This study indicated that the frequency of emergency admittance is not dependent on the duration of PD. According to assumed PD progress in years, we had expected more frequent emergency admittances. This could be explained by three factors; first, only major problems (ie, cerebrovascular accident, hip fracture) require admittance to the emergency department; second, late stage PD patients’ minor problems are managed at home or caregiving centers by professional visits; and third, the psychological ignorance of caregiving families.
In patients with PD, progressive postural instability causing frequent falls is common. These falls may result in severe head and bodily injury, such as hip fractures. Another problem in late disease is dysphagia leading to aspiration pneumonia or asphyxation. Autonomic dysfunction is also a fairly common cause leading to orthostatic hypotension, bowel and bladder dysfunction. Constipation, fecal impaction, and urinary tract infections are common problems at the later stages of disease. Orthostatic hypotension is not only a disease-related but also a treatment-related disorder. The disease-related component is correlated with disease duration. The treatment-related component is a result of tendency of dopaminergic medications to decrease blood pressure that should be kept in mind (Factor et al 2000
The H&Y score is not dependent on the time passed from the onset of PD, at least in our patients. This is also reflected in our study: the H&Y score is not correlated with the emergency admittance, regarding reason, and outcome parameters. In the study by Giladi and colleagues (2001)
festinating gait (FSG), which can be the main reason for falls and fractures, was strongly associated with the H&Y score and progressed disease as a result, but not with disease severity evaluated by UPDRS. In this study, longer disease duration had been found to be the only clinical factor to be associated with FSG, but not the whole picture. A study by Sato and colleagues (2006)
concluded that early onset PD patients showed a longer duration to reach stage III, IV, and V in H&Y scale, which may be another clue that disease duration and motor disability are not always related.
Emergency admittances of patients with PD are not dependent on their primary disease, but it is indirectly dependent regarding the process of PD. Our study population consisted of clearly defined PD patients and had been evaluated before and after emergency admissions regarding their PD, which was unique. The pioneering reasons for emergency admittance defined in our study was similar to a study done by Woodford and colleagues (2005)
. In a study by Temlett and colleagues (2006)
, it was concluded that complications of the later stages of PD and associated treatments are more likely to lead to hospital admission than management of the primary motor disease, which is similar to what we have found in our study as H&Y scores are not dependant to emergency admissions.
The trauma, cerebrovascular accident and cerebrovascular stroke risks of the patients are not dependent on the patients’ PD stage (by H&Y scale) and the treatment at the ED. In Derejko’s study (2006)
cardiovascular risk factors had been studied and found not significantly related with motor disability.
The patients with PD start to take medications on a proper schedule when they are in need of caregiving, but this medication does not make any meaningful difference in the frequency of emergency admittance. Meanwhile we cannot predict this for the early stages.
There are unique points we observed in our study. First, the H&Y scale is not dependent on the disease duration and emergency admittance. Second, the motor disability by itself cannot predict the whole picture of PD and the systemic complications leading to emergency admittance.
Limitations of the study
The former H&Y scores which were obtained retrospectively from the files of patients’ were performed by another neurologist and not by the authors of this study.