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Relationships between age and late progression of Parkinson's disease: a clinico-pathological study.
Brain. 2010 Jun; 133(Pt 6):1755-62.B

Abstract

To investigate the relationships between age, the advanced clinical stages of Parkinson's disease and neuropathology, we surveyed 129 case records from donors with pathologically proven Parkinson's disease at the Queen Square Brain Bank for Neurological Disorders. Cases were separated into five groups according to age at death, thus comparing patients who reached the advanced stage of the disease at different ages. Four milestones of advanced disease (frequent falls, visual hallucinations, dementia and need for residential care) occurred at a similar time from death in each group. There were no significant differences in disease duration across these age groupings, nor were there differences in the severity and distribution of Lewy body and other pathologies. The milestones of dementia (P < 0.0005) and visual hallucinations (P = 0.02) as well as the accumulation of multiple milestones (P < 0.0005) were associated with high cortical Lewy body scores. Demented cases also had significantly more Alzheimer neurofibrillary and amyloid-beta plaque pathology. Correlation analysis showed that the time intervals between disease onset and recording of milestones were strongly influenced by age at onset (P < 0.0001) and by total disease duration (P < 0.0001). The advanced disease phase plays out in a similar fashion at whatever age it occurs, with a common pathological endpoint. The clinico-pathological comparisons for the final stage of Parkinson's disease do support a staging system based on the rostral extent and severity of Lewy body pathology, although other pathologies may play a synergistic role in causing cognitive disability. The chief effects of age on the rate of progression are seen over the early-middle part of the disease. An exponential curve for clinical progression provides the best explanation for these observations about age and the disease course.

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Publisher Full Text (DOI)

Authors+Show Affiliations

Kempster PA
Reta Lila Weston Institute of Neurological Studies, University College London, 1 Wakefield Street, London WC1N 1PJ, UK.
O'Sullivan SS
No affiliation info available
Holton JL
No affiliation info available
Revesz T
No affiliation info available
Lees AJ
No affiliation info available

MeSH

Accidental FallsAdultAge FactorsAge of OnsetAgedAged, 80 and overBrainDementiaDisease ProgressionFemaleHallucinationsHumansLewy BodiesMaleMiddle AgedModels, NeurologicalNeurofibrillary TanglesParkinson DiseasePlaque, AmyloidSeverity of Illness IndexTime Factors

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

20371510

Citation

Kempster, Peter A., et al. "Relationships Between Age and Late Progression of Parkinson's Disease: a Clinico-pathological Study." Brain : a Journal of Neurology, vol. 133, no. Pt 6, 2010, pp. 1755-62.
Kempster PA, O'Sullivan SS, Holton JL, et al. Relationships between age and late progression of Parkinson's disease: a clinico-pathological study. Brain. 2010;133(Pt 6):1755-62.
Kempster, P. A., O'Sullivan, S. S., Holton, J. L., Revesz, T., & Lees, A. J. (2010). Relationships between age and late progression of Parkinson's disease: a clinico-pathological study. Brain : a Journal of Neurology, 133(Pt 6), 1755-62. https://doi.org/10.1093/brain/awq059
Kempster PA, et al. Relationships Between Age and Late Progression of Parkinson's Disease: a Clinico-pathological Study. Brain. 2010;133(Pt 6):1755-62. PubMed PMID: 20371510.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Relationships between age and late progression of Parkinson's disease: a clinico-pathological study. AU - Kempster,Peter A, AU - O'Sullivan,Sean S, AU - Holton,Janice L, AU - Revesz,Tamas, AU - Lees,Andrew J, Y1 - 2010/04/05/ PY - 2010/4/8/entrez PY - 2010/4/8/pubmed PY - 2010/6/23/medline SP - 1755 EP - 62 JF - Brain : a journal of neurology JO - Brain VL - 133 IS - Pt 6 N2 - To investigate the relationships between age, the advanced clinical stages of Parkinson's disease and neuropathology, we surveyed 129 case records from donors with pathologically proven Parkinson's disease at the Queen Square Brain Bank for Neurological Disorders. Cases were separated into five groups according to age at death, thus comparing patients who reached the advanced stage of the disease at different ages. Four milestones of advanced disease (frequent falls, visual hallucinations, dementia and need for residential care) occurred at a similar time from death in each group. There were no significant differences in disease duration across these age groupings, nor were there differences in the severity and distribution of Lewy body and other pathologies. The milestones of dementia (P < 0.0005) and visual hallucinations (P = 0.02) as well as the accumulation of multiple milestones (P < 0.0005) were associated with high cortical Lewy body scores. Demented cases also had significantly more Alzheimer neurofibrillary and amyloid-beta plaque pathology. Correlation analysis showed that the time intervals between disease onset and recording of milestones were strongly influenced by age at onset (P < 0.0001) and by total disease duration (P < 0.0001). The advanced disease phase plays out in a similar fashion at whatever age it occurs, with a common pathological endpoint. The clinico-pathological comparisons for the final stage of Parkinson's disease do support a staging system based on the rostral extent and severity of Lewy body pathology, although other pathologies may play a synergistic role in causing cognitive disability. The chief effects of age on the rate of progression are seen over the early-middle part of the disease. An exponential curve for clinical progression provides the best explanation for these observations about age and the disease course. SN - 1460-2156 UR - https://www.unboundmedicine.com/medline/citation/20371510/Relationships_between_age_and_late_progression_of_Parkinson's_disease:_a_clinico_pathological_study_ DB - PRIME DP - Unbound Medicine ER -