Abstract:
Parkinson's disease (PD) is a common progressive neurodegenerative disorder. During the early stage of the illness, patients tend to tolerate pharmacologic agents well and can undergo rehabilitation, and sometimes, deep brain stimulation. However, as the severity of the disease worsens, the status of patients deteriorates and hospitalization rates increase due to motor and non-motor symptoms as well as systemic disorders. Hospitalization leads to an increase in healthcare costs.
The highest healthcare costs associated with PD are suggested to be drug costs and costs related to hospital admissions. Studies describing hospitalization in patients with PD showed that up to 99% of admissions were emergency admissions. Common reasons for emergency admissions were infectious diseases, including aspiration pneumonia, urinary tract infection, and others. Other major reasons included falls with or without bone fracture, psychiatric symptoms, medication control, and systemic disorders.
One study estimated that approximately £200 million per year were spent on emergency admissions for patients with PD in the United Kingdom, and costs for admissions increased with patient age]. Few studies, however, have focused on emergency admissions for patients with PD, and no studies have provided a detailed clinical course of patients during their hospitalization.
This hospital-based study was conducted in consecutive series of patients with PD who were admitted to our department on an emergency basis over the past six years and discuss the characteristics and prognosis of these patients.
Objective
Parkinson's disease (PD) is a progressive neurodegenerative disease. As the severity of disease worsens, patients have lower tolerance for treatments and occasionally need to be hospitalized. This study focuses on characteristics of patients with PD who were emergently admitted to our hospital and evaluates their prognosis during hospitalization.
Methods
Hospital-based study on emergency admission was conducted in a consecutive series of patients with PD between April 2009 and March 2015.
Results
A total of 164 admissions involving 136 patients with PD with available medical records were identified. Among these, 40 admissions involving 38 patients were emergency admissions. The most common cause of hospitalization was aspiration pneumonia (n=17) followed by parkinsonism hyperpyrexia syndrome (n=6), cerebrovascular disease (n = 2), dehydration (n = 2), and others (n = 13). The mean Hoehn and Yahr stage at admission and discharge were 3.5 and 4.2, respectively, with significant differences between time points (p b 0.001). All patients except one presented with either postural instability gait difficulty phenotype (PIGD) or mixed phenotype with PIGD and tremor. All 17 patients with aspiration pneumonia had various combinations of three components: abnormalities seen on videofluoroscopy swallowing study, cognitive impairment, and history of psychiatric symptoms.
Conclusion
Aspiration pneumonia was the most common reason for emergency admission in patients afflicted with PD for more than five years. Abnormalities seen in videofluoroscopy, PIGD and mixed phenotypes, cognitive impairment, and history of psychiatric symptoms could potentially be predictors for aspiration pneumonia in patients with PD.
