Abstract
Background: Advanced Parkinson’s disease (APD) has been recently defined as a stage in which certain symptoms and complications are present, with a detrimental influence on the overall patient’s health conditions and with a poor response to conventional treatments. However, historically, the term APD has been controversial, thus consequently, APD prevalence has not been previously studied. Objectives: The main objective was to determine the prevalence of APD in patients diagnosed with idiopathic PD in hospitals of the Spanish National Healthcare System. Secondary objectives were the prevalence and incidence of PD and the clinical and sociodemographic characteristics and quality of life of patients with APD or non-APD. Methods: This was a non-interventional, cross-sectional, multicenter, national study in the hospital setting. Results: The study population included 929 patients with PD (mean age 71.8 ± 10.1 years; 53.8% male) and a mean time since diagnosis of 6.6 ± 5.4 years. At the time of diagnosis, 613 patients (66.06%) reported having had premotor symptoms. The Hoehn and Yahr stage was 1 in 15.7% of the patients, 2 in 42.8%, 3 in 30.1%, 4 in 9.9%, and 5 in 1.4%; 46.9% of the patients had comorbidities (mean age-adjusted Charlson comorbidity index 3.5 ± 1.7; median 10-year survival 77%) and the mean 8-item Parkinson’s Disease Quality of Life Questionnaire was 27.8 ± 20.5. We found an APD prevalence of 38.21% (95%CI: 35.08–41.42%), a PD prevalence of 118.4 (95%CI: 117.3–119.6), and a PD incidence of 9.4 (95%CI: 5.42–13.4) all per 100,000 population. Among the APD population, a 15.2% were receiving some form of therapy for advanced stages of the disease (deep brain stimulation, levodopa/carbidopa intestinal gel, or apomorphine subcutaneous infusion). Conclusions: The percentage of patients with APD in the hospitals of the Spanish National Healthcare System was 38.2%.
Highlights
Parkinson’s disease (PD) is one of the most prevalent neurodegenerative disorders in the world [1] and a growing source of disability globally [2]
No statistically significant differences were seen in the percentages of patients with Advanced Parkinson’s disease (APD) among those patients with PD attended at hospitals with general neurology services (38.1% (95%CI: 33.3–42.9%)), with PD dedicated clinics (37.7% (95%CI: 32.2–43.5%)), and with movement disorder units (39.2% (95%CI: 32.8–45.9%)) (p = 0.94)
The fact that the sites participating in the OBSERVE-PD study were movement disorder centers does not seem to explain the higher percentages of patients with APD found in that study, as we found no significant differences between the different hospital types
Summary
Parkinson’s disease (PD) is one of the most prevalent neurodegenerative disorders in the world [1] and a growing source of disability globally [2]. Parkinson’s disease is a progressive disease; most patients progress to an advanced stage after 7–10 years form diagnosis [4]. Advanced Parkinson’s disease (APD) patients develop motor fluctuations, dyskinesias, and non-motor symptoms within 3 to 5 years of starting dopaminergic therapy, and these motor complications could be, at this stage, refractory to treatment. Comorbidities within this population, arising independently of the underlying disease, such as neoplasms [5], may increase the burden of the social and Healthcare System. Conclusions: The percentage of patients with APD in the hospitals of the Spanish National Healthcare System was 38.2%
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