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From the Gertrude H. Sergievsky Center (Drs. Levy, Tang, Louis, Stern, and Marder, and B. Alfaro and H. Mejia), the Department of Neurology (Drs. Louis, Côté, Stern, and Marder, and B. Alfaro and H. Mejia), and the Department of Psychiatry (Dr. Stern), College of Physicians and Surgeons; the Division of Biostatistics (Dr. Tang), School of Public Health; and the Taub Institute for Research on Alzheimer’s Disease and The Aging Brain (Drs. Tang, Stern, and Marder), Columbia University, New York, NY.
Address correspondence and reprint requests to Dr. Karen Marder, G.H. Sergievsky Center, 630 West 168th Street, P & S Box 16, New York, NY 10032; e-mail: marderk{at}sergievsky.cpmc.columbia.edu
Objective: To evaluate the association of incident dementia with mortality in a cohort of patients with idiopathic PD who were nondemented at baseline evaluation, controlling for extrapyramidal sign (EPS) severity at each study visit.
Background: The development of dementia has been associated with reduced survival in PD. Because EPS severity is associated with both dementia and mortality in PD, the association of dementia with mortality may be confounded by disease severity.
Methods: A cohort of patients with PD was followed annually with neurologic and neuropsychological evaluations. The association of incident dementia and the total Unified PD Rating Scale (UPDRS) motor score with mortality in PD was examined using Cox proportional hazards models with time-dependent covariates. All analyses were adjusted for age at baseline, sex, years of education, ethnicity, and duration of PD.
Results: Of 180 PD patients, 41 (22.8%) died during a mean follow-up period of 3.9 ± 2.2 years. Among those who died during the study period, 48.8% (20 of 41) became demented during follow-up, as compared to 23.0% (32 of 139) of those who remained alive. Both incident dementia (RR: 2.2, 95% CI: 1.1 to 4.5, p = 0.04) and the total UPDRS motor score at each study visit (RR: 1.04, 95% CI: 1.02 to 1.07, p = 0.001) were associated with mortality in PD when included in the same Cox model.
Conclusions: Incident dementia has an independent effect on mortality when controlling for EPS severity. The development of dementia is associated with a twofold increased mortality risk in PD.
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