Source: Mayo Clinic.
The incidence of Parkinson’s disease and parkinsonism increased significantly in 30 years from 1976 to 2005, Mayo Clinic researchers reported today in a study in JAMA Neurology. This trend was noted in particular for men age 70 and older. According to the researchers, this is the first study to suggest such an increasing trend.
The study shows that men of all ages had a 17 percent higher risk of developing parkinsonism and 24 percent higher risk of developing Parkinson’s disease for every 10 calendar years. The study also showed that men 70 and older had an even greater increase — a 24 percent higher risk of developing parkinsonism and 35 percent higher risk of developing Parkinson’s disease for every 10 calendar years.
Using the Rochester Epidemiology Project, Mayo Clinic researchers were able to look at the complete medical records — from birth to death — of anyone in Olmsted County, Minnesota, who received at least one of the diagnoses related to parkinsonism. The records were reviewed by a movement disorders specialist to confirm the diagnosis and to classify different types of parkinsonism, including the most common type, Parkinson’s disease.
“We have reasons to believe that this is a real trend,” says Rodolfo Savica, M.D., Ph.D., lead author and neurologist at Mayo Clinic. “The trend is probably not caused merely by changes in people’s awareness or changes in medical practice over time. We have evidence to suggest that there has been a genuine increase in the risk of Parkinson’s disease.”
The researchers point to environmental and lifestyle changes as potential causes for the increase.
“There has been a dramatic change in exposure to some risk factors in the United States,” Dr. Savica says. “We know that environmental agents like pesticides or smoking or other agents in the environment have changed in the last 70 years or so. Changes in exposure to a number of risk factors may have caused Parkinson’s disease to rise.”
The study, based on almost 1,000 patients affected by parkinsonism, is the first to consider long-term trends in risk over 30 years. It also provides evidence contrary to two previous U.S. studies and one Canadian study that showed no trend, and particularly contrary to three United Kingdom studies that suggested a possible decline in the occurrence of Parkinson’s disease over time.
The Mayo Clinic study also revealed a possible higher incidence of both parkinsonism and Parkinson’s disease in men and women born from 1915 to 1924.
“This observation is important because the persons born in that particular decade may have been exposed to some environmental or other factors during their intrauterine life or early after birth that increased the risk,” Dr. Savica says. “We need to confirm this hypothesis.”
Parkinsonism is the umbrella term that includes Parkinson’s disease but also may include other disorders. The diagnosis of parkinsonism requires the presence of slowness of movement and at least one other symptom — a tremor while at rest, muscle rigidity or a tendency to fall. Parkinson’s disease is defined as having the manifestations of parkinsonism but without any other known causes, and it is the most common type of parkinsonism.
The researchers urged caution in interpreting the trends, which may be from an increased awareness of symptoms and improved access to care. In the study’s earlier years, for example, patients with cancer or severe cardiac disease may not have been diagnosed with parkinsonism or Parkinson’s disease if doctors did not consider their movement disorder to be important in their care.
“Parkinson’s disease is an important disease and a cause of disability, especially in older ages, and we don’t want to have people untreated for a condition that is treatable just because they have four or five other diseases that are more prominent,” Dr. Savica says.
The observation that the time trends were more evident in men than in women may support a genuine trend in incidence. Recognition of symptoms in the context of multiple illnesses should have changed similarly over time in men and women, the study notes. Thus, if the trend was not genuine it should have been similar in men and women.
Parkinsonism and Parkinson’s disease tend to affect more men than women in general. But Dr. Savica also notes that the increase was more dramatic in men, but the study also showed a similar trend in women — an increase in Parkinson’s disease in women 70 years of age and older. However, the trend in women did not reach statistical significance.
“Differences in men and women may be important in understanding the environmental causes of Parkinson’s disease,” Dr. Savica says.
If the trend of increasing incidence rates is genuine, and can be replicated in other populations, it has major implications for finding the causes of Parkinson’s disease and for public health, the researchers note. From a research perspective, the trend should prompt studies to identify environmental or lifestyle changes during the study subjects’ lifespan. Environmental or lifestyle factors could include smoking, pesticide use, head trauma, coffee consumption and other factors.
Study co-authors are Brandon Grossardt, M.S.; James Bower, M.D.; Eric Ahlskog, M.D., Ph.D.; and senior author Walter Rocca, M.D., M.P.H., all of Mayo Clinic.
Funding: The study was supported by an award from the National Institute on Aging of the National Institutes of Health (grant AG 034676) and by the Mayo Foundation for Medical Education and Research.
Source: Susan Barber Lindquist – Mayo Clinic
Image Source: This NeuroscienceNews.com image is adapted from the Mayo Clinic press release.
Video Source: The video is credited to Mayo Clinic.
Original Research: Abstract for “Time Trends in the Incidence of Parkinson Disease” by Rodolfo Savica, MD, MSc, PhD; Brandon R. Grossardt, MS; James H. Bower, MD, MSc; J. Eric Ahlskog, PhD, MD; and Walter A. Rocca, MD, MPH in JAMA Neurology. Published online June 20 2016 doi:10.1001/jamaneurol.2016.0947
Time Trends in the Incidence of Parkinson Disease
Importance Changes over time in the incidence of parkinsonism and Parkinson disease (PD) remain uncertain.
Objective To investigate secular trends (period effects) and birth cohort trends in the incidence of parkinsonism and PD over 30 years in a geographically defined American population.
Design, Setting, and Participants We used the medical records–linkage system of the Rochester Epidemiology Project to identify incidence cases of PD and other types of parkinsonism in Olmsted County, Minnesota, from 1976 to 2005. All cases were classified by a movement disorder specialist using defined criteria through the review of the complete medical records within the system. The analyses for this study were conducted between May 2015 and January 2016.
Main Outcomes and Measures Incidence rates of parkinsonism and PD over 30 years. We tested for secular trends (period effects) using negative binomial regression models and for birth cohort effects using age–period-cohort models.
Results Of 906 patients with parkinsonism, 501 were men, and the median age at onset was 74 years (interquartile range, 66-81 years). Of the 464 patients with PD, 275 were men, and the median age at onset was 73 years (interquartile range, 64-80 years). The overall incidence rates increased significantly over 30 years in men for both parkinsonism (relative risk [RR], 1.17 per decade; 95% CI, 1.03-1.33) and PD (RR, 1.24 per decade; 95% CI, 1.08-1.43). These trends were driven primarily by the older age groups. In particular, for men 70 years or older, incidence rates increased for both parkinsonism (RR, 1.24 per decade; 95% CI, 1.07-1.44) and PD (RR, 1.35 per decade; 95% CI, 1.10-1.65). The secular trends were not significant for women overall or in age strata. We observed an increased risk for both men and women born in the 1920 cohort (1915-1924). However, this birth cohort effect was significant only for PD and only in men.
Conclusions and Revelance Our study suggests that the incidence of parkinsonism and PD may have increased between 1976 and 2005, particularly in men 70 years and older. These trends may be associated with the dramatic changes in smoking behavior that took place in the second half of the 20th century or with other lifestyle or environmental changes. However, the trends could be spurious and need to be confirmed in other populations.
“Time Trends in the Incidence of Parkinson Disease” by Rodolfo Savica, MD, MSc, PhD; Brandon R. Grossardt, MS; James H. Bower, MD, MSc; J. Eric Ahlskog, PhD, MD; and Walter A. Rocca, MD, MPH in JAMA Neurology. Published online June 20 2016 doi:10.1001/jamaneurol.2016.0947