Very old onset parkinsonism: A clinical-pathological study

Area of Science:

• Geriatric Neurology
• Neurodegenerative Diseases
• Pathology

Background:

• The global population is aging, leading to an expected rise in parkinsonism cases among the very old.
• Clinical and morphological data on parkinsonism with onset in individuals aged 80 and above are limited.
• Existing autopsy-confirmed studies on this demographic are scarce.

Purpose of the Study:

• To investigate the clinical and morphological characteristics of parkinsonism in patients with disease onset at age 80 or older.
• To compare the phenotype and survival rates of very old onset parkinsonism with younger onset groups.
• To explore the neuropathological findings in this elderly population.

Main Methods:

• A retrospective autopsy study was conducted on 345 patients clinically diagnosed with Parkinson disease (PD).
• The study specifically analyzed 90 cases with disease onset at age 80 years or older.
• Clinical data, response to l-dopa, survival times, and post-mortem neuropathological findings were examined.

Main Results:

• The majority of very old onset cases (60%) exhibited a rigid-akinetic phenotype; 80% were demented.
• Response to l-dopa therapy was positive in only about 49% of patients.
• Neuropathological examination revealed significant heterogeneity, with Lewy body disease (PD) alone in 23.3%, PD plus Alzheimer disease (AD) in 48.9%, and other comorbidities in a substantial proportion.
• Survival time was significantly shorter (4.34 ± 2.95 years) compared to younger onset groups.

Conclusions:

• Parkinsonism in octogenarians is clinically and morphologically heterogeneous.
• This population experiences accelerated disease progression and shorter survival.
• The findings underscore the complexity of parkinsonism in the very elderly, often involving co-existing pathologies like Alzheimer disease.