The CamPaIGN study of Parkinson's disease : 10-year outlook in an incident population-based cohort
(2013) In Journal of Neurology, Neurosurgery and Psychiatry 84(11). p.64-1258- Abstract
BACKGROUND: Prognosis in Parkinson's disease (PD) remains poorly understood due to a lack of unbiased data on the natural history of treated PD. The CamPaIGN study has been the first to prospectively track disease evolution from diagnosis in an unselected population-representative incident cohort. We now report the 10-year follow-up data, focusing on three key irreversible milestones: postural instability (Hoehn and Yahr 3), dementia and death.
METHODS: The cohort was collected between December 2000 and 2002. Those meeting diagnostic criteria (n=142) were followed-up until 1 January 2012. Clinical, neuropsychological and genetic testing were performed. Progression to key milestones was evaluated using Kaplan-Meier and Cox... (More)
BACKGROUND: Prognosis in Parkinson's disease (PD) remains poorly understood due to a lack of unbiased data on the natural history of treated PD. The CamPaIGN study has been the first to prospectively track disease evolution from diagnosis in an unselected population-representative incident cohort. We now report the 10-year follow-up data, focusing on three key irreversible milestones: postural instability (Hoehn and Yahr 3), dementia and death.
METHODS: The cohort was collected between December 2000 and 2002. Those meeting diagnostic criteria (n=142) were followed-up until 1 January 2012. Clinical, neuropsychological and genetic testing were performed. Progression to key milestones was evaluated using Kaplan-Meier and Cox regression survival analyses.
RESULTS: At 10 years, 55% had died, 68% had postural instability and 46% dementia. 23% had a good outcome at 10 years (surviving free of dementia/postural instability). Death rate was comparable with the UK population (standardised mortality ratio 1.29 (0.97-1.61)). Death certificates indicated PD was a substantial contributor in only 20%, with pneumonia being the commonest cause of death. Age, non-tremor-dominant motor phenotype and comorbidity predicted earlier postural instability. Baseline predictors of dementia were age, motor impairment, 'posterior-cortical' cognitive deficits and MAPT genotype.
CONCLUSIONS: (1) outlook in PD is heterogeneous, with most dying or developing dementia or postural instability by 10 years from diagnosis, but a quarter still doing well, with preserved mobility and intact cognition; (2) death is not directly related to PD in the majority; (3) baseline clinical and genetic variables are predictive of outcome and may be helpful in selecting patients for clinical trials.
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- author
- Williams-Gray, Caroline H ; Mason, Sarah L ; Evans, Jonathan R ; Foltynie, Thomas ; Brayne, Carol ; Robbins, Trevor W and Barker, Roger A LU
- organization
- publishing date
- 2013-11
- type
- Contribution to journal
- publication status
- published
- keywords
- Adult, Aged, Cause of Death, Cohort Studies, Dementia, Disease Progression, England, Female, Genotype, Humans, Incidence, Kaplan-Meier Estimate, Longitudinal Studies, Male, Middle Aged, Parkinson Disease, Postural Balance, Prognosis, Proportional Hazards Models, Survival Analysis, Journal Article, Research Support, Non-U.S. Gov't
- in
- Journal of Neurology, Neurosurgery and Psychiatry
- volume
- 84
- issue
- 11
- pages
- 64 - 1258
- publisher
- BMJ Publishing Group
- external identifiers
-
- pmid:23781007
- scopus:84885666304
- ISSN
- 1468-330X
- DOI
- 10.1136/jnnp-2013-305277
- language
- English
- LU publication?
- no
- id
- 115426fe-b93b-4447-a125-a198cc6b9df2
- date added to LUP
- 2016-11-24 15:19:52
- date last changed
- 2024-06-15 20:18:09
@article{115426fe-b93b-4447-a125-a198cc6b9df2,
abstract = {{<p>BACKGROUND: Prognosis in Parkinson's disease (PD) remains poorly understood due to a lack of unbiased data on the natural history of treated PD. The CamPaIGN study has been the first to prospectively track disease evolution from diagnosis in an unselected population-representative incident cohort. We now report the 10-year follow-up data, focusing on three key irreversible milestones: postural instability (Hoehn and Yahr 3), dementia and death.</p><p>METHODS: The cohort was collected between December 2000 and 2002. Those meeting diagnostic criteria (n=142) were followed-up until 1 January 2012. Clinical, neuropsychological and genetic testing were performed. Progression to key milestones was evaluated using Kaplan-Meier and Cox regression survival analyses.</p><p>RESULTS: At 10 years, 55% had died, 68% had postural instability and 46% dementia. 23% had a good outcome at 10 years (surviving free of dementia/postural instability). Death rate was comparable with the UK population (standardised mortality ratio 1.29 (0.97-1.61)). Death certificates indicated PD was a substantial contributor in only 20%, with pneumonia being the commonest cause of death. Age, non-tremor-dominant motor phenotype and comorbidity predicted earlier postural instability. Baseline predictors of dementia were age, motor impairment, 'posterior-cortical' cognitive deficits and MAPT genotype.</p><p>CONCLUSIONS: (1) outlook in PD is heterogeneous, with most dying or developing dementia or postural instability by 10 years from diagnosis, but a quarter still doing well, with preserved mobility and intact cognition; (2) death is not directly related to PD in the majority; (3) baseline clinical and genetic variables are predictive of outcome and may be helpful in selecting patients for clinical trials.</p>}},
author = {{Williams-Gray, Caroline H and Mason, Sarah L and Evans, Jonathan R and Foltynie, Thomas and Brayne, Carol and Robbins, Trevor W and Barker, Roger A}},
issn = {{1468-330X}},
keywords = {{Adult; Aged; Cause of Death; Cohort Studies; Dementia; Disease Progression; England; Female; Genotype; Humans; Incidence; Kaplan-Meier Estimate; Longitudinal Studies; Male; Middle Aged; Parkinson Disease; Postural Balance; Prognosis; Proportional Hazards Models; Survival Analysis; Journal Article; Research Support, Non-U.S. Gov't}},
language = {{eng}},
number = {{11}},
pages = {{64--1258}},
publisher = {{BMJ Publishing Group}},
series = {{Journal of Neurology, Neurosurgery and Psychiatry}},
title = {{The CamPaIGN study of Parkinson's disease : 10-year outlook in an incident population-based cohort}},
url = {{http://dx.doi.org/10.1136/jnnp-2013-305277}},
doi = {{10.1136/jnnp-2013-305277}},
volume = {{84}},
year = {{2013}},
}