Progression of Parkinson's disease as evaluated by Hoehn and Yahr stage transition times

Authors

  • Ying Jiao Zhao BSc,

    1. Department of Pharmacy, National University of Singapore, Republic of Singapore
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  • Hwee Lin Wee PhD,

    1. Department of Pharmacy, National University of Singapore, Republic of Singapore
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  • Yiong-Huak Chan PhD,

    1. Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Republic of Singapore
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  • Soo Hoon Seah,

    1. Parkinson's Disease and Movement Disorders Center, Department of Neurology, National Neuroscience Institute, Republic of Singapore, USA, National Parkinson Foundation International Centre of Excellence
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  • Wing Lok Au FRCP,

    1. Parkinson's Disease and Movement Disorders Center, Department of Neurology, National Neuroscience Institute, Republic of Singapore, USA, National Parkinson Foundation International Centre of Excellence
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  • Puay Ngoh Lau BHSc,

    1. Parkinson's Disease and Movement Disorders Center, Department of Neurology, National Neuroscience Institute, Republic of Singapore, USA, National Parkinson Foundation International Centre of Excellence
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  • Emmanuel Camara Pica MD,

    1. Parkinson's Disease and Movement Disorders Center, Department of Neurology, National Neuroscience Institute, Republic of Singapore, USA, National Parkinson Foundation International Centre of Excellence
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  • Shu Chuen Li PhD,

    1. Discipline of Pharmacy & Experimental Pharmacology, School of Biomedical Sciences, University of Newcastle, Australia
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  • Nan Luo PhD,

    1. Department of Epidemiology and Public Health, National University of Singapore, Republic of Singapore
    2. Centre for Health Services Research, National University of Singapore, Republic of Singapore
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  • Louis C.S. Tan FRCP

    Corresponding author
    1. Parkinson's Disease and Movement Disorders Center, Department of Neurology, National Neuroscience Institute, Republic of Singapore, USA, National Parkinson Foundation International Centre of Excellence
    • National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore 308433
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  • Potential conflict of interest: Nothing to report.

Abstract

This study was carried out to evaluate progression in Parkinson's disease (PD) by analyzing time taken to transit from one Hoehn and Yahr (H&Y) stage to the next stage and to investigate the variables that would be associated with H&Y transition times using a large PD database that contained prospectively collected information. Data were obtained from the movement disorder database of the National Neuroscience Institute in Singapore. Kaplan-Meier (KM) survival analysis was adopted to investigate the time taken to progress through various H&Y stages. Cox regression analysis was used to examine the association between the baseline variables at the entry point of each H&Y stage and the progression to the next stage. A total of 695 patients (mean age: 65.2, male: 57.3%) were studied. Using KM analysis, the median time taken to transit from H&Y stage 1 to 2, 2 to 2.5, 2.5 to 3 were 20, 62, and 25 months, respectively; whereas the median time taken to progress from stage 3 to 4 and 4 to 5 were 24 and 26 months, respectively. Cox regression analysis revealed that older age-at-diagnosis, longer PD duration, and higher Unified Parkinson's Disease Rating Scale (UPDRS) motor scores at baseline were associated with a significantly faster progression through various H&Y stages. Gender and ethnicity were not associated with disease progression. In conclusion, H&Y transition time is a useful measure of disease progression in PD and may be utilized in clinical studies evaluating therapeutic interventions and prognostic factors in PD. © 2010 Movement Disorder Society

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