Schrag, Anette; (2000) The epidemiology of parkinsonism. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

This thesis is concerned with the descriptive epidemiology of parkinsonism with a particular emphasis on the differentiation of parkinsonian disorders. The areas investigated were the population prevalence of different parkinsonian disorders, the accuracy of their diagnosis in the community, and the clinical characteristics and natural history of Parkinson's disease (PD) in a population-based sample, including quality of life (QoL). The age-adjusted prevalence rates of MSA was 4.4, of PSP 6.4, and of PD 168 per 100,000. At least 15% of patients with a diagnosis of PD in the general population were misdiagnosed, and, conversely, approximately 20% of patients were unrecognised to have PD. The most disabling problems in the population of patients with PD in the community were disease severity, depression and dementia. Unfavourable prognostic factors were older age at onset and development of dementia. The rates of motor complications in PD increased with disease duration and severity, but were also related to dose of levodopa and duration of levodopa treatment. Depression in patients with PD was associated with advancing disease severity and disability. However, it was also strongly influenced by the patients' own perceptions of their handicap rather than being simply the result of objective impairment. This study also found evidence for the existence of different subtypes of PD. Factors associated with a faster rate of progression but a lower rate of motor fluctuations were older age at onset, older current age and presence of dementia. PD in this community-based sample of patients interfered with various aspects of QoL, particularly with those related to physical and social functioning, whereby depression, disability, postural instability and cognitive impairment had the greatest influence on QoL. The generic instrument EQ-5D was demonstrated to be a feasible and valid instrument to measure QoL in PD that reflects severity and complications of disease.

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