Agricultural activities and the incidence of Parkinson’s disease in the general French population

Most studies on pesticides and Parkinson’s disease (PD) focused on occupational exposure in farmers. Whether non-occupational exposure is associated with PD has been little explored. We investigated the association between agricultural characteristics and PD incidence in a French nationwide ecologic study. We hypothesized that persons living in regions with agricultural activities involving more intensive pesticide use would be at higher risk. We identified incident PD cases from French National Health Insurance databases (2010–2012). The proportion of land dedicated to 18 types of agricultural activities was defined at the canton of residence level. We examined the association between agricultural activities and PD age/sex-standardized incidence ratios using multivariable multilevel Poisson regression adjusted for smoking, deprivation index, density of neurologists, and rurality (proportion of agricultural land); we used a false discovery rate approach to correct for multiple comparisons and compute q-values. We also compared incidence in clusters of cantons with similar agricultural characteristics (k-means algorithm). We identified 69,010 incident PD cases. Rurality was associated with higher PD incidence (p < 0.001). Cantons with higher density of vineyards displayed the strongest association (RR_{top/bottom quartile} = 1.102, 95% CI = 1.049–1.158; q-trend = 0.040). This association was similar in men, women, and non-farmers, stronger in older than younger persons, and present in all French regions. Persons living in the cluster with greatest vineyards density had 8.5% (4.4–12.6%) higher PD incidence (p < 0.001). In France, vineyards rank among the crops that require most intense pesticide use. Regions with greater presence of vineyards are characterized by higher PD risk; non-professional pesticides exposure is a possible explanation.     

Axial rigidity and quality of life in patients with Parkinson’s disease: a preliminary study

Purpose  

Rigidity is a cardinal symptom of Parkinson’s disease (PD) and is often clinically assessed by passively flexing and extending a patient’s limb. Objective measurements had been employed to examine rigidity in PD subjects, including wrist, elbow, knee and trunk. This study aimed to investigate the relationship between an objective measurement of trunk rigidity and health-related quality of life (HRQoL) and functional status in patients with mild to moderate PD.     

Socioeconomic and occupational groups and Parkinson’s disease: a nationwide study based on hospitalizations in Sweden

Objectives  The aim of this study was to investigate whether there is an association between socioeconomic status, occupation and hospitalization for Parkinson’s disease (PD). Methods  A nationwide database was constructed by linking the Swedish Census to the Hospital Discharge Register to obtain data on all first adult hospitalizations for PD diagnosed in Sweden during the study period from 1987 to 2004. Standardized incidence ratios (SIRs) with 95% confidence intervals (CIs) were calculated. Results  A total of 8,870 males and 3,724 females first hospitalizations for PD were retrieved during the study period for adults aged 30 and older. Significantly increased SIRs for hospitalization for PD were found for men with high socioeconomic status. Among male occupations, increased SIRs were noted for several occupational groups such as teachers, administrators and managers, farmers, sales agents, wood workers, and painters and wall paperhangers. For female occupations, an increased risk was observed only among assistant nurses. The significant SIRs varied between 1.08 and 1.60. Conclusions  The socioeconomic and occupational groups used in the present study have a relatively small effect on the population’s likelihood of hospitalization for PD but could give a notion of future research on specific occupational exposures.     

Increasing incidence of Barrett’s oesophagus: a population-based study

Oesophageal adenocarcinoma, a highly fatal cancer, has risen in incidence in Western societies, but it is unclear whether this is due to increasing incidence of its pre-cursor condition, Barrett’s oesophagus (BO) or whether the proportion of BO patients undergoing malignant progression has increased in the face of unchanged BO incidence. Data from population-based studies of BO incidence is limited, with equivocal results to date difficult to distinguish from changes in endoscopic practices. The aim of this study was to assess population trends in Barrett’s oesophagus (BO) diagnoses in relation to endoscopy and biopsy rates over a 13 year period. The Northern Ireland Barrett’s oesophagus Register (NIBR) is a population-based register of all 9,329 adults diagnosed with columnar epithelium of the oesophagus in Northern Ireland between 1993 and 2005, of whom 58.3% were male. European age-standardised annual BO incidence rates were calculated per 100,000 of the population, per 100 endoscopies and per 100 endoscopies including an oesophageal biopsy. Average annual BO incidence rates rose by 159% during the study period, increasing from 23.9/100,000 during 1993–1997 to 62.0/100,000 during 2002–2005. This elevation far exceeded corresponding increases in rates of endoscopies and oesophageal biopsies being conducted. BO incidence increased most markedly in individuals aged <60 years, and most notably amongst males aged <40 years. This study points towards a true increase in the incidence of BO which would appear to be most marked in young males. These findings have significant implications for future rates of oesophageal adenocarcinoma and surveillance programmes.     

Association of Cumulative Lead Exposure with Parkinson’s Disease

Background

Research using reconstructed exposure histories has suggested an association between heavy metal exposures, including lead, and Parkinson’s disease (PD), but the only study that used bone lead, a biomarker of cumulative lead exposure, found a nonsignificant increase in risk of PD with increasing bone lead.

Objectives

We sought to assess the association between bone lead and PD.

Methods

Bone lead concentrations were measured using ¹⁰⁹Cd excited K-shell X-ray fluorescence from 330 PD patients (216 men, 114 women) and 308 controls (172 men, 136 women) recruited from four clinics for movement disorders and general-community cohorts. Adjusted odds ratios (ORs) for PD were calculated using logistic regression.

Results

The average age of cases and controls at bone lead measurement was 67 (SD = 10) and 69 (SD = 9) years of age, respectively. In primary analyses of cases and controls recruited from the same groups, compared with the lowest quartile of tibia lead, the OR for PD in the highest quartile was 3.21 [95% confidence interval (CI), 1.17–8.83]. Results were similar but slightly weaker in analyses restricted to cases and controls recruited from the movement disorders clinics only (fourth-quartile OR = 2.57; 95% CI, 1.11–5.93) or when we included controls recruited from sites that did not also contribute cases (fourth-quartile OR = 1.91; 95% CI, 1.01–3.60). We found no association with patella bone lead.

Conclusions

These findings, using an objective biological marker of cumulative lead exposure among typical PD patients seen in our movement disorders clinics, strengthen the evidence that cumulative exposure to lead increases the risk of PD.     

Determinants of health-related quality of life in people with Parkinson’s disease: a path analysis

Purpose

To identify the demographic factors, impairments and activity limitations that contribute to health-related quality of life (HRQOL) in people with idiopathic Parkinson’s disease (PD).

Method

Two hundred and ten individuals with idiopathic PD who participated in the baseline assessment of a randomized clinical trial were included. The Parkinson’s Disease Questionnaire-39 summary index was used to quantify HRQOL. In order to provide greater clarity regarding the determinants of HRQOL, path analysis was used to explore the relationships between the various predictors in relation to the functioning and disability framework of the International Classification of Functioning model.

Results

The two models of HRQOL that were examined in this study had a reasonable fit with the data. Activity limitations were found to be the strongest predictor of HRQOL. Limitations in performing self-care activities contributed the most to HRQOL in Model 1 (β = 0.38; p < 0.05), while limitations in functional mobility had the largest contribution in Model 2 (β = ?0.31; p < 0.0005). Self-reported history of falls was also found to have a significant and direct relationship with HRQOL in both models (Model 1 β = ?0.11; p < 0.05; Model 2 β = ?0.21; p < 0.05).

Conclusions

Health-related quality of life in PD is associated with self-care limitations, mobility limitations, self-reported history of falls and disease duration. Understanding how these factors are inter-related may assist clinicians focus their assessments and develop strategies that aim to minimize the negative functional and social sequelae of this debilitating disease.     

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

The respective contribution of occupational and behavioural factors to social disparities in all-cause mortality has been studied very seldom. The objective of this study was to evaluate the role of occupational and behavioural factors in explaining social inequalities in premature and total mortality in the French working population. The study population consisted of a sample of 2,189 and 1,929 French working men and women, who responded to a self-administered questionnaire in mid-1996, and were followed up until the end of 2008. Mortality was derived from register-based information and linked to the baseline data. Socioeconomic status was measured using occupation. Occupational factors included biomechanical and physical exposures, temporary contract, psychological demands, and social support, and behavioural factors, smoking, alcohol abuse, and body mass index. Significant social differences were observed for premature and total mortality. Occupational factors reduced the hazard ratios of mortality for manual workers compared to managers/professionals by 72 and 41%, from 1.88 (95% CI: 1.17–3.01) to 1.25 (95% CI: 0.74–2.12) for premature mortality, and from 1.71 (95% CI: 1.18–2.47) to 1.42 (95% CI: 0.95–2.13) for total mortality. The biggest contributions were found for biomechanical and physical exposures, and job insecurity. The role of behavioural factors was very low. Occupational factors played a substantial role in explaining social disparities in mortality, especially for premature mortality and men. Improving working conditions amongst the lowest social groups may help to reduce social inequalities in mortality.     

Being in control of Parkinson’s disease: A qualitative study of community-dwelling patients’ coping with changes in care

Background: Chronically ill patients have to cope with transfers in the level or setting of care. Patients with prevalent disorders such as diabetes mellitus can be supported by their general practitioner (GP) when experiencing such care changes, as the GP already offers them disease-specific care. For community-dwelling patients with low-prevalent diseases such as Parkinson’s disease (PD) – for which disease-specific care is provided by medical specialists – tailoring support to handle care changes requires more insight into patients’ coping.

Objectives: To explore PD patients’ coping with care changes.

Methods: A qualitative interview study was performed in 2013–2015 with a purposive sample of 16 community-dwelling PD patients in the Netherlands. A research assistant visited patients every month to explore if they had experienced a care change. If so, patients were interviewed face-to-face. An inductive approach to comparative content analysis was used.

Results: Patients encountered a variety of care changes such as changes in the level of unpaid care, the purchase of tools, modification of pharmacotherapy or admission to hospital. Being able to anticipate, initiate and independently handle care changes contributes to patients’ sense of control and acceptance of the post-change situation. Patients, who commenced care changes themselves, had more realistic expectations of it.

Conclusion: Community-dwelling PD patients seem to be able to cope with the care changes they face. Offering education to facilitate their anticipation and initiation of changes in care and their ability to act independently, can contribute to patients’ wellbeing. GPs can play a role in this.     

Augmented reality-based dance intervention for individuals with Parkinson’s disease: A pilot study

BackgroundThe effects of dance on improving the symptoms of individuals with Parkinson’s disease (PD) is well documented. Augmented reality devices, such as Google Glass, may be used to implement dance interventions to improve mobility and balance.ObjectiveTo evaluate the feasibility, safety, and acceptability of a mobile dance intervention and obtain preliminary efficacy estimates for assessment of the research protocol.MethodsSeven participants with PD were asked to use Google Glass preloaded with Moving Through Dance modules for three weeks. Changes in motor functions (balance, mobility) and non-motor functions (mood, quality of life) were evaluated before and after completion of the intervention.ResultsRecruitment rate was 50%, retention rate was 100%, and adherence to usage was 95%. The intervention was safe and accepted by participants. Use of Moving Through Glass improved mobility with a cognitive load (F(1, 5) = 10.76; p < 0.05). However, there were no significant changes to the participants’ balance scores, quality of life or mood.ConclusionsThe outcomes of this pilot study suggest that Moving Through Glass, as a mobile dance intervention, may be a safe way to increase physical activity through dance in individuals with PD. Its efficacy should be investigated in a properly powered randomized controlled trial.     

Quality of life in Serbian patients with Parkinson’s disease

Background  The Parkinson’s Disease Questionnaire (PDQ-39) is a well-validated British scale for the assessment of health-related quality of life (QoL) in Parkinson’s disease (PD). Objective  To validate the Serbian version of the PDQ-39, while also providing additional information on the characteristics of this instrument. Patient and methods  A total of 102 Serbian PD patients were asked to complete the PDQ-39, a disease-specific QoL questionnaire, as well as the generic, health status questionnaire (SF-36-version 1), and the 21-item Beck Depression Inventory. Neurological examination included the Hoehn and Yahr staging, Unified Parkinson’s disease rating scale (UPDRS)-part III, Schwab and England scale, and the Mini-Mental State Examination. Results  Internal consistency analysis yielded a Cronbach’s α of 0.83. Cronbach’s α was above 0.70 for seven out of eight subscales (range from 0.73 to 0.91). A hierarchical structure of the PDQ-39 was revealed, with one global higher-order factor and two lower-order factors. The strongest predictor of the QoL in PD was the presence of depression, while motor disability (UPDRS-part III score) additionally contributed to poor QoL. Cognitive impairment has not been correlated with poor QoL. Also, QoL measures were not different between young- (≤50 years) and older-onset PD patients. Conclusions  The PDQ-39 is a reliable and valid instrument for the assessment of QoL in Serbian PD patients.     

Dietary and lifestyle variables in relation to incidence of Parkinson’s disease in Greece

Identification of dietary and lifestyle variables associated with the development of Parkinson’s disease (PD) may offer pathogenetic clues and prevention opportunities. In a population-based prospective cohort study, 26,173 participants in the EPIC–Greece cohort had sociodemographic, anthropometric, medical, dietary and lifestyle variables ascertained at enrolment and periodically reassessed with follow-up contacts. Based on these data, subjects were screened as possible PD cases if they (1) reported either a medical diagnosis of PD or use of anti-PD drugs and (2) did not report preceding causes of secondary parkinsonism. For diagnostic validation, possible incident PD cases were assessed by a focused 3-item telephone questionnaire. Cox proportional hazards regression was used to evaluate associations between potential predictors and incident PD. The main multivariate model included gender, age, marital status, schooling years, farming occupation, smoking status, caffeinated coffee, body mass index, physical activity and energy intake. Additional models included all above variables plus one dietary item at a time. Incidence rate adjusted to the European population was 16.9 per 100,000 person-years. In multivariate models, incident PD exhibited strong positive association with consumption of milk, but not cheese or yoghurt. This finding may help narrow down the search for potential dairy product components with a facilitatory role in PD. Concerning other dietary components, inverse association was found between polyunsaturated fat intake and incident PD. Also, inverse association was found with tobacco smoking, in line with previous studies, but not with caffeine.     

Association between serum cholesterol levels and Alzheimer’s disease in China: a case-control study

To examine the association between blood cholesterol concentrations and Alzheimer’s disease (AD) in the Chinese elderly. A case-control study was implemented between November 2011 and November 2017. Elderly patients aged ≥?55?years with (n?=?117) and without AD (control participants; n?=?117) were recruited from the Neurology Central Hospital of Tianjin, China. The associations between AD and blood parameters were assessed using multiple binary logistic regression analyses adjusted for multiple covariates. Higher serum total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) levels and lower serum high-density lipoprotein cholesterol (HDL-C) levels associated with AD risk in the models adjusted for (1) age, sex and education; and (2) further adjusted for body mass index, smoking status, stroke, hypertension, type 2 diabetes mellitus and heart disease. Increased serum TC and LDL-C levels and lower HDL-C levels were independently associated with the risk of AD.     

Cardiometabolic factors and disease duration in patients with Parkinson’s disease

ObjectivePrevious studies have reported that patients with Parkinson’s disease (PD) have a favorable cardiometabolic risk profile. The aim of this study was to investigate the relationship between cardiometabolic risk factors and the duration of disease.MethodsOne hundred and fifty patients with PD (56.7% men) were studied, measuring body mass index (BMI), waist circumference (WC), body fat percentage (BF%) by impedance, fasting glucose, serum lipids, and transaminases.ResultsIn sex- and age-adjusted correlation models, duration of PD was inversely related to BMI (r = ?0.20; P < 0.05) and BF% (r = ?0.29; P < 0.005). Using multivariable regression models (adjustments: age, gender, smoking status, levodopa dose and, alternatively, BMI, WC, or BF%), high-density lipoprotein (HDL) levels were positively correlated with disease duration (P < 0.01 for all). In models adjusted for WC and BF%, total HDL-cholesterol ratio was also inversely associated with duration of PD (P < 0.05 for both). No other association between biochemical variables and the duration of PD was found. Moreover, no dose–response effect of levodopa on metabolic risk factors was observed.ConclusionsHDL levels and total HDL-cholesterol ratio were favorably associated with duration of PD. This factor may contribute to cardiometabolic protection in PD. The mechanisms underlying this association deserve further investigation.     

Quality of life of caregivers in Parkinson’s disease

Objective: To assess the impact of PD on informal caregivers of patients and identify the main factors related to caregiver strain. Patients and methods: Pairs of PD patients and their caregivers. Evaluation by neurologists included the Hoehn and Yahr, Schwab and England, UPDRS (parts 1–3), ISAPD, and Pfeiffers SPMSQ rating scales. Patients completed the Euro-QoL 5D, PDQ-8, and Hospital Anxiety and Depression Scale. The SQLC was used to assess caregivers quality of life (QoL), with caregivers, in turn, applying the Euro-QoL and PDQ-8 to assess patients health-related quality of life (HRQoL). Multiple linear regression models were fitted to ascertain factors linked to the SQLC. Results: Significant correlations were in evidence between the following scores: SQLC and clinical rating scales and SQLC and patients HRQoL. Based on multiple regression analysis, patients functional state (ADL) proved to be the main predictor of caregivers QoL. Self- and caregiver-assessed patients HRQoL also proved to be a relevant factor. Conclusions: (1) Patients functional state was significantly related to caregivers psychosocial burden; (2) patients HRQoL proved to be an additional factor linked to caregiver QoL; (3) improvement of patient disability and HRQoL might alleviate caregiver strain.     

Perception of Alzheimer’s disease in the French population

Background: Objective

The aim of this study was to investigate the perception, knowledge, opinions and beliefs about AD in the French population to improve care for patients with Alzheimer’s disease.

Design

A cross-sectional telephone survey in 2008.

Setting

French “Alzheimer Plan 2008–2012”.

Participants

2013 respondents, representative of the French population.

Measurements

The respondents answered a questionnaire in which they were presented with a series of attitudinal statements about health in general and AD.

Results

Main results are summarized as followed: (a) Respondents think that AD can be devastating for a family (93%). This devastating feeling prevails in the population >75 years old and in people who know patient with AD. (b) General population has a reasonable knowledge about AD, but is still unable to recognize early stages: 95% of respondents considered that difficulties to manage administrative papers and find their way back home suggest early AD. (c) 91% of the population would like to know the diagnosis if they had AD. (d) 38% of the population know or have known at least one patient within their social circle. People think that the care of AD’s patient can be better but they trust in the French government to improve it.

Conclusion

General representation of AD is changing in a positive way and, even though AD is perceived as a calamity, people are confident that solutions will be found in the future.     

The use of decision-analytic models in Parkinson’s disease

The aims of this review were to review decision-analytic models used to evaluate interventions in idiopathic Parkinson's disease (PD), and to consider the future directions for development of methods to model the progression of PD over time. A systematic search of the healthcare literature up to June 2010 identified model-based economic evaluations in PD. The modelling methods used in the identified studies were appraised using good practice guidelines for decision-analytic modelling. The review identified 18 model-based evaluations of interventions in PD. All models evaluated treatments targeted towards the motor symptoms of PD or the motor complications of PD treatment. There were no models identified that evaluated interventions targeted towards the non-motor symptoms of PD, such as neuropsychiatric problems or autonomic dysfunction. Consequently, models characterized disease progression in PD using clinical measures of motor functioning. Most studies (n = 13) evaluated medications, three evaluated diagnostic technologies and two examined surgical procedures. Overall, the models reported structural components and data inputs appropriately and clearly, although limited evidence was provided to support choices made on the structures used in the models or the data synthesis reported. Models did not adequately consider structural uncertainty or internal/external consistency. Modelling methods used to date do not capture the full impact of PD. The emphasis in the current literature is on the motor symptoms of PD, characterizing the clinical nature of disease progression, largely neglecting the important impacts of non-motor symptoms. Modelling methods reported for the motor symptoms of PD may not be suitable for future interventions targeted towards modifying disease progression in PD across the entire spectrum of PD. More comprehensive models of disease progression, including both motor and non-motor symptoms will be needed where it is important to capture the effects of interventions more broadly.     

Stigma as a key determinant of health-related quality of life in Parkinson’s disease

Purpose

People with Parkinson’s disease (PD) may experience stigma due to their visible features of movement and communication difficulties. This paper aimed to examine the role of experienced stigma in health-related quality of life (QOL), after controlling for personal and clinical characteristics.

Methods

This is a preliminary analysis of a subset of baseline data from the Social Self-Management of Parkinson’s Disease Study (SocM-PD), an ongoing 3-year prospective cohort study. Seventy-three people with PD (M _age = 65.72, 29 women) participated in this study. Hierarchical multiple regression analyses were used to determine the role of stigma in QOL, after controlling for gender, disease severity, depression, and motor difficulties of daily living.

Results

Significant correlations were found between QOL with gender (r = .26), disease severity (r = .38), depression (r = .65), motor difficulties of daily living (r = .71), and stigma (r = .83). After controlling for the significant covariates, stigma made a significant and unique contribution to the explanation of QOL by 13.7 % (p < 0.001). A final hierarchical multiple regression with stigma and the 4 covariates revealed an overall model that explained 77.8 % of the total variance of QOL (F [5, 63] = 48.79, p < 0.001).

Conclusions

Experienced stigma appears to be a key determinant of QOL in people with PD. The results suggest the importance of further understanding stigma in PD to develop possible intervention strategies. Future work is also needed to verify the results with a larger and longitudinal dataset of the SocM-PD.