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Progression of Hoehn and Yahr stages in parkinsonian disorders: A clinicopathologic study

From the Cognitive Neuropharmacology Unit (Dr. Litvan), Henry M. Jackson Foundation, Bethesda, MD; the Department of Neurology, University Hospital Innsbruck (Drs. Müller, Wenning, and Poewe), Vienna; the Ludwig Boltzmann Institute of Clinical Neurology (Dr. Jellinger), Vienna, Austria; and the Veteran’s Administration Medical Center GRECC (Dr. McKee), Bedford, MA.

Address correspondence and reprint requests to Dr. Irene Litvan, Chief, Cognitive Neuropharmacology Unit, Henry M. Jackson Foundation, The Champlain Bdg., 6410 Rockledge Drive, Suite 600, Bethesda, MD 20817-1844.

The progression to different Hoehn and Yahr (HY) stages was evaluated in 81 pathologically confirmed patients with parkinsonism. Patients with PD (n = 18) showed significantly longer latencies to each HY stage than patients with atypical parkinsonian disorder (APD). While no patient with PD developed a HY-III stage within 1 year of onset of motor symptoms, 72% of those with APDs did. In fact, development of a HY-III within 1 year of motor onset accurately predicted an APD. However, the progression to each HY stage was unhelpful in distinguishing the APDs from each other. Once patients with PD and APD became wheelchair-bound, both had equally short survival times.

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