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The Epidemiology of Parkinson's Disease: A Case-Control Study of Young-Onset and Old-Onset Patients

The Epidemiology of Parkinson's Disease: A Case-Control Study of Young-Onset and Old-Onset Patients Abstract • While the cause of Parkinson's disease (PD) remains unknown, recent evidence suggests that certain external factors, ie, environmental agents, may act as neurotoxins, initiating the chain of oxidative reactions that ultimately destroy neurons in the substantia nigra. Young-onset PD might result from greater exposure to a putative neurotoxin. This hypothesis has rekindled interest in the epidemiology of PD. We therefore conducted a detailed analysis of various environmental exposures and early life experiences in 80 patients with old-onset PD (at an age older than 60 years), 69 young-onset patients (younger than 40 years), and 149 age- and sex-matched control subjects. Contrary to previous reports, we were unable to implicate well water or exposure to herbicides, pesticides, or industrial toxins as significant PD risk factors. A residential history of rural living was reported by more patient cases than control subjects and was marginally significant. On the other hand, at least one episode of head trauma "severe enough to cause vertigo, dizziness, blurred or double vision, seizures or convulsions, transient memory loss, personality changes, or paralysis" occurred significantly more often prior to disease onset in patients with both young-onset and old-onset PD than in control subjects (odds ratio=2.7). When adjusted for head trauma and rural living, smoking was inversely associated with PD, as has been previously reported (odds ratio=0.5). There were no significant differences in early life experiences or environmental exposures between young-onset and old-onset patients. We suggest that the risk of developing PD is influenced by a variety of factors. While we were unable to link specific environmental agents with PD, our study suggests that head trauma should be reassessed as a potential risk factor for PD. References 1. Calne DB, Langston WJ. Hypothesis: the aetiology of Parkinson's disease . Lancet . 1984;2:1457-1458. 2. Calne DB. Current concepts on the etiology of Parkinson's disease . Mov Disord . 1989;4( (suppl) ): S11-S14.Crossref 3. Burns RS, LeWitt PA, Ebert MH, et al. The clinical syndrome of striatal dopamine deficiency: parkinsonism induced by 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) . N Engl J Med . 1985;312:1418-1421.Crossref 4. Langston JW, Ballard P, Tetrud JW, et al. Chronic parkinsonism in humans due to a product of meperidine-analog synthesis . Science . 1983;219:9789-9790.Crossref 5. Parkinson Study Group. Effect of deprenyl on the progression of disability in early Parkinson's disease . N Engl J Med . 1989;213:1364-1371.Crossref 6. Koller W, Vetere-Overfield RN, Gray C, et al. Environmental risk factors in Parkinson's disease . Neurology . 1990;40:1218-1221.Crossref 7. Schoenberg BS. Environmental risk factors for Parkinson's disease: the epidemiologic evidence . Can J Neurol Sci . 1987;14:407-413. 8. Tanner CM. The role of environmental toxins in the etiology of Parkinson's disease . Trends Neurosci . 1989;12:49-54.Crossref 9. Koller WC, Dolezal J, Chin T, Hassanein RS, Weldon G. Environmental risk factors in Parkinson's disease . Neurology . 1989;39( (suppl) ):285. 10. Rajput AH, Uitti RJ, Stern W, et al. Early onset Parkinson's disease in Saskatchewan: environmental considerations for etiology . Can J Neurol Sci . 1986;13:212-216. 11. Tanner CM, Chen B, Wang W-Z, et al. Environmental factors in the etiology of Parkinson's disease . Can J Neurol Sci . 1987;14:419-423. 12. Kelsey JL, Thompson WD, Evans AS. Methods in Observational Epidemiology . New York, NY: Oxford University Press; 1986. 13. Breslow NE, Day NE. The Analysis of Case-Control Studies . Lyons, France: International Agency for Research on Cancer: 1980;1. Statistical Methods in Cancer Research. 14. Barbeau A, Roy M, Bernier G, et al. Ecogenetics of Parkinson's disease: prevalence and environmental aspects in rural areas . Can J Neurol Sci . 1987;14:36-41. 15. Barbeau A, Roy M, Cloutier T, et al. Environmental and genetic factors in aetiology of Parkinson's disease . Adv Neurol . 1986;45:299-306. 16. Lux WE, Kurtzke JF. Is Parkinson's disease acquired? Evidence from a geographic comparison with multiple sclerosis . Neurology . 1987;37:467-471.Crossref 17. Tanner CM, Chen B, Wang W-Z, et al. Environmental factors and Parkinson's disease: a case-control study in China . Neurology . 1989;39:660-664.Crossref 18. Ho SC, Woo J, Lee C-M. Epidemiologic study of Parkinson's disease in Hong Kong . Neurology . 1989;39:1314-1318.Crossref 19. Rajput AH, Uitti RJ, Stern W, et al. Geography, drinking water chemistry, pesticides and herbicides and the etiology of Parkinson's disease . Can J Neurol Sci . 1987;14:414-418. 20. Rajput AH, Vitti RJ. Paraquat and Parkinson's disease . Neurology . 1987;33:1820.Crossref 21. Meador KJ, Meador MP, Loring DS, et al. Neuroepidemiology of Parkinson's disease . Neurology . 1987;37( (suppl 1) ):120. 22. Bharucha NE, Stokes LS, Schoenberg BS, et al. A case-control study of twin pairs discordant for Parkinson's disease: a search for environmental risk factors . Neurology . 1986;36:284-288.Crossref 23. Wong G, Gray C, Koller W. Environmental factors in siblings with Parkinson's disease . Ann Neurol . 1989;26:162. 24. McGeer P, Itagaki S, Akiyama H, McGeer E. Rate of cell death in parkinsonism indicates active neuropathological process . Ann Neurol . 1988;24:574-576.Crossref 25. Scherman D, Desnos C, Darchen F, et al. Striatal dopamine deficiency in Parkinson's disease: role of aging . Ann Neurol . 1989;26:551-557.Crossref 26. Riederer P, Wuketich S. Time course of nigrostriatal degeneration in Parkinson's disease . J Neurol Transm . 1976;38:277-301.Crossref 27. Gibb WRG, Lees AJ. A comparison of clinical and pathological features of young- and old-onset Parkinson's disease . Neurology . 1988;38:1402-1406.Crossref 28. Baron JA. Cigarette smoking and Parkinson's disease . Neurology . 1986;36:1490-1496.Crossref 29. Aceto MD, Martin BR. Central actions of nicotine . Med Res Rev . 1982;2:43-62.Crossref 30. Balfour DJK. The effects of nicotine on brain neurotransmitter systems . In: Balfour DJK, ed. Nicotine and the Tobacco Smoking Habit . Oxford, England: Pergamon Press; 1984. 31. Lichtensteiger W, Hefti F, Felix D, et al. Stimulation of nigrostriatal dopamine neurones by nicotine . Neuropharmacology . 1982;21:963-968.Crossref 32. Clarke PBS, Hommer DW, Pert A, Skirboll LR. Electrophysiological actions of nicotine on substantia nigra single units . Br J Pharmacol . 1985;85:827-835.Crossref 33. Calne DB. Current views of Parkinson's disease . Can J Neurol Neurol Sci . 1983;10:11-15. 34. Testa B, Naylor R, Costall B, Jenner P, Marsden CD. Does an endogenous methylpyridinium analogue cause Parkinson's disease? J Pharm Pharmacol . 1985;37:679-680.Crossref 35. Golbe LI, Cody RA, Duvoisin RC. Smoking and Parkinson's disease: search for a dose-response relationship . Arch Neurol . 1986;43:774-778.Crossref 36. Rajput AH, Offord KP, Beard CM, Kurland LT. A case-control study of smoking habits, dementia, and other illnesses in idiopathic Parkinson's disease . Neurology . 1987;37:226-232.Crossref 37. Parkinson J. Essay on the Shaking Palsy . London, England: Whittingham and Rowland, for Sherwood, Neely and Jones; 1817. 38. Factor SA, Sanchez-Ramos J, Weiner WJ. Trauma as an etiology of parkinsonism: a historical review of the concept . Mov Disord . 1988;3:30-36.Crossref 39. Ward CD, Duvoisin RC, Luce SE, et al. Parkinson's disease in 65 pairs of twins and a set of quadruplets . Neurology . 1983;33:815-824.Crossref 40. Koller WC, Wong GF, Lang A. Post-traumatic movement disorders: review . Mov Disord . 1989;4:20-36.Crossref 41. Factor SA, Weiner WJ. Head trauma and Parkinson's disease . Mov Disord . 1990;5( (suppl) ):13.Crossref 42. Corsellis J, Burton C, Freeman-Browne D. The aftermath of boxing . Psychol Med . 1973;3:270-303.Crossref 43. Amaduci LA, Fratiglioni L, Rocca WA, et al. Risk factors for Alzheimer's disease (AD): a case-control study on an Italian population . Neurology . 1986;36:209-211.Crossref 44. French LR, Schuman LM, Mortimer JA, et al. A case-control study of dementia of the Alzheimer type . Am J Epidemiol . 1985;121:414-421. 45. Gallagher JP, Sanders M. Trauma and amyotrophic lateral sclerosis: a report of 78 patients . Acta Neurol Scand . 1987;75:145-150.Crossref 46. Sienko DG, Davis JP, Taylor JA, Brooks BR. Amyotrophic lateral sclerosis: a case-control study following detection of a cluster in a small Wisconsin community . Arch Neurol . 1990;47:38-41.Crossref 47. Roberts GW, Allsop D, Bruton C. The occult aftermath of boxing . J Neurol Neurosurg Psychiatry . 1990;53:373-378.Crossref 48. Rudelli R, Strom JO, Welch PT, et al. Posttraumatic premature Alzheimer's disease: neuropathologic findings and pathogenetic considerations . Arch Neurol . 1982;39:570-575.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Neurology American Medical Association

The Epidemiology of Parkinson's Disease: A Case-Control Study of Young-Onset and Old-Onset Patients

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Publisher
American Medical Association
Copyright
Copyright © 1991 American Medical Association. All Rights Reserved.
ISSN
0003-9942
eISSN
1538-3687
DOI
10.1001/archneur.1991.00530210029018
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Abstract

Abstract • While the cause of Parkinson's disease (PD) remains unknown, recent evidence suggests that certain external factors, ie, environmental agents, may act as neurotoxins, initiating the chain of oxidative reactions that ultimately destroy neurons in the substantia nigra. Young-onset PD might result from greater exposure to a putative neurotoxin. This hypothesis has rekindled interest in the epidemiology of PD. We therefore conducted a detailed analysis of various environmental exposures and early life experiences in 80 patients with old-onset PD (at an age older than 60 years), 69 young-onset patients (younger than 40 years), and 149 age- and sex-matched control subjects. Contrary to previous reports, we were unable to implicate well water or exposure to herbicides, pesticides, or industrial toxins as significant PD risk factors. A residential history of rural living was reported by more patient cases than control subjects and was marginally significant. On the other hand, at least one episode of head trauma "severe enough to cause vertigo, dizziness, blurred or double vision, seizures or convulsions, transient memory loss, personality changes, or paralysis" occurred significantly more often prior to disease onset in patients with both young-onset and old-onset PD than in control subjects (odds ratio=2.7). When adjusted for head trauma and rural living, smoking was inversely associated with PD, as has been previously reported (odds ratio=0.5). There were no significant differences in early life experiences or environmental exposures between young-onset and old-onset patients. We suggest that the risk of developing PD is influenced by a variety of factors. While we were unable to link specific environmental agents with PD, our study suggests that head trauma should be reassessed as a potential risk factor for PD. References 1. Calne DB, Langston WJ. Hypothesis: the aetiology of Parkinson's disease . Lancet . 1984;2:1457-1458. 2. Calne DB. Current concepts on the etiology of Parkinson's disease . Mov Disord . 1989;4( (suppl) ): S11-S14.Crossref 3. Burns RS, LeWitt PA, Ebert MH, et al. The clinical syndrome of striatal dopamine deficiency: parkinsonism induced by 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) . N Engl J Med . 1985;312:1418-1421.Crossref 4. Langston JW, Ballard P, Tetrud JW, et al. Chronic parkinsonism in humans due to a product of meperidine-analog synthesis . Science . 1983;219:9789-9790.Crossref 5. Parkinson Study Group. Effect of deprenyl on the progression of disability in early Parkinson's disease . N Engl J Med . 1989;213:1364-1371.Crossref 6. Koller W, Vetere-Overfield RN, Gray C, et al. Environmental risk factors in Parkinson's disease . Neurology . 1990;40:1218-1221.Crossref 7. Schoenberg BS. Environmental risk factors for Parkinson's disease: the epidemiologic evidence . Can J Neurol Sci . 1987;14:407-413. 8. Tanner CM. The role of environmental toxins in the etiology of Parkinson's disease . Trends Neurosci . 1989;12:49-54.Crossref 9. Koller WC, Dolezal J, Chin T, Hassanein RS, Weldon G. Environmental risk factors in Parkinson's disease . Neurology . 1989;39( (suppl) ):285. 10. Rajput AH, Uitti RJ, Stern W, et al. Early onset Parkinson's disease in Saskatchewan: environmental considerations for etiology . Can J Neurol Sci . 1986;13:212-216. 11. Tanner CM, Chen B, Wang W-Z, et al. Environmental factors in the etiology of Parkinson's disease . Can J Neurol Sci . 1987;14:419-423. 12. Kelsey JL, Thompson WD, Evans AS. Methods in Observational Epidemiology . New York, NY: Oxford University Press; 1986. 13. Breslow NE, Day NE. The Analysis of Case-Control Studies . Lyons, France: International Agency for Research on Cancer: 1980;1. Statistical Methods in Cancer Research. 14. Barbeau A, Roy M, Bernier G, et al. Ecogenetics of Parkinson's disease: prevalence and environmental aspects in rural areas . Can J Neurol Sci . 1987;14:36-41. 15. Barbeau A, Roy M, Cloutier T, et al. Environmental and genetic factors in aetiology of Parkinson's disease . Adv Neurol . 1986;45:299-306. 16. Lux WE, Kurtzke JF. Is Parkinson's disease acquired? Evidence from a geographic comparison with multiple sclerosis . Neurology . 1987;37:467-471.Crossref 17. Tanner CM, Chen B, Wang W-Z, et al. Environmental factors and Parkinson's disease: a case-control study in China . Neurology . 1989;39:660-664.Crossref 18. Ho SC, Woo J, Lee C-M. Epidemiologic study of Parkinson's disease in Hong Kong . Neurology . 1989;39:1314-1318.Crossref 19. Rajput AH, Uitti RJ, Stern W, et al. Geography, drinking water chemistry, pesticides and herbicides and the etiology of Parkinson's disease . Can J Neurol Sci . 1987;14:414-418. 20. Rajput AH, Vitti RJ. Paraquat and Parkinson's disease . Neurology . 1987;33:1820.Crossref 21. Meador KJ, Meador MP, Loring DS, et al. Neuroepidemiology of Parkinson's disease . Neurology . 1987;37( (suppl 1) ):120. 22. Bharucha NE, Stokes LS, Schoenberg BS, et al. A case-control study of twin pairs discordant for Parkinson's disease: a search for environmental risk factors . Neurology . 1986;36:284-288.Crossref 23. Wong G, Gray C, Koller W. Environmental factors in siblings with Parkinson's disease . Ann Neurol . 1989;26:162. 24. McGeer P, Itagaki S, Akiyama H, McGeer E. Rate of cell death in parkinsonism indicates active neuropathological process . Ann Neurol . 1988;24:574-576.Crossref 25. Scherman D, Desnos C, Darchen F, et al. Striatal dopamine deficiency in Parkinson's disease: role of aging . Ann Neurol . 1989;26:551-557.Crossref 26. Riederer P, Wuketich S. Time course of nigrostriatal degeneration in Parkinson's disease . J Neurol Transm . 1976;38:277-301.Crossref 27. Gibb WRG, Lees AJ. A comparison of clinical and pathological features of young- and old-onset Parkinson's disease . Neurology . 1988;38:1402-1406.Crossref 28. Baron JA. Cigarette smoking and Parkinson's disease . Neurology . 1986;36:1490-1496.Crossref 29. Aceto MD, Martin BR. Central actions of nicotine . Med Res Rev . 1982;2:43-62.Crossref 30. Balfour DJK. The effects of nicotine on brain neurotransmitter systems . In: Balfour DJK, ed. Nicotine and the Tobacco Smoking Habit . Oxford, England: Pergamon Press; 1984. 31. Lichtensteiger W, Hefti F, Felix D, et al. Stimulation of nigrostriatal dopamine neurones by nicotine . Neuropharmacology . 1982;21:963-968.Crossref 32. Clarke PBS, Hommer DW, Pert A, Skirboll LR. Electrophysiological actions of nicotine on substantia nigra single units . Br J Pharmacol . 1985;85:827-835.Crossref 33. Calne DB. Current views of Parkinson's disease . Can J Neurol Neurol Sci . 1983;10:11-15. 34. Testa B, Naylor R, Costall B, Jenner P, Marsden CD. Does an endogenous methylpyridinium analogue cause Parkinson's disease? J Pharm Pharmacol . 1985;37:679-680.Crossref 35. Golbe LI, Cody RA, Duvoisin RC. Smoking and Parkinson's disease: search for a dose-response relationship . Arch Neurol . 1986;43:774-778.Crossref 36. Rajput AH, Offord KP, Beard CM, Kurland LT. A case-control study of smoking habits, dementia, and other illnesses in idiopathic Parkinson's disease . Neurology . 1987;37:226-232.Crossref 37. Parkinson J. Essay on the Shaking Palsy . London, England: Whittingham and Rowland, for Sherwood, Neely and Jones; 1817. 38. Factor SA, Sanchez-Ramos J, Weiner WJ. Trauma as an etiology of parkinsonism: a historical review of the concept . Mov Disord . 1988;3:30-36.Crossref 39. Ward CD, Duvoisin RC, Luce SE, et al. Parkinson's disease in 65 pairs of twins and a set of quadruplets . Neurology . 1983;33:815-824.Crossref 40. Koller WC, Wong GF, Lang A. Post-traumatic movement disorders: review . Mov Disord . 1989;4:20-36.Crossref 41. Factor SA, Weiner WJ. Head trauma and Parkinson's disease . Mov Disord . 1990;5( (suppl) ):13.Crossref 42. Corsellis J, Burton C, Freeman-Browne D. The aftermath of boxing . Psychol Med . 1973;3:270-303.Crossref 43. Amaduci LA, Fratiglioni L, Rocca WA, et al. Risk factors for Alzheimer's disease (AD): a case-control study on an Italian population . Neurology . 1986;36:209-211.Crossref 44. French LR, Schuman LM, Mortimer JA, et al. A case-control study of dementia of the Alzheimer type . Am J Epidemiol . 1985;121:414-421. 45. Gallagher JP, Sanders M. Trauma and amyotrophic lateral sclerosis: a report of 78 patients . Acta Neurol Scand . 1987;75:145-150.Crossref 46. Sienko DG, Davis JP, Taylor JA, Brooks BR. Amyotrophic lateral sclerosis: a case-control study following detection of a cluster in a small Wisconsin community . Arch Neurol . 1990;47:38-41.Crossref 47. Roberts GW, Allsop D, Bruton C. The occult aftermath of boxing . J Neurol Neurosurg Psychiatry . 1990;53:373-378.Crossref 48. Rudelli R, Strom JO, Welch PT, et al. Posttraumatic premature Alzheimer's disease: neuropathologic findings and pathogenetic considerations . Arch Neurol . 1982;39:570-575.Crossref

Journal

Archives of NeurologyAmerican Medical Association

Published: Sep 1, 1991

References