The association between frailty and Parkinson’s disease in the ReSPOnD trial

Abstract

Background: Frailty and Parkinson’s disease (PD) are both highly prevalent in older people, but few studies have studied frailty in people with Parkinson’s. Identifying frailty in this population is vital, to target new interventions to those who would most benefit.

Methods:  Data were collected as part of the double-blind randomised controlled rivastigmine to stabilise gait ReSPonD trial in 130 people with Hoehn and Yahr 2-3, idiopathic PD who had fallen in the year prior to enrolment.  Individuals were assessed at baseline and followed up at 8 months, including determination of frailty status.    

Results: 120 patients attended for follow-up.  At follow-up, the mean (SD) age was 70.2 years (8.0) and MDS-UPDRS total score 91.5 (29.1). Median disease duration was 9.2 years (IQR 4.6 to 13.1), Geriatric Depression Score 4 (IQR 2 to 6). Using the Fried frailty criteria, 31 (26%) were frail and 70 (58%) pre-frail.  In univariable analysis, being female, higher depression score and MDS-UPDRS score was associated with greater frailty. Using ordinal regression, in the multivariable model, being female (Odds ratio [OR] 3.10, 95%CI 1.53 to 6.26, p=0.002), higher total MDS-UPDRS score (OR 2.02, 95%CI 1.42 to 2.87, p<0.0001) and higher depression (OR 1.47, 95%CI 1.05 to 2.06, p=0.03) were associated with higher number of frailty markers.

Conclusion: There was a high prevalence (84%) of pre-frail and frail individuals in patients participating in this RCT. Future research should determine the optimum tool to assess frailty in this at-risk population and delineate the association between Parkinson’s, frailty and health outcomes.