and for patients who became stage 5 after fall, the mean age at onset was 74.2.

Conclusions: A significant, negative correlation was seen between age at PD onset and disease duration to become Hoehn and Yahr stage 5. Around half of the patients become stage 5 as part of the natural course of PD. A fourth of patients became stage 5 as a result of trauma due to falls. PD patients complicated by falls which led to becoming stage 5 were significantly associated with older age at onset of PD.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/when-and-why-patients-with-parkinsons-disease-become-bed-ridden/