German Center for Neurodegenerative Diseases, Rostock, Germany.
Chair of Geriatric Medicine and Center for Translational Neuro- and Behavioural Sciences, University Duisburg-Essen, Essen, Germany.
Mov Disord. 2023 Nov;38(11):2041-2052. doi: 10.1002/mds.29596. Epub 2023 Sep 1.
The aim of our study is to analyze sex-specific patterns of Parkinson's disease dementia (PDD) incidence. We are investigating the extent to which sex differences in survival after initial Parkinson's disease (PD) diagnosis influence differences in PDD risk among PD patients.
We used a random sample of German longitudinal health claims data of persons ages 50+ (2004-2019; n = 250,000) and identified new PD cases ages 65+ who were followed-up for a PDD diagnosis or death between 2006 and 2017. We performed Cox and competing-risk regression models, with death as competing event, to calculate PDD hazard ratios (HR) adjusted for age at PD onset, PD severity as measured by the modified Hoehn and Yahr (HY) scale, comorbidities, and medications.
Of 2195 new PD cases, 602 people died before PDD and 750 people developed PDD by the end of 2017. The adjusted risk of PDD differs by sex, with men having a higher PDD risk than women. When accounting for death, men and women do not differ in their PDD risk (HR = 1.02, P = 0.770). Sex-specific analyses showed significant age and severity effects in women (age: HR = 1.05, P < 0.001; HY 3-5 vs. 0-2.5: HR = 1.46, P = 0.011), but not in men.
Older age at first PD diagnosis and higher disease severity increase PDD risk, but this association is attenuated for PD men when controlling for death. This implies that the most frail PD men die rapidly before receiving a dementia diagnosis, whereas women with PD survive at higher rates, regardless of their age at onset and disease severity. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
本研究旨在分析帕金森病痴呆（PDD）发病的性别特异性模式。我们正在研究帕金森病（PD）诊断后最初的生存性别差异对 PD 患者 PDD 风险的影响程度。
我们使用德国纵向健康索赔数据的随机样本，该样本包括 50 岁以上的人群（2004-2019 年；n=250,000），并确定了年龄在 65 岁以上的新 PD 病例，这些病例在 2006 年至 2017 年间接受了 PDD 诊断或死亡的随访。我们使用 Cox 和竞争风险回归模型，以死亡为竞争事件，计算了调整 PD 发病年龄、改良 Hoehn 和 Yahr（HY）量表测量的 PD 严重程度、合并症和药物治疗后，PDD 的危害比（HR）。
在 2195 例新 PD 病例中，有 602 人在 PDD 之前死亡，750 人在 2017 年底前发展为 PDD。调整后的性别 PDD 风险不同，男性的 PDD 风险高于女性。当考虑到死亡时，男性和女性的 PDD 风险没有差异（HR=1.02，P=0.770）。性别特异性分析显示，女性的年龄和严重程度有显著影响（年龄：HR=1.05，P<0.001；HY 3-5 与 0-2.5：HR=1.46，P=0.011），但男性没有。
PD 首次诊断时年龄较大和疾病严重程度较高会增加 PDD 风险，但在控制死亡时，PD 男性的这种关联会减弱。这意味着最脆弱的 PD 男性会在获得痴呆诊断之前迅速死亡，而无论其发病年龄和疾病严重程度如何，患有 PD 的女性的存活率都较高。© 2023 作者。运动障碍由 Wiley 期刊出版社代表国际帕金森病和运动障碍学会出版。
