The cause of death in idiopathic Parkinson’s disease☆
Introduction
According to most previous studies of standardized mortality ratio (SMR), idiopathic Parkinson’s disease (IPD) does appear to affect life expectancy, but this varies depending on the age at onset [1]. It has been suggested that people with IPD are less likely to die of malignant conditions or ischaemic heart disease but it is unclear how many die as a direct result of the IPD or its complications.
There are few data evaluating the cause of death in Parkinson’s disease (PD) with some previous studies limited due to smaller sample sizes [2], or with samples arguably based on unrepresentative populations (e.g. tertiary referral clinics) [3]. Other studies have less clearly defined inclusion criteria [4], [5].
The aim of this study, therefore, was to identify the cause of death in patients with IPD in a prospective cohort of patients under the care of a PD service with a representative community-based population.
Section snippets
Methods
Ethical approval was obtained from the NHS National Research Ethics Service (Gateshead and South Tyneside Local Research Ethics Committee) in April 2007.
Patients under the care of the North Tyneside PD Service (NTPDS) who died between January 1st 1999 and January 1st 2007 were identified from service records as has been previously described [6]. Patients with IPD under the NTPDS are not discharged and are therefore followed up life-long.
Results
Of the 219 patients registered with the NTPDS during the study period, 143 patients had IPD, 26 had Vascular Parkinsonism, 17 had Lewy Body Disease, 7 had progressive supranuclear palsy (PSP) and 5 had multi-system atrophy (MSA). Of the remainder, 8 were excluded due to insufficient data, and 12 were excluded because they were documented as not having features of Parkinsonism. One further patient was excluded as they had emigrated and died abroad, and therefore ONS data were not available.
For
Discussion
In this study we have demonstrated that the most common cause of death classified using the ICD-10 data is IPD (29%) followed by malignancy (12%), ischaemic heart disease (12%), pneumonia (11%), and cerebrovascular disease (9%). Our study includes patients with clearly established IPD, as defined by the UK PD Society Brain Bank Criteria, based on follow up and assessment, including response to dopaminergic treatment, during life. A previously published prevalence study has demonstrated that the
Conclusion
The most commonly ascribed cause of death in this study was IPD followed by malignancy, ischaemic heart disease, pneumonia and cerebrovascular disease in decreasing order. However, pneumonia was a terminal event in 45% of patients. One potential way of reducing pneumonia risk would be to have more frequent formal swallowing assessments in people with PD to identify aspiration risk, in people who are potentially “asymptomatic” for swallowing problems. This might involve a speech and language
Ethical approval
Ethical approval was obtained from the NHS National Research Ethics Service (Gateshead and South Tyneside Local Research Ethics Committee) in April 2007.
Conflicts of interest
There are no competing interests for any of the authors.
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The review of this paper was entirely handled by the Co-Editor-in-Chief, Ronald Pfeiffer.