Death in Parkinson’s Disease

This article was written at the request of a Parkinson’s patient who wanted to know how patients die from PD.

Most patients die with Parkinson’s Disease and not from it. The illnesses that kill most people are the same as those that kill people with PD. These are heart conditions, stroke and cancer. As we age we become increasingly aware that more than one bad thing can happen to our bodies.

Two areas in which Parkinson’s Disease may bring about death.

I. Falls

PD patients are at an increased risk of falling and bad falls can lead to death. This usually occurs as a complication of a fall that requires hospitalization, particularly if it involves surgery. While most people do not fracture their hips when they fall, some do, and hip surgery, while routine, is still major surgery. It carries the risk of infection, delirium related to pain medications and anesthesia, heart failure, pneumonia, blood clots in the legs that then go to the lungs, and general weakness from immobility. Hip fractures are probably the main cause for death for those who fall, but people can fracture other bones and require surgery. They may fracture their ribs, which leads to reduced coughing, because of the pain, and an increased risk of lung infections (pneumonia). It is surprisingly uncommon for Parkinson’s Disease patients to die from brain injuries related to falls, but it still may occur.

II. Pneumonia

Pneumonia used to be called “the old man’s friend,” because it was thought to be a painless way for an old person to die. It still is as painless a way to go as any. People with Parkinson’s Disease are at risk for aspiration pneumonias. “Aspiration” means that something was “inspired” or breathed in. This refers to food or liquid going “the wrong way” down the windpipe. Because Parkinson’s Disease patients often have swallowing problems, there is an increased tendency for this to happen, and because Parkinson’s Disease patients don’t cough as strongly as they used to, they cannot always cough up the material they aspirated. When this happens, some liquid or food particles remain behind in the lung, where they may set up an infection. Infections in the lungs are called pneumonias. Pneumonias are harder to treat in Parkinson’s Disease patients because their coughing is weak. Many pneumoniae produce purulent material which needs to be coughed up and out. Failure to completely clear the lungs of this “gunk” makes it more difficult to clear the infection.

PD patients also may develop pneumonias completely unrelated to difficulties with swallowing, just like their non-PD friends and relatives.

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