Long-duration Parkinson's disease: Role of lateralization of motor features

• Published in: Parkinsonism & related disorders Vol. 19; no. 1; pp. 77 - 80
• Main Authors: Munhoz, Renato P., Espay, Alberto J., Morgante, Francesca, Li, Jie-Yuan, Teive, Helio A., Dunn, Emily, Gallin, Eliza, Litvan, Irene
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.01.2013
• Subjects: Adult; Age of Onset; Aged; Aged, 80 and over; Case-Control Studies; Dementia - complications; Disease Progression; Female; Functional Laterality - physiology; Handedness; Humans; Levodopa - therapeutic use; Longevity; Longevity - physiology; Male; Middle Aged; Neurology; Parkinson Disease - physiopathology; Parkinson's disease; REM Sleep Behavior Disorder - complications; REM Sleep Behavior Disorder - physiopathology; Tremor - complications; Handedness; Parkinson's disease; Longevity
• ISSN: 1353-8020; 1873-5126; 1873-5126
• DOI: 10.1016/j.parkreldis.2012.07.008

A mean of 10 years elapse before patients with Parkinson's disease (PD) reach Hoehn & Yahr (H&Y) stage 4, and 14 years for stage 5. A small proportion of PD patients survive and are ambulatory for ≥20 years. We sought to identify features associated with long-duration PD (dPD). This five-center, case–control study compared 136 PD patients with ≥20 years of duration and H&Y stage ≤4 (dPD) to 134 H&Y-, age- and gender-matched PD patients between 10 and 15 years of disease (cPD). By study design, there were no between-group differences in age, gender and H&Y. dPD subjects were younger at onset (p < 0.0001), had more psychosis (p: 0.038), were receiving higher levodopa equivalent daily doses (p: 0.02), were predominantly left-handed (p: 0.048), and had greater frequency of left-sided onset (p: 0.015) compared to cPD subjects. Both groups had similar rates of resting tremor, dementia and REM sleep behavior disorder. Early disease onset, left-handedness and left-sided onset are associated with long disease and ambulatory PD survival. The neurobiological basis of the prognostic value of lateralization deserves further investigation.