ABSTRACT
Background: The hospitalization rates of patients with Parkinson’s disease (PD) are 1.45 times higher than for age matched controls. We studied the causes for admission, hospital course and outcomes in PD population so that preventive measures could be developed. Methods: We prospectively studied patients with the diagnosis of PD admitted to a tertiary care hospital in Ludhiana, India from January, 2012 to December, 2014. Etiology for hospitalization was determined and the patients were divided into two groups, admission due to causes related to PD or not associated with PD. The PD related admissions were further categorized into Group I: directly disease related causes and Group II: indirectly disease related causes. The primary outcome was mortality. The secondary outcome measures were duration of hospitalization, requirement for ICU, need for mechanical ventilation and complications. Results: There were 146 patients of PD out of 25,326 hospital admissions. Forty two patients (28.7%) had direct cause, 73(50%) had indirect cause and 31(21.2%) were non-PD related admissions. The mean age was 68.5+9.9 years, 97males (66.7%). There were 16(10.9%) deaths. The commonest cause of admission was infections and encephalopathy. The indirect PD related admission had significantly higher age (p= 0.0014), increased risk of ICU admission (p=0.011), need for mechanical ventilation (p < 0.005) and longer duration of hospital stay (p=0.0001) as compared to group I. Also there was a six fold increased risk of death in this group (p 0.034). Conclusion: As disease progresses, the indirect reasons for admission becomes more troublesome than the initial motor complaints.
ABSTRACT
Background & Objective: Parkinson’s disease (PD) is a chronic neurological disease, many a times presenting with non-motor symptoms. Pain is one of the most important non-motor symptom and there is no consensus regarding its exact mechanism and characterisation. This study was planned to evaluate the characteristics of pain and possible factors influencing it, in a cohort of patients with established Parkinson’s disease. Methods: 104 patients consenting to participate were included in the study. Data regarding age of onset, duration of disease, treatment, Hoehn-Yahr scale, phenotype of PD, UPDRS scores, pain type and distribution of pain were noted. Single and multiple logistical regression models with pain (1/0) as the outcome variable were used to check the association of pain with the above mentioned variables. Results: 54.8% of patients with PD experience pain. Presence of sensory symptoms was significantly associated with the pain group (42.1%) than the no pain group (21%). Pain was more pronounced on the side with predominant motor symptoms (72%) and in 68.4 % patients pain responded to dopaminergic treatment. Musculoskeletal pain (82.5%) was the commonest type and lower limbs were the commonest site of pain (43.2%). Conclusion: Pain in Parkinson’s disease has multiple dimensions and characteristics. Pain itself may be the reason for early diagnosis. Proper classification of pain will help in improved management of these patients.