Quantitative Poincaré plot analysis of heart rate variability: effect of endurance training

BACKGROUND: Parkinson's disease (PD) patients with 20 years or more survival (PD-20) are not well characterized. OBJECTIVE: To evaluate PD-20 patient characteristics and identify areas for improvement of their health care. METHODS: The international, multicenter National Parkinson's Foundation Quality Improvement Initiative (NPF-QII) study database was queried to identify PD-20 subjects. Demographic and clinical data were analyzed. RESULTS: We identified 187 PD-20 subjects (55% men) representing 4% (187/4,619) of all NPF-QII participants. Subjects were mean age 69.5 years; mean age at PD onset was 44.0 years. The majority (75% ) had 20-25 years of PD duration, the longest duration being 49 years. They were median Hoehn and Yahr stage 3, and 75% had motor fluctuations. Half (54% ) reported exercising. The majority (89% ) were living at home and required a caregiver (88% ). They were mildly cognitively impaired for age (Montreal Cognitive Assessment estimate 22.6+/-3.7), with most deficits in verbal fluency and delayed recall. Quality of life (Parkinson's Disease Quality of Life Questionnaire index 36+/-15% ) was mild to moderately impaired, with most impairment in mobility and activities of daily living. Caregiver strain measured by the Multidimensional Caregiver Strain Index (27+/-16% ), recorded highest subscores in social constraint. PD-20 subjects aged /=70 only differed significantly by worse cognition (P < 0.0001). CONCLUSIONS: PD-20 subjects reflect an elite group of PD survivors with early-onset disease and relatively mild cognitive disability despite long disease duration. Interventions for caregivers, mobility, and activities of daily living are areas that could improve caregiver burden and patient quality of life