Examining Frailty Risk in Patients With Parkinson Disease

Patients with Parkinson disease (PD) who are female and have more significant depression and disease severity were associated with greater frailty, according to study findings published in the Canadian Geriatrics Journal.

Although frailty does not have a consensus definition, the researchers note there are 2 approaches to quantifying the condition:

• A phenotype model by Linda P. Fried and fellow authors defines frailty as the presence of 3 or more of 5 symptoms: weakness, weight loss, slow walking speed,  fatigue, and low physical activity
• An alternative approach by Kenneth Rockwood and Arnold Mitniski measures acquired deficits of symptoms, diseases, and disability to describe an overall frailty burden
  

Speaking on the implications of frailty for patients with PD, frailty is a common multisystem disorder in older people that results in increased vulnerability to stressors, similar to PD, which can lead to increased risk of negative outcomes such as impaired quality of life and mortality.

“The pathophysiology of frailty is not fully understood, but it is thought that chronic inflammation and immune system activation result in multisystem dysfunction affecting the musculoskeletal, endocrine, hematological, and cardiovascular systems,” expanded the study authors.

With few studies having described the impact of frailty in people with PD, the researchers sought to identify its prevalence in these populations, as well as those at greatest risk who would most benefit from therapeutic interventions.

Collecting data as part of the double-blind, randomized, controlled ReSPonD trial on 130 people with low- to midstage idiopathic PD, identified as stage 2 and 3 on the Hoehn and Yahr scale, all participants had fallen in the year prior, could walk 18 meters unaided, and had been stable on anti-Parkinsonian medication for 2 weeks prior to enrollment.

Utilizing the 5-symptom criteria developed by Fried et al, participants’ frailty status was determined at baseline and at a 32-week follow-up visit. A score of 3 or more features was defined as frailty, with the presence of 1 or 2 factors indicated as pre-frailty.

Participants were additionally assessed for disease severity via the Movement Disorders Society Unified Parkinson’s Disease Rating Scale (MDS-UPDRS; range, 0-265) and for depression via the Geriatric Depression Scale (range, 0-15), with higher scores on both scales indicating greater severity of symptoms.

At the 8-month follow-up, data were gathered on 120 patients:

• Mean (SD) age was 70.2 (8.0) years
• MDS-UPDRS total score was 91.5 (29.1)
• MDS-UPDRS motor score (Part III) was 42.7 (14.8)
• Median disease duration was 9.2 years (interquartile range [IQR], 4.6-13.1)
• Geriatric Depression score was 4 (IQR, 2-6)

Based on Fried et al’s frailty criteria, 31 (26%) patients were frail and 70 (58%) were pre-frail. Those associated with higher number of frailty markers, as identified by ordinal regression in the multivariable model, included being female (odds ratio [OR], 3.10; 95% CI, 1.53-6.26; P = .002), having a higher total MDS-UPDRS score (OR, 2.02; 95% CI, 1.42-2.87; P < .0001), and having a higher Geriatric Depression score (OR, 1.47; 95% CI, 1.05-2.06; P = .03).

The univariable analysis also identified these groups as being at greater risk for frailty.

In concluding, the researchers say that future research should determine the optimal tool to assess frailty in at-risk populations and better delineate the association between PD, frailty, and health outcomes.

Reference

Smith N, Gaunt DM, Whone A, Ben-Shlomo Y, Henderson EJ. The association between frailty and Parkinson’s disease in the ReSPOnD trial. Can Geriatr J. Published online February 18, 2021. doi:10.5770/cgj.24.437