“Frailty” in patients with Parkinsonian Spectrum Disorders: an observation from a tertiary care teaching hospital

Patients with movement disorders are in a pre-frail state due to the physical limitation or reduction in tolerance to physical stress. The study was conducted in the Department of Neurology of a tertiary care teaching hospital in Northern-east Rajasthan with 50 patients. Inclusion criteria: patients with parkinsonian features aged >18 years; and willing to give consent regarding participation in the study. Exclusion criteria: patients with age <18 years; not willing to participate in the study; and exclusion of alternative diagnosis. Frailty and pre-frailty states were assessed using the Fried’s criteria. Modified Frailty Index (MFI) was used to classify it as mild, moderate, and severe. Unified Parkinson's Disease Rating Scale (UPDRS), Multisystem Atrophy Rating Scale (MSARS), and Progressive Supranuclear Palsy Rating Scale (PSPRS) were used for respective disorders. The data was compiled using an MS Excel sheet, and SPSS 20 was used for statistical analysis. Thirty-nine patients fulfilled the criteria for “frailty-phenotype”; only 9 were “pre-frail”, and 2 were non-frail. On the MFI, patients with atypical parkinsonism had severe frailty with a mean index score of 0.54, where the mean scores were higher in the progressive supranuclear palsy (PSP) group (0.57) than in the multisystem atrophy (MSA) group (0.5). Patients with idiopathic Parkinson’s disease (IPD) had mild to moderate frailty with a mean score of 0.29 (Range 0.17-0.51). With a higher UPDRS score, the frailty index score in IPD patients was also higher, as was PSPRS in patients with PSP and UMSARS in patients with MSA. The mean MMSE score was also lower in the group with a higher frailty index. The levodopa dose requirement was higher in the frail group than in the non-frail or prefrail group (125mg/day vs. 625mg/day; p<0.05). Frailty is part and parcel of neurodegenerative movement disorders, including movement disorders, and adds to the burden of disease.