XXXX with old-age onset: a comparative study with subjects with middle-age onset.

@entity1 @entity2003 @entity146 @entity73 @entity191 @entity2845 @entity400 @entity717
BACKGROUND: To our knowledge, no prior study has focused on subjects with @entity191 ( @entity191 ) with elderly disease onset, and there is little evidence-based knowledge of treatment outcomes in these @entity1 . OBJECTIVE: To compare the clinical presentation, comorbidities, treatment, and evolution of @entity191 in @entity1 with old-age onset with those of @entity1 with middle-age onset in one US university center. DESIGN: In the Rush @entity717 Database, we retrieved 43 @entity1 with @entity191 with onset at 78 years or older. By using a case-control design, we assigned each @entity1 with old-age @entity191 onset 1 (n = 5) or 2 (n = 38) @entity1 with middle-age @entity191 onset, matched for disease duration but with disease onset between the ages of 43 and 66 years. We compared the groups on several clinical measures using conditional logistic regression. RESULTS: At a comparable length of @entity191 duration (mean, 5.1 years for @entity1 with old-age @entity191 onset and 5.5 years for @entity1 with middle-age @entity191 onset), the total Unified @entity191 Rating Scale motor score was significantly higher in those with old-age @entity191 onset than in those with middle-age @entity191 onset (33.3 vs 21.2; P<.001). The @entity1 with old-age onset had higher scores for @entity2003 (5.2 vs 4.3; P =.03), @entity2845 (13.0 vs 9.6; P =.001), and @entity73 (12.8 vs 5.2; P<.001), but not for @entity400 (2.2 vs 2.0; P =.68). They were more likely to have at least one comorbid condition compared with @entity1 with middle-age onset (24 [56%] of 43 @entity1 vs 20 [25%] of 81 @entity1 ; P =.002), but even when adjusting for comorbidities, they still maintained higher motor scores than controls. When treating @entity1 with old-age @entity191 onset, clinicians used levodopa monotherapy more frequently than in @entity1 with middle-age @entity191 onset (34 @entity1 [79%] vs 16 @entity1 [20%]; P<.001), and agonists were prescribed less frequently (5 @entity1 [12%] vs 29 @entity1 [36%]; P =.005). CONCLUSIONS: At the same disease duration, @entity1 with old-age @entity191 onset have greater motor impairment than @entity1 with middle-age @entity191 onset. This difference may be due to more rapid disease progression, less @entity146 or less potent medical treatment, the elderly age of the subjects with old-age @entity191 onset at study end independent of disease onset, or yet-to-be elucidated influences of comorbid conditions. Focused research on old-age @entity191 onset is important to delineate the confounding influences of aging and comorbidities and to establish the safety and efficacy of new treatments for this group of @entity1 .
