Mortality rate, main causes of death and factors associated with higher mortality hazard in late stage Parkinson's disease

Background A cohort of 107 patients in late stage Parkinson's disease (PD) was followed for a decade. Objective To assess mortality rate, main causes of death and factors associated with higher mortality hazard. Methods Late stage PD was defined as Hoehn and Yahr IV-V in “on” or ≤ 50% independency in activities of daily living (ADL). Medical records and mortality records were used to obtain data on mortality. Results After three years from baseline, 52 (54%) of the participants were alive, after five years 30 (31%) and after seven years 14 (15%). The most common main cause of death was aspiration pneumonia (34%), followed by sepsis (16%), unspecified pneumonia (13%), ileus (5%) and Covid-19 (5%). Baseline variables significantly associated with higher mortality hazard were worse ADL independency ( P < 0.001), worse Hoehn and Yahr stage ( P < 0.001), worse motor function ( P < 0.001), worse cognition ( P < 0.001) higher age ( P = 0.005), worse perceptual problems/hallucinations ( P = 0.020) and having moved to a nursing home ( P = 0.021). In a multivariable model, worse motor function ( P = 0.001), worse depressive symptoms ( P = 0.023) and worse cognition ( P = 0.042). Conclusions The present end-of-life data provide enhanced knowledge on factors associated with higher mortality hazard in late stage PD. As aspiration pneumonia is the most common cause of death in PD worldwide and swallowing difficulties with the risk of aspiration are common in late stage PD, enhanced focus on prevention and treatment is essential. This may contribute to a better understanding of and care for late stage PD.