Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, United States of America.
Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, United States of America.
PLoS One. 2021 Feb 3;16(2):e0246206. doi: 10.1371/journal.pone.0246206. eCollection 2021.
Mobility disability and parkinsonism are associated with decreased survival in older adults. This study examined the transition from no motor impairment to mobility disability and parkinsonism and their associations with death.
867 community-dwelling older adults without mobility disability or parkinsonism at baseline were examined annually. Mobility disability was based on annual measured gait speed. Parkinsonism was based on the annual assessment of 26 items from the motor portion of the Unified Parkinson's Disease Rating Scale. A multistate Cox model simultaneously examined the incidences of mobility disability and parkinsonism and their associations with death.
Average age at baseline was 75 years old and 318 (37%) died during 10 years of follow-up. Mobility disability was almost 2-fold more common than parkinsonism. Some participants developed mobility disability alone (42%), or parkinsonism alone (5%), while many developed both (41%). Individuals with mobility disability or parkinsonism alone had an increased risk of death, but their risk was less than the risk in individuals with both impairments. The risk of death did not depend on the order in which impairments occurred.
The varied patterns of transitions from no motor impairment to motor impairment highlights the heterogeneity of late-life motor impairment and its contribution to survival. Further studies are needed to elucidate the underlying biology of these different transitions and how they might impact survival.
行动障碍和帕金森病与老年人的生存率降低有关。本研究探讨了从不伴有运动障碍的状态进展为行动障碍和帕金森病的情况，以及这些情况与死亡的关联。
在基线时，867 名无行动障碍或帕金森病的社区居住老年人每年接受检查。行动障碍基于每年测量的步速。帕金森病基于统一帕金森病评定量表运动部分的 26 项年度评估。多状态 Cox 模型同时考察了行动障碍和帕金森病的发生率，以及它们与死亡的关联。
基线时的平均年龄为 75 岁，在 10 年的随访期间，有 318 人（37%）死亡。行动障碍的发生率几乎是帕金森病的两倍。一些参与者仅出现行动障碍（42%）或帕金森病（5%），而许多人同时出现两种疾病（41%）。仅出现行动障碍或帕金森病的个体死亡风险增加，但风险低于同时存在两种障碍的个体。死亡风险与障碍发生的顺序无关。
从不伴有运动障碍的状态进展为运动障碍的各种模式突显了老年期运动障碍的异质性及其对生存率的影响。需要进一步的研究来阐明这些不同转变的潜在生物学机制，以及它们如何影响生存。
