Frailty in prodromal Parkinson's disease in Medicare beneficiaries

Authors

George K. Karway, Department of Neurology, Barrow Neurological Institute, 240 W. Thomas Road, Phoenix, AZ, 85013, USA. Electronic address: George.Karway@barrowneuro.org.
Jordan A. Killion, Department of Neurology, Barrow Neurological Institute, 240 W. Thomas Road, Phoenix, AZ, 85013, USA. Electronic address: Jordan.Killion@barrowneuro.org.
Irene M. Faust, Department of Neurology, Barrow Neurological Institute, 240 W. Thomas Road, Phoenix, AZ, 85013, USA. Electronic address: Irene.Faust@barrowneuro.org.
Kassu M. Beyene, Department of Neurology, Barrow Neurological Institute, 240 W. Thomas Road, Phoenix, AZ, 85013, USA. Electronic address: Kassu.Beyene@barrowneuro.org.
Brad A. Racette, Department of Neurology, Barrow Neurological Institute, 240 W. Thomas Road, Phoenix, AZ, 85013, USA; Department of Neurology, Washington University in St. Louis, St. Louis, 660 S. Euclid Avenue, Campus Box 8111, St. Louis, MO, 63110, USA; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 27 St Andrews Road, Parktown, 2193, South Africa. Electronic address: Brad.Racette@Barrowneuro.org.
Alejandra Camacho-Soto, Department of Physical Medicine and Rehabilitation, University of Kansas Medical Center, 4000 Cambridge Street, Kansas City, KS, 66160, USA. Electronic address: acamacho-soto@kumc.edu.

Document Type

Article

Abstract

INTRODUCTION: Frailty, a common syndrome of aging associated with a decline in physiological reserve, places individuals with Parkinson's disease (PD) at a greater risk of poor health outcomes. We hypothesized that frailty would also be greater in prodromal PD patients compared to the general population and, thus, could be part of the prodromal phase of PD. METHODS: We conducted a population-based case-control study of incident PD cases (N = 82,560) and controls (N = 96,482) ages 70-90 identified in 2009. Using 2004-2009 Medicare data, we examined frailty in five individual 12-month time windows during the prodromal period using the claims-based frailty index (CFI), categorized as nonfrail, mildly frail, and moderately-to-severely frail. For each time window, we calculated the odds ratios (ORs) and 95 % confidence intervals (CIs) for the association between frailty and PD, while adjusting for age, sex, race/ethnicity, and use of care. We examined variables in CFI that were associated with PD in the 12 months prior to diagnosis. RESULTS: Mildly frail (OR = 1.70, 95 % CI 1.62-1.78) and moderately-to-severely frail (OR = 1.29, 95 % CI 1.16-1.43) were associated with PD five years prior to diagnosis. This association strengthened in the final year prior to diagnosis: mildly frail (OR = 7.75, 95 % CI 7.51-7.99); moderately-to-severely frail (OR = 10.22, 95 % CI 9.63-10.86). In the 12 months prior to PD diagnosis, the CFI variable encompassing psychiatric/cognitive disorders had the most marked association with PD (OR = 4.63, 95 % CI 4.50-4.77). CONCLUSIONS: Medicare beneficiaries with PD are frailer than controls in the prodromal period. Frailty was highest in the 12 months prior to PD diagnosis.

Medical Subject Headings

Humans; Parkinson Disease (epidemiology, diagnosis); Aged; Male; Female; United States (epidemiology); Prodromal Symptoms; Aged, 80 and over; Medicare (statistics & numerical data); Case-Control Studies; Frailty (epidemiology)

Publication Date

9-1-2025

Publication Title

Parkinsonism & related disorders

E-ISSN

1873-5126

Volume

138

First Page

107965

PubMed ID

40714659

Digital Object Identifier (DOI)

10.1016/j.parkreldis.2025.107965

Recommended Citation

Karway, George K.; Killion, Jordan A.; Faust, Irene M.; Beyene, Kassu M.; Racette, Brad A.; and Camacho-Soto, Alejandra, "Frailty in prodromal Parkinson's disease in Medicare beneficiaries" (2025). Neurology. 2026.
https://scholar.barrowneuro.org/neurology/2026