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Future Parkinson Disease Stage May Be Predictable by Present Low HRQOL


This follow-up study of patients first analyzed 10 years ago sought to determine if health-related quality of life (HRQOL) was still a reliable predictor of Parkinson disease severity, especially at it relates to Hoehn-Yahr stage increase.

Low health-related quality of life (HRQOL) appears to remain a reliable predictor of disease severity for individuals with Parkinson disease (PD), according to a new study from Japan published in Neurology.

“Previous longitudinal studies of such are very limited,” the authors wrote.

This follow-up study focused on patients who all had Hoehn-Yahr stage III PD 10 years ago. During that original investigation, fall predictors—walking speed, step number, and step time—for 30 patients were determined via originally designed narrow paths, with the authors concluding that higher step totals may indicate a “greater risk for an upgrade of Hoehn-Yahr stage in a 6-year period.”

For the present study, patients were divided into 2 groups, based on progression or not in Hoehn-Yahr stage, with multiple logistic regression analysis adjusting for age and disease duration and 36-item Short-Form Health Survey (SF-36) scores at the 2-, 4-, 6-, and 8-year marks indicating HRQOL.

At baseline, the mean (SD) patient age was 68.3 (7.0) years, mean (SD) disease duration was 85.4 (69.2) months, half had a history of falling, the mean (SD) SF-36 score was 61.1 (19.6), and mean (SD) levodopa equivalent dose (LED) was 390.3 (245.0) mg/d.

Overall, SF-36 scores at 2, 4, 6, and 8 years after the first study, as well as Tinetti balance, motor complication, step number, and LED at 2, 4, 6, and 10 years, respectively, significantly varied between those with and without a Hoehn-Yahr stage increase. In addition, following single logistic regression analysis, significant correlations were seen for Hoehn-Yahr stage increase were seen and the following:

  • 2-year Tinetti balance (P = .047) and SF-36 score (P = .014)
  • 4-year motor complication (P = .04) and SF-36 score (P = .019)
  • 6-year step number (P = .03) and SF-36 score (P = .012)
  • 8-year SF-36 score (P= .016)

After adjusting for age and disease duration, multiple logistic regression analysis produced these results:

  • SF-36 score at 2 years (odds ratio [OR], 1.112; 95% CI, 1.012-1.223; P = 0.028)
  • SF-36 score at 4 years (OR, 1.066; 95% CI, 1.002-1.135; P = 0.045)
  • SF-36 score at 6 years (OR, 1.074; 95% CI, 1.010-1.142; P = 0.023)
  • SF-36 score at 8 years (OR, 1.109; 95% CI, 1.012-1.214; P = 0.026)

For this study at 2, 4, 6, 8, and 10 years, data were available on 28, 27, 26, 24, and 22 patients respectively. Every 2 years, the numbers of those who progressed to a higher Hoehn-Yahr stage increased: 21.4% at 2 years, 25.9% at 4 years, 53.8% at 6 years, 62.5% at 8 years, and 68.1% at 10 years.

“This study found out that HRQOL, as measured by SF-36, was a significant predictor of the upgrade of Hoehn-Yahr stage in 10 years,” the authors concluded. “The lower HRQOL, particularly in social functioning, may reflect the severity of both motor and nonmotor symptoms.”

Limitations to generalizability of their findings include that SF-36 was not developed specifically for patients with PD and the 30-patient sample size, while strengths include that the SF-36 has proved effective at monitoring population health and evaluating treatment effects.


Kataoka H, Sugie K. Health-related quality of life may predict disease staging in 10 years in Parkinson disease with Hoehn-Yahr stage III. Neurol Clin Pract.2021;11(3):e261-e266. doi:10.1212/CPJ.0000000000000924

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