Older Age, Low Physical Activity Linked with Faster Motor Decline
Better treatment for symptoms, preventing immobility may improve patients' quality of life
An older age at diagnosis, but also reduced physical activity due to medical or social conditions, were significantly linked with faster motor decline in people with Parkinson’s disease, a Japanese study has found.
According to its authors, maintaining daily physical activity and allowing patients to move freely is paramount to improving their quality of life and delaying motor decline.
The study “Time Taken for and Causes of a Decline to Hoehn and Yahr Stage 5 in Patients with Parkinson’s Disease” was published in Internal Medicine.
Parkinson’s disease is marked mainly by motor symptoms such as involuntary tremor (shaking), stiff muscles, and slow movement. Older age at diagnosis is usually linked with worse motor impairment and disability.
Researchers in Japan investigated the relationship between age at disease onset and motor decline as well as the causes for progressive motor impairment. They sought to determine if age could be used as predictive factor for motor decline.
A total of 123 Parkinson’s patients (80 women and 43 men, mean age 69.3 at disease onset) followed between April 2015 and December 2020 at the Okayama Kyokuto Hospital, Japan were included.
All had clinical data available since their early disease stages and all had reached score five in the Hoehn and Yahr scale for more than three months. The Hoehn and Yahr scale is a common tool to evaluate Parkinson’s symptoms’ progress and disability level. It ranges from a score of one to five with higher scores meaning worse disability. A score of five indicates the need to use a wheelchair or being bedridden unless assisted.
The analysis revealed that older age at disease onset was significantly correlated with a faster motor decline, with patients reaching the maximum score in the Hoehn and Yahr scale sooner. Patients diagnosed at age 50 took around 20 years to reach stage five, while 80-year-old patients took six years.
A lower systolic blood pressure – the force the heart exerts on the walls of the arteries each time it beats – on standing was linked with the time to reach stage five of the Hoehn and Yahr scale (HY5). Despite men being significantly younger at Parkinson’s diagnosis and at the maximum stage of Hoehn and Yahr scale than women, no significant differences were seen between sexes relative to the time to reach this stage.
Patients with postural instability gait disturbance — usually referred to as PIGD — were significantly older at disease onset and showed a tendency to reach HY5 faster when compared to those with tremors only.
Of the 123 patients, 49 (39.8%) said Parkinson’s natural progression led them to need a wheelchair or become bedridden.
Thirty-two patients (26%) declined to HY5 after hospitalization due to other issues (e.g., pneumonia, depression, and stroke), while 25 (20.3%) reported a locomotive disorder as the cause for their decline to HY5.
Relocating to a nursing home was the factor pointed by nine patients (7.3%) to HY5 progression. Eight patients (6.5%) reported other conditions that reduced their physical activity as the cause to HY5 progression.
Besides an older age “several physical and social factors causing reduced physical activity or immobilization were found to accelerate motor decline,” the researchers wrote. “Optimized treatment for PD [Parkinson’s disease] symptoms, prevention of conditions that may result in immobilization, maintenance of daily physical activity, and provision of a safe environment for patients with PD to move actively and independently may improve the quality of life of patients with PD and prolong the time until they become bed- ridden.”