Comorbid Conditions in Parkinson's Disease: A Population-Based Study of Statewide Parkinson's Disease Registry.

In 1996, Nebraska became the first state in the United States to establish a Parkinson's disease (PD) Registry. The objectives of this study were to determine the most common comorbid conditions among PD patients receiving inpatient and outpatient services in Nebraska between 2004 and 2012, and to examine whether PD patients had increased risks of these conditions. Statewide linkage was performed between Nebraska PD Registry data and hospital discharge database. The cohort comprised of 3,852 PD inpatients and 19,260 non-PD inpatients, and 5,217 PD outpatients and 26,085 non-PD outpatients. Referent subjects were matched to PD patients by age at initial hospital admissions or visits, gender, and county of residence using systematic random-sampling method. Compared to non-PD inpatients, PD inpatients were at higher risks for dementia (relative risk [RR] 2.29; 95% CI 2.14-2.45), mood disorders (RR 1.57; 95% CI 1.44-1.70), gastrointestinal disorders (RR 1.15; 95% CI 1.06-1.25), and urinary tract infections (RR 1.33; 95% CI 1.22-1.45), while PD outpatients had higher risks for spondylosis (RR 1.23; 95% CI 1.09-1.38), genitourinary disorders (RR 1.48; 95% CI 1.29-1.69), gastrointestinal disorders (RR 1.59; 95% CI 1.38-1.84), and dementia (RR 2.83; 95% CI 2.38-3.37) than non-PD outpatients. The findings highlight PD as a multisystem neurodegenerative disorder, and this information is crucial for creating strategies to better prevent and manage PD complications.

Xu K ，Alnaji N ，Zhao J ，Bertoni JM ，Chen LW ，Bhatti D ，Qu M ... -  《-》

Epidemiology of inpatient stay in Parkinson's disease in the United States: Insights from the Nationwide Inpatient Sample.

The total number of people living with Parkinson's disease (PD) worldwide is expected to double by 2030. The risk factors for emergency department visits in PD patients have been described before, however, there is limited data on inpatient hospitalizations of PD patients. We derived our study cohort from the Nationwide Inpatient Sample (NIS) database from 2002-2011. The NIS is a stratified 20% sample of discharges from all U.S. hospitals. We extracted causes of hospitalization using International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) codes and calculated inpatient mortality, length of stay and cost. Further, the significance of trends over 10 years was assessed. A total of 3,015,645 (weighted) admissions of PD patients were documented from 2002-2011. Pneumonia, urinary tract infection (UTI), septicemia and aspiration pneumonitis were the most common causes of admission, of which incidence of sepsis and UTI was trending up. Of all causes, 3.9% of the admissions resulted in inpatient mortality. Inpatient mortality for PD patients decreased from 4.9% in 2002 to 3.3% in 2011 (p<0.001). The median length of stay has also steadily declined from 3.6days in 2002 to 2.3days in 2011. However, the inflation-adjusted cost of care has been steadily rising, from $22,250 per hospitalization in 2002 to $37,942 in 2011. We conclude that the epidemiology of inpatient admissions in PD has changed significantly over the last decade. Our study underscores the need for future, in-depth prospective studies to explore this changing disease spectrum to design preventive measures and targeted interventions.

Mahajan A ，Balakrishnan P ，Patel A ，Konstantinidis I ，Nistal D ，Annapureddy N ，Poojary P ，Nadkarni GN ，Sidiropoulos C ... -  《-》

Do risk factors for Alzheimer's disease predict dementia in Parkinson's disease? An exploratory study.

The extent to which concomitant Alzheimer's disease (AD) is etiologically related to the development of dementia in Parkinson's disease (PD) remains controversial. We explored the association of four risk factors associated with AD, including head injury, smoking, hypertension, and diabetes mellitus, with incident dementia in PD. A cohort of 180 nondemented PD patients from the Washington Heights community in northern Manhattan, New York, completed a risk factor questionnaire at baseline and was followed annually with neurological and neuropsychological evaluations. The association of baseline variables with incident dementia was analyzed by using Cox proportional hazards models. All analyses controlled for age at baseline, gender, years of education, duration of PD, and total Unified Parkinson's Disease Rating Scale (UPDRS) motor score at baseline. Of 180 patients (mean age, 71.0 +/- 10.3 years), 52 (29%) became demented during a mean follow-up period of 3.6 +/- 2.2 years. Head injury risk ratio ([RR] 0.9; 95% confidence interval [CI], 0.4-2.2; P = 0.9), hypertension (RR, 0.7; 95% CI, 0.4-1.4, P = 0.3), and diabetes mellitus (RR, 0.8; 95% CI, 0.3-2.3; P = 0.7) were not significantly associated with incident dementia in the Cox models. Patients who reported having ever smoked were at increased risk for the development of dementia compared with nonsmokers (RR, 2.0; 95% CI, 1.0-3.9; P = 0.05). Current smoking was significantly associated with incident dementia (RR, 4.5; 95% CI, 1.2-16.4; P = 0.02), whereas past smoking approached significance (RR, 1.9; 95% CI, 0.9-3.7; P = 0.07). Although an inverse association between smoking and PD has been reported in several studies, our study showed a positive association between smoking and dementia in the setting of PD. The association of smoking with incident dementia in PD deserves further study.

Levy G ，Tang MX ，Cote LJ ，Louis ED ，Alfaro B ，Mejia H ，Stern Y ，Marder K ... -  《MOVEMENT DISORDERS》

Hospitalisation and comorbidities in Parkinson's disease: a large Australian retrospective study.

Patients with Parkinson's disease (PD) require higher levels of care during hospitalisation. Management of comorbidities in these patients aims to optimise function while minimising complications. The objective of this study was to examine patterns of hospitalisation of patients with PD in NSW with regards to sociodemographic factors, comorbidities and aspects of clinical management. A retrospective study of all patients with idiopathic PD and a control group of non-PD patients admitted for acute care to NSW hospitals between 2008 and 2012. The study group comprised 5637 cases and 8143 controls. The mean PD patient age was 75.0 years (±10.9). Patients with PD had a significantly longer hospital stay (median 7 days, IQR 3-13 vs 1 day, IQR 1-7, p<0.001) than control patients. Patients with PD were five times more likely to be treated for delirium, three times more likely to experience an adverse drug event and syncope, more than twice as likely to require management of falls/fractures, dementia, gastrointestinal complications, genitourinary infections, reduced mobility and other trauma but half as likely to require hospitalisation for chronic airways disease and neoplasia, including melanoma, than the control group (all p<0.001). Patients with PD are more likely to suffer serious health problems, including delirium, adverse drug reactions, syncope, falls and fractures than controls. These findings highlight PD as a multisystem neuropsychiatric disorder in which motor and non-motor features contribute to morbidity. Increased awareness of the added risk PD poses in acute hospitalised patients can be used to inform strategies to improve patient outcomes.

Lubomski M ，Rushworth RL ，Tisch S 《-》

Fracture risk after the diagnosis of Parkinson's disease: Influence of concomitant dementia.

In an inception cohort of 196 Olmsted County, Minnesota, residents with Parkinson's disease (PD) first recognized in 1976 to 1995, we tested whether the increased risk of bone fractures is associated with concomitant dementia. Using the data resources of the Rochester Epidemiology Project, information about PD, dementia, other clinical risk factors for fracture and fracture events was obtained from review of complete inpatient and outpatient medical records spanning each subject's residence in the community. Compared to an equal number of age- and sex-matched non-PD referent subjects from the community, PD patients were at a 2.2-fold increased risk of fractures generally and a 3.2-fold greater risk of hip fractures specifically. Adjusting for age, the independent predictors of overall fracture risk in the PD subjects included female sex (hazard ratio [HR] 1.6; 95% confidence interval [CI], 1.1-2.3), dementia (HR, 1.6; 95% CI, 1.1-2.4) and chronic depression, which was associated with a reduced risk (HR, 0.4; 95% CI, 0.2-0.8). Hip fractures were predicted by dementia (HR, 2.2; 95% CI, 1.2-4.1). The increased fracture risk in patients with PD is not entirely explained by concomitant dementia, and additional study is needed to determine the relative contributions to fracture risk of falls versus bone loss in these patients.

Melton LJ 3rd ，Leibson CL ，Achenbach SJ ，Bower JH ，Maraganore DM ，Oberg AL ，Rocca WA ... -  《MOVEMENT DISORDERS》