According to a Swedish research report reviewed on November 6 this year (the full study was published online on October 31, 2018), Parkies who have normal cognition when they are diagnosed do not face an increased risk of early death when compared to non-Parkies of the same age.
The conclusion, quoted from the full study:
Patients with Parkinson disease presenting with normal cognitive function [at the initial diagnosis] seem to have a largely normal life expectancy.
The study’s lead author, David Backstrom, says in the follow-up review, “This is a positive message to be able to give to these patients, which made up about 40% of the Parkinson’s patients in our study…Our study shows that Parkinson’s disease is not necessarily a death sentence, especially if cognitive function is normal at presentation.”
Backstrom also says, “Our results suggest that it is beneficial to diagnose patients very carefully when they first present. While we can give good news to those with normal cognitive function, we should also follow more carefully those with characteristics linked to higher mortality.”
The study followed 178 patients with Parkinson’s and/or related conditions, such as progressive supranuclear palsy and multiple system atrophy. Their ages at baseline ranged from 40 years to 90 years. They were followed for up to 13.5 years; each year they were thoroughly tested for Parkinson’s symptoms and cognitive functioning. At the end of the study, their death rates (109 patients died) were compared to standard mortality rates in the general Swedish population. The overall mean age of the study’s patients at death was 82 years; pneumonia was the most common form of death.
The general results (taken verbatim from the review article):
Results showed that the standardized mortality ratio for the whole parkinsonism cohort was 1.84 times higher than the comparable age and sex distribution standardized mortality of the Swedish population during the years 2004-2017.
However, a lot depended on the condition of each volunteer patient:
Patients with atypical parkinsonism, including progressive supranuclear palsy or multiple system atrophy, had a markedly worse prognosis than patients with Parkinson’s disease….Assuming the mean age of 71.1 years at baseline in idiopathic parkinsonism, the expected survival in Parkinson’s disease was 9.6 years, but it was only 6.1 years in atypical parkinsonism….
These findings paralleled what the researchers discovered about cognitive function.
To wit:
Life expectancy was also strongly related to cognitive function. Those with cognitive impairment at the beginning of the study were 2.4 times more likely to die during the study than those who had normal cognitive function….Assuming the mean age of 71.2 years at baseline, the expected survival in patients with Parkinson’s disease was 11.6 years without cognitive impairment and 8.2 years with mild cognitive impairment. Patients with dementia were excluded.
Or, to quote from the main article:
Mortality in patients with PD (both male and female) with normal cognition at baseline was not significantly different from the general population.
The study notes that cognitive function did not equate with level of education. Thus, someone with just a high school diploma and no cognitive deterioration would fare better than a Ph.D. whose thinking was already slipping.
What’s my two cents on this? Research findings move the world forward, and this study offers psychological relief for the 40% of Parkinson’s patients who do not exhibit cognitive malfunctioning at the time of diagnosis. However, everyone with PD needs to remain physically, mentally and socially active. They need to keep their minds sharp by reading and/or writing; by doing mental challenges such as Sudoku; by learning a new skill or a new language; by taking tango lessons or by learning to play ping-pong.
Also, the participants’ mean age at the start of the study was 71.2 years. To my mind (which I hope is still working), once you are in your seventies, all sorts of medical mishaps, illnesses and accidents can occur, making every day you’re still alive a gift, even though the Grim Reaper lurks behind every closet door, behind every bush and tree, and in the back seat of your car. Furthermore, this current study doesn’t report on the quality of life for the participants who kept on living. The lucky 40% may have had to deal with other issues or symptoms that could make life unbearable.
And then there’s the question of Young Onset PD. Were their results similar to the people who were older than the mean age of 71.2 years? It seems to me that there’d be major differences between someone diagnosed at age 40 and someone diagnosed at age 80.
I guess it’s time for me to read more articles on the Internet.
