The motor phenotype of Parkinson's disease in relation to age at onset.
BACKGROUND: Parkinson's disease (PD) is heterogeneous and age at onset may define variation in clinical phenotype. Most previous studies have used various age cut-offs and have been based on clinical case series. METHODS: We have studied the association between clinical features and age of ons...
| Main Authors: | , , , , , , , , , , , , , , |
|---|---|
| Format: | Journal article |
| Language: | English |
| Published: |
2011
|
| _version_ | 1797087484715204608 |
|---|---|
| author | Wickremaratchi, M Knipe, MD Sastry, B Morgan, E Jones, A Salmon, R Weiser, R Moran, M Davies, D Ebenezer, L Raha, S Robertson, N Butler, C Ben-Shlomo, Y Morris, H |
| author_facet | Wickremaratchi, M Knipe, MD Sastry, B Morgan, E Jones, A Salmon, R Weiser, R Moran, M Davies, D Ebenezer, L Raha, S Robertson, N Butler, C Ben-Shlomo, Y Morris, H |
| author_sort | Wickremaratchi, M |
| collection | OXFORD |
| description | BACKGROUND: Parkinson's disease (PD) is heterogeneous and age at onset may define variation in clinical phenotype. Most previous studies have used various age cut-offs and have been based on clinical case series. METHODS: We have studied the association between clinical features and age of onset in 358 community-based and regional patients with PD. RESULTS: Tremor at presentation is twice as common in those with onset over 64 years as compared to those with onset under 45 (early onset PD - EOPD) and becomes more common with increasing age at onset (p values for trend ≤ 0.004). Dystonia affects 60% of those with EOPD, shows a curvilinear relationship with age at onset (cubic versus linear p=0.01) with highest risk in patients whose disease began before 48 years. In this study age at onset was a strong predictor of the development of dyskinesias, with younger age associated with a higher risk of dyskinesias. Following multivariable analysis, allowing for possibly confounding factors (disease duration, L-DOPA dosage, L-DOPA treatment duration) younger age at onset, (less than 55 years) predicted the development of L-DOPA induced dyskinesia (odds ratio <45 years 2.1, 95% CI 1.0, 4.8; odds ratio < 55 years 3.8, 95% CI 1.8, 8.0). Only 2/70 (2.9%) EOPD patients carried pathogenic parkin or PINK1 mutations and the clinical differences between early and late onset disease were not explained by the presence of mutations in these genes. DISCUSSION: This study highlights the clinical differences between early and late onset PD, which have important implications for diagnosis and management. |
| first_indexed | 2024-03-07T02:36:18Z |
| format | Journal article |
| id | oxford-uuid:a8e86283-edb1-43d2-bbf1-9a14134a97b0 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T02:36:18Z |
| publishDate | 2011 |
| record_format | dspace |
| spelling | oxford-uuid:a8e86283-edb1-43d2-bbf1-9a14134a97b02022-03-27T03:04:50ZThe motor phenotype of Parkinson's disease in relation to age at onset.Journal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:a8e86283-edb1-43d2-bbf1-9a14134a97b0EnglishSymplectic Elements at Oxford2011Wickremaratchi, MKnipe, MDSastry, BMorgan, EJones, ASalmon, RWeiser, RMoran, MDavies, DEbenezer, LRaha, SRobertson, NButler, CBen-Shlomo, YMorris, H BACKGROUND: Parkinson's disease (PD) is heterogeneous and age at onset may define variation in clinical phenotype. Most previous studies have used various age cut-offs and have been based on clinical case series. METHODS: We have studied the association between clinical features and age of onset in 358 community-based and regional patients with PD. RESULTS: Tremor at presentation is twice as common in those with onset over 64 years as compared to those with onset under 45 (early onset PD - EOPD) and becomes more common with increasing age at onset (p values for trend ≤ 0.004). Dystonia affects 60% of those with EOPD, shows a curvilinear relationship with age at onset (cubic versus linear p=0.01) with highest risk in patients whose disease began before 48 years. In this study age at onset was a strong predictor of the development of dyskinesias, with younger age associated with a higher risk of dyskinesias. Following multivariable analysis, allowing for possibly confounding factors (disease duration, L-DOPA dosage, L-DOPA treatment duration) younger age at onset, (less than 55 years) predicted the development of L-DOPA induced dyskinesia (odds ratio <45 years 2.1, 95% CI 1.0, 4.8; odds ratio < 55 years 3.8, 95% CI 1.8, 8.0). Only 2/70 (2.9%) EOPD patients carried pathogenic parkin or PINK1 mutations and the clinical differences between early and late onset disease were not explained by the presence of mutations in these genes. DISCUSSION: This study highlights the clinical differences between early and late onset PD, which have important implications for diagnosis and management. |
| spellingShingle | Wickremaratchi, M Knipe, MD Sastry, B Morgan, E Jones, A Salmon, R Weiser, R Moran, M Davies, D Ebenezer, L Raha, S Robertson, N Butler, C Ben-Shlomo, Y Morris, H The motor phenotype of Parkinson's disease in relation to age at onset. |
| title | The motor phenotype of Parkinson's disease in relation to age at onset. |
| title_full | The motor phenotype of Parkinson's disease in relation to age at onset. |
| title_fullStr | The motor phenotype of Parkinson's disease in relation to age at onset. |
| title_full_unstemmed | The motor phenotype of Parkinson's disease in relation to age at onset. |
| title_short | The motor phenotype of Parkinson's disease in relation to age at onset. |
| title_sort | motor phenotype of parkinson s disease in relation to age at onset |
| work_keys_str_mv | AT wickremaratchim themotorphenotypeofparkinsonsdiseaseinrelationtoageatonset AT knipemd themotorphenotypeofparkinsonsdiseaseinrelationtoageatonset AT sastryb themotorphenotypeofparkinsonsdiseaseinrelationtoageatonset AT morgane themotorphenotypeofparkinsonsdiseaseinrelationtoageatonset AT jonesa themotorphenotypeofparkinsonsdiseaseinrelationtoageatonset AT salmonr themotorphenotypeofparkinsonsdiseaseinrelationtoageatonset AT weiserr themotorphenotypeofparkinsonsdiseaseinrelationtoageatonset AT moranm themotorphenotypeofparkinsonsdiseaseinrelationtoageatonset AT daviesd themotorphenotypeofparkinsonsdiseaseinrelationtoageatonset AT ebenezerl themotorphenotypeofparkinsonsdiseaseinrelationtoageatonset AT rahas themotorphenotypeofparkinsonsdiseaseinrelationtoageatonset AT robertsonn themotorphenotypeofparkinsonsdiseaseinrelationtoageatonset AT butlerc themotorphenotypeofparkinsonsdiseaseinrelationtoageatonset AT benshlomoy themotorphenotypeofparkinsonsdiseaseinrelationtoageatonset AT morrish themotorphenotypeofparkinsonsdiseaseinrelationtoageatonset AT wickremaratchim motorphenotypeofparkinsonsdiseaseinrelationtoageatonset AT knipemd motorphenotypeofparkinsonsdiseaseinrelationtoageatonset AT sastryb motorphenotypeofparkinsonsdiseaseinrelationtoageatonset AT morgane motorphenotypeofparkinsonsdiseaseinrelationtoageatonset AT jonesa motorphenotypeofparkinsonsdiseaseinrelationtoageatonset AT salmonr motorphenotypeofparkinsonsdiseaseinrelationtoageatonset AT weiserr motorphenotypeofparkinsonsdiseaseinrelationtoageatonset AT moranm motorphenotypeofparkinsonsdiseaseinrelationtoageatonset AT daviesd motorphenotypeofparkinsonsdiseaseinrelationtoageatonset AT ebenezerl motorphenotypeofparkinsonsdiseaseinrelationtoageatonset AT rahas motorphenotypeofparkinsonsdiseaseinrelationtoageatonset AT robertsonn motorphenotypeofparkinsonsdiseaseinrelationtoageatonset AT butlerc motorphenotypeofparkinsonsdiseaseinrelationtoageatonset AT benshlomoy motorphenotypeofparkinsonsdiseaseinrelationtoageatonset AT morrish motorphenotypeofparkinsonsdiseaseinrelationtoageatonset |