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Epidemiology and etiology of Parkinson’s disease: a review of the evidence

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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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Abbreviations

AHS:

Agricultural Health Study

BMI:

Body mass index

CI:

Confidence interval

DDE:

Dichlorodiphenyldichloroethylene

DDT:

Dichlorodiphenyltrichloroethane

DLB:

Dementia with Lewy bodies

GIS:

Geographical information system

GWAS:

Genome-wide association study

HDL:

High-density lipoprotein

HR:

Hazard ratio

IOM:

Institute of Medicine

JEM:

Job exposure matrix

LDL:

Low-density lipoprotein

LPS:

Lipopolysacharide

MSA:

Multiple system atrophy

MET:

Metabolic equivalent task

MPTP:

1-methyl-4-phenyl-1, 2, 3, 6,-tetrahydropiridine

NAS–NRC:

National Academy of Sciences–National Research Council

NSAID:

Non-steroid anti-inflammatory drugs

OR:

Odds ratio

PD:

Parkinson’s disease

PET:

Positron emission tomography

PMR:

Proportionate mortality ratio

POR:

Prevalence odds ratio

PSP:

Progressive supranuclear palsy

RBD:

REM sleep behavior disorder

RR:

Relative risk

SPECT:

Single photon emission computed tomography

SIR:

Standardized incidence ratio

SHR:

Standardized hospitalization ratio

SMR:

Standardized mortality ratio

TIA:

Transient ischaemic attack

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Acknowledgments

This project was supported by a grant from Syngenta Crop Protection, Inc.

Conflict of interest

Other than receiving research support for the present study, none of the authors reports any disclosures. Karin Wirdefeldt received research support for the research described in this article from Syngenta Crop Protection, Inc. She did not receive any other payments or incentives related to the work reported in this article. Hans-Olov Adami received research support for the research described in this article from Syngenta Crop Protection, Inc. He did not receive any other payments or incentives related to the work reported in this article. Philip Cole received research support for the research described in this article from Syngenta Crop Protection, Inc. He did not receive any other payments or incentives related to the work reported in this article. Dimitrios Trichopoulos received research support for the research described in this article from Syngenta Crop Protection, Inc. He did not receive any other payments or incentives related to the work reported in this article. Jack Mandel received research support for the research described in this article from Syngenta Crop Protection, Inc. He did not receive any other payments or incentives related to the work reported in this article.

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Wirdefeldt, K., Adami, HO., Cole, P. et al. Epidemiology and etiology of Parkinson’s disease: a review of the evidence. Eur J Epidemiol 26 (Suppl 1), 1 (2011). https://doi.org/10.1007/s10654-011-9581-6

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