Very old onset parkinsonism: A clinical-pathological study

Abstract

BackgroundWith increasing age of the world population, the number of parkinsonian patients with disease onset in very old age is expected to increase. Information about the clinical and morphological phenotype of very old age onset parkinsonism is poor, and only three autopsy-confirmed studies of parkinsonian patients of 80 years and older onset are available. MethodsA retrospective autopsy study of 345 patients clinically diagnosed as Parkinson disease (PD) included 90 cases with disease onset ≥80 years). ResultsClinically, the majority (60%) presented with a rigid-akinetic phenotype, 13.3% with mixed tremor, akinesia and rigidity, 8.9% tremor-dominant type, 7.8% with tremor + rigidity, 5.6% with tremor-akinesia, and 4.4% with pure akinesia or gait disorder. Additional 8.9% developed hemiparesis, and 80% were demented. In only about 49% of the patients, positive reaction to l-dopa therapy was reported. The progress of disease was accelerated, and survival time (4.34 ± 2.95 SD) was significantly shorter than in younger onset groups. At post mortem examination, only 21 cases (23.3%) revealed Lewy body disease of brainstem type (PD) alone, 44 cases (48.9%) had PD plus Alzheimer disease (AD) (including 6 cases of Lewy body variant of AD). 11% had PD plus cerebrovascular lesions, 6 cases (6.7%) were cerebrovascular disorders and 8 cases (8.9%) were other neurodegenerative diseases (AD, single cases of multiple system atrophy, progressive supranuclear palsy). ConclusionThe present and other data confirm the clinical and morphological heterogeneity of parkinsonism with shorter survival in the octogenarian population.