Pilot study of prevalence of Parkinson's disease in Australia

Australian Parkinson's Genetics Study (APGS): pilot (n=1532)

PURPOSE

Parkinson's disease (PD) is a neurodegenerative disorder associated with progressive disability. While the precise aetiology is unknown, there is evidence of significant genetic and environmental influences on individual risk. The Australian Parkinson's Genetics Study seeks to study genetic and patient-reported data from a large cohort of individuals with PD in Australia to understand the sociodemographic, genetic and environmental basis of PD susceptibility, symptoms and progression.

PARTICIPANTS

In the pilot phase reported here, 1819 participants were recruited through assisted mailouts facilitated by Services Australia based on having three or more prescriptions for anti-PD medications in their Pharmaceutical Benefits Scheme records. The average age at the time of the questionnaire was 64±6 years. We collected patient-reported information and sociodemographic variables via an online (93% of the cohort) or paper-based (7%) questionnaire. One thousand five hundred and thirty-two participants (84.2%) met all inclusion criteria, and 1499 provided a DNA sample via traditional post.

FINDINGS TO DATE

65% of participants were men, and 92% identified as being of European descent. A previous traumatic brain injury was reported by 16% of participants and was correlated with a younger age of symptom onset. At the time of the questionnaire, constipation (36% of participants), depression (34%), anxiety (17%), melanoma (16%) and diabetes (10%) were the most reported comorbid conditions.

FUTURE PLANS

We plan to recruit sex-matched and age-matched unaffected controls, genotype all participants and collect non-motor symptoms and cognitive function data. Future work will explore the role of genetic and environmental factors in the aetiology of PD susceptibility, onset, symptoms, and progression, including as part of international PD research consortia.

Prevalence and incidence of Parkinson's disease and other forms of parkinsonism in a cohort of elderly individuals in Southern Brazil: protocol for a population-based study

INTRODUCTION

Parkinsonism is one of the most common neurological disorders affecting the elderly. Several population-based studies have determined the epidemiology of parkinsonism, mainly Parkinson's disease (PD), but there is still little evidence in the Brazilian population. This protocol study aims to assess the prevalence and incidence of cases of PD and other parkinsonian syndromes in a 5-year cohort in a population-based study in the southern region of Brazil.

METHODS AND ANALYSIS

A prospective population-based longitudinal study, with a cohort of development of cases of parkinsonism, divided into two phases: in phase I, two questionnaires to screen for parkinsonism (Tanner's questionnaire), Rapid Eyes Movement (REM) sleep behaviour disorder (REM Sleep Behavior Disorder Single-Question Screen) and a short interview will be conducted with all elderly residents of Veranópolis (the first longevity Brazilian county located in the Rio Grande do Sul, Brazil) aged 60 or over. The positive screened cases will be examined independently by at least two movement disorder-trained physicians and prevalence will be determined. A comprehensive evaluation of prodromic symptoms, risk factors and clinical characteristics will be carried out. Subjects with subtle parkinsonism and a sample of healthy subjects will be followed for 5 years in a developmental cohort of parkinsonism cases. For crude incidence, all individuals admitted at the beginning of the study will be re-evaluated.

ETHICS AND DISSEMINATION

The study was approved by the research ethics committee of the Hospital de Clínicas de Porto Alegre (protocol n° 4.095.609). All participants provide their informed consent before evaluations. Findings from this survey will be disseminated through peer-reviewed publications and will be presented at conferences.

The prevalence of Parkinson's disease: a systematic review and meta-analysis

Parkinson's Disease (PD) is a common neurodegenerative disorder. We sought to synthesize studies on the prevalence of PD to obtain an overall view of how the prevalence of this disease varies by age, by sex, and by geographic location. We searched MEDLINE and EMBASE for epidemiological studies of PD from 1985 to 2010. Data were analyzed by age group, geographic location, and sex. Geographic location was stratified by the following groups: 1) Asia, 2) Africa, 3) South America, and 4) Europe/North America/Australia. Meta-regression was used to determine whether a significant difference was present between groups. Forty-seven studies were included in the analysis. Meta-analysis of the worldwide data showed a rising prevalence of PD with age (all per 100,000): 41 in 40 to 49 years; 107 in 50 to 59 years; 173 in 55 to 64 years; 428 in 60 to 69 years; 425 in 65 to 74 years; 1087 in 70 to 79 years; and 1903 in older than age 80. A significant difference was seen in prevalence by geographic location only for individuals 70 to 79 years old, with a prevalence of 1,601 in individuals from North America, Europe, and Australia, compared with 646 in individuals from Asia (P < 0.05). A significant difference in prevalence by sex was found only for individuals 50 to 59 years old, with a prevalence of 41 in females and 134 in males (P < 0.05). PD prevalence increases steadily with age. Some differences in prevalence by geographic location and sex can be detected.

Impact of the Parkinson's disease medication protocol program on nurses' knowledge and management of Parkinson's disease medicines in acute and aged care settings

AIMS

To determine the impact of a Parkinson's medicine education program on nurses' knowledge and practices in two settings where people with Parkinson's disease are cared for: hospitals and residential aged care facilities. The Parkinson's Disease Medication Protocol Program aimed to increase nurse knowledge of Parkinson's medication administration and safety in care management in order to improve health outcomes, function and well-being for the person with Parkinson's.

BACKGROUND

The ageing demographic of the developed world is concomitant with an increase in chronic disease, with Parkinson's disease being one of the most debilitating and costly. Individually complex medication regimens and unique spectrums of symptoms require disease-specific knowledge in nurses. People with Parkinson's disease admitted to hospitals and/or living in residential aged care facilities often have multiple co-morbidities, rendering care more complex still. Nurse ignorance of Parkinson's disease medicines, their uses, side effects and administration regimens, and safe care practices, can cause unnecessary distress and dysfunction for the person.

METHOD

The two pilot studies employed an eighteen month pre/post-test/follow up design at different time frames, using a questionnaire developed by the study team and an expert panel to evaluate nurses' self-assessed 'perceived' knowledge and actual knowledge of Parkinson's disease, Parkinson's medicines and safe care practices, and satisfaction with the targeted Parkinson's education program.

RESULTS/FINDINGS

Nurses in the hospital pilot (2006/8) revealed deficits in pre-test perceived and actual knowledge levels, which increased significantly at post-test and follow-up. In contrast, in the residential aged care pilot (2008/10) the nurses had higher perceived and actual (correct) knowledge relevant to experience at pre-test and these levels increased at follow-up. Both pilot study cohorts were very satisfied with the PDMPP as an education and support vehicle in Parkinson's management.

CONCLUSION

These study results concur with the international literature which identifies that without targeted clinical education nurses do not necessarily have sufficient knowledge to effectively manage Parkinson's medicines and avoid unnecessary negative outcomes arising from delays, errors and omissions, nor do they know how to provide safe and effective care for persons with Parkinson's. A well-developed and resourced Parkinson's medicine education program, such as the PDMPP, has the potential to improve deficits in clinical practice.

PREVALENCE OF PARKINSON'S DISEASE AND PARKINSONISM IN A COLOMBIAN POPULATION USING THE CAPTURE-RECAPTURE METHOD

Our objective was to estimate the prevalence of Parkinson's disease (PD) and Parkinsonism (Ps) in Antioquia (Colombia), using the Capture-Recapture method. The two biggest institutions for attending neurological patients in Antioquia were selected as sources for the use of the Capture-Recapture method. Prevalences of PD (PPD) and Ps (PPs) were estimated according to the following expression: PPD (or PPs) = n/Nl105. The number of cases (n) of PD (or Ps), n = a + b + c + d, where a = cases identified from the two sources, b = cases identified only in the first source, c = cases identified only in the second source, and d = nondetected cases from any source = bc/a. The projected Antioquian population for the year 2000 was used as denominator. Information obtained between January 1, 1996, and December 31, 2000, was reviewed in order to identify the clinical records of all patients that fulfilled the Ps or PD criteria. General prevalence of PD in Antioquia was 30.7/100.000 (C195% = 29.2-32.2), and that of Ps was 42.1/100.000 (CI95% = 40.3-43.8). Prevalence of PD in people older than 50 years was 176.4/100.000 (CI95% = 166.6-186.3) and that of Ps was of 339.6/100.000 (C195% = 326.0-353.2). Ps and PD prevalences in Antioquia were lower than the figures reported by the National Neuroepidemiologic Study (470/100.000) and similar to the estimated prevalence of these diseases in Caucasian populations (80 to 270/100.000). These findings evidence the great variability of PD prevalence in different regions; therefore, a nationwide study is necessary to determine the prevalence of PD and Ps in Colombia.

Neurological disorders in a rural Western Australian population

BACKGROUND

There is limited information on the causes of neurological disorders in an Australian rural setting.

METHODS

This study reports on a prospective cohort of 160 patients (95 women and 65 men) with a mean age of 55.1 years (standard deviation 19.78 years, range 12-92 years) receiving a neurological work-up from one neurologist attending the Geraldton and Midwest region of Western Australia over a 12-month period.

RESULTS

Patients were divided into 15 diagnostic classifications. Movement disorders were the most common diagnostic classification (38 of 160 or 23.75%) and Parkinson's disease was the most common movement disorder (30 of 38 or 78.95%) with an estimated period of prevalence of 187.5 persons per 1000. Of the other neurological disorder diagnosis classifications the following number of patients per group was observed: epilepsy (27 or 16.87%); neuromuscular disorders (22 or 13.75%); multiple sclerosis (12 or 7.5%); cerebrovascular disease (10 or 6.25%); headaches (7 or 4.37%); neurodegenerative (7 or 4.37%); dementias (6 or 3.75%); memory dysfunction (6 or 3.75%); gait disorders (4 or 2.5%); vestibular syndrome (3 or 1.87%); pain syndrome (3 or 1.87%); sensory syndrome (2 or 1.25%); brain injury (1 or 0.62%) and miscellaneous (12 or 7.5%). A high number of persons having Parkinson's disease was found.

CONCLUSION

Possible risk factors for Parkinson's disease for individuals living in Geraldton and Midwest region need to be investigated. This study raises issues pertaining to the provision of services and allocation of resources in rural areas, especially for patients with Parkinson's disease.

Population prevalence and incidence of Parkinson’s disease in an Australian community

BACKGROUND

Parkinson's disease (PD) is the second most common neurodegenerative disorder affecting older individuals. Few studies have determined the prevalence and incidence of this disease in Australia. The aim of the study was to estimate the prevalence and 10-year incidence of PD in the Australian community.

METHODS

In the Blue Mountains Eye Study (BMES), a population-based health survey of Australian residents aged 49 years or more, we determined the cross-sectional prevalence (BMES2, 1997-1999, n = 3509) and 10-year incidence (BMES1, 2 and 3, 1992-1994, 1997-1999 and 2002-2004, respectively, n = 2545) of PD. We screened participants who took PD medications. PD diagnosis was confirmed by contacting the participant's medical/general practitioners.

RESULTS

Nineteen new cases of PD were identified over the 10-year period, a 10-year incidence of 0.84% (95% confidence interval (CI) 0.54-1.33%). In the cross-sectional study, 16/3509 participants were confirmed to have PD (0.46%), with age-specific prevalence rates of 0.48% in persons aged 60-69 years, 0.82% for ages 70-79 years and 0.56% in persons aged 80 years or older. No PD cases were identified among participants less than 60 years of age. When age standardized to the 2001 Australian population, the prevalence of PD was 362 per 100,000 (95%CI 183-541) among persons aged 50 years or older and 104 per 100,000 for the Australian population at all ages, assuming no prevalent cases in persons aged less than 50 years.

CONCLUSION

This study estimates a 0.46% (95%CI 0.23-0.68) prevalence of PD patients treated with medications aged 50 years or older and a 10-year incidence of 0.84% (95%CI 0.54-1.33).

Prevalence of Parkinson’s disease in metropolitan and rural Queensland: A general practice survey

The prevalence of idiopathic Parkinson's disease (IPD) in Australia is unclear. We estimated the prevalence of IPD, and other forms of parkinsonism, through the study of typical caseloads in general practice. A random sample of general practitioners (GPs) throughout Queensland (401 responses from 528 validated practice addresses) was asked to estimate the numbers of patients with IPD and parkinsonism seen in the preceding year. The estimated prevalence of diagnosed IPD in Queensland was 146 per 100,000 (95% CI=136-155). A further 51 per 100,000 in the population were suspected by doctors to have IPD without formal diagnosis, whereas another 51 per 100,000 people may have non-idiopathic parkinsonism. Idiopathic Parkinson's disease was more common in rural than metropolitan areas. Although most GPs were confident in making diagnoses of IPD, the majority had little or no confidence in their ability to treat the disease, especially in its later stages. Support from neurologists was perceived by GPs to be very good in cities, but poor in remote areas.

Parkinsonism and Parkinson's disease in the elderly: A community-based survey in Brazil (the Bambuí study)

Several community-based surveys on the prevalence of Parkinsonism and Parkinson's disease have been conducted worldwide, with variations on their methodology and results. The objective of this study is to assess the prevalence of Parkinsonism and its causes in a cohort of individuals age 64 years or older in Bambuí, a Brazilian town. In phase I, 1,186 people older than 64 years responded to a 9-question screening questionnaire for Parkinsonism. In phase II, all subjects who scored > or = 2 points on the test were examined independently by at least 2 movement disorder-trained physicians. A movement disorder senior specialist excluded or confirmed the diagnosis in all suspected cases. The response rate was high for both phases (96% for phase I and 94% for phase II). The prevalence rate per 100 population over 64 years of age in this group was 7.2% for Parkinsonism of all types (n = 86). The most frequent causes were idiopathic Parkinson's disease and drug-induced Parkinsonism, with prevalence rates of 3.3% (n = 39) and 2.7% (n = 32), respectively. The prevalence of vascular Parkinsonism was 1.1% (n = 13). We found 1 case of posttraumatic Parkinsonism and another with multiple system atrophy. In this first population-based study of Parkinsonism conducted in Brazil, the prevalence in a cohort of elderly subjects was higher than the observed in other populations worldwide, especially because of the high rates of drug-induced and vascular Parkinsonism. The prevalence of Parkinson's disease was similar to that observed in elderly people in door-to-door surveys in other American, European, and Eastern countries.

Dieldrin-induced neurotoxicity: relevance to Parkinson's disease pathogenesis

Parkinson's disease (PD) is increasingly recognized as a neurodegenerative disorder strongly associated with environmental chemical exposures. Recent epidemiological data demonstrate that environmental risk factors may play a dominant role as compared to genetic factors in the etiopathogenesis of idiopathic Parkinson's disease. Identification of key genetic defects such as alpha-synuclein and parkin mutations in PD also underscores the important role of genetic factors in the disease. Thus, understanding the interplay between genes and environment in PD may be critical to unlocking the mysteries of this 200-year-old neurodegenerative disease. Pesticides and metals are the most common classes of environmental chemicals that promote dopaminergic degeneration. The organochlorine pesticide dieldrin has been found in human PD postmortem brain tissues, suggesting that this pesticide has potential to promote nigral cell death. Though dieldrin has been banned, humans continue to be exposed to the pesticide through contaminated dairy products and meats due to the persistent accumulation of the pesticide in the environment. This review summarizes various neurotoxic studies conducted in both cell culture and animals models following dieldrin exposure and discusses their relevance to key pathological mechanisms associated with nigral dopaminergic degeneration including oxidative stress, mitochondrial dysfunction, protein aggregation, and apoptosis.

Self-reported parkinsonian symptoms in the EPIC-Norfolk cohort

BACKGROUND

Parkinsonian symptoms have been associated with increased morbidity and mortality. Several studies have reported on the prevalence of signs and symptoms. Symptoms questionnaires can identify potential PD cases for further neurological examination to save resources. They can also provide information about how much of the population reports specific signs and symptoms. The objective of the study was to determine the self-reported prevalence of parkinsonian symptoms from a questionnaire, and to examine their association with age and self-reported Parkinson's disease in a large cohort.

METHODS

A cross-sectional study was conducted within a sub-cohort of the EPIC-Norfolk (European Prospective Investigation of Cancer) cohort study.

RESULTS

The prevalence of six self-reported parkinsonian symptoms are reported for 11,539 individuals who answered all symptoms questions (62% of sub-cohort): rest tremor (4%), difficulty starting to walk (4%), difficulty getting out of a chair (6%), slower walking (34%), smaller handwriting (micrographia- 9%), and less acute sense of smell (olfactory dysfunction- 9%). The presence of individual symptoms increased with age except for difficulty getting out of a chair.

CONCLUSION

The results support previous findings that the presence of self-reported parkinsonian symptoms is strongly associated with age and self-reported PD diagnosis. The data also provide information regarding the prevalence of symptoms in a large, younger population of adults than previously reported in the literature.

Prevalence of Parkinson's disease in Sydney

OBJECTIVE

To examine the prevalence of Parkinson's disease (PD) in Bankstown, Sydney, using the same methodology as a previous study in Randwick, Sydney, Australia (1998-1999).

PARTICIPANTS AND METHODS

Twenty census districts (CDs) for the Bankstown local government area were randomly selected. Research personnel door-knocked every household within the CDs to locate people aged > or =55 years. A structured questionnaire (containing four screening questions for PD) was administered to those agreeing to participate. Screened positive participants were invited to come for a clinical examination. This is a continuation of the previous study and data have been combined.

RESULTS

Combining data for Bankstown and Randwick gave 1028 participants; crude prevalence, 780 per 100,000 (CI: 546-1077). In Bankstown, there were 501 participants aged > or =55 years (response rate 70%); 135 were screened positive with 101 (74.8%) agreeing to a clinical examination. The prevalence of PD in the Bankstown community was 3.4% (17 of 501) (95% CI: 1.98-5.43) for those aged > or =55 years; crude prevalence 776 per 100,000 (CI: 452-1241).

CONCLUSION

The combined results of two Sydney studies appear to indicate that Sydney has one of the highest prevalence estimates of PD in developed countries.

Prevalence of Parkinson's disease in a Chinese population

BACKGROUND

Ethnic differences in the prevalence of Parkinson's disease have been observed, but may be due to differences in screening instruments and diagnostic criteria.

AIMS

To compare the prevalence of Parkinson's disease in Hong Kong Chinese and Australians in Sydney.

METHODS

A door-to-door community survey in the Hong Kong Chinese population was carried out using a two-staged procedure (screening questionnaire followed by physical examination), which had been validated for use in the community in a survey among Australians, to determine the prevalence in Chinese and to compare with that in Australians.

RESULTS

A total of 1080 households were contacted, the non-response rate was 27%. The prevalence among those aged 55 years in the community and above was 0.5%, and 0.186% for the overall population assuming no subjects were below 55 years. These figures are lower than the 3.6% for Australians, aged >55 years.

CONCLUSION

There appears to be a difference in prevalence of Parkinson's disease between Hong Kong Chinese and Australians in Sydney. Such differences may be due to documented differences in prevalence of genetic polymorphisms associated with Parkinson's disease between Chinese and Australians, or to differences in environmental factors.

Survey of major chronic iIlnesses and hospital admissions via the emergency department in a randomized older population in Randwick, Australia

OBJECTIVE

To find out if patients with chronic illnesses living in the community are at risk of unplanned hospital admissions through emergency departments; what types of chronic illnesses may be putative risk factors; and if an increase in the number of chronic illnesses may be associated with increased risk.

METHODS

The survey included the completion of a standardized questionnaire for medical illnesses in a random sample of older people dwelling in the community and analysis of admission records to our hospital. The principal diagnoses for admissions were recorded. The risk factors for admissions were analysed.

RESULTS

Five hundred and twenty-six (239 men and 287 women) people aged 55 years and over were interviewed. Musculoskeletal disorders, hypertension, gastrointestinal disorders and ischaemic heart disease were the most frequently reported of the chronic illnesses surveyed. A total number of 70 people from the survey group with a total of 115 admissions through emergency departments were recorded. Using logistic regression model, hypertension, ischaemic heart disease and age were found to be risk factors for emergency admissions amongst this group of community-dwelling residents. The ratios were 2.03 (95% confidence interval (CI): 1.2-3.44), 2.02 (95% CI: 1.16-3.49) and 1.05 (95% CI: 1.02-1.09), respectively. Furthermore, multiple (three or more) chronic illnesses were found to be a strong predictor of hospital admission via emergency department (chi-square = 16.647, DF = 1, P-value < 0.001).

CONCLUSION

We conclude that there was significant association between multiple chronic diseases and emergency admissions for older people. Of these, hypertension and ischaemic heart disease were found to be significant predictors. Age per se was found to be of borderline significance.