Survival and Progression in Synucleinopathy Phenotypes With Parkinsonism: A Population-Based Study

Rodolfo Savica, Pierpaolo Turcano, James Howard Bower, J. Eric Ahlskog, Michelle M Mielke

Research output: Contribution to journalArticle

Abstract

Objective: To compare survival by the presenting parkinsonism symptoms at diagnosis among patients with incident clinically diagnosed synucleinopathies. Patients and Methods: Using the Rochester Epidemiology Project medical records–linkage system, we identified all persons residing in Olmsted County, Minnesota, who received a diagnostic code of parkinsonism from January 1, 1991, through December 31, 2010. A movement disorder specialist reviewed the complete medical records of each individual to confirm the presence of parkinsonism, determine the type of synucleinopathy, and identify the onset dates of each cardinal symptom (tremor at rest, bradykinesia, rigidity, and impaired postural reflexes). We determined the median time from age at diagnosis to death or censoring (June 30, 2015) for each presenting symptom and the age- and sex-adjusted risk of death. Results: From 1991 through 2010, a total of 433 individuals had a synucleinopathy diagnosed (301 [69.5%], Parkinson disease; 68 [15.7%], dementia with Lewy bodies; 52 [12.0%], Parkinson disease dementia; and 12 [2.8%], multiple systems atrophy with parkinsonism). Overall, the risk of death in the tremor-predominant group was less than that in the bradykinesia/rigidity-only group (hazard ratio [HR], 0.59; 95% CI, 0.40-0.87; P=.007). Similarly, risk of death in the bradykinesia/rigidity-only group was significantly greater than in the tremor-predominant group (HR, 1.75; 95% CI, 1.23-2.51; P=.002) and compared with tremor before bradykinesia (HR, 1.75; 95% CI, 1.24-2.47; P=.001). Conclusion: Patients with tremor as a presenting symptom have longer survival. In contrast, the presence of bradykinesia/rigidity as a presenting symptom correlates with reduced survival across all types of synucleinopathies.

Original languageEnglish (US)
Pages (from-to)1825-1831
Number of pages7
JournalMayo Clinic proceedings
Volume94
Issue number9
DOIs
StatePublished - Sep 1 2019

Fingerprint

Hypokinesia
Parkinsonian Disorders
Tremor
Phenotype
Survival
Population
Parkinson Disease
Multiple System Atrophy
Lewy Body Disease
Movement Disorders
Medical Records
Reflex
Dementia
Epidemiology

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Survival and Progression in Synucleinopathy Phenotypes With Parkinsonism : A Population-Based Study. / Savica, Rodolfo; Turcano, Pierpaolo; Bower, James Howard; Ahlskog, J. Eric; Mielke, Michelle M.

In: Mayo Clinic proceedings, Vol. 94, No. 9, 01.09.2019, p. 1825-1831.

Research output: Contribution to journalArticle

@article{52a6f2b3cad2452ea0db5bc20b43891d,
title = "Survival and Progression in Synucleinopathy Phenotypes With Parkinsonism: A Population-Based Study",
abstract = "Objective: To compare survival by the presenting parkinsonism symptoms at diagnosis among patients with incident clinically diagnosed synucleinopathies. Patients and Methods: Using the Rochester Epidemiology Project medical records–linkage system, we identified all persons residing in Olmsted County, Minnesota, who received a diagnostic code of parkinsonism from January 1, 1991, through December 31, 2010. A movement disorder specialist reviewed the complete medical records of each individual to confirm the presence of parkinsonism, determine the type of synucleinopathy, and identify the onset dates of each cardinal symptom (tremor at rest, bradykinesia, rigidity, and impaired postural reflexes). We determined the median time from age at diagnosis to death or censoring (June 30, 2015) for each presenting symptom and the age- and sex-adjusted risk of death. Results: From 1991 through 2010, a total of 433 individuals had a synucleinopathy diagnosed (301 [69.5{\%}], Parkinson disease; 68 [15.7{\%}], dementia with Lewy bodies; 52 [12.0{\%}], Parkinson disease dementia; and 12 [2.8{\%}], multiple systems atrophy with parkinsonism). Overall, the risk of death in the tremor-predominant group was less than that in the bradykinesia/rigidity-only group (hazard ratio [HR], 0.59; 95{\%} CI, 0.40-0.87; P=.007). Similarly, risk of death in the bradykinesia/rigidity-only group was significantly greater than in the tremor-predominant group (HR, 1.75; 95{\%} CI, 1.23-2.51; P=.002) and compared with tremor before bradykinesia (HR, 1.75; 95{\%} CI, 1.24-2.47; P=.001). Conclusion: Patients with tremor as a presenting symptom have longer survival. In contrast, the presence of bradykinesia/rigidity as a presenting symptom correlates with reduced survival across all types of synucleinopathies.",
author = "Rodolfo Savica and Pierpaolo Turcano and Bower, {James Howard} and Ahlskog, {J. Eric} and Mielke, {Michelle M}",
year = "2019",
month = "9",
day = "1",
doi = "10.1016/j.mayocp.2019.04.010",
language = "English (US)",
volume = "94",
pages = "1825--1831",
journal = "Mayo Clinic Proceedings",
issn = "0025-6196",
publisher = "Elsevier Science",
number = "9",

}

TY - JOUR

T1 - Survival and Progression in Synucleinopathy Phenotypes With Parkinsonism

T2 - A Population-Based Study

AU - Savica, Rodolfo

AU - Turcano, Pierpaolo

AU - Bower, James Howard

AU - Ahlskog, J. Eric

AU - Mielke, Michelle M

PY - 2019/9/1

Y1 - 2019/9/1

N2 - Objective: To compare survival by the presenting parkinsonism symptoms at diagnosis among patients with incident clinically diagnosed synucleinopathies. Patients and Methods: Using the Rochester Epidemiology Project medical records–linkage system, we identified all persons residing in Olmsted County, Minnesota, who received a diagnostic code of parkinsonism from January 1, 1991, through December 31, 2010. A movement disorder specialist reviewed the complete medical records of each individual to confirm the presence of parkinsonism, determine the type of synucleinopathy, and identify the onset dates of each cardinal symptom (tremor at rest, bradykinesia, rigidity, and impaired postural reflexes). We determined the median time from age at diagnosis to death or censoring (June 30, 2015) for each presenting symptom and the age- and sex-adjusted risk of death. Results: From 1991 through 2010, a total of 433 individuals had a synucleinopathy diagnosed (301 [69.5%], Parkinson disease; 68 [15.7%], dementia with Lewy bodies; 52 [12.0%], Parkinson disease dementia; and 12 [2.8%], multiple systems atrophy with parkinsonism). Overall, the risk of death in the tremor-predominant group was less than that in the bradykinesia/rigidity-only group (hazard ratio [HR], 0.59; 95% CI, 0.40-0.87; P=.007). Similarly, risk of death in the bradykinesia/rigidity-only group was significantly greater than in the tremor-predominant group (HR, 1.75; 95% CI, 1.23-2.51; P=.002) and compared with tremor before bradykinesia (HR, 1.75; 95% CI, 1.24-2.47; P=.001). Conclusion: Patients with tremor as a presenting symptom have longer survival. In contrast, the presence of bradykinesia/rigidity as a presenting symptom correlates with reduced survival across all types of synucleinopathies.

AB - Objective: To compare survival by the presenting parkinsonism symptoms at diagnosis among patients with incident clinically diagnosed synucleinopathies. Patients and Methods: Using the Rochester Epidemiology Project medical records–linkage system, we identified all persons residing in Olmsted County, Minnesota, who received a diagnostic code of parkinsonism from January 1, 1991, through December 31, 2010. A movement disorder specialist reviewed the complete medical records of each individual to confirm the presence of parkinsonism, determine the type of synucleinopathy, and identify the onset dates of each cardinal symptom (tremor at rest, bradykinesia, rigidity, and impaired postural reflexes). We determined the median time from age at diagnosis to death or censoring (June 30, 2015) for each presenting symptom and the age- and sex-adjusted risk of death. Results: From 1991 through 2010, a total of 433 individuals had a synucleinopathy diagnosed (301 [69.5%], Parkinson disease; 68 [15.7%], dementia with Lewy bodies; 52 [12.0%], Parkinson disease dementia; and 12 [2.8%], multiple systems atrophy with parkinsonism). Overall, the risk of death in the tremor-predominant group was less than that in the bradykinesia/rigidity-only group (hazard ratio [HR], 0.59; 95% CI, 0.40-0.87; P=.007). Similarly, risk of death in the bradykinesia/rigidity-only group was significantly greater than in the tremor-predominant group (HR, 1.75; 95% CI, 1.23-2.51; P=.002) and compared with tremor before bradykinesia (HR, 1.75; 95% CI, 1.24-2.47; P=.001). Conclusion: Patients with tremor as a presenting symptom have longer survival. In contrast, the presence of bradykinesia/rigidity as a presenting symptom correlates with reduced survival across all types of synucleinopathies.

UR - http://www.scopus.com/inward/record.url?scp=85070307787&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85070307787&partnerID=8YFLogxK

U2 - 10.1016/j.mayocp.2019.04.010

DO - 10.1016/j.mayocp.2019.04.010

M3 - Article

C2 - 31405749

AN - SCOPUS:85070307787

VL - 94

SP - 1825

EP - 1831

JO - Mayo Clinic Proceedings

JF - Mayo Clinic Proceedings

SN - 0025-6196

IS - 9

ER -