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January 23, 2013

Prognostic factors of motor impairment, disability, and quality of life in newly diagnosed PD

Daan C. Velseboer, MD, Mark Broeders, MSc, Bart Post, MD, PhD, Nan van Geloven, MSc, Johannes D. Speelman, MD, PhD, Ben Schmand, PhD, Rob J. de Haan, PhD, and Rob M.A. de Bie, MD, PhD on behalf of the CARPA Study GroupAuthors Info & Affiliations
February 12, 2013 issue
80 (7) 627-633
https://doi.org/10.1212/WNL.0b013e318281cc99
Letters to the Editor
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Abstract

Objective:

In Parkinson disease (PD), the rate of clinical progression is highly variable. To date, there are conflicting findings concerning the prognostic factors influencing the rate of progression. Methodologic issues such as the use of selected patients from therapeutic trials, and short durations of follow-up probably underlie this problem. We therefore designed a prospective follow-up study of a cohort of newly diagnosed patients with PD.

Methods:

A cohort of 129 patients with newly diagnosed PD was assessed at baseline, and 1, 2, 3, and 5 years later. The rate of progression and its prognostic factors on the level of motor impairments, disability, and quality of life were investigated using linear mixed-model analysis.

Results:

Annual increase of motor impairments measured with the Unified Parkinson's Disease Rating Scale–Motor Examination was estimated to be 2.46 points (95% confidence interval: 2.05–2.88). The main determinants of faster increase of motor impairments were male sex and cognitive dysfunction at the time of diagnosis. The main determinants of faster increase of disability were higher age at onset, cognitive dysfunction, and the presence of levodopa-nonresponsive motor symptoms at the time of diagnosis. No clinically relevant determinants were found for the decrease in quality of life.

Conclusion:

This study shows the importance of nondopaminergic symptoms at the time of diagnosis, because these symptoms are the main determinants of increased disability in the first 5 years of the disease.

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Supplementary Material

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Information & Authors

Information

Published In

Neurology®
Volume 80 • Number 7 • February 12, 2013
Pages: 627-633
PubMed: 23345637

Copyright

© 2013 American Academy of Neurology.

Publication History

Received: June 13, 2012
Accepted: October 11, 2012
Published online: January 23, 2013
Published in print: February 12, 2013

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Disclosure

D.C. Velseboer, M. Broeders, B. Post, N. van Geloven, J.D. Speelman, B. Schmand, and R.J. de Haan report no disclosures. R.M.A. de Bie received a research grant from GE Healthcare. Go to Neurology.org for full disclosures.

Study Funding

This study was funded by ZonMw (grant 14350029), The Hague, the Netherlands. The movement disorders group of the Academic Medical Center received an unrestricted fellowship grant from Medtronic (Minneapolis, MN).

Authors

Affiliations & Disclosures

Daan C. Velseboer, MD
From the Department of Neurology (D.C.V., J.D.S., B.S., R.M.A.d.B.), Clinical Research Unit (N.v.G., R.J.d.H.), Academic Medical Center, and Department of Brain and Cognition (M.B., B.S.), University of Amsterdam; and Department of Neurology (B.P.), Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
View all articles by this author
Mark Broeders, MSc
From the Department of Neurology (D.C.V., J.D.S., B.S., R.M.A.d.B.), Clinical Research Unit (N.v.G., R.J.d.H.), Academic Medical Center, and Department of Brain and Cognition (M.B., B.S.), University of Amsterdam; and Department of Neurology (B.P.), Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
View all articles by this author
Bart Post, MD, PhD
From the Department of Neurology (D.C.V., J.D.S., B.S., R.M.A.d.B.), Clinical Research Unit (N.v.G., R.J.d.H.), Academic Medical Center, and Department of Brain and Cognition (M.B., B.S.), University of Amsterdam; and Department of Neurology (B.P.), Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
View all articles by this author
Nan van Geloven, MSc
From the Department of Neurology (D.C.V., J.D.S., B.S., R.M.A.d.B.), Clinical Research Unit (N.v.G., R.J.d.H.), Academic Medical Center, and Department of Brain and Cognition (M.B., B.S.), University of Amsterdam; and Department of Neurology (B.P.), Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
View all articles by this author
Johannes D. Speelman, MD, PhD
From the Department of Neurology (D.C.V., J.D.S., B.S., R.M.A.d.B.), Clinical Research Unit (N.v.G., R.J.d.H.), Academic Medical Center, and Department of Brain and Cognition (M.B., B.S.), University of Amsterdam; and Department of Neurology (B.P.), Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
1. Medtronic ltd, Minneapolis, concerning DBS
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
1. Medtronic Ltd Minneapolis
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
View all articles by this author
Ben Schmand, PhD
From the Department of Neurology (D.C.V., J.D.S., B.S., R.M.A.d.B.), Clinical Research Unit (N.v.G., R.J.d.H.), Academic Medical Center, and Department of Brain and Cognition (M.B., B.S.), University of Amsterdam; and Department of Neurology (B.P.), Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
Abbott, partial funding for travel and conference attendance.
Editorial Boards:
1.
Tijdschrift voor Neuropsychologie, 2005 - present
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
Michael J. Fox Foundation
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
View all articles by this author
Rob J. de Haan, PhD
From the Department of Neurology (D.C.V., J.D.S., B.S., R.M.A.d.B.), Clinical Research Unit (N.v.G., R.J.d.H.), Academic Medical Center, and Department of Brain and Cognition (M.B., B.S.), University of Amsterdam; and Department of Neurology (B.P.), Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
View all articles by this author
Rob M.A. de Bie, MD, PhD
From the Department of Neurology (D.C.V., J.D.S., B.S., R.M.A.d.B.), Clinical Research Unit (N.v.G., R.J.d.H.), Academic Medical Center, and Department of Brain and Cognition (M.B., B.S.), University of Amsterdam; and Department of Neurology (B.P.), Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
Received funding for a trip from Medtronic (2010) and fora trip from Abbot (2010).
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
Received an unrestricted fellowship grant from Medtronic.Received a reserach grant from GE Health
Research Support, Government Entities:
1.
Received a research grant from ZonMw Doelmatigheid(171102018).
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
Received research grants from the Parkinson Vereniging(Patient's Society), the Prinses Beatrix Fonds (WAR08-02), Internationaal Parkinson Fonds, Michael J FoxFoundation, Kinetics Foundation
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
View all articles by this author
on behalf of the CARPA Study Group
From the Department of Neurology (D.C.V., J.D.S., B.S., R.M.A.d.B.), Clinical Research Unit (N.v.G., R.J.d.H.), Academic Medical Center, and Department of Brain and Cognition (M.B., B.S.), University of Amsterdam; and Department of Neurology (B.P.), Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands.
View all articles by this author

Notes

Correspondence to Dr. Velseboer: [email protected]
CARPA Study Group coinvestigators are listed on the Neurology® Web site at www.neurology.org.
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

Author Contributions

Daan C. Velseboer: acquisition of data, analysis and interpretation, first draft of manuscript (including tables and figures). Mark Broeders: acquisition of data, critical revision of the manuscript for important intellectual content. Bart Post: study concept and design, acquisition of data, critical revision of the manuscript for important intellectual content. Nan van Geloven: analysis and interpretation, critical revision of the manuscript for important intellectual content. Johannes D. Speelman: study concept and design, acquisition of data, critical revision of the manuscript for important intellectual content. Ben Schmand: acquisition of data, critical revision of the manuscript for important intellectual content. Rob J. de Haan: study concept and design, critical revision of the manuscript for important intellectual content. Rob M.A. de Bie: study supervision, analysis and interpretation, critical revision of the manuscript for important intellectual content.

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