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The CamPaIGN study of Parkinson's disease : 10-year outlook in an incident population-based cohort

Williams-Gray, Caroline H; Mason, Sarah L; Evans, Jonathan R; Foltynie, Thomas; Brayne, Carol; Robbins, Trevor W and Barker, Roger A LU (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
publishing date
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
  • 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
2018-04-15 04:38:19
@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},
  keyword      = {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},
  volume       = {84},
  year         = {2013},
}