Predictors of functional dependency in Parkinson’s disease

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Abstract

Background Functional dependency, the need for help in basic activities of daily living, is an important patient-orientated outcome. We aimed to describe the development of dependency in Parkinson’s disease (PD) and identify independent prognostic factors for this outcome. Methods We analysed data from the PINE study, a prospective, community-based incident cohort of PD with ongoing follow-up. We described the development of dependency defined by both Schwab & England score (S&E) <80% and Barthel Index <19. We identified baseline predictors of dependency using multivariable Cox regression. Results In 198 patients with PD, the rate of development of dependency was 14 per 100 person years. Older age at diagnosis (hazard ratio [HR] for 10-year increase 2.23 [95% CI 1.66–2.98]), greater smoking history (HR for 10-pack-year increase, 1.15 [1.04–1.26]), more severe axial impairment (HR for 5-point increase in sum of axial items from UPDRS scale, 1.78 [1.30–2.44]), and lower MMSE score (HR 0.88 [0.79–0.98]) were independently associated with higher risk of dependency defined by S&E. Only older age (HR for 10-year increase 1.35 [1.04–1.76]) and severity of axial impairment (HR for 5-point increase 1.85 [1.31–2.62]) were associated with higher risk of dependency defined by the Barthel Index. Sex, deprivation, co-morbidity, overall UPDRS motor score and disease stage were not independently associated with dependency. Conclusion This is the first community-based study of dependency in PD. There was a high rate of development of dependency. Older age, more smoking, more axial impairment, and poorer cognition were independent predictors.
Original languageEnglish
Pages (from-to)1482-1488
Number of pages7
JournalMovement Disorders
Early online date22 Aug 2016
DOIs
Publication statusPublished - Oct 2016

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Parkinson Disease
Smoking
Dependency (Psychology)
Activities of Daily Living
England
Cognition
History
Prospective Studies
Morbidity

Keywords

  • Parkinson’s disease
  • predictors
  • dependency
  • prognosis

Cite this

Predictors of functional dependency in Parkinson’s disease. / MacLeod, Angus D; Counsell, Carl E.

In: Movement Disorders, 10.2016, p. 1482-1488.

Research output: Contribution to journalArticle

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title = "Predictors of functional dependency in Parkinson’s disease",
abstract = "Background Functional dependency, the need for help in basic activities of daily living, is an important patient-orientated outcome. We aimed to describe the development of dependency in Parkinson’s disease (PD) and identify independent prognostic factors for this outcome. Methods We analysed data from the PINE study, a prospective, community-based incident cohort of PD with ongoing follow-up. We described the development of dependency defined by both Schwab & England score (S&E) <80{\%} and Barthel Index <19. We identified baseline predictors of dependency using multivariable Cox regression. Results In 198 patients with PD, the rate of development of dependency was 14 per 100 person years. Older age at diagnosis (hazard ratio [HR] for 10-year increase 2.23 [95{\%} CI 1.66–2.98]), greater smoking history (HR for 10-pack-year increase, 1.15 [1.04–1.26]), more severe axial impairment (HR for 5-point increase in sum of axial items from UPDRS scale, 1.78 [1.30–2.44]), and lower MMSE score (HR 0.88 [0.79–0.98]) were independently associated with higher risk of dependency defined by S&E. Only older age (HR for 10-year increase 1.35 [1.04–1.76]) and severity of axial impairment (HR for 5-point increase 1.85 [1.31–2.62]) were associated with higher risk of dependency defined by the Barthel Index. Sex, deprivation, co-morbidity, overall UPDRS motor score and disease stage were not independently associated with dependency. Conclusion This is the first community-based study of dependency in PD. There was a high rate of development of dependency. Older age, more smoking, more axial impairment, and poorer cognition were independent predictors.",
keywords = "Parkinson’s disease, predictors, dependency, prognosis",
author = "MacLeod, {Angus D} and Counsell, {Carl E}",
note = "Financial disclosures/conflicts of interest: Dr Macleod was funded by a Clinical Academic Fellowship from the Chief Scientist Office of the Scottish Government and received grant funding from Parkinson’s UK, the Wellcome Trust, University of Aberdeen, and NHS Grampian endowments relating to this research. Dr Counsell received grant funding from Parkinson’s UK, National Institute for Health Research, the Scottish Chief Scientist Office, the BMA Doris Hillier award, RS Macdonald Trust, the BUPA Foundation, NHS Grampian endowments and SPRING relating to this research. We declare we have no conflicts of interest. Financial support: This study was funded by Parkinson’s UK, the Scottish Chief Scientist Office, NHS Grampian endowments, the BMA Doris Hillier award, RS Macdonald Trust, the BUPA Foundation, and SPRING.  ",
year = "2016",
month = "10",
doi = "10.1002/mds.26751",
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T1 - Predictors of functional dependency in Parkinson’s disease

AU - MacLeod, Angus D

AU - Counsell, Carl E

N1 - Financial disclosures/conflicts of interest: Dr Macleod was funded by a Clinical Academic Fellowship from the Chief Scientist Office of the Scottish Government and received grant funding from Parkinson’s UK, the Wellcome Trust, University of Aberdeen, and NHS Grampian endowments relating to this research. Dr Counsell received grant funding from Parkinson’s UK, National Institute for Health Research, the Scottish Chief Scientist Office, the BMA Doris Hillier award, RS Macdonald Trust, the BUPA Foundation, NHS Grampian endowments and SPRING relating to this research. We declare we have no conflicts of interest. Financial support: This study was funded by Parkinson’s UK, the Scottish Chief Scientist Office, NHS Grampian endowments, the BMA Doris Hillier award, RS Macdonald Trust, the BUPA Foundation, and SPRING.  

PY - 2016/10

Y1 - 2016/10

N2 - Background Functional dependency, the need for help in basic activities of daily living, is an important patient-orientated outcome. We aimed to describe the development of dependency in Parkinson’s disease (PD) and identify independent prognostic factors for this outcome. Methods We analysed data from the PINE study, a prospective, community-based incident cohort of PD with ongoing follow-up. We described the development of dependency defined by both Schwab & England score (S&E) <80% and Barthel Index <19. We identified baseline predictors of dependency using multivariable Cox regression. Results In 198 patients with PD, the rate of development of dependency was 14 per 100 person years. Older age at diagnosis (hazard ratio [HR] for 10-year increase 2.23 [95% CI 1.66–2.98]), greater smoking history (HR for 10-pack-year increase, 1.15 [1.04–1.26]), more severe axial impairment (HR for 5-point increase in sum of axial items from UPDRS scale, 1.78 [1.30–2.44]), and lower MMSE score (HR 0.88 [0.79–0.98]) were independently associated with higher risk of dependency defined by S&E. Only older age (HR for 10-year increase 1.35 [1.04–1.76]) and severity of axial impairment (HR for 5-point increase 1.85 [1.31–2.62]) were associated with higher risk of dependency defined by the Barthel Index. Sex, deprivation, co-morbidity, overall UPDRS motor score and disease stage were not independently associated with dependency. Conclusion This is the first community-based study of dependency in PD. There was a high rate of development of dependency. Older age, more smoking, more axial impairment, and poorer cognition were independent predictors.

AB - Background Functional dependency, the need for help in basic activities of daily living, is an important patient-orientated outcome. We aimed to describe the development of dependency in Parkinson’s disease (PD) and identify independent prognostic factors for this outcome. Methods We analysed data from the PINE study, a prospective, community-based incident cohort of PD with ongoing follow-up. We described the development of dependency defined by both Schwab & England score (S&E) <80% and Barthel Index <19. We identified baseline predictors of dependency using multivariable Cox regression. Results In 198 patients with PD, the rate of development of dependency was 14 per 100 person years. Older age at diagnosis (hazard ratio [HR] for 10-year increase 2.23 [95% CI 1.66–2.98]), greater smoking history (HR for 10-pack-year increase, 1.15 [1.04–1.26]), more severe axial impairment (HR for 5-point increase in sum of axial items from UPDRS scale, 1.78 [1.30–2.44]), and lower MMSE score (HR 0.88 [0.79–0.98]) were independently associated with higher risk of dependency defined by S&E. Only older age (HR for 10-year increase 1.35 [1.04–1.76]) and severity of axial impairment (HR for 5-point increase 1.85 [1.31–2.62]) were associated with higher risk of dependency defined by the Barthel Index. Sex, deprivation, co-morbidity, overall UPDRS motor score and disease stage were not independently associated with dependency. Conclusion This is the first community-based study of dependency in PD. There was a high rate of development of dependency. Older age, more smoking, more axial impairment, and poorer cognition were independent predictors.

KW - Parkinson’s disease

KW - predictors

KW - dependency

KW - prognosis

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JO - Movement Disorders

JF - Movement Disorders

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