The association between parkinsonism, Alzheimer's disease, and mortality: A comprehensive approach

BACKGROUND: The impact of parkinsonism on survival in older persons independent of dementia is not well understood. METHODS: Participants in the clinical examination of the Canadian Study of Health and Aging who had parkinsonism and were older than age 65 were identified. The impact of parkinsonism on 5-year survival was determined for a combined cohort with and without dementia, and a stratified analysis was then conducted for the subgroups with Alzheimer's disease (AD) and those without dementia. Subjects with a previous diagnosis of Parkinson's disease and those prescribed drugs causing extrapyramidal side effects were excluded. FINDINGS: A total of 721 subjects with AD and 1705 subjects without dementia were examined. After adjusting for age and residential status (community vs institution), parkinsonism was associated with poorer survival in the combined cohort (risk ratio 1.51; 95% CI, 1.22-1.85), in those with AD (risk ratio 1.34; 95% CI, 1.02-1.76), and those without dementia (risk ratio 1.54; 95% CI, 1.11-2.15). In the combined cohort, parkinsonism remained independently associated with higher mortality after adjusting for AD status (risk ratio 1.39; 95% CI, 1.13-1.72). In the subgroup with AD, parkinsonism remained associated with poorer survival after adjusting for severity of cognitive impairment (risk ratio 1.33; 95% CI. 1.04-1.74). INTERPRETATION: Parkinsonism is significantly associated with poorer survival in older persons, regardless of whether they have dementia.