Increased risk of parkinsonism among patients with cirrhosis: a 7-year follow-up study

Liver International
Early View (Articles online in advance of print)

Jiunn-Horng Kang 1,2,†, Ming-Chieh Tsai 3,4,†, Ching-Chun Lin 5, Hsiu-Li Lin 6, Herng-Ching Lin 5

Article first published online: 11 JAN 2011
DOI: 10.1111/j.1478-3231.2010.02432.x
© 2011 John Wiley & Sons A/S

Author Information
1 Neuroscience Research Center, Taipei Medical University Hospital, Taipei, Taiwan
2 School of Medicine, Taipei Medical University, Taipei, Taiwan
3 School of Health Care Administration, Taipei Medical University, Taipei, Taiwan
4 Department of Internal Medicine, Division of Gastroenterology, General Cathay Hospital, Sijhih Branch, Taipei, Taiwan
5 School of Health Care Administration, Taipei Medical University, Taipei, Taiwan
6 Department of Neurology, General Cathay Hospital, Sijhih Branch, Taipei, Taiwan
* Correspondence: Correspondence Herng-Ching Lin, School of Health Care Administration, Taipei Medical University, 250 Wu-Hsing St., Taipei 110, Taiwan Tel: +886 2 2736 1661x3613 Fax: +886 2 2378 9788 e-mail: henry11111@tmu.edu.tw

†* Contributed equally.

Keywords: cirrhosis;epidemiology;parkinsonism

Abstract

Background/Aims: Previous studies have suggested that hepatic (toxic-metabolic) encephalopathy, the major complication of cirrhosis, is a neuropsychiatric disorder typically seen in patients with liver dysfunction after exclusion of other known brain disease. This study aims to investigate the risk for parkinsonism during a 7-year follow-up period after a diagnosis of cirrhosis.

Methods: In total, 1361 patients with cirrhosis and 6805 comparison patients without cirrhosis were included in this study. Each patient was then individually tracked for 7 years from the time of their initial diagnosis of cirrhosis to identify those who developed parkinsonism during the follow-up period. Stratified Cox proportional hazard regressions were conducted to calculate the hazard of parkinsonism for the two groups during the follow-up period, after adjusting for patient's age, monthly income, level of urbanization and geographic location.

Results: Of the total 8166 sampled patients, 141 (1.7%) developed parkinsonism during the follow-up period, 48 from the study group (3.5% of the patients with cirrhosis) and 93 from the comparison group (1.4% of patients in the comparison group). Stratified Cox proportional hazard regressions show that the hazard for parkinsonism for patients with cirrhosis was 2.65 times as high (95% confidence interval=1.85–3.80, P<0.001) as the patients in the comparison group over the 7-year follow-up period, after adjusting for patient's age, monthly income, level of urbanization and the geographic location of the community in which the patient resided.

Conclusions: We concluded that cirrhosis significantly increased the risk of parkinsonism.

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