Objective: To describe differences in sociodemographic and clinical profiles between patients with Parkinson’s disease (PD) who remain at Hoehn and Yahr (HY) stage 1–2 up to 15 years from diagnosis versus those who progress to HY stage 3–5.

Background: PD is characterized by bradykinesia, rigidity, and resting tremor. Though clinical experience confirms that some patients with PD progress more slowly than others, the factors underlying this variability are not well understood. We aim to identify demographic characteristics and medication exposures associated with progression in PD.

Method: We performed a retrospective longitudinal chart review of patients diagnosed with PD and who had at least 15 years of follow-up in our clinic. Patients were included if their initial HY stage was 1 or 2. Data collected from the visits included demographic information, HY stage, smoking status, and medication use. Slow progression was defined as patients who either (1) did not progress to HY stage 3–5 during follow-up or (2) progressed to HY stage 3–5 after more than 15 years. The comparison group consisted of patients with normal or fast progression, defined as progression from HY stage 1–2 to stage 3–5 within 15 years.

Results: We identified 884 patients who had been followed at RUMC for at least 10 years since 2011, when our electronic medical record became active. Patients without HY data and those with an initial documented HY stage of 3–5 were excluded. Among the remaining 657 patients with an initial HY stage of 1 or 2, 388 (59.1%) were classified as having no/slow progression and 269 (40.9%) as having normal/fast progression. Among patients in the slow progression group who progressed to HY stage 3–5 after more than 15 years, the median time to HY stage 3 was 19.0 years. In the normal/fast progression group, the median time to HY stage 3 was 9.0 years. There were significant differences between groups in age at diagnosis (p<0.001) and smoking status (p<0.05). In our cohort, memantine (OR 2.2, CI 1.2 – 4.0, p=0.01) and melatonin (OR 1.7, CI 1.08–2.65, p=0.02) were associated with a higher risk of progression.

Conclusion: In this retrospective cohort, melatonin and memantine use were associated with a higher risk of PD progression, although comorbidities such as dementia and REM sleep behavioral disorder potentially prompting the use of these drugs may influence this relationship, warranting further investigation.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/describing-factors-associated-with-progression-in-parkinsons-disease-a-retrospective-chart-review/