| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
From the Departments of Neurology (Drs. Uitti, Ahlskog, and Maraganore) and Health Sciences Research (E.J. Atkinson, R.H. Cha, and Dr. O'Brien), Mayo Clinic and Mayo Foundation, Rochester, MN; and the Department of Neurology (Dr. Muenter), Mayo Clinic, Scottsdale, AZ.
We studied survival in all Olmsted County Parkinson's disease (PD) patients seen at the Mayo Clinic from 1964 to 1978, attempting to answer two questions: (1) What effect does levodopa have on survival in PD? and (2) Does the timing of levodopa administration influence survival? We chose this period because it allowed us to study patient records with a spectrum of disease durations before levodopa treatment; in many patients, the treatment delay was exclusively due to levodopa being unavailable prior to 1969. Mortality of the entire PD cohort (N = 179; 61% levodopa-treated) was greater than that of the general population (matched chronologically, geographically, and by age and gender). Lower age at onset of motor symptoms, lower Hoehn and Yahr stage at first neurologic visit for parkinsonism, and treatment with levodopa were all independent predictors of improved survival. Using a time-dependent Cox regression model, we assessed the impact of the timing of levodopa administration during the course of illness on mortality, while statistically controlling for other factors (ie, patient selection for levodopa treatment, and independent predictors of survival). Risk of death following initiation of levodopa was significantly reduced (p < 0.001), regardless of pre-levodopa duration of illness. This reduction gradually diminished over a period of 4 years on levodopa, but continued to be significantly reduced. After 4 years, increasing survival benefit again progressively accrued over time to at least 17 years of levodopa treatment (p < 0.001). At no point in time was levodopa treatment associated with increased mortality, arguing against substantial levodopa toxicity. However, despite levodopa-improved survival, mortality continues to be increased in PD relative to the general population.
Address correspondence and reprint requests to Dr. Ryan J. Uitti, University Hospital, UBC Site, 2211 Wesbrook Mall, Vancouver, BC, Canada V6T 2B5.
Received December 8, 1992. Accepted for publication in final form February 17, 1993.
This article has been cited by other articles:
|
|
 |
|
  J. E. Ahlskog Beating a dead horse: Dopamine and Parkinson disease Neurology, October 23, 2007; 69(17): 1701 - 1711. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Herlofson, S. A. Lie, D. Arsland, and J. P. Larsen Mortality and Parkinson disease: A community based study Neurology, March 23, 2004; 62(6): 937 - 942. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. A. Jellinger Parkinson Disease With Old-Age Onset Arch Neurol, December 1, 2003; 60(12): 1814 - 1815. [Full Text] [PDF]
|
|
|
|
|
|
R. L. Albin and K. A. Frey Initial agonist treatment of Parkinson disease: A critique Neurology, February 11, 2003; 60(3): 390 - 394. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Mytilineou, R. H. Walker, R. JnoBaptiste, and C. W. Olanow Levodopa Is Toxic to Dopamine Neurons in an in Vitro but Not an in Vivo Model of Oxidative Stress J. Pharmacol. Exp. Ther., February 1, 2003; 304(2): 792 - 800. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J.C. Pressley, E.D. Louis, M.-X. Tang, L. Cote, P.D. Cohen, S. Glied, and R. Mayeux The impact of comorbid disease and injuries on resource use and expenditures in parkinsonism Neurology, January 14, 2003; 60(1): 87 - 93. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. S. Knopman, W. A. Rocca, R. H. Cha, S. D. Edland, and E. Kokmen Survival Study of Vascular Dementia in Rochester, Minnesota Arch Neurol, January 1, 2003; 60(1): 85 - 90. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Elbaz, J. H. Bower, B. J. Peterson, D. M. Maraganore, S. K. McDonnell, J. E. Ahlskog, D. J. Schaid, and W. A. Rocca Survival Study of Parkinson Disease in Olmsted County, Minnesota Arch Neurol, January 1, 2003; 60(1): 91 - 96. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. A. Parashos, D. M. Maraganore, P. C. O'Brien, and W. A. Rocca Medical Services Utilization and Prognosis in Parkinson Disease: A Population-Based Study Mayo Clin. Proc., September 1, 2002; 77(9): 918 - 925. [Abstract] [PDF]
|
|
|
|
|
|
J. A. Van Gerpen, J. E. Ahlskog, Y. Ben-Shlomo, J. Head, A. Lees, P. T. Donnan, D. T. Steinke, P. G. Davey, and T. M. MacDonald Selegiline and mortality in subjects with Parkinson's disease: A longitudinal community study Neurology, July 24, 2002; 57(2): 368 - 370. [Full Text] [PDF]
|
|
|
|
|
|
J. Jankovic Levodopa strengths and weaknesses Neurology, February 1, 2002; 58(90001): S19 - 32. [Abstract] [Full Text]
|
|
|
|
|
|
L. Morgante, G. Salemi, F. Meneghini, A. E. Di Rosa, A. Epifanio, F. Grigoletto, P. Ragonese, F. Patti, A. Reggio, R. Di Perri, et al. Parkinson Disease Survival: A Population-Based Study Arch Neurol, April 1, 2000; 57(4): 507 - 512. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. M. Shulman Levodopa Toxicity in Parkinson Disease: Reality or Myth?: Reality--Practice Patterns Should Change Arch Neurol, March 1, 2000; 57(3): 406 - 408. [Full Text] [PDF]
|
|
|
|
 |
|
 M. A Hely, J. G L Morris, R. Traficante, W. G J Reid, D. J O'Sullivan, and P. M Williamson The Sydney multicentre study of Parkinson's disease: progression and mortality at 10 years J. Neurol. Neurosurg. Psychiatry, September 1, 1999; 67(3): 300 - 307. [Abstract] [Full Text]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
