- 3 subtypes of Parkinson's disease evident at diagnosis are associated with disease course and survival.
Why this matters
- Persistent difficulty in accurately estimating prognosis.
- 3 subtypes identified:
- Mild-motor predominant (48.7% of patients).
- Intermediate (35.1% of patients).
- Diffuse malignant (16.2% of patients).
- Graded associations seen for earlier milestone development, shorter survival.
- Diffuse malignant subtype independently predicted:
- Any disease milestone (aHR, 10.90; P<.001>
- Death (aHR, 3.65; P<.001>
- Any disease milestone (aHR, 1.09; P<.001>
- Death (aHR, 1.14; P<.001>
- UK retrospective cohort study: 111 consecutive patients with autopsy-confirmed Parkinson's disease regularly seen throughout their disease course, having brain autopsy.
- Subtypes defined on 4 factors at diagnosis: motor symptom severity, rapid eye movement sleep behavior disorder, autonomic function, cognitive function.
- Main outcomes: time to disease milestones (recurrent falls, wheelchair dependence, dementia, care home placement), survival.
- Funding: National Institute for Health Research University College London Hospitals Biomedical Research Centre.
- Variations in patient assessment.
- Patients predominantly had advanced clinical, pathologic stages.