Amantadine treatment is an independent predictor of improved survival in Parkinson's disease

被引:130
作者
Uitti, RJ
Rajput, AH
Ahlskog, JE
Offord, KP
Schroeder, DR
Ho, MM
Prasad, M
Rajput, A
Basran, P
机构
[1] UNIV SASKATCHEWAN, DEPT MED, SASKATOON, SK S7N 0W0, CANADA
[2] UNIV SASKATCHEWAN, MOVEMENT DISORDERS CTR, SASKATOON, SK, CANADA
[3] MAYO CLIN & MAYO FDN, DEPT NEUROL, ROCHESTER, MN 55905 USA
[4] MAYO CLIN & MAYO FDN, DEPT HLTH SCI RES, ROCHESTER, MN 55905 USA
[5] UNIV IOWA, DEPT NEUROL, IOWA CITY, IA 52242 USA
关键词
D O I
10.1212/WNL.46.6.1551
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Amantadine has been used for more than 20 years in the symptomatic treatment of Parkinson's disease (PD). Several recent discoveries suggest that amantadine could also have a neuroprotective effect in PD. We studied survival in all parkinsonism (including PD and other parkinsonian syndromes) patients attending a single clinic, employing standard survival curves and a Cox regression model, to identify independent predictive variables for survival (while taking into account factors potentially associated with both outcome and treatment selection). Amantadine-treated patients (n = 250) were similar to the patients not treated with amantadine (n = 586) in terms of age, gender, type of parkinsonism, Hoehn and Yahr stage and dementia status at initial neurological visit. Amantadine use was an independent predictor of improved survival (p < 0.01). Improved survival was also associated with a higher 10-year expected survival (based on age, gender, and birth year), absence of dementia, type of parkinsonism = PD, and low Hoehn and Yahr stage (I or II) at initial neurologic visit (all p < 0.01); these additional factors occurred in statistically similar proportions in the groups that were and were not treated with amantadine. The association of improved survival with amantadine use may stem from symptomatic benefit or may reflect a ''neuroprotective'' effect, mediated through N-methyl-D-aspartate (NMDA) receptor antagonism, dopamine uptake blockade activity, or other mechanisms. Our preliminary findings suggest that a prospective, controlled, randomized trial of amantadine's effects on PD progression is warranted.
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页码:1551 / 1556
页数:6
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