To determine the effect of dysphagia and hospital admissions on mortality in late stage Parkinson’s disease

Dempsey, S.

Gray, William Keith

Hand, Annette

McDonald, L.

Sayers, I.

Walker, Richard

English

Northumbria Research Link

Northumbria Research Link
Citation:  Dempsey,  S.,  McDonald,  L.,  Sayers,  I.,  Gray,  William Keith,  Hand,  Annette  and Walker, 
Richard  (2019)  Factors  affecting  mortality  in  late  stage  Parkinson’s  Disease.  In:  International 
Parkinson and Movement Disorder Society, 22-26th September 2019, Nice, France. 
URL:  https://www.mdsabstracts.org/abstract/factors-affe... 
<https://www.mdsabstracts.org/abstract/factors-affecting-mortality-in-late-stage-parkinsons-disease/>
This version was downloaded from Northumbria Research Link: http://nrl.northumbria.ac.uk/42908/
Northumbria University has developed Northumbria Research Link (NRL) to enable users to access 
the University’s research output. Copyright © and moral rights for items on NRL are retained by the 
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available online in accordance with publisher policies. To read and/or cite from the published version 
of the research, please visit the publisher’s website (a subscription may be required.)
                        
Factors Affecting Mortality in Late Stage Parkinson’s Disease
Results
• Of the 162 patients originally interviewed, 36 (22.2%) 
died during the two-year follow-up.
• 18 patients (11.1%) entered a care home during follow-up, 
including 10 of the 36 who died.
Discussion
• There was a significant increase in mortality in those with 
dysphagia when using either UPDRS 2.3 or a yes/no 
question, possibly due to the complications of dysphagia, 
e.g. pneumonia, or as a sign of disease progression.
• Those with hospital admissions had higher rates of 
mortality than those without, with a trend of increased 
mortality the greater the number of admissions.
Limitations
• Only one patient had a UPDRS score of 4, so the impact of 
enteral nutrition on mortality could not be assessed.
• There was only a small number of patients with a large 
amount of admissions, so a larger sample size may have 
altered the observed trend between increasing number of 
admissions and mortality.
Background
• Parkinson’s disease (PD) is a neurodegenerative condition 
associated with increased mortality, although studies disagree 
to what extent.[1]
• Previous research on predictors of mortality has focused on 
early rather than late stage PD.[2,3]
• The leading cause of mortality in Parkinson’s disease 
patients is pneumonia.[4]
Method
• A prospective study where patients with later stage PD 
(Hoehn & Yahr stages III-V) known to the Northumbria PD 
service were interviewed at baseline and had deaths, 
hospital and care home admissions recorded for 2 years.
• Dysphagia was assessed with a binary question about the 
presence of swallowing problems and using question 2.3 of 
the “Unified Parkinson’s Disease Rating Scale (UPDRS), 
where 0	=	no	problems,	 1	=	increased	effort	swallowing,	 2	=	
modified	 diet,	3	=	episode	of	choking	 in	the	past	week,	4	=	
tube	feeding.
Recommendations
• Dysphagia should be assessed in Parkinson’s patients 
when predicting mortality.
• Patients with multiple hospital admissions may need 
greater follow-up due to its relationship with mortality.
• Analysis surrounding cause of admission and total length 
of stay may allow more accurate prediction of mortality in 
future.
Objectives
• To determine the association of dysphagia and hospital 
admissions with mortality in Parkinson’s Disease.
References:
1) Macleod,	A.	D.,	Taylor,	K.	S.	and	Counsell,	C.	E.	(2014),	Mortality	in	Parkinson's	
disease:	A	systematic	review	and	meta-analysis.	Mov Disord.,	29	(13):	pp1615-
1622.
2) Bäckström,	D.,	Granåsen,	G.,	Domellöf,	M.	E.,	Linder,	J.	et	al.	(2018)	Early	
predictors	of	mortality	in	parkinsonism	and	Parkinson	disease.	Neurology,	91	(22):	
pp2045-2056.
3) Macleod,	A.	D.	and	Counsell,	C.	E.	(2016)	Predictors	of	mortality	in	Parkinson's	
disease	and	the	development	of	a	prognostic	model.	Lancet,	387:	p67
4) Pennington,	S.,	Snell,	K.,	Lee,	M.	and	Walker,	R.	(2010)	The	cause	of	death	in	
idiopathic	Parkinson’s	disease.	Parkinsonism	&	Related	Disorders,	16	(7):	pp434-
437.
UPDRS	2.3 Mortality
0 11.9%
1 19.4%
2 33.3%
3 72.7%
4 0.0%
P	Value 0.0004
Hospital
Admissions Mortality
0 14.9%
1 29.3%
2 30.0%
3	or	More 41.2%
P	Value 0.006
Swallowing Mortality
No	dysphagia 17.4%
Dysphagia 32.6%
P	Value 0.034
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
0 1 2 3 4
Pe
rc
en
ta
ge
	M
or
ta
lit
y
UPDRS	Swallow	Score
UPDRS	Swallow	Score	vs	Mortality
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
45.0%
0 1 2 3	or	More
Pe
rc
en
ta
ge
	M
or
ta
lit
y
Hospital	Admissions	 in	2-year	Period
Number	of	Hospital	Admissions	vs	Mortality
S.	DempseyA,	 L.	McDonaldA,	 I.	SayersA,	W.	GrayB,	A.	HandB,C and	R.	WalkerA,B
A. Newcastle	University
B. Northumbria	Healthcare	NHS	Foundation	Trust
C. Northumbria	University


Factors affecting mortality in late stage Parkinson’s Disease

Northumbria University Research Portal

Northumbria Research LinkCitation:  Dempsey,  S.,  McDonald,  L.,  Sayers,  I.,  Gray,  William Keith,  Hand,  Annette  and Walker, Richard  (2019)  Factors  affecting  mortality  in  late  stage  Parkinson’s  Disease.  In:  International Parkinson and Movement Disorder Society, 22-26th September 2019, Nice, France. URL:  https://www.mdsabstracts.org/abstract/factors-affe... <https://www.mdsabstracts.org/abstract/factors-affecting-mortality-in-late-stage-parkinsons-disease/>This version was downloaded from Northumbria Research Link: http://nrl.northumbria.ac.uk/42908/Northumbria University has developed Northumbria Research Link (NRL) to enable users to access the University’s research output. Copyright © and moral rights for items on NRL are retained by the individual author(s) and/or other copyright owners.  Single copies of full items can be reproduced, displayed or performed, and given to third parties in any format or medium for personal research or study, educational, or not-for-profit purposes without prior permission or charge, provided the authors, title and full bibliographic details are given, as well as a hyperlink and/or URL to the original metadata page. The content must not be changed in any way. Full items must not be sold commercially in any  format or medium without formal permission of the copyright holder.  The full policy is available online: http://nrl.northumbria.ac.uk/pol  i cies.html  This  document  may differ  from the  final,  published version of  the research  and has been made available online in accordance with publisher policies. To read and/or cite from the published version of the research, please visit the publisher’s website (a subscription may be required.)                        Factors Affecting Mortality in Late Stage Parkinson’s DiseaseResults• Of the 162 patients originally interviewed, 36 (22.2%) died during the two-year follow-up.• 18 patients (11.1%) entered a care home during follow-up, including 10 of the 36 who died.Discussion• There was a significant increase in mortality in those with dysphagia when using either UPDRS 2.3 or a yes/no question, possibly due to the complications of dysphagia, e.g. pneumonia, or as a sign of disease progression.• Those with hospital admissions had higher rates of mortality than those without, with a trend of increased mortality the greater the number of admissions.Limitations• Only one patient had a UPDRS score of 4, so the impact of enteral nutrition on mortality could not be assessed.• There was only a small number of patients with a large amount of admissions, so a larger sample size may have altered the observed trend between increasing number of admissions and mortality.Background• Parkinson’s disease (PD) is a neurodegenerative condition associated with increased mortality, although studies disagree to what extent.[1]• Previous research on predictors of mortality has focused on early rather than late stage PD.[2,3]• The leading cause of mortality in Parkinson’s disease patients is pneumonia.[4]Method• A prospective study where patients with later stage PD (Hoehn & Yahr stages III-V) known to the Northumbria PD service were interviewed at baseline and had deaths, hospital and care home admissions recorded for 2 years.• Dysphagia was assessed with a binary question about the presence of swallowing problems and using question 2.3 of the “Unified Parkinson’s Disease Rating Scale (UPDRS), where 0	=	no	problems,	 1	=	increased	effort	swallowing,	 2	=	modified	 diet,	3	=	episode	of	choking	 in	the	past	week,	4	=	tube	feeding.Recommendations• Dysphagia should be assessed in Parkinson’s patients when predicting mortality.• Patients with multiple hospital admissions may need greater follow-up due to its relationship with mortality.• Analysis surrounding cause of admission and total length of stay may allow more accurate prediction of mortality in future.Objectives• To determine the association of dysphagia and hospital admissions with mortality in Parkinson’s Disease.References:1) Macleod,	A.	D.,	Taylor,	K.	S.	and	Counsell,	C.	E.	(2014),	Mortality	in	Parkinson's	disease:	A	systematic	review	and	meta-analysis.	Mov Disord.,	29	(13):	pp1615-1622.2) Bäckström,	D.,	Granåsen,	G.,	Domellöf,	M.	E.,	Linder,	J.	et	al.	(2018)	Early	predictors	of	mortality	in	parkinsonism	and	Parkinson	disease.	Neurology,	91	(22):	pp2045-2056.3) Macleod,	A.	D.	and	Counsell,	C.	E.	(2016)	Predictors	of	mortality	in	Parkinson's	disease	and	the	development	of	a	prognostic	model.	Lancet,	387:	p674) Pennington,	S.,	Snell,	K.,	Lee,	M.	and	Walker,	R.	(2010)	The	cause	of	death	in	idiopathic	Parkinson’s	disease.	Parkinsonism	&	Related	Disorders,	16	(7):	pp434-437.UPDRS	2.3 Mortality0 11.9%1 19.4%2 33.3%3 72.7%4 0.0%P	Value 0.0004HospitalAdmissions Mortality0 14.9%1 29.3%2 30.0%3	or	More 41.2%P	Value 0.006Swallowing MortalityNo	dysphagia 17.4%Dysphagia 32.6%P	Value 0.0340.0%10.0%20.0%30.0%40.0%50.0%60.0%70.0%80.0%0 1 2 3 4Percentage	MortalityUPDRS	Swallow	ScoreUPDRS	Swallow	Score	vs	Mortality0.0%5.0%10.0%15.0%20.0%25.0%30.0%35.0%40.0%45.0%0 1 2 3	or	MorePercentage	MortalityHospital	Admissions	 in	2-year	PeriodNumber	of	Hospital	Admissions	vs	MortalityS.	DempseyA,	 L.	McDonaldA,	 I.	SayersA,	W.	GrayB,	A.	HandB,C and	R.	WalkerA,BA. Newcastle	UniversityB. Northumbria	Healthcare	NHS	Foundation	TrustC. Northumbria	University

http://nrl.northumbria.ac.uk/42908/1/Factors%20Affecting%20Mortality%20in%20Late%20Stage%20Parkinson%E2%80%99s%20Disease.pdf

Factors affecting mortality in late stage Parkinson’s Disease

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