Abstract
BackgroundIn Parkinson disease (PD), systemic inflammation caused by respiratory infections such as pneumonia frequently occurs, often resulting in delirium in the advanced stages of this disease. Delirium can lead to cognitive and functional decline, institutionalization, and mortality, especially in the elderly. Inflammation causes rapid worsening of PD motor symptoms and signs, sometimes irreversibly in some, but not all, patients.PurposeTo identify factors associated with subacute motor deterioration in PD patients with systemic inflammation.MethodsThe association of clinical factors with subacute motor deterioration was analyzed by a case-control study. Subacute motor deterioration was defined as sustained worsening by one or more modified Hoehn and Yahr (H–Y) stages. Using multivariable logistic regression incorporating baseline characteristics (age, sex, PD duration, modified H–Y stage, dementia, and psychosis history) and statistically selected possible predictors (peak body temperature, duration of leukocytosis, and presence of delirium), the odds ratios for these factors were estimated as relative risks.ResultsOf 80 PD patients with systemic inflammation, 26 with associated subacute motor deterioration were designated as cases and the remainder as controls. In the 26 cases, 6 months after its onset the motor deterioration had persisted in 19 patients and resolved in four (three were lost for follow-up). Multivariable logistic regression analysis showed that delirium and body temperature are significantly associated with motor deterioration after systemic inflammation (P = 0.001 for delirium and P = 0.026 for body temperature), the adjusted odds ratios being 15.89 (95% confidence interval [CI]: 3.23–78.14) and 2.78 (95% CI: 1.13–6.83), respectively.ConclusionsIn patients with PD and systemic inflammation, delirium and high body temperature are strong risk factors for subsequent subacute motor deterioration and such deterioration can persist for over 6 months.
Highlights
Parkinson disease (PD), a common neurodegenerative disorder, occurs mainly in the elderly
Using multivariable logistic regression incorporating baseline characteristics and statistically selected possible predictors, the odds ratios for these factors were estimated as relative risks
Of 80 PD patients with systemic inflammation, 26 with associated subacute motor deterioration were designated as cases and the remainder as controls
Summary
Parkinson disease (PD), a common neurodegenerative disorder, occurs mainly in the elderly. It is characterized by bradykinesia, muscular rigidity, and tremor, these motor symptoms and signs being caused by progressive dopaminergic neuronal degeneration in the brain. Some patients experience subacute worsening of motor symptoms in certain situations, the most common of which are infections, anxiety, and medication problems [4,5]. Most such subacute motor deteriorations are transient and reversible. Even after adjustment of anti-Parkinsonian medications, they are irreversible in some patients, suggesting that systemic inflammation can be associated with persistent motor exacerbation. Inflammation causes rapid worsening of PD motor symptoms and signs, sometimes irreversibly in some, but not all, patients.
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