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a Department of
Neurology, Westmead Hospital, Sydney, Australia, b Intstat
Australia Pty, Ainslie, ACT, Australia, c Department of Neurology, St Vincent's Hospital,
Sydney, Australia, d Department
of Neurology, Royal North Shore Hospital, Sydney, Australia
Correspondence to: Dr M A Hely, Neurology Department A4B, Westmead Hospital, Westmead NSW 2145, Australia.
Received 29 June 1998 and in revised form 24 February 1999;
Accepted 5 March
1999
OBJECTIVES
To report
on a 10 year follow up of patients with idiopathic Parkinson's
disease, particularly with respect to mortality and the effect of early
treatment with bromocriptine.
METHODSThe
patients are from the 149 new patients recruited for a double blind,
randomised study of low dose levodopa-carbidopa versus low dose
bromocriptine. Patients were examined neurologically at least yearly.
Neuropsychological examinations were performed at 0, 3, 5, and 10 years. Mortality and cause of death in these patients were compared
with the Australian population using standardised mortality ratios
(SMRs). Mortality and disease progression were compared by sex and
treatment group. Predictors of death within 10 years, nursing home
admission, and progression in Columbia score of 
20 points were
examined by logistic regression analysis.
RESULTSThirteen
patients were excluded as having atypical Parkinsonism and six were
lost to follow up. All available patients have been followed up for 10 years. Fifty patients (38%) were dead by 10 years and 63 by the last
follow up. The SMR was 1.58 for all patients (p<0.001). There was no
significant difference in SMRs between the sexes. The mean duration of
disease until death was 9.1 years. Parkinson's disease was thought to
have contributed substantially to the death of 30 patients. The most
common cause of death was pneumonia. Women progressed at a similar rate
to men until 8 years, when the severity of their disease as measured by
Hoehn and Yahr stage became greater (p<0.05). Older age of onset
correlated with increased risk of death but the SMR was increased even
in those aged <70 years (SMR 1.80, p=0.03). Early use of
bromocriptine did not reduce mortality or slow progression of
disease. One quarter of all patients had been admitted to nursing homes
by 10 years. Only four patients were still employed.
CONCLUSIONSMortality
in Parkinson's disease remains increased despite low dose
levodopa-carbidopa therapy and no additional benefit was gained from
early use of bromocriptine. Duration of disease was similar to that in
the era before levodopa.
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