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Gardner RC, Burke JF, Nettiksimmons J, Goldman S, Tanner CM, Yaffe K. Traumatic brain injury in later life increases risk for Parkinson disease. Ann Neurol 2015; 77:987-95. [PMID: 25726936 DOI: 10.1002/ana.24396] [Citation(s) in RCA: 198] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 02/16/2015] [Accepted: 02/22/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Traumatic brain injury (TBI) is thought to be a risk factor for Parkinson disease (PD), but results are conflicting. Many studies do not account for confounding or reverse causation. We sought to address these concerns by quantifying risk of PD after TBI compared to non-TBI trauma (NTT; defined as fractures). METHODS Using inpatient/emergency department (ED) International Classification of Disease, Ninth Revision code data for California hospitals from 2005-2006, we identified patients aged ≥55 years with TBI (n = 52,393) or NTT (n = 113,406) and without baseline PD or dementia who survived hospitalization. Using Kaplan-Meier estimates and Cox proportional hazards models (adjusted for age, sex, race/ethnicity, income, comorbidities, health care use, and trauma severity), we estimated risk of PD after TBI during follow-up ending in 2011. We also assessed interaction with mechanism of injury (fall vs nonfall) and effect of TBI severity (mild vs moderate/severe) and TBI frequency (1 TBI vs >1 TBI). RESULTS TBI patients were significantly more likely to be diagnosed with PD compared to NTT patients (1.7% vs 1.1%, p < 0.001, adjusted hazard ratio [HR] = 1.44, 95% confidence interval [CI] = 1.31-1.58). Risk of PD was similar for TBI sustained via falls versus nonfalls (interaction p = 0.6). Assessment by TBI severity (mild TBI: HR = 1.24, 95% CI = 1.04-1.48; moderate/severe TBI: HR = 1.50, 95% CI = 1.35-1.66) and TBI frequency (1 TBI: HR = 1.45, 95% CI = 1.30-1.60; >1 TBI: HR = 1.87, 95% CI = 1.58-2.21) revealed a dose response. INTERPRETATION Among patients aged ≥55 years presenting to inpatient/ED settings with trauma, TBI is associated with a 44% increased risk of developing PD over 5 to 7 years that is unlikely to be due to confounding or reverse causation.
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Affiliation(s)
- Raquel C Gardner
- Department of Neurology, University of California, San Francisco, San Francisco, CA.,San Francisco Veterans Affairs Medical Center, San Francisco, CA
| | - James F Burke
- Department of Neurology, University of Michigan and Department of Veterans Affairs, VA Center for Clinical Management and Research, Ann Arbor VA Healthcare System, Ann Arbor, MI
| | - Jasmine Nettiksimmons
- San Francisco Veterans Affairs Medical Center, San Francisco, CA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
| | - Sam Goldman
- Department of Neurology, University of California, San Francisco, San Francisco, CA.,San Francisco Veterans Affairs Medical Center, San Francisco, CA
| | - Caroline M Tanner
- Department of Neurology, University of California, San Francisco, San Francisco, CA.,San Francisco Veterans Affairs Medical Center, San Francisco, CA
| | - Kristine Yaffe
- Department of Neurology, University of California, San Francisco, San Francisco, CA.,San Francisco Veterans Affairs Medical Center, San Francisco, CA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA.,Department of Psychiatry, University of California, San Francisco, San Francisco, CA
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Kenborg L, Rugbjerg K, Lee PC, Ravnskjær L, Christensen J, Ritz B, Lassen CF. Head injury and risk for Parkinson disease: results from a Danish case-control study. Neurology 2015; 84:1098-103. [PMID: 25681453 PMCID: PMC4371406 DOI: 10.1212/wnl.0000000000001362] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 09/29/2014] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To examine the association between head injuries throughout life and the risk for Parkinson disease (PD) in an interview-based case-control study. METHODS We identified 1,705 patients diagnosed with PD at 10 neurologic centers in Denmark in 1996-2009 and verified their diagnoses in medical records. Patients were matched to 1,785 controls randomly selected from the Danish Central Population Register on sex and year of birth. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using unconditional logistic regression. RESULTS We observed no association between any head injury before first cardinal symptom and PD (OR 1.02; 95% CI 0.88, 1.19). Examination of number of head injuries (1: OR 1.02; 95% CI 0.87, 1.20; ≥2: OR 1.03; 95% CI 0.72, 1.47) or hospitalization for a head injury (OR 0.89; 95% CI 0.70, 1.12) did not show an association with PD. For 954 study subjects with at least one head injury, there was no evidence of an association between loss of consciousness (OR 0.89; 95% CI 0.67, 1.17), duration of loss of consciousness (≤1 minute: OR 0.93; 95% CI 0.58, 1.49; 1-5 minutes: OR 0.74; 95% CI 0.51, 1.08; ≥5 minutes: OR 0.81; 95% CI 0.53, 1.24), or amnesia (OR 1.31; 95% CI 0.88, 1.95) and risk for PD. Application of a lag time of 10 years between head injury and first cardinal symptom resulted in similar risk estimates. CONCLUSIONS The results do not support the hypothesis that head injury increases the risk for PD.
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Affiliation(s)
- Line Kenborg
- From the Danish Cancer Society Research Center (L.K., K.R., L.R., J.C., C.F.L.), Danish Cancer Society, Copenhagen, Denmark; the Department of Epidemiology, Fielding School of Public Health (P.-C.L., B.R.), and the Department of Neurology, School of Medicine (B.R.), University of California, Los Angeles; the Department of Health Care Management (P.-C.L.), College of Healthcare Administration and Management, National Taipei University of Nursing Health Sciences, Taipei, Taiwan; and the Department of Occupational and Environmental Medicine (C.F.L.), Bispebjerg Hospital, Copenhagen, Denmark.
| | - Kathrine Rugbjerg
- From the Danish Cancer Society Research Center (L.K., K.R., L.R., J.C., C.F.L.), Danish Cancer Society, Copenhagen, Denmark; the Department of Epidemiology, Fielding School of Public Health (P.-C.L., B.R.), and the Department of Neurology, School of Medicine (B.R.), University of California, Los Angeles; the Department of Health Care Management (P.-C.L.), College of Healthcare Administration and Management, National Taipei University of Nursing Health Sciences, Taipei, Taiwan; and the Department of Occupational and Environmental Medicine (C.F.L.), Bispebjerg Hospital, Copenhagen, Denmark
| | - Pei-Chen Lee
- From the Danish Cancer Society Research Center (L.K., K.R., L.R., J.C., C.F.L.), Danish Cancer Society, Copenhagen, Denmark; the Department of Epidemiology, Fielding School of Public Health (P.-C.L., B.R.), and the Department of Neurology, School of Medicine (B.R.), University of California, Los Angeles; the Department of Health Care Management (P.-C.L.), College of Healthcare Administration and Management, National Taipei University of Nursing Health Sciences, Taipei, Taiwan; and the Department of Occupational and Environmental Medicine (C.F.L.), Bispebjerg Hospital, Copenhagen, Denmark
| | - Line Ravnskjær
- From the Danish Cancer Society Research Center (L.K., K.R., L.R., J.C., C.F.L.), Danish Cancer Society, Copenhagen, Denmark; the Department of Epidemiology, Fielding School of Public Health (P.-C.L., B.R.), and the Department of Neurology, School of Medicine (B.R.), University of California, Los Angeles; the Department of Health Care Management (P.-C.L.), College of Healthcare Administration and Management, National Taipei University of Nursing Health Sciences, Taipei, Taiwan; and the Department of Occupational and Environmental Medicine (C.F.L.), Bispebjerg Hospital, Copenhagen, Denmark
| | - Jane Christensen
- From the Danish Cancer Society Research Center (L.K., K.R., L.R., J.C., C.F.L.), Danish Cancer Society, Copenhagen, Denmark; the Department of Epidemiology, Fielding School of Public Health (P.-C.L., B.R.), and the Department of Neurology, School of Medicine (B.R.), University of California, Los Angeles; the Department of Health Care Management (P.-C.L.), College of Healthcare Administration and Management, National Taipei University of Nursing Health Sciences, Taipei, Taiwan; and the Department of Occupational and Environmental Medicine (C.F.L.), Bispebjerg Hospital, Copenhagen, Denmark
| | - Beate Ritz
- From the Danish Cancer Society Research Center (L.K., K.R., L.R., J.C., C.F.L.), Danish Cancer Society, Copenhagen, Denmark; the Department of Epidemiology, Fielding School of Public Health (P.-C.L., B.R.), and the Department of Neurology, School of Medicine (B.R.), University of California, Los Angeles; the Department of Health Care Management (P.-C.L.), College of Healthcare Administration and Management, National Taipei University of Nursing Health Sciences, Taipei, Taiwan; and the Department of Occupational and Environmental Medicine (C.F.L.), Bispebjerg Hospital, Copenhagen, Denmark
| | - Christina F Lassen
- From the Danish Cancer Society Research Center (L.K., K.R., L.R., J.C., C.F.L.), Danish Cancer Society, Copenhagen, Denmark; the Department of Epidemiology, Fielding School of Public Health (P.-C.L., B.R.), and the Department of Neurology, School of Medicine (B.R.), University of California, Los Angeles; the Department of Health Care Management (P.-C.L.), College of Healthcare Administration and Management, National Taipei University of Nursing Health Sciences, Taipei, Taiwan; and the Department of Occupational and Environmental Medicine (C.F.L.), Bispebjerg Hospital, Copenhagen, Denmark
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Gardner RC, Burke JF, Nettiksimmons J, Kaup A, Barnes DE, Yaffe K. Dementia risk after traumatic brain injury vs nonbrain trauma: the role of age and severity. JAMA Neurol 2015; 71:1490-7. [PMID: 25347255 DOI: 10.1001/jamaneurol.2014.2668] [Citation(s) in RCA: 308] [Impact Index Per Article: 34.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Epidemiologic evidence regarding the importance of traumatic brain injury (TBI) as a risk factor for dementia is conflicting. Few previous studies have used patients with non-TBI trauma (NTT) as controls to investigate the influence of age and TBI severity. OBJECTIVE To quantify the risk of dementia among adults with recent TBI compared with adults with NTT. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study was performed from January 1, 2005, through December 31, 2011 (follow-up, 5-7 years). All patients 55 years or older diagnosed as having TBI or NTT in 2005 and 2006 and who did not have baseline dementia or die during hospitalization (n = 164,661) were identified in a California statewide administrative health database of emergency department (ED) and inpatient visits. EXPOSURES Mild vs moderate to severe TBI diagnosed by Centers for Disease Control and Prevention criteria using International Classification of Diseases, Ninth Revision (ICD-9)codes, and NTT, defined as fractures excluding fractures of the head and neck, diagnosed using ICD-9 codes. MAIN OUTCOMES AND MEASURES Incident ED or inpatient diagnosis of dementia (using ICD-9 codes) 1 year or more after initial TBI or NTT. The association between TBI and risk of dementia was estimated using Cox proportional hazards models before and after adjusting for common dementia predictors and potential confounders. We also stratified by TBI severity and age category (55-64, 65-74, 75-84, and ≥85 years). RESULTS A total of 51,799 patients with trauma (31.5%) had TBI. Of these, 4361 (8.4%) developed dementia compared with 6610 patients with NTT (5.9%) (P < .001). We found that TBI was associated with increased dementia risk (hazard ratio [HR], 1.46; 95% CI, 1.41-1.52; P < .001). Adjustment for covariates had little effect except adjustment for age category (fully adjusted model HR, 1.26; 95% CI, 1.21-1.32; P < .001). In stratified adjusted analyses, moderate to severe TBI was associated with increased risk of dementia across all ages (age 55-64: HR, 1.72; 95% CI, 1.40-2.10; P < .001; vs age 65-74: HR, 1.46; 95% CI, 1.30-1.64; P < .001), whereas mild TBI may be a more important risk factor with increasing age (age 55-64: HR, 1.11; 95% CI, 0.80-1.53; P = .55; vs age 65-74: HR, 1.25; 95% CI, 1.04-1.51; P = .02; age interaction P < .001). CONCLUSIONS AND RELEVANCE Among patients evaluated in the ED or inpatient settings, those with moderate to severe TBI at 55 years or older or mild TBI at 65 years or older had an increased risk of developing dementia. Younger adults may be more resilient to the effects of recent mild TBI than older adults.
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Affiliation(s)
- Raquel C Gardner
- Memory and Aging Center, Department of Neurology, University of California, San Francisco2Department of Veterans Affairs, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - James F Burke
- Department of Neurology, University of Michigan, Ann Arbor4Department of Veterans Affairs, Veterans Affairs Center for Clinical Management and Research, Ann Arbor Veterans Affairs Healthcare System, Ann Arbor, Michigan
| | - Jasmine Nettiksimmons
- Department of Veterans Affairs, San Francisco Veterans Affairs Medical Center, San Francisco, California5Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Allison Kaup
- Department of Veterans Affairs, San Francisco Veterans Affairs Medical Center, San Francisco, California6Department of Psychiatry, University of California, San Francisco
| | - Deborah E Barnes
- Department of Veterans Affairs, San Francisco Veterans Affairs Medical Center, San Francisco, California5Department of Epidemiology and Biostatistics, University of California, San Francisco6Department of Psychiatry, University of California, San Francisc
| | - Kristine Yaffe
- Memory and Aging Center, Department of Neurology, University of California, San Francisco2Department of Veterans Affairs, San Francisco Veterans Affairs Medical Center, San Francisco, California5Department of Epidemiology and Biostatistics, University of
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Gardner RC, Yaffe K. Epidemiology of mild traumatic brain injury and neurodegenerative disease. Mol Cell Neurosci 2015; 66:75-80. [PMID: 25748121 DOI: 10.1016/j.mcn.2015.03.001] [Citation(s) in RCA: 400] [Impact Index Per Article: 44.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 02/25/2015] [Accepted: 03/02/2015] [Indexed: 12/14/2022] Open
Abstract
Every year an estimated 42 million people worldwide suffer a mild traumatic brain injury (MTBI) or concussion. More severe traumatic brain injury (TBI) is a well-established risk factor for a variety of neurodegenerative diseases including Alzheimer's disease, Parkinson's disease, and amyotrophic lateral sclerosis (ALS). Recently, large epidemiological studies have additionally identified MTBI as a risk factor for dementia. The role of MTBI in risk of PD or ALS is less well established. Repetitive MTBI and repetitive sub-concussive head trauma have been linked to increased risk for a variety of neurodegenerative diseases including chronic traumatic encephalopathy (CTE). CTE is a unique neurodegenerative tauopathy first described in boxers but more recently described in a variety of contact sport athletes, military veterans, and civilians exposed to repetitive MTBI. Studies of repetitive MTBI and CTE have been limited by referral bias, lack of consensus clinical criteria for CTE, challenges of quantifying MTBI exposure, and potential for confounding. The prevalence of CTE is unknown and the amount of MTBI or sub-concussive trauma exposure necessary to produce CTE is unclear. This review will summarize the current literature regarding the epidemiology of MTBI, post-TBI dementia and Parkinson's disease, and CTE while highlighting methodological challenges and critical future directions of research in this field. This article is part of a Special Issue entitled SI:Traumatic Brain Injury.
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Affiliation(s)
- Raquel C Gardner
- Department of Neurology, University of California San Francisco, CA, United States.
| | - Kristine Yaffe
- Department of Neurology, University of California San Francisco, CA, United States; San Francisco Veterans Affairs Medical Center, CA, United States; Departments of Epidemiology/Biostatistics and Psychiatry, University of California San Francisco, CA, United States
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Gao J, Liu R, Zhao E, Huang X, Nalls MA, Singleton AB, Chen H. Head injury, potential interaction with genes, and risk for Parkinson's disease. Parkinsonism Relat Disord 2015; 21:292-6. [PMID: 25603768 DOI: 10.1016/j.parkreldis.2014.12.033] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 11/25/2014] [Accepted: 12/31/2014] [Indexed: 01/13/2023]
Abstract
INTRODUCTION To evaluate the association between head injury and Parkinson's disease (PD), focusing on the timing of head injury, and to explore potential interactions between head injury and genetic factors in PD etiology. METHODS The analysis included 507 PD cases and 1330 controls, all non-Hispanic Whites. Head injury was retrospectively asked, and genotyping was performed mainly as part of a previous GWAS. RESULTS We found a positive association between head injury and PD risk. Compared with no previous head injury, the odds ratio (OR) was 1.39 (95% confidence interval [CI]: 1.00, 1.94) for one and 2.33 (95% CI: 1.25, 4.35) for two or more head injuries (P for trend = 0.0016). We further found that the higher risk was largely attributed to head injuries before age 30. Compared with no previous head injury, the OR was 2.04 (95% CI: 1.33, 3.14) for head injury that occurred before age 18, 1.39 (95% CI: 0.81, 2.36) for head injury between ages 18-<30, and 1.04 (95% CI: 0.58, 1.87) for head injury that occurred at age 30 or older (P for trend = 0.001). Exploratory interaction analyses showed a significant interaction between head injury and a SNP at the RBMS3 locus (rs10510622, uncorrected P = 0.0001). No interaction was found with GWAS tag SNPs at or near the MAPT, SNCA, LRRK2, and HLA loci. CONCLUSION Our study suggests that head injury early in life may be an important risk factor for PD. The potential interaction with RBMS3 needs confirmation.
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Affiliation(s)
- Jianjun Gao
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA.
| | - Rui Liu
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Edward Zhao
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Xuemei Huang
- Department of Neurology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Michael A Nalls
- Molecular Genetics Section, Laboratory of Neurogenetics, National Institute on Aging, Bethesda, MD, USA
| | - Andrew B Singleton
- Molecular Genetics Section, Laboratory of Neurogenetics, National Institute on Aging, Bethesda, MD, USA
| | - Honglei Chen
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA.
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Zou YM, Tan JP, Li N, Yang JS, Yu BC, Yu JM, Zhao YM, Wang LN. Do physical exercise and reading reduce the risk of Parkinson's disease? a cross-sectional study on factors associated with Parkinson's disease in elderly Chinese veterans. Neuropsychiatr Dis Treat 2015; 11:695-700. [PMID: 25834444 PMCID: PMC4370918 DOI: 10.2147/ndt.s79707] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The purpose of this study was to investigate risk factors for and factors protecting against Parkinson's disease (PD) in elderly Chinese veterans. METHODS Using a database containing detailed information on the health status of the nervous system in elderly Chinese veterans, univariate and multivariate analyses of factors that may be associated with PD were performed. Univariate analysis of qualitative data was done using the Pearson Chi-square and Fisher's exact tests, and the Mann-Whitney U nonparametric test was used for univariate analysis of quantitative data. Multivariate logistic regression analysis was used to identify independent risk factors for and factors protecting against PD in elderly Chinese veterans. RESULTS A total of 9,676 elderly Chinese veterans were enrolled, including 228 cases with PD and 183 cases with Parkinson's syndrome, with 9,265 non-PD subjects serving as controls. Age (odds ratio [OR] 1.343, 95% confidence interval [CI] 1.028-1.755) and medical history of essential tremor (OR 1.228, 95% CI 1.081-1.396) were identified as independent risk factors for PD, with age being the most important risk factor. Physical exercise (OR 0.478, 95% CI 0.355-0.643) and reading (OR 0.513, 95% CI 0.357-0.735) were identified as independent factors protecting against PD, and physical exercise showed better protection against PD relative to reading. Smoking, alcohol use, anemia, cerebral trauma, education level, and electromagnetic field exposure showed no association with PD. CONCLUSION Physical exercise and reading may be independent factors that protect against PD among elderly Chinese veterans, while advancing age and medical history of essential tremor may be independent risk factors for PD. This study was cross-sectional, so further research is needed to confirm its results.
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Affiliation(s)
- Y M Zou
- Department of Neurology, Huanhu Hospital, Tianjin, People's Republic of China
| | - J P Tan
- Department of Geriatric Neurology, Chinese PLA General Hospital, Peking University Third Hospital, Beijing, People's Republic of China
| | - N Li
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, People's Republic of China
| | - J S Yang
- Department of Neurology, General Hospital of Lanzhou Military Command, Lanzhou, People's Republic of China
| | - B C Yu
- Department of Gerontology, Bethune International Peace Hospital, Shijiazhuang, People's Republic of China
| | - J M Yu
- Department of Neurology, Chinese PLA 107 Hospital, Yantai, People's Republic of China
| | - Y M Zhao
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, People's Republic of China
| | - L N Wang
- Department of Geriatric Neurology, Chinese PLA General Hospital, Peking University Third Hospital, Beijing, People's Republic of China
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Abstract
Over the past few decades it has been recognized that traumatic brain injury may result in various movement disorders. In survivors of severe head injury, post-traumatic movement disorders were reported in about 20%, and they persisted in about 10% of patients. The most frequent persisting movement disorder in this population is kinetic cerebellar outflow tremor in about 9%, followed by dystonia in about 4%. While tremor is associated most frequently with cerebellar or mesencephalic lesions, patients with dystonia frequently have basal ganglia or thalamic lesions. Moderate or mild traumatic brain injury only rarely causes persistent post-traumatic movement disorders. It appears that the frequency of post-traumatic movement disorders overall has been declining which most likely is secondary to improved treatment of brain injury. In patients with disabling post-traumatic movement disorders which are refractory to medical treatment, stereotactic neurosurgery can provide long-lasting benefit. While in the past the primary option for severe kinetic tremor was thalamotomy and for dystonia thalamotomy or pallidotomy, today deep brain stimulation has become the preferred treatment. Parkinsonism is a rare consequence of single head injury, but repeated head injury such as seen in boxing can result in chronic encephalopathy with parkinsonian features. While there is still controversy whether or not head injury is a risk factor for the development of Parkinson's disease, recent studies indicate that genetic susceptibility might be relevant.
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Affiliation(s)
- Joachim K Krauss
- Department of Neurosurgery, Medical School Hannover, Hannover, Germany.
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Head trauma in sport and neurodegenerative disease: an issue whose time has come? Neurobiol Aging 2014; 36:1383-9. [PMID: 25725943 DOI: 10.1016/j.neurobiolaging.2014.12.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 12/22/2014] [Accepted: 12/23/2014] [Indexed: 12/13/2022]
Abstract
A number of small studies and anecdotal reports have been suggested that sports involving repeated head trauma may have long-term risks of neurodegenerative disease. There are now plausible mechanisms for these effects, and a recognition that these problems do not just occur in former boxers, but in a variety of sports involving repeated concussions, and possibly also in sports in which low-level head trauma is common. These neurodegenerative effects potentially include increased risks of impaired cognitive function and dementia, Parkinson's disease, and amyotrophic lateral sclerosis. Many would argue for taking a precautionary approach and immediately banning or restricting sports such as boxing. However, there are important public health issues in terms of how wide the net should be cast in terms of other sports, and what remedial measures could be taken? This in turn requires a major research effort involving both clinical and basic research to understand the underlying mechanisms, leading from head trauma to neurodegenerative disease and epidemiologic studies to assess the long-term consequences.
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Frandsen R, Kjellberg J, Ibsen R, Jennum P. Morbidity in early Parkinson's disease and prior to diagnosis. Brain Behav 2014; 4:446-52. [PMID: 24944873 PMCID: PMC4055194 DOI: 10.1002/brb3.228] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 03/05/2014] [Accepted: 03/13/2014] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Nonmotor symptoms are probably present prior to, early on, and following, a diagnosis of Parkinson's disease. Nonmotor symptoms may hold important information about the progression of Parkinson's disease. OBJECTIVE To evaluated the total early and prediagnostic morbidities in the 3 years before a hospital contact leading to a diagnosis of Parkinson's disease. METHODS Retrospective morbidity data from Danish National Patient Registry records (1997-2007) of 10,490 adult patients with a secondary care diagnosis of Parkinson's disease were compared with 42,505 control cases. RESULTS Parkinson's disease was associated with significantly higher morbidity rates associated with conditions in the following categories: mental and psychiatric, nervous system, gastrointestinal, musculoskeletal system and connective tissue, genitourinary, abnormal clinical and laboratory findings, injury, poisoning and certain other external causes, and other factors influencing health status and contact with health services. It was negatively associated with neoplasm, cardiovascular, and respiratory diseases. CONCLUSIONS Patients with a diagnosis of Parkinson's disease present significant differences in morbidities early on, following, and prior to, their diagnosis, compared with healthy controls.
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Affiliation(s)
- Rune Frandsen
- Department of Clinical Neurophysiology, Danish Center for Sleep Medicine, Glostrup Hospital Glostrup, Denmark
| | - Jakob Kjellberg
- Danish Institute for Health Services Research Copenhagen, Denmark
| | | | - Poul Jennum
- Department of Clinical Neurophysiology, Danish Center for Sleep Medicine, Glostrup Hospital Glostrup, Denmark ; Faculty of Health Sciences, Center for Healthy Aging, University of Copenhagen Copenhagen, Denmark
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Marras C, Hincapié CA, Kristman VL, Cancelliere C, Soklaridis S, Li A, Borg J, af Geijerstam JL, Cassidy JD. Systematic review of the risk of Parkinson's disease after mild traumatic brain injury: results of the International Collaboration on Mild Traumatic Brain Injury Prognosis. Arch Phys Med Rehabil 2014; 95:S238-44. [PMID: 24581909 DOI: 10.1016/j.apmr.2013.08.298] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2013] [Revised: 07/30/2013] [Accepted: 08/08/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To synthesize the best available evidence on the risk of Parkinson's disease (PD) after mild traumatic brain injury (MTBI). DATA SOURCES MEDLINE and other databases were searched (1990-2012) with terms including "craniocerebral trauma" and "parkinsonian disorders." Reference lists of eligible articles and relevant systematic reviews and meta-analyses were also searched. STUDY SELECTION Controlled clinical trials, cohort studies, and case-control studies were selected according to predefined criteria. Studies had to have a minimum of 30 concussion cases. DATA EXTRACTION Eligible studies were critically appraised using a modification of the Scottish Intercollegiate Guidelines Network criteria. Two reviewers independently reviewed and extracted data from accepted studies into evidence tables. DATA SYNTHESIS Evidence was synthesized qualitatively according to modified Scottish Intercollegiate Guidelines Network criteria. Sixty-five studies were eligible and reviewed, and 5 of these with a low risk of bias were accepted as scientifically admissible and form the basis of our findings. Among these admissible studies, the definitions of MTBI were highly heterogeneous. One study found a significant positive association between MTBI and PD (odds ratio, 1.5; 95% confidence interval, 1.4-1.7). The estimated odds ratio decreased with increasing latency between MTBI and PD diagnosis, which suggests reverse causality. The other 4 studies did not find a significant association. CONCLUSIONS The best available evidence argues against an important causal association between MTBI and PD. There are few high-quality studies on this topic. Prospective studies of long duration would address the limitations of recall of head injury and the possibility of reverse causation.
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Affiliation(s)
- Connie Marras
- Morton and Gloria Shulman Movement Disorders Centre, and the Edmond J. Safra Program in Parkinson's Research, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.
| | - Cesar A Hincapié
- Division of Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada; Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Vicki L Kristman
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Department of Health Sciences, Lakehead University, Thunder Bay, Ontario, Canada; Institute for Work and Health, Toronto, Ontario, Canada; Division of Human Sciences, Northern Ontario School of Medicine, Lakehead University, Thunder Bay, Ontario, Canada
| | - Carol Cancelliere
- Division of Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | | | - Alvin Li
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Jörgen Borg
- Department of Clinical Sciences, Rehabilitation Medicine, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden
| | - Jean-Luc af Geijerstam
- Department of Clinical Sciences, Rehabilitation Medicine, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden
| | - J David Cassidy
- Division of Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada; Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Institute of Sports Science and Clinical Biomechanics, Faculty of Health, University of Southern Denmark, Odense, Denmark
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61
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Wang HC, Lin CC, Lau CI, Chang A, Sung FC, Kao CH. Risk of accidental injuries amongst Parkinson disease patients. Eur J Neurol 2014; 21:907-13. [PMID: 24629012 DOI: 10.1111/ene.12410] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 02/07/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE To investigate the spectrum and risks of accidental injuries (AIs) amongst Parkinson disease (PD) patients. METHODS The participants comprised PD patients aged 50 years and older who were initially diagnosed between 2000 and 2009, and a comparison group of non-PD patients. The incidence rates of accidental injury types amongst PD and non-PD patients were calculated; hazard ratios were calculated and adjusted for comorbidities, using 95% confidence intervals (CIs) of developing such outcomes in PD patients. RESULTS In total, 4046 PD patients and 16 184 non-PD patients were followed over time. The PD patients demonstrated the following incidence rates and hazard ratios in comparison to the control cohort for accidental injuries: all injuries, 19.78 per 100 person-years (100 PYs), adjusted hazard ratio (HR) 1.30 (95% CI 1.24-1.36); head injury, 2.95 per 100 PYs, HR 1.88 (95% CI 1.64-2.15); bone fracture and dislocation, 4.61 per 100 PYs, HR 1.39 (95% CI 1.25-1.54); burns, 0.66 per 100 PYs, HR 1.01 (95% CI 0.78-1.32); injury to spinal cord, plexus and nerves, 0.15 per 100 PYs, HR 1.25 (95% CI 0.72-2.17); superficial injuries and contusions, 11.41 per 100 PYs, HR 1.20 (95% CI 1.12-1.27). The injury risk for the 69-79 years age group in PD compared with controls of the same age (HR 1.38) was significantly higher compared with that of the 50-69 age groups in PD and controls (HR 1.16). CONCLUSIONS Parkinson disease patients demonstrate a significantly elevated risk of developing all accidental injury types except burn injuries and injuries to spinal cord, plexus and nerves, compared with age-matched controls. The risk increases as age increases.
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Affiliation(s)
- H-C Wang
- Department of Neurology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; College of Medicine, National Taiwan University, Taipei, Taiwan; College of Medicine, Taipei Medical University, Taipei, Taiwan
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62
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Hosseini Tabatabaei N, Babakhani B, Hosseini Tabatabaei A, Vahabi Z, Soltanzadeh A. Non-genetic factors associated with the risk of Parkinson's disease in Iranian patients. FUNCTIONAL NEUROLOGY 2014; 28:107-13. [PMID: 24125560 DOI: 10.11138/fneur/2013.28.2.107] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this study was to investigate some of nongenetic factors associated with Parkinson's disease (PD) in a sample of Iranian patients. This case-control study included 75 patients with idiopathic PD and 75 control patients. The patients in the control group were found to have drunk more glasses of tea per day than the case group before the onset of their problem (p=0.019). Every extra glass of tea per day decreased the risk of PD by 0.8 times (OR=0.8, 95%CI=0.73-0.97, p=0.02). Each cup of coffee per week decreased the chance of developing PD by 0.5 times (OR=0.5, 95%CI=0.28-0.9, p=0.021). A previous history of evening work increased PD risk by 4.6 times (OR=4.6, 95%CI=1.29-16.86, p=0.019) while major stressful events increased it by 13.5 times (OR=13.5, 95%CI=4.7-38.1, p=0.0001). In conclusion, coffee and tea consumption may exert a protective effect against PD, while evening work and stress may be risk factors for the development of the disease.
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63
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Wong JC, Hazrati LN. Parkinson’s disease, parkinsonism, and traumatic brain injury. Crit Rev Clin Lab Sci 2013; 50:103-6. [DOI: 10.3109/10408363.2013.844678] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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64
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Nielsen NM, Pasternak B, Stenager E, Koch-Henriksen N, Frisch M. Multiple sclerosis and risk of Parkinson's disease: a Danish nationwide cohort study. Eur J Neurol 2013; 21:107-11. [PMID: 24053187 DOI: 10.1111/ene.12255] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 07/26/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Case reports have observed a co-occurrence of multiple sclerosis (MS) and Parkinson's disease (PD) and it has been hypothesized that MS lesions could affect dopaminergic pathways causing parkinsonism. Our aim was to examine the association between MS and PD in a historically prospective cohort study using Danish nationwide register data. METHODS Multiple sclerosis patients identified in the Multiple Sclerosis Registry were followed for PD from 1977 to 2011 in the National Patient Register. As measures of relative risk, ratios of observed to expected incidence rates of first hospitalization for PD amongst persons with MS were used, i.e. standardized incidence ratios (SIRs) with 95% confidence intervals (CIs). RESULTS Amongst 15,557 MS patients 26 cases of PD were observed versus 26.51 expected, reflecting no overall increased risk of PD (SIR 0.98, 95% CI 0.67-1.44). Similar estimates were seen for female (SIR 0.99, 95% CI 0.58-1.67) and male MS patients (SIR 0.97, 95% CI 0.55-1.72). Likewise, no increased risk of PD amongst MS patients was observed in a robustness analysis backdating the date of diagnosis of PD by 5 years to account for the time lag between disease onset and first hospital contact with PD (SIR 0.57, 95% CI 0.32-1.00). CONCLUSION Our data do not suggest an increased risk of PD amongst patients with MS.
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Affiliation(s)
- N M Nielsen
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
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65
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Harris MA, Shen H, Marion SA, Tsui JKC, Teschke K. Head injuries and Parkinson's disease in a case-control study. Occup Environ Med 2013; 70:839-44. [DOI: 10.1136/oemed-2013-101444] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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66
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Shahaduzzaman M, Acosta S, Bickford PC, Borlongan CV. α-Synuclein is a pathological link and therapeutic target for Parkinson's disease and traumatic brain injury. Med Hypotheses 2013; 81:675-80. [PMID: 23920272 DOI: 10.1016/j.mehy.2013.07.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 07/05/2013] [Accepted: 07/13/2013] [Indexed: 10/26/2022]
Abstract
Parkinson's disease (PD) affects more than 1% of population over 65 and it is characterized by gradual loss of nigrostriatal dopaminergic neurons and wide spread accumulation of α-synuclein. Collectively 30% of familial and 3-5% of sporadic form of PD are associated with genetic mutation. Compelling evidence implicates that in addition to inherited factors, acquired co-morbidities contribute to PD pathology. Here, we hypothesize that traumatic brain injury (TBI) exacerbates nigrostriatal dopaminergic degeneration by modulating PD-associated genes including α-synuclein, DJ-1, LRRK2, among others. Thus this article will present speculative arguments of a genetic component contributing to this TBI and PD pathological overlap.
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Affiliation(s)
- Md Shahaduzzaman
- Center of Excellence for Aging & Brain Repair, Department of Neurosurgery and Brain Repair, University of South Florida Morsani College of Medicine, Tampa, FL, USA.
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67
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Clark AJ, Ritz B, Prescott E, Rod NH. Psychosocial risk factors, pre-motor symptoms and first-time hospitalization with Parkinson's disease: a prospective cohort study. Eur J Neurol 2013; 20:1113-20. [PMID: 23433314 PMCID: PMC3664243 DOI: 10.1111/ene.12117] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Accepted: 01/03/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Experimental studies support a link between stress and development of parkinsonian symptoms, but prospective population studies are lacking. The aim of the current study is to determine the effects of several psychosocial factors on the risk of Parkinson's disease (PD), as well as to identify potential pre-motor symptoms for PD in a large prospective cohort study. METHODS In 1991-1993, a total of 9955 women and men free of PD from the Copenhagen City Heart Study were asked about major life events, economic hardship, social network, impaired sleep and vital exhaustion. The participants were followed for first-time hospitalization with PD in nationwide registers until 2011. RESULTS Vital exhaustion was associated with a higher risk of PD hospitalization in an exposure-dependent manner (P(trend) = 0.001), with high vs. low vital exhaustion being associated with a hazard ratio of 2.50 [95% confidence interval (CI): 1.28-4.89]. A slightly higher risk of PD hospitalization (hazard ratio = 1.49; 95% CI: 0.87-2.56) was suggested in participants with impaired sleep at baseline. No more than weak associations were observed for economic hardship, major life events or inadequate social network in the current study. CONCLUSIONS Overall, the hypothesis that psychosocial risk factors affect the risk of PD is not supported. The results, however, suggest that vital exhaustion may be a pre-motor marker of the neurodegenerative process eventually leading to motor symptoms and clinical PD. Vital exhaustion may be useful for screening aimed at early detection and when considering disease-modifying therapies in people at high risk of clinical PD.
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Affiliation(s)
- A J Clark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
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68
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Boot BP, Orr CF, Ahlskog JE, Ferman TJ, Roberts R, Pankratz VS, Dickson DW, Parisi J, Aakre JA, Geda YE, Knopman DS, Petersen RC, Boeve BF. Risk factors for dementia with Lewy bodies: a case-control study. Neurology 2013; 81:833-40. [PMID: 23892702 DOI: 10.1212/wnl.0b013e3182a2cbd1] [Citation(s) in RCA: 111] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the risk factors associated with dementia with Lewy bodies (DLB). METHODS We identified 147 subjects with DLB and sampled 2 sex- and age-matched cognitively normal control subjects for each case. We also identified an unmatched comparison group of 236 subjects with Alzheimer disease (AD). We evaluated 19 candidate risk factors in the study cohort. RESULTS Compared with controls, subjects with DLB were more likely to have a history of anxiety (odds ratio; 95% confidence interval) (7.4; 3.5-16; p < 0.0001), depression (6.0; 3.7-9.5; p < 0.0001), stroke (2.8; 1.3-6.3; p = 0.01), a family history of Parkinson disease (PD) (4.6; 2.5-8.6; p < 0.0001), and carry APOE ε4 alleles (2.2; 1.5-3.3; p < 0.0001), but less likely to have had cancer (0.44; 0.27-0.70; p = 0.0006) or use caffeine (0.29; 0.14-0.57; p < 0.0001) with a similar trend for alcohol (0.65; 0.42-1.0; p = 0.0501). Compared with subjects with AD, subjects with DLB were younger (72.5 vs 74.9 years, p = 0.021) and more likely to be male (odds ratio; 95% confidence interval) (5.3; 3.3-8.5; p < 0.0001), have a history of depression (4.3; 2.4-7.5; p < 0.0001), be more educated (2.5; 1.1-5.6; p = 0.031), have a positive family history of PD (5.0; 2.4-10; p < 0.0001), have no APOE ε4 alleles (0.61; 0.40-0.93; p = 0.02), and to have had an oophorectomy before age 45 years (7.6; 1.5-39; p = 0.015). CONCLUSION DLB risk factors are an amalgam of those for AD and PD. Smoking and education, which have opposing risk effects on AD and PD, are not risk factors for DLB; however, depression and low caffeine intake, both risk factors for AD and PD, increase risk of DLB more strongly than in either.
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Affiliation(s)
- Brendon P Boot
- Department of Neurology, Mayo Clinic College of Medicine, Rochester MN, Scottsdale, AZ, USA
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69
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Moretto A, Colosio C. The role of pesticide exposure in the genesis of Parkinson's disease: Epidemiological studies and experimental data. Toxicology 2013; 307:24-34. [DOI: 10.1016/j.tox.2012.11.021] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 11/04/2012] [Accepted: 11/17/2012] [Indexed: 12/21/2022]
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Jafari S, Etminan M, Aminzadeh F, Samii A. Head injury and risk of Parkinson disease: a systematic review and meta-analysis. Mov Disord 2013; 28:1222-9. [PMID: 23609436 DOI: 10.1002/mds.25458] [Citation(s) in RCA: 167] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Revised: 02/26/2013] [Accepted: 03/10/2013] [Indexed: 11/10/2022] Open
Abstract
Head trauma has been implicated in the etiopathogenesis of Parkinson's disease (PD). We performed a meta-analysis to investigate the association between head trauma and the risk of developing PD. We included observational studies if they (1) clearly defined PD, (2) defined head trauma leading to concussion, and (3) presented odds ratios (ORs) and 95% confidence intervals (CIs) or provided data to compute these statistics. Random effect model was used to estimate the pooled, adjusted OR. Heterogeneity between studies was evaluated with the Q test and the I(2) statistic. We conducted a sensitivity analysis to assess the influence of each study and repeated the analysis by excluding the studies with the largest weights. We used funnel plot to assess the presence of publication bias. After reviewing more than 636 article titles, 34 articles were selected for full review. In total, 22 studies (19 case-control studies, 2 nested case-control studies, and 1 cohort study) were included in the meta-analysis. The pooled OR for the association of PD and head trauma was 1.57 (95% CI, 1.35-1.83). The results of our meta-analysis indicate that a history of head trauma that results in concussion is associated with a higher risk of developing PD. © 2013 Movement Disorder Society.
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Affiliation(s)
- Siavash Jafari
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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71
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DeKosky ST, Blennow K, Ikonomovic MD, Gandy S. Acute and chronic traumatic encephalopathies: pathogenesis and biomarkers. Nat Rev Neurol 2013; 9:192-200. [PMID: 23558985 PMCID: PMC4006940 DOI: 10.1038/nrneurol.2013.36] [Citation(s) in RCA: 198] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Over the past decade, public awareness of the long-term pathological consequences of traumatic brain injury (TBI) has increased. Such awareness has been stimulated mainly by reports of progressive neurological dysfunction in athletes exposed to repetitive concussions in high-impact sports such as boxing and American football, and by the rising number of TBIs in war veterans who are now more likely to survive explosive blasts owing to improved treatment. Moreover, the entity of chronic traumatic encephalopathy (CTE)--which is marked by prominent neuropsychiatric features including dementia, parkinsonism, depression, agitation, psychosis, and aggression--has become increasingly recognized as a potential late outcome of repetitive TBI. Annually, about 1% of the population in developed countries experiences a clinically relevant TBI. The goal of this Review is to provide an overview of the latest understanding of CTE pathophysiology, and to delineate the key issues that are challenging clinical and research communities, such as accurate quantification of the risk of CTE, and development of reliable biomarkers for single-incident TBI and CTE.
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Affiliation(s)
- Steven T DeKosky
- Office of the Dean and Department of Neurology, University of Virginia School of Medicine, P. O. Box 800793, Charlottesville, VA 22908, USA.
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Lee PC, Bordelon Y, Bronstein J, Ritz B. Traumatic brain injury, paraquat exposure, and their relationship to Parkinson disease. Neurology 2013; 79:2061-6. [PMID: 23150532 DOI: 10.1212/wnl.0b013e3182749f28] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES Traumatic brain injury (TBI) increased risk of Parkinson disease (PD) in many but not all epidemiologic studies, giving rise to speculations about modifying factors. A recent animal study suggested that the combination of TBI with subthreshold paraquat exposure increases dopaminergic neurodegeneration. The objective of our study was to investigate PD risk due to both TBI and paraquat exposure in humans. METHODS From 2001 to 2011, we enrolled 357 incident idiopathic PD cases and 754 population controls in central California. Study participants were asked to report all head injuries with loss of consciousness for >5 minutes. Paraquat exposure was assessed via a validated geographic information system (GIS) based on records of pesticide applications to agricultural crops in California since 1974. This GIS tool assesses ambient pesticide exposure within 500 m of residences and workplaces. RESULTS In logistic regression analyses, we observed a 2-fold increase in risk of PD for subjects who reported a TBI (adjusted odds ratio [AOR] 2.00, 95% confidence interval [CI] 1.28-3.14) and a weaker association for paraquat exposures (AOR 1.36, 95% CI 1.02-1.81). However, the risk of developing PD was 3-fold higher (AOR 3.01, 95% CI 1.51-6.01) in study participants with a TBI and exposure to paraquat than those exposed to neither risk factor. CONCLUSIONS While TBI and paraquat exposure each increase the risk of PD moderately, exposure to both factors almost tripled PD risk. These environmental factors seem to act together to increase PD risk in a more than additive manner.
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Affiliation(s)
- Pei-Chen Lee
- Department of Epidemiology, Fielding School of Public Health, University of California at Los Angeles, Los Angeles, CA, USA.
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Fang F, Chen H, Feldman AL, Kamel F, Ye W, Wirdefeldt K. Head injury and Parkinson's disease: a population-based study. Mov Disord 2012; 27:1632-5. [PMID: 23143933 DOI: 10.1002/mds.25143] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Revised: 06/12/2012] [Accepted: 07/17/2012] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The epidemiological evidence on head injury and the risk of Parkinson's disease (PD) has been inconsistent. METHODS We examined the relation between previous hospitalization for head injury and PD using a population-based nested case-control design based on the Swedish National Patient Register from 2001 until 2007, including 18,648 PD cases and 93,240 controls, randomly selected from the general population. Exposure was defined as hospitalization for head injury between 1987 and index date. RESULTS Overall, previous hospitalization resulting from head injury was associated with an increased risk of PD; this association appeared to be largely explained by head injuries experienced recently, especially within 1 year before PD ascertainment. CONCLUSIONS Our results do not provide convincing evidence for a causal relationship between head injury later in life and PD.
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Affiliation(s)
- Fang Fang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Fang F, Wirdefeldt K, Jacks A, Kamel F, Ye W, Chen H. CNS infections, sepsis and risk of Parkinson's disease. Int J Epidemiol 2012; 41:1042-9. [PMID: 22523201 DOI: 10.1093/ije/dys052] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Neuroinflammation may play an important role in the aetiology of Parkinson's disease (PD); however, little is known about infections in relation to future PD risk. METHODS We conducted a register-based nested case-control study in Sweden to examine infections of the central nervous system (CNS) and sepsis in relation to PD with 18,648 patients and 93,240 matched controls. We defined the index date as the date of first recorded PD diagnosis in the Swedish Patient Register. RESULTS Overall, PD patients were more likely to have a previous hospitalization for CNS infections [odds ratio (OR) = 1.5, 95% confidence interval (CI): 1.2-1.9] or sepsis (OR = 1.6, 95% CI: 1.4-1.7) than controls, largely due to hospitalizations in the year before PD identification (CNS infections: OR = 3.0, 95% CI: 1.6-5.7; sepsis: OR = 3.5, 95% CI: 3.0-4.0). However, we found that subjects with multiple CNS infections at least 5 years before the index date had higher PD occurrence than those without CNS infections (OR = 3.3, 95% CI: 1.4-8.2), whereas the corresponding OR for sepsis was 1.4 (95% CI: 0.8-2.4). After the index date, PD patients were more likely to be hospitalized for CNS infections [hazard ratio (HR) =1.8, 95% CI: 1.2-2.7] or sepsis (HR = 2.2, 95% CI: 2.1-2.4) than controls. CONCLUSIONS This study provides preliminary evidence for an association between CNS infections, but not sepsis, and a higher future risk of PD. It also shows that PD patients were more prone to CNS infections and sepsis than controls.
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Affiliation(s)
- Fang Fang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Goldman SM, Kamel F, Ross GW, Jewell SA, Bhudhikanok GS, Umbach D, Marras C, Hauser RA, Jankovic J, Factor SA, Bressman S, Lyons KE, Meng C, Korell M, Roucoux DF, Hoppin JA, Sandler DP, Langston JW, Tanner CM. Head injury, α-synuclein Rep1, and Parkinson's disease. Ann Neurol 2012; 71:40-8. [PMID: 22275250 DOI: 10.1002/ana.22499] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To test the hypothesis that variability in SNCA Rep1, a polymorphic dinucleotide microsatellite in the promoter region of the gene encoding α-synuclein, modifies the association between head injury and Parkinson's disease (PD) risk. METHODS Participants in the Farming and Movement Evaluation (FAME) and the Study of Environmental Association and Risk of Parkinsonism using Case-Control Historical Interviews (SEARCH), 2 independent case-control studies, were genotyped for Rep1 and interviewed regarding head injuries with loss of consciousness or concussion prior to Parkinson's disease (PD) diagnosis. Logistic regression modeling adjusted for potential confounding variables and tested interaction between Rep1 genotype and head injury. RESULTS Consistent with prior reports, relative to medium-length Rep1, short Rep1 genotype was associated with reduced PD risk (pooled odds ratio [OR], 0.7; 95% confidence interval [CI], 0.5-0.9), and long Rep1 with increased risk (pooled OR, 1.4; 95% CI, 0.95-2.2). Overall, head injury was not significantly associated with PD (pooled OR, 1.3; 95% CI, 0.9-1.8). However, head injury was strongly associated with PD in those with long Rep1 (FAME OR, 5.4; 95% CI, 1.5-19; SEARCH OR, 2.3; 95% CI, 0.6-9.2; pooled OR, 3.5; 95% CI 1.4-9.2, p-interaction = 0.02). Individuals with both head injury and long Rep1 were diagnosed 4.9 years earlier than those with neither risk factor (p = 0.03). INTERPRETATION While head injury alone was not associated with PD risk, our data suggest head injury may initiate and/or accelerate neurodegeneration when levels of synuclein are high, as in those with Rep1 expansion. Given the high population frequency of head injury, independent verification of these results is essential.
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Hutson CB, Lazo CR, Mortazavi F, Giza CC, Hovda D, Chesselet MF. Traumatic brain injury in adult rats causes progressive nigrostriatal dopaminergic cell loss and enhanced vulnerability to the pesticide paraquat. J Neurotrauma 2012; 28:1783-801. [PMID: 21644813 DOI: 10.1089/neu.2010.1723] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Parkinson's disease (PD) is a neurodegenerative disorder characterized by the loss of nigrostriatal dopaminergic neurons and the accumulation of alpha-synuclein. Both traumatic brain injury (TBI) and pesticides are risk factors for PD, but whether TBI causes nigrostriatal dopaminergic cell loss in experimental models and whether it acts synergistically with pesticides is unknown. We have examined the acute and long-term effects of TBI and exposure to low doses of the pesticide paraquat, separately and in combination, on nigrostriatal dopaminergic neurons in adult male rats. In an acute study, rats received moderate TBI by lateral fluid percussion (LFP) injury, were injected with saline or paraquat (10 mg/kg IP) 3 and 6 days after LFP, were sacrificed 5 days later, and their brains processed for immunohistochemistry. TBI alone increased microglial activation in the substantia nigra, and caused a 15% loss of dopaminergic neurons ipsilaterally. Paraquat increased the TBI effect, causing a 30% bilateral loss of dopaminergic neurons, reduced striatal tyrosine hydroxylase (TH) immunoreactivity more than TBI alone, and induced alpha-synuclein accumulation in the substantia nigra pars compacta. In a long-term study, rats received moderate LFP, were injected with saline or paraquat at 21 and 22 weeks post-injury, and were sacrificed 4 weeks later. At 26 weeks post injury, TBI alone induced a 30% bilateral loss of dopaminergic neurons that was not exacerbated by paraquat. These data suggest that TBI is sufficient to induce a progressive degeneration of nigrostriatal dopaminergic neurons. Furthermore, TBI and pesticide exposure, when occurring within a defined time frame, could combine to increase the PD risk.
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Affiliation(s)
- Che Brown Hutson
- Department of Neurology, The David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Chesselet MF, Hovda DA. Traumatic brain injury and dopaminergic degeneration: the long-term risks require greater attention. Neurodegener Dis Manag 2011. [DOI: 10.2217/nmt.11.71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
| | - David A Hovda
- Departments of Neurology, Neurosurgery & Molecular & Medical Pharmacology, UCLA Brain Injury Research Center, David Geffen School of Medicine, UCLA, USA
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Moretto A, Colosio C. Biochemical and toxicological evidence of neurological effects of pesticides: The example of Parkinson's disease. Neurotoxicology 2011; 32:383-91. [DOI: 10.1016/j.neuro.2011.03.004] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Accepted: 03/03/2011] [Indexed: 12/21/2022]
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Wirdefeldt K, Adami HO, Cole P, Trichopoulos D, Mandel J. Epidemiology and etiology of Parkinson's disease: a review of the evidence. Eur J Epidemiol 2011; 26 Suppl 1:S1-58. [PMID: 21626386 DOI: 10.1007/s10654-011-9581-6] [Citation(s) in RCA: 711] [Impact Index Per Article: 54.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Accepted: 04/05/2011] [Indexed: 12/14/2022]
Abstract
The etiology of Parkinson's disease (PD) is not well understood but likely to involve both genetic and environmental factors. Incidence and prevalence estimates vary to a large extent-at least partly due to methodological differences between studies-but are consistently higher in men than in women. Several genes that cause familial as well as sporadic PD have been identified and familial aggregation studies support a genetic component. Despite a vast literature on lifestyle and environmental possible risk or protection factors, consistent findings are few. There is compelling evidence for protective effects of smoking and coffee, but the biologic mechanisms for these possibly causal relations are poorly understood. Uric acid also seems to be associated with lower PD risk. Evidence that one or several pesticides increase PD risk is suggestive but further research is needed to identify specific compounds that may play a causal role. Evidence is limited on the role of metals, other chemicals and magnetic fields. Important methodological limitations include crude classification of exposure, low frequency and intensity of exposure, inadequate sample size, potential for confounding, retrospective study designs and lack of consistent diagnostic criteria for PD. Studies that assessed possible shared etiological components between PD and other diseases show that REM sleep behavior disorder and mental illness increase PD risk and that PD patients have lower cancer risk, but methodological concerns exist. Future epidemiologic studies of PD should be large, include detailed quantifications of exposure, and collect information on environmental exposures as well as genetic polymorphisms.
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Affiliation(s)
- Karin Wirdefeldt
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
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Frankola KA, Greig NH, Luo W, Tweedie D. Targeting TNF-α to elucidate and ameliorate neuroinflammation in neurodegenerative diseases. CNS & NEUROLOGICAL DISORDERS DRUG TARGETS 2011; 10:391-403. [PMID: 21288189 PMCID: PMC4663975 DOI: 10.2174/187152711794653751] [Citation(s) in RCA: 165] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Accepted: 09/30/2010] [Indexed: 12/21/2022]
Abstract
Inflammatory signals generated within the brain and peripheral nervous system direct diverse biological processes. Key amongst the inflammatory molecules is tumor necrosis factor-α (TNF-α), a potent pro-inflammatory cytokine that, via binding to its associated receptors, is considered to be a master regulator of cellular cascades that control a number of diverse processes coupled to cell viability, gene expression, synaptic integrity and ion homeostasis. Whereas a self-limiting neuroinflammatory response generally results in the resolution of an intrinsically or extrinsically triggered insult by the elimination of toxic material or injured tissue to restore brain homeostasis and function, in the event of an unregulated reaction, where the immune response persists, inappropriate chronic neuroinflammation can ensue. Uncontrolled neuroinflammatory activity can induce cellular dysfunction and demise, and lead to a self-propagating cascade of harmful pathogenic events. Such chronic neuroinflammation is a typical feature across a range of debilitating common neurodegenerative diseases, epitomized by Alzheimer's disease, Parkinson's disease and amyotrophic lateral sclerosis, in which TNF-α expression appears to be upregulated and may represent a valuable target for intervention. Elaboration of the protective homeostasis signaling cascades from the harmful pathogenic ones that likely drive disease onset and progression could aid in the clinical translation of approaches to lower brain and peripheral nervous system TNF-α levels, and amelioration of inappropriate neuroinflammation.
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Affiliation(s)
- Kathryn A. Frankola
- Drug Design & Development Section, Laboratory of Neurosciences, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, USA
| | - Nigel H. Greig
- Drug Design & Development Section, Laboratory of Neurosciences, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, USA
| | - Weiming Luo
- Drug Design & Development Section, Laboratory of Neurosciences, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, USA
| | - David Tweedie
- Drug Design & Development Section, Laboratory of Neurosciences, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, USA
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Rugbjerg K, Friis S, Jørgensen TL, Ritz B, Korbo L, Olsen JH. Risk for Parkinson's disease among patients with osteoarthritis: a Danish cohort study. Mov Disord 2011; 25:2355-60. [PMID: 20721917 DOI: 10.1002/mds.23274] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
It has been suggested that use of nonsteroidal anti-inflammatory drugs (NSAID) protects against Parkinson's disease, although the results are not consistent. We investigated the risk for Parkinson's disease in patients with osteoarthritis, who are typically intensive users of NSAID. By using the files of the National Danish Hospital Register for the period 1977-2006, we identified a cohort of 134,176 patients with osteoarthritis severe enough to have required subsequent hip or knee implant surgery. The number of first hospital contacts for Parkinson's disease among cohort members in 1986-2007 was compared with that expected from the age-, gender- and period-specific hospital contact rates of the general Danish population, and standardized incidence ratios (SIRs) and associated 95% confidence intervals (CIs) were derived. Cohort members were also linked to the Danish Cancer Register to estimate the SIRs for colorectal and lung cancer. We observed a slightly increased risk for Parkinson's disease among patients with osteoarthritis and subsequent implant surgery (SIR, 1.07; 95% CI, 0.99-1.16). Decreased SIRs were found for both colorectal cancer (0.92; 95% CI, 0.88-0.97), consistent with a high prevalence of NSAID use among cohort members, and lung cancer (0.77; 95% CI, 0.73-0.80), indicating a lower prevalence of smoking than usual. Our results do not support the hypothesis that patients with prolonged use of NSAID and other analgesics are at reduced risk for Parkinson's disease. A possible lower smoking prevalence among patients with osteoarthritis might explain the slightly increased risk for Parkinson's disease.
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Affiliation(s)
- Kathrine Rugbjerg
- Department of Genetics and Medical Treatment, Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark.
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Lin CH, Wu RM, Tai CH, Chen ML, Hu FC. Lrrk2 S1647T and BDNF V66M interact with environmental factors to increase risk of Parkinson’s disease. Parkinsonism Relat Disord 2011; 17:84-8. [DOI: 10.1016/j.parkreldis.2010.11.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Revised: 11/12/2010] [Accepted: 11/17/2010] [Indexed: 01/01/2023]
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Kenborg L, Lassen CF, Ritz B, Schernhammer ES, Hansen J, Gatto NM, Olsen JH. Outdoor work and risk for Parkinson's disease: a population-based case-control study. Occup Environ Med 2010; 68:273-8. [PMID: 20884793 DOI: 10.1136/oem.2010.057448] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Sunlight is the main contributor to vitamin D in humans. Since inadequate levels of vitamin D have been linked to increased risks for neurodegenerative diseases, we examined whether outdoor work is associated with a reduced risk for Parkinson's disease in a population-based case-control study of Danish men. METHODS We identified 3819 men with a primary diagnosis of Parkinson's disease in the period 1995-2006 in the Danish National Hospital Register and selected 19,282 age- and sex-matched population controls at random from the Central Population Register. Information on work history was ascertained from the Danish Supplementary Pension Fund and the Central Population Register. Based on trade grouping codes and job titles, we evaluated the extent of outdoor work of study subjects as a proxy of exposure to sunlight. RESULTS Relying on trade grouping codes, we estimated ORs for study subjects with moderate, frequent and maximal outdoor work compared with exclusive indoor work of 0.90 (95% CI 0.78 to 1.02), 0.86 (95% CI 0.75 to 0.99) and 0.72 (95% CI 0.63 to 0.82), respectively, for Parkinson's disease. Reduced risks were also found for Parkinson's disease among outdoor workers based on study subjects' job titles. CONCLUSIONS Our findings suggest that men working outdoors have a lower risk for Parkinson's disease. Further studies of measured vitamin D levels in outdoor workers are warranted to clarify a potential inverse association between vitamin D and the risk for Parkinson's disease.
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Affiliation(s)
- Line Kenborg
- Institute of Cancer Epidemiology, Danish Cancer Society, Strandboulevarden 49, 2100 Copenhagen, Denmark.
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Rugbjerg K, Friis S, Ritz B, Schernhammer ES, Korbo L, Olsen JH. Autoimmune disease and risk for Parkinson disease: a population-based case-control study. Neurology 2009; 73:1462-8. [PMID: 19776374 DOI: 10.1212/wnl.0b013e3181c06635] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Inflammatory mediators are increased in autoimmune diseases and may activate microglia and might cause an inflammatory state and degeneration of dopaminergic neurons in the brain. Thus, we evaluated whether having an autoimmune disease increases the risk for developing Parkinson disease (PD). METHODS A population based case-control study was conducted in Denmark of 13,695 patients with a primary diagnosis of PD recorded in the Danish National Hospital Register during the period 1986-2006. Each case was matched on year of birth and sex to 5 population controls selected at random from among inhabitants of Denmark who were alive at the date of the patient's diagnosis. The main exposure measure was a hospital diagnosis of 1 of 32 selected autoimmune diseases recorded 5 or more years before the index date in the files of the Danish Hospital Register. RESULTS We observed no overall association between a diagnosis of autoimmune disease and risk for subsequent PD (odds ratio 0.96, 95% confidence interval 0.85-1.08). In a subgroup of patients with autoimmune diseases with systemic involvement, primarily rheumatoid arthritis, we saw a decrease in risk for PD of 30%. CONCLUSIONS Our results do not support the hypothesis that autoimmune diseases increase the risk for Parkinson disease. The decreased risk observed among patients with rheumatoid arthritis might be explained by underdiagnosis of movement disorders such as Parkinson disease in this patient group or by a protective effect of the treatment with anti-inflammatory drugs over prolonged periods.
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Affiliation(s)
- K Rugbjerg
- Institute of Cancer Epidemiology, Danish Cancer Society, Strandboulevarden 49, DK-2100 Copenhagen, Denmark.
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