Frailty in prodromal Parkinson's disease in Medicare beneficiaries

Frailty, a common syndrome of aging associated with a decline in physiological reserve, places individuals with Parkinson's disease (PD) at a greater risk of poor health outcomes. We hypothesized that frailty would also be greater in prodromal PD patients compared to the general population and, thus, could be part of the prodromal phase of PD.

We conducted a population-based case-control study of incident PD cases (N = 82,560) and controls (N = 96,482) ages 70-90 identified in 2009. Using 2004-2009 Medicare data, we examined frailty in five individual 12-month time windows during the prodromal period using the claims-based frailty index (CFI), categorized as nonfrail, mildly frail, and moderately-to-severely frail. For each time window, we calculated the odds ratios (ORs) and 95 % confidence intervals (CIs) for the association between frailty and PD, while adjusting for age, sex, race/ethnicity, and use of care. We examined variables in CFI that were associated with PD in the 12 months prior to diagnosis.

Mildly frail (OR = 1.70, 95 % CI 1.62-1.78) and moderately-to-severely frail (OR = 1.29, 95 % CI 1.16-1.43) were associated with PD five years prior to diagnosis. This association strengthened in the final year prior to diagnosis: mildly frail (OR = 7.75, 95 % CI 7.51-7.99); moderately-to-severely frail (OR = 10.22, 95 % CI 9.63-10.86). In the 12 months prior to PD diagnosis, the CFI variable encompassing psychiatric/cognitive disorders had the most marked association with PD (OR = 4.63, 95 % CI 4.50-4.77).

Medicare beneficiaries with PD are frailer than controls in the prodromal period. Frailty was highest in the 12 months prior to PD diagnosis.