Decreased Anti‐Parkinson's Therapy during Hospitalization due to Infectious Diseases is Associated with Worse Prognosis

Parkinson disease (PD) is a multisystem disease characterized with various motor and nonmotor symptoms [1]. Patients with PD are at increased risk for both pneumonia and urinary tract infections (UTI) [2] as a result of various autonomic abnormalities. Indeed, pneumonia and UTI are leading causes for PD patients’ hospitalizations, mainly during the advanced stages of disease [3]. Previous publications stressed that medication errors are common right after hospital admission and necessitated recommended frequent consultations with professional neurologists [4]. The investigators of this study hypothesized that patients with PD might have worse prognosis when hospitalized due to infections due to dopaminergic treatment under-dose. These assumptions were confirmed in a previous analysis of a smaller cohort [5]. The main clinical outcomes were in-hospital mortality and worse discharge destination after hospitalizations (defined as worse in any case that the patient arrived from home and was discharged to a nursing home, rehabilitation facility, or was referred to chronic hospitalization). This was a follow-up, retrospective study of consecutive PD patients diagnosed with either pneumonia, UTI, or both and hospitalized to internal medicine departments (IMD) in one large tertiary medical center through 2008–2013. The follow-up study doubled the patient population included in a previous publication [5]. All the data collected for this study was originally documented in the electronic medical record on patient’s admission, compiled into an electronic sheet and was analyzed by SAS (Ver. 9.1). The study was approved by the institutional ethics/review board (head, Prof D. Haratz). Patients had to fulfill the following inclusion criteria: (1) diagnosis of idiopathic Parkinson disease, (2) active dopaminergic therapy, prior to hospitalization, (3) over 30 years of age, and (4) hospitalized to IMD due to pneumonia, UTI, or both. Patients were excluded due to: (1) dementia, (2) active therapy, prior to hospitalization, with antipsychotic medications, (3) state post-deep brain stimulation or other cranial neurosurgical intervention, (4) other neurodegenerative diseases or extrapyramidal disorders, and (5) any degree of immune compromise. Anti-Parkinson drugs’ dosing was taken into account as follows: the L-dopa equivalent was calculated for each dose as previously published and was then summed in order to describe a daily dosage—the L-dopa equivalent daily dose (LEDD) [6]. LEDD reduction was evaluated using multivariate logistic regression with the aforementioned main clinical outcomes and was adjusted to potentially confounding parameters: (1) gender, (2) age, and (c) plasma creatinine levels. Statistical significance was assumed only when p values were lower than 0.05 in accord with confidence intervals of 95%, as generally accepted. The medical records of 1171 consecutive PD patients were reviewed. About 995 patients were excluded, 684 of which due to dementia. A total of 205 patients were included in our analysis, of which 107 (52.2%) were