Parkinson’s patients who see a neurologist may live longer

A study of more than 100,000 people with Parkinson’s disease has found that they may live longer if they see a neurologist for specialized care for their condition.

Researchers at Washington University School of Medicine in St. Louis also found that Parkinson’s patients seeing a neurologist were less likely to be placed in a nursing home or to break a hip. The findings are reported online in the journal Neurology.

Allison Willis

Lead author Allison Wright Willis, MD, assistant professor of neurology, conducted the study by analyzing data on every patient on Medicare in 2002 with a new diagnosis of Parkinson’s disease. Of these 138,000 patients, 58 percent were seen by a neurologist between 2002-05. The rest relied on primary-care physicians for treatment.

“To improve the quality of life for people with Parkinson’s and also to minimize any avoidable health-care costs, we need to understand how access to care affects their health outcomes,” Willis says. “The benefit to people with Parkinson’s disease and their families of avoiding an outcome like a hip fracture or delaying the need for nursing home placement is immeasurable.”

In the six years following diagnosis, patients receiving care from a neurologist were 20 percent less likely to die than those seeing general practitioners. They were also 20 percent less likely to be placed in a nursing home and 14 percent less likely to break a hip.

“One possible explanation for this effect, not proven by the data in our paper, is that neurologists manage Parkinson’s disease more often and have more experience dealing with the disorder and the medications used to treat it,” Willis says.

Willis also speculates that additional experience dealing with Parkinson’s may help neurologists prevent or better manage Parkinson’s complications such as psychosis, fainting, thinking problems and infections, which are more common as Parkinson’s progresses.

When she examined the gender and ethnicity of the Parkinson’s disease patients, Willis found that women were 22 percent less likely than men to see a neurologist, and minorities were 17 percent less likely to see a neurologist than Caucasians.

She emphasizes, though, that discrimination may not be at the root of these differences, noting that her analysis did not consider severity of disease.

“There’s evidence that estrogen receptors in the brain, which are more common in women, can protect the part of the brain harmed by Parkinson’s disease,” she says. “Other studies have shown that having more melanin in the skin also protects against Parkinson’s disease. So women and non-whites could easily have milder forms of disease that make them more comfortable seeing a general practitioner.”

To develop a fuller understanding of the benefits conveyed by seeing a neurologist, Willis and her colleagues plan follow-up studies of the complications that afflict Parkinson’s patients near the end of life. They will be looking to see if patients who see a neurologist are less likely to develop these complications.

“We also soon will be starting a nationwide prospective study to determine the optimal care pathways for Parkinson’s patients,” she says. “We will try to learn if it’s best for patients to see a neurologist from the time Parkinson’s symptoms start or only in later stages when other conditions are present.”

Willis AW, Schootman M, Evanoff BA, Perlmutter JS, Racette BA. Neurologist care in Parkinson’s disease: a utilization, outcomes, and survival study. Neurology, online Aug. 10, 2011.

The study was supported by the National Institutes of Health (NIH), the National Center for Research Resources, the Roadmap for Medical Research, the American Parkinson Disease Association and its St. Louis chapter, Walter and Connie Donius, and the Robert Renschen Fund.

Washington University School of Medicine’s 2,100 employed and volunteer faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children’s hospitals. The School of Medicine is one of the leading medical research, teaching and patient care institutions in the nation, currently ranked fourth in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children’s hospitals, the School of Medicine is linked to BJC HealthCare.