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Prognosis and Neuropathologic Correlation of Clinical Subtypes of Parkinson Disease
De Pablo-Fernández E, Lees AJ, Holton JL, Warner TT.. JAMA neurology, 2019-04-01
Topic: Risk, prevention and care in population studies
Importance Clinical subtyping of Parkinson disease at diagnosis is useful in estimating disease course and survival. Severity and rate of progression of neuropathologies are important determinants of clinical Parkinson subtypes. Objective To provide longitudinal clinical disease-course data and neuropathologic correlation for newly proposed Parkinson disease subtypes. Design, setting, and participants Retrospective cohort study of consecutive patients with autopsy-confirmed Parkinson disease who were regularly seen throughout their disease course by hospital specialists in the United Kingdom and donated their brain at death to the Queen Square Brain Bank between January 2009 and December 2017. Patients with additional neuropathologic diagnoses, monogenic forms of parkinsonism, or insufficiently detailed clinical information were excluded. Based on severity of motor symptoms, rapid eye movement sleep behavior disorder, and autonomic and cognitive function at diagnosis, patients were classified adapting a subtyping classification into mild-motor predominant, intermediate, or diffuse malignant subtypes. Main outcomes and measures Time from diagnosis to disease milestones (recurrent falls, wheelchair dependence, dementia, and care home placement) and death were compared between subtypes, and their risk was estimated using Cox hazard regression models. Severity and distribution of Lewy pathology and Alzheimer disease-related pathology were assessed using staging systems. Results From a total of 146 patients, 111 patients were included (67 men [60.4%]; mean [SD] age at diagnosis, 62.5 [11.5] years). The diffuse malignant subtype had earlier development of milestones and reduced survival. Cox proportional hazard regression showed an increased adjusted risk of any disease milestone (hazard ratio, 10.90; 95% CI, 5.51-21.58; P Conclusions and relevance Parkinson clinical subtypes at diagnosis may estimate disease course and survival, which may be useful in providing a more accurate prognosis in individual patients in clinical practice and helping to stratify subgroups in clinical trials. Different severity and progression of neuropathologies are important determinants of Parkinson subtypes, and age at diagnosis should be included in future subtype classifications.
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APA 7th
De Pablo-Fernández, E., Lees, A. J., Holton, J. L., & Warner, T. T. (2019). Prognosis and Neuropathologic Correlation of Clinical Subtypes of Parkinson Disease. JAMA neurology. https://doi.org/10.1001/jamaneurol.2018.4377
Vancouver
De Pablo-Fernández E, Lees AJ, Holton JL, Warner TT. Prognosis and Neuropathologic Correlation of Clinical Subtypes of Parkinson Disease. JAMA neurology. 2019. doi:10.1001/jamaneurol.2018.4377. PMID: 30640364.
BibTeX
@article{depablofernandez2019-30640364,
author = {De Pablo-Fernández, E. and Lees, A. J. and Holton, J. L. and Warner, T. T.},
title = {{Prognosis and Neuropathologic Correlation of Clinical Subtypes of Parkinson Disease}},
journal = {JAMA neurology},
year = {2019},
doi = {10.1001/jamaneurol.2018.4377},
pmid = {30640364},
url = {https://doi.org/10.1001/jamaneurol.2018.4377}
}
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
Key findings
- Results From a total of 146 patients, 111 patients were included (67 men [60.4%]; mean [SD] age at diagnosis, 62.5 [11.5] years).
Why it matters
This retrospective cohort study of 111 patients with autopsy-confirmed Parkinson disease classified them into subtypes based on symptoms at diagnosis and compared disease milestones and death between subtypes. It does not report anything about treating, curing, or preventing Alzheimer's disease.
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Study details
- Study designcohort study
- Participants146
- Effect size60.4%
- Evidence strengthModerate
How this study scored 68/100
Published in a leading specialty journal, and it is a cohort study following people over time. Scored zero for randomized / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 9 / 10 | Tier 2 — leading specialty journal (JAMA neurology) |
| Journal's citation record | 2 / 4 | JAMA Neurology: journal h-index 235 (OpenAlex, 2026-10-29) |
| Study design | 7 / 12 | A cohort study following people over time |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 2 / 5 | 2019 — within 10 year(s) of the newest study here |
| Sample size | 2 / 4 | 146 participants |
| Effect reported | 2 / 3 | Effect reported as a number, without an interval or test |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomized / blinded | 0 / 2 | No randomization or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 6 / 7 | Cited 333 times (OpenAlex, 2026-10-10) |
| Citations per year | 4 / 5 | 37.0 citations a year over 9 year(s) since 2019 |
| Impact for its field and year | 5 / 6 | Cited 24.3× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 2 / 6 | Cited by 6 other studies in this library |
| Still being cited | 3 / 4 | Cited 120 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 3 / 4 | Last-listed author Thomas T. Warner: h-index 73 (OpenAlex, whole career) |
| Institution's track record | 2 / 3 | University College London: institution h-index 2,029 (OpenAlex) |
| Multicenter collaboration | 1 / 3 | OpenAlex lists 3 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 30640364) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 68 / 100 | — |
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Read the original
- DOI: 10.1001/jamaneurol.2018.4377
- PubMed: 30640364
- Original source →
- Free full text: JAMA Neurology →
Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).
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