Parkinson's Disease in the Very Old - Clinicopathological Observations

Background:The incidence of Parkinson syndrome (PS) increases dramatically after age 80 years. As the number of the very old (>80 years) is rising in the population, the number of PS cases would increase. In the general population the most common variant of PS is the Parkinson's disease (PD). PD is characterized by marked loss of substantia nigra neurons and Lewy Body (LB) inclusions. All the pathological variants of PS in the elderly however remain unknown. The objective of this study was to determine the frequency of different PS variants and their course in the elderly individuals. Results:We studied 30 PS cases that had onset age >80 years and came to autopsy between 1968 and 2015. Autopsy study was performed by certified neuropathologists. 21 of 30 cases had PD as the only movement disorder, two more patients had PD plus another movement disorder. Detailed analysis of 21 PD only cases revealed that mode of onset was the upper limb tremor, which is similar to the PD cases of all ages. They all improved on levodopa, as do most PD patients. Compared to younger onset PD cases, there was higher incidence of stroke and dementia in this age group. But stroke was not the cause of PD. The motor disability was more rapid than in the younger onset PD cases. We recommend that all elderly persons that have a clinical diagnosis of PS or PD should be treated with levodopa.