Symptoms and biomarkers predicting mortality in parkinsonism

Since parkinsonism disorders can be confused for each other — Parkinson’s disease, Lewy body dementia, progressive supranuclear palsy, multiple system atrophy, corticobasal degeneration, and vascular parkinsonism — especially early on in the disease process, perhaps more important than the clinical diagnosis is the prognosis.

In a recently published (June 2022) article, Dutch researchers state:

“Life expectancy is markedly reduced in persons with atypical
parkinsonism (AP), such as multiple system atrophy (MSA), progressive supranuclear palsy (PSP), or corticobasal degeneration. In contrast, Parkinson’s disease (PD) patients with normal cognition may have a largely normal life expectancy. Moreover, AP patients are more likely to become wheelchair-bound or be admitted to a nursing home shortly after disease onset. In these patients, timely identifying palliative care needs and initiating advanced care planning may be extra important. However, particularly in early disease stages, it is often difficult to precisely diagnose the various parkinsonian syndromes, because of considerable overlap with the phenotype of PD. Misdiagnosis is common, with a diagnostic accuracy of only 58% in early stages of parkinsonism… When the diagnosis remains uncertain for a while, which is not rare, there is a risk of postponing the conversation about the patient’s prognosis because the patient remains in the ‘diagnostic process.’ Nonetheless, even when the clinical picture is ambiguous, a patient wishes to be informed as accurately as possible about the prognosis.”

To that end, these researchers examined what symptoms, tests, and fluid
biomarkers predict mortality.  The study included 156 patients who had
been recently diagnosed with parkinsonism, from 2003 to 2006.  Patients
were followed since then — some up to 15 years.  91 patients have died.

The researchers found:

“Orthostatic hypotension, impaired cognition, abnormal tandem gait, and elevated neurofilament light chain concentration in serum or CSF were associated with mortality. … These findings help clinicians to estimate a patient’s prognosis, irrespective of the specific diagnosis.”

“Tandem gait” is walking where the toes of the first foot touch the heel of the next foot. It’s the sort of walk that police make suspected drunk drivers perform at the side of the road. “Abnormal tandem gait” refers to an uncoordinated walking style, characterized by a jerky motion in the body’s trunk and an unsteady gait, when walking in “tandem.”

The full article is available online at no charge:

Factors associated with mortality in early stages of parkinsonism
Anouke van Rumund, Rianne A. J. Esselink, Marjolein B. Berrevoets-Aerts,
Markus Otto, Bastiaan R. Bloem & Marcel M. Verbeek
npj Parkinson’s Disease, volume 8, Article number: 67 (2022)
Published: 02 June 2022