Milk Linked to Greater Risk of Parkinson’s, Swedish Study Shows

milk risk factor

Consumption of more than 40 milliliters (1.3 ounces) of milk per day is associated with an increased risk of developing Parkinson’s disease. Still, dietary intake of yogurts or soured milk does not pose a risk, results from a large-scale Swedish study show.

The study “Milk, Yogurt, and Soured Milk Consumption and Risk of Parkinson’s Disease,” will be presented Erik Olsson, PhD, an associate professor at Uppsala University, during the 14th International Conference on Alzheimer’s and Parkinson’s Diseases and related neurological disorders, March 26-31, in Lisbon, Portugal.

Dairy products are widely consumed worldwide and could be important contributors for the development of human disease.

Previous studies have suggested consuming dairy products could be linked to an increased risk of Parkinson’s disease, particularly among men.

More recently, a study has shown that total dairy intake was not associated with a significant risk of Parkinson’s. However, daily consumption of low-fat or skim milk instead of full-fat milk was linked to a 39% higher chance of Parkinson’s disease.

To further explore this issue, Swedish researchers reviewed the incidence of Parkinson’s disease in 81,889 adults during a mean follow-up period of 13.9 years. None of the participants had Parkinson’s when the study started in 1997, and they all answered a questionnaire about dietary regimens and food intake frequency.

A total of 1,251 cases of Parkinson’s disease were reported among this population, according to information from the Swedish National Patient and Cause of Death Registers.

Analysis of the dietary patterns of this population revealed that people who consumed 40 milliliters (ml) or more of milk per day had increased risk of having Parkinson’s disease.

In particular, individuals who drank 40 to 159 ml per day of milk had a 30% higher risk of developing Parkinson’s, compared to people who had low daily milk intake (less than 40 ml per day). The risk increased similarly for people who consumed even higher amounts of milk, with 25%, 33%, and 33% higher risk for 160-200 ml, 201-400 ml, or more than 400 ml per day of milk.

In contrast, researchers did not find any significant association between intake of yogurt or soured milk and long-term risk of developing Parkinson’s disease.

These risk estimates did not change when the team analyzed the data according to participants’ gender, with no differences found between men and women.

“Findings from this cohort study indicate that consumption of milk, but not soured milk and yogurt, is associated with an increased risk of Parkinson’s disease,” researchers concluded.

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Study Examines Risk Factors for Impulse Control Disorders in Parkinson’s Patients

impulse control disorders

Use of dopamine agonists, earlier disease onset, being male, and having personality traits such as impulsiveness and high novelty-seeking are among the risk factors for developing impulse control disorders (ICDs) in people with Parkinson’s, according to a review study.

The research, “Impulse control disorders in Parkinson’s disease: A systematic review on risk factors and pathophysiology,” was published in the Journal of the Neurological Sciences.

ICDs are characterized by failure to resist an impulse, drive, or temptation to perform a risky behavior, a growing sense of tension before performing the behavior, and a sense of pleasure while doing it.

In people with Parkinson’s, ICDs may result from treatments intending to increase the levels of dopamine in the brain. Despite their impact on patients’ quality of life, studies about ICDs in this patient population are scarce.

Aiming to address this gap, a research team from IRCCS Centro Neurolesi “Bonino Pulejo”, in Italy, conducted a systematic review of the potential risk factors for the development of ICDs in people with Parkinson’s, including the effects of dopaminergic treatment. Three online databases were used covering studies published from January 2000 to July 2018.

According to research published in 2003 and 2008, the prevalence of gambling, compulsive sexual behavior, and compulsive shopping is 1.7-7.0%, 2.0–4.0%, and 0.4-3.0%, respectively. The 2003 study found one or more ICDs in 13.6% of patients, which included binge eating and hypersexuality. Recent epidemiological studies have indicated that the prevalence of ICDs is 7.2% in patients with Parkinson’s, but only 1% in controls (participants who did not have Parkinson’s.

Specifically, for example, although binge eating typically leads to weight gain, people with Parkinson’s commonly lose weight, which is attributed to swallowing difficulties (dysphagia) and dyskinesia (involuntary, jerky movements).

Slot machine gambling has been identified as the most common form of pathological gambling among these patients. Major depression in middle-aged men has been reported as a comorbidity of pathological gambling, with common genetic factors.

Patients also have an increased risk of developing dopamine dysregulation syndrome, which results from unregulated self-administration and dependence on dopaminergic treatment. “Patients increase drugs doses spontaneously and progressively and this is often associated to behavioral and mood disorders, such as hallucinations, manic states, aggression, psychomotor agitation and delusions,” researchers explained.

Developing addiction-like behavior has been associated with the type, dose and duration of dopaminergic treatment, in particular dopamine agonists.

A 2006 study showed a correlation between earlier onset of Parkinson’s and earlier appearance of motor fluctuations, dyskinesia and psychiatric symptoms. Also, a study with 3,090 patients indicated that greater impulsive choice, faster reaction time and impulsive decisions are among the potential factors for the development of ICDs, although Parkinson’s patients are thought to have increased caution and be risk-averse prior to diagnosis.

Comparing to women, men not only have higher frequency of ICDs, but also show six-times greater difficulty managing them, as shown in a 2012 study. Other factors shown to associate with ICDs in Parkinson’s include sleep impairment, substance abuse, high novelty-seeking, impulsiveness, aggressiveness, cigarette smoking, having more formal education, and being unmarried.

As for brain pathways underlying the development of ICDs, dysregulation of the mesolimbic circuit (responsible for reward learning and the mesocortical pathway (responsible for executive decision-making) leads to impulsive and compulsive behaviors.

Upon exposure to a reward, a brain area called the ventral striatum is activated, prompting a strong emotional response and dopamine release. This behavior ultimately may become compulsive, being reinforced by the dorsal striatum.

Two types of dopamine receptors — D1 and D2 — are involved in the connections between the striatum and the globus pallidus (a part of the brain’s basal ganglia) and subsequently the substantia nigra, a major brain region involved in Parkinson’s disease.

These receptors, and their pathways, have opposing roles in reward-based decision making, either stimulation (D1) or suppression (D2).

The researchers noted that standardized tests to evaluate the type and severity of ICDs are still lacking. Also, consistent use of international criteria for Parkinson’s diagnosis and prospective studies with larger samples are still needed to more accurately determine risk factors for ICDs among these patients.

“A better assessment of the behavioral disorders of [Parkinson’s] may be useful in the rehabilitative intervention for increasing the quality of life,” researchers concluded.

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Cancer Patients Have Lower Risk of Developing Parkinson’s Disease, Study Suggests

cancer, Parkinson's risk

Cancer patients appear to have a lower risk of developing Parkinson’s disease, even when taking into account important risk factors and overall survival, a study has found.

The study, “Cancers Preceding Parkinson’s Disease after Adjustment for Bias in a Danish Population-Based Case-Control Study,” was published in Neuroepidimiology.

Previous studies have shown that cancer patients are less likely to develop Parkinson’s during their lifetime than the general population. However, it is unclear whether this could be caused by the negative association between Parkinson’s disease and smoking, when, for many cancers, smoking is a known risk factor, or simply by the fact that most cancer patients do not survive long enough to reach a stage in which they are more likely to develop Parkinson’s.

Researchers at the University of California Los Angeles carried out a large population-based case-control study in Denmark (PASIDA) to investigate if cancer correlated with a lower risk of Parkinson’s disease, even after normalizing important risk factors, such as smoking, physical activity, and survival bias.

The study involved a total of 1,813 patients with Parkinson’s disease and 1,887 age- and sex-matched individuals without Parkinson’s used as controls.

Demographic analysis showed the percentage of non-smokers was higher in the group of Parkinson’s patients (49.6%) than in controls (35.3%). Conversely, the incidence of cancer was lower among Parkinson’s patients (3.8%) than in controls (4.2%), a difference that was even more pronounced when comparing the incidence of smoking-related cancers (1.7% versus 2.2%).

Apart from skin and breast cancer, further analysis showed a negative correlation between Parkinson’s disease and all types of cancers, including those related and not related to smoking. Even after normalization for risk factors and cancer patients’ survival bias, the negative association between Parkinson’s disease and cancer remained the same.

“Since PD [Parkinson’s disease] cases stop smoking many years prior to PD diagnosis, one might say that ‘PD prevents smoking’ and thus reduces the risk of smoking-related cancers and mortality. [However,] in PASIDA adjustment for pack-years of smoking did not change the observed associations between cancer and PD, which suggested that smoking is unlikely to be a strong confounder between cancer and PD,” the researchers wrote.

“In conclusion, our study suggested a lower frequency of most cancers preceding PD diagnosis after adjustment for major lifestyle factors. Our bias analysis indicated that survival bias minimally impacts the observed associations,” they added.

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Gout May Increase Parkinson’s Risk in Older People, Study of US Medicare Data Suggests

gout, Parkinson's risk

Gout appears to be associated with a higher risk of incident Parkinson’s disease in older adults, according to a study that looked at Medicare data in the U.S.

The study, “Gout and the risk of Parkinson’s disease in older adults: a study of U.S. Medicare data” was published in BMC Neurology.

Parkinson’s disease is a progressive neurological disorder that mainly affects motor function due to the loss of nerve cells in the brain that produce dopamine. When dopamine-producing neurons die, it causes symptoms such as tremors, stiffness, and balance problems.

About 1 percent of the population older than 60 are diagnosed with Parkinson’s. Due to this low incidence, risk factors for the disease have not been fully explored. It is known, however, that herbicide or pesticide exposure, along with hypertension, are potential risk factors for developing Parkinson’s. Inversely, use of statins (lipid-lowering medicines) and smoking are thought to lower the risk of developing the disease.

Previous studies have attempted to associate the levels of urate — a salt derived from uric acid — in the blood with the risk of developing Parkinson’s. Urate has an antioxidant effect that researchers think may help prevent the disease. As a result, lower levels of serum urate could lead to a higher Parkinson’s prevalence. However, so far, studies have not been able to confirm this association.

Gout is an inflammatory arthritis disease caused by increased oxidative stress and chronic inflammation, factors that can potentially increase the risk for Parkinson’s disease. Oxidative stress is an imbalance between the production of free radicals and the ability of cells to detoxify them. These free radicals or reactive oxygen species are harmful to cells and are associated with a number of diseases.

However, in a patient who has gout, serum urate levels are actually increased. “Acute and chronic inflammatory state in gout might potentially negate the anti-oxidant effects of urate, if one exists physiologically,” the researchers wrote.

Whether there is an association between urate and Parkinson’s risk in gout patients is still a matter of controversy.

In this study, researchers at the University of Alabama at Birmingham aimed to clarify the existence of a possible association between gout and Parkinson’s, taking into account other known risks for the disease such as age, sex, hypertension, hyperlipidemia (high levels of fat, also called lipids, in the blood), statin use, and demographic variables.

Using a random sample encompassing 5% of Medicare claims data, acquired from 2006 to 2012, a total of 1.72 million people — 1.63 million without gout and 94,133 with gout — were analyzed. Their mean age was 75.3 years, 58% were female, 36% were white, and they had a mean Charlson-Romano comorbidity index score — which predicts 10-year mortality — of 1.6.

The analysis was adjusted for statin use and cardiovascular disease, two potential confounding variables of Parkinson’s risk, as well as for the use of urate-lowering therapy.

A total of 22,636 people developed incident Parkinson’s disease — 21,507 without gout and 1,129 with gout. Older age, male gender, white race, and higher Charlson-Romano comorbidity index score were associated with a higher risk of Parkinson’s.

The analysis revealed that gout was independently linked to a 1.14 times higher risk of Parkinson’s. The risk differed significantly by age, with patients between the ages of 65 and 75 having the highest risk (1.27 times higher) and those older than 85 having a smaller risk (0.97). There was no risk association with gender or race/ethnicity for gout patients with incident Parkinson’s.

“Gout is associated with a modest increase in the risk of Prkinson’s for adults 65 years or older as a group, independent of other factors,” the researchers wrote, concluding that the “mechanisms of this increased risk of Parkinson’s in patients with gout needs to be investigated further.”

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Older IBD Patients Show Increased Risk for Parkinson’s Disease, Study Suggests

IBD risk factor

Older patients with inflammatory bowel disease (IBD) are more likely to develop Parkinson’s disease than those without the condition, a meta-analysis suggests.

Whether the same association exists for younger patients — ages 59 or younger — remains to be determined, according to the researchers.

The study, “Older patients with IBD might have higher risk of Parkinson’s disease,” was published in the journal Gut.

The chronic activation of pro-inflammatory mechanisms, which occurs in autoimmune conditions, has been increasingly recognized as a critical contributor of neurodegenerative disorders.

Studies suggest that this may happen due to the “gut-brain axis” — the two-way communication between the nervous system and the intestine that monitors gut function and links certain regions of the brain to intestinal functions, such as immune activation or intestinal permeability.

In line with the findings, some studies have already reported that patients with IBD — an autoimmune condition characterized by chronic inflammation of the gut — are 22-41% more likely to develop Parkinson’s than those without IBD.

However, a case-control study that examined Medicare data from 89,790 Parkinson’s cases and 118,095 population-based controls suggested that IBD actually reduced the risk for Parkinson’s by 15%.

To clarify this association, a team at Sichuan University in China reviewed all studies investigating the link between IBD and risk of Parkinson’s. Five studies met the inclusion criteria defined by the team, including a total of 9,174,766 participants.

Overall, IBD patients did not have a significantly higher risk of Parkinson’s than reference individuals, nor did patients with ulcerative colitis or Crohn’s disease — the two main forms of IBD — when examined individually.

However, patients 60 years or older were found to have a 32% higher risk of developing Parkinson’s. Patients 50 years or younger did not show this association, the researchers said.

“Our meta-analysis showed that patients with IBD did not have an increased risk of PD; however, subgroup analysis with cohort studies showed that they might be associated with increased risk of PD,” the researchers wrote.

“Age has been regarded as an important risk factor for Parkinson’s disease,” they added, but the findings suggest that “age at IBD diagnosis might be a risk factor of Parkinson’s disease.”

Interestingly, the team found that some studies reported medication-related side effects in the IBD population that resembled parkinsonism in the older population.

“It is necessary to take it into consideration whether older people will take more medications, and whether these medications lead to a higher risk of Parkinson’s also needs further studies to verify in the future,” they said.

Additional well-designed observational studies are still warranted to further explore the risk of Parkinson’s disease within the younger IBD population, the team noted.

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Taste, Smell Impairments May Help Identify People at Risk for Parkinson’s, Study Suggests

taste and smell impairment

Impaired sense of smell or taste can raise a person’s risk of developing Parkinson’s disease 2.5 times, a study suggests.

The study, “Incidence of Parkinson’s disease in a large patient cohort with idiopathic smell and taste loss,” was published in the Journal of Neurology.

Currently, Parkinson’s disease is diagnosed mainly on the assessment of patients’ motor symptoms and their severity. However, evaluation scales can be subjective and might fail to detect small changes.

Non-motor symptoms have gained increased attention because of their potential to anticipate Parkinson’s-related motor manifestations. Approximately 90% of Parkinson’s patients have altered smell sensitivity during the disease’s initial and moderate stages, thought to be partly because of brain connectivity changes.

To explore the incidence and diagnostic potential of smell and taste disorders in Parkinson’s disease, researchers reviewed the clinical records of 474 people who had been diagnosed with smell and taste loss of unknown cause.

Patients diagnosed and followed over a period of 15 years at the Smell and Taste Clinic in Dresden, Germany, were interviewed by phone using a standardized questionnaire to record their condition and clinical history.

At the time of the first assessment at the clinic, patients had already experienced reduced or lost  odor and taste sensitivity for a mean period of 4.6 years. Onset of olfactory (smell) disturbances was in general noticed at a mean age of 57.9 years; gustatory (taste) disorders, 59.3 years.

Of the 474 participants, 14.3% had a normal sense of smell, 40.5% had reduced, and 45.1% had complete loss of smell. Regarding taste, 90.1% of the participants had normal sensation, 9.5% had reduced, and 0.4% had complete loss of taste.

Collectively, 242 people were diagnosed with a qualitative olfactory or gustatory disorder, of whom 21.1% had parosmia (distortions of the sense of smell), 32.9% had phantosmia (olfactory hallucinations), and 7.6% had parageusia (distortions of the sense of taste).

Participants’ clinical reports revealed that 45 (9.5%) had developed Parkinson’s disease after the initial idiopathic smell and/or taste loss diagnosis.

Six of the Parkinson’s patients had combined olfactory and gustatory disorders at the time of diagnosis, whereas 38 had pure olfactory disorders and one patient had a pure gustatory disorder.

The frequency of taste disorders was similar between those with and without Parkinson’s. In contrast, Parkinson’s patients had a higher prevalence of initial complete loss of smell compared to those without the disease.

The team did not find a significant association between taste or smell loss and the development of the disease. Still, patients who developed Parkinson’s reported a decrease in olfactory and gustatory function more frequently than non-Parkinson’s patients.

Researchers found that “patients with a decrease in olfactory or gustatory function developed Parkinson’s with a significantly higher rate compared to patients with a stable smell or taste function.” Overall, impaired smell or taste sense increased the risk of developing Parkinson’s disease 2.47 times.

“Risk stratification might be considerably improved by correct diagnostic allocation of smell and taste loss, the use of both olfactory and gustatory testing, and subsequent long-term monitoring of these functions,” researchers said.

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Study Outlines Risk Factors for Levodopa-induced Dyskinesia in Newly Diagnosed PD Patients

Parkinson's levodopa-induced dyskinesia

Severe motor, functional, and gait impairment; cumulative levodopa exposure; anxiety, and sex are among the risk factors for developing levodopa-induced dyskinesia (LID) in people newly diagnosed  with Parkinson’s disease, according to results from the Parkinson’s Progression Markers Initiative (PPMI).

The research, “Risk factors of levodopa-induced dyskinesia in Parkinson’s disease: results from the PPMI cohort,” was published in the journal npj Parkinson’s Disease.

Long-term dopamine repletion therapy in Parkinson’s patients can lead to motor fluctuations, including dyskinesia — involuntary, jerky movements. According to observational studies, over 50% of Parkinson’s patients on levodopa — the gold-standard treatment for Parkinson’s — for more than five years develop LID.

Proposed risk factors for LID include levodopa dosage — associated with the loss of dopamine-producing neurons in the brain — treatment duration, low body weight, and being a woman. However, available studies have employed different methodological approaches and follow-up duration.

The PPMI is an ongoing, large-scale, collaborative study initiated in 2010 to identify markers of disease progression in de novo patients — newly diagnosed and still untreated. Patients’ clinical, neuroimaging and cerebrospinal fluid (the liquid surrounding the brain and the spinal cord)/blood biomarkers are collected yearly in this international study.

Analyzed biomarkers include the total amount of the tau protein as well as its altered (phosphorylated) version — which forms tangles inside neurons in Parkinson’s patients — total alpha-synuclein (the main component of Lewy bodies), and amyloid-beta (1-42), a protein that is also relevant in Alzheimer’s disease.

Researchers from Ospedale S. Maria della Misericordia, in Perugia, Italy, wanted to define factors predictive of LID development in de novo Parkinson’s patients.

Data from 423 patients were analyzed. Median follow-up duration was 4.6 years and average time to start dopaminergic therapy was one year.

A combination of factors, such as disease duration, anxiety — assessed with the State-Trait Anxiety Inventory (STAI) — and higher (worse) score on the Movement Disorder Society-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) part III, which assesses motor function, predicted the initiation of dopaminergic therapy.

Overall, 109 of 390 patients analyzed experienced LID (27.9%), 33 of whom lacked data regarding levodopa treatment and/or LID onset. The median time to LID was 3.6 years (range 0.8-7.1 years), with a mean onset time of 5.81 years from Parkinson’s diagnosis, and an incidence rate of 64 per 1,000 person-years. This measure comprises actual follow-up duration in each patient and is higher with the length of the study.

Individual risk factors for LID development included being a woman, not being completely functional independent as measured by the modified Schwab & England Activities of Daily Living scale, higher MDS-UPDRS part III score, postural instability-gait disturbance (PIGD) or intermediate phenotype, higher DaTscan caudate asymmetry index — which reflects the difference in the levels of dopamine transport between two areas of the brain involved in motor control — higher genetic risk score, and anxiety.

Of note, no cerebral spinal fluid biomarker predicted LID development.

Researchers also found that the onset of dyskinesia was associated with depression and anxiety.

Combining all factors with an additional variable of 1,000 mg/day of levodopa equivalent daily dose — the amount of levodopa with a similar effect as the medication taken — was also found to be fairly accurate to predict dyskinesia onset.

“In summary, our findings indicate that data deriving from a large cohort of de novo PD patients monitored longitudinally are useful in understanding the composite aspects involved in the progression of disease,” researchers stated.

The team also said the findings may help “future design of both biomarker studies and randomized clinical trials.”

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Most Untreated Parkinson’s Patients Have Non-Motor Symptoms, Study Shows

non-motor symptoms

Non-motor symptoms are common among patients with Parkinson’s disease who have not yet received any treatment, and the type of symptoms differs between men and women and onset age groups, a study shows.

The study, “Gender and onset age related-differences of non-motor symptoms and quality of life in drug-naïve Parkinson’s disease,” was published in the journal Clinical Neurology and Neurosurgery.

Parkinson’s disease is mostly recognized by its motor symptoms, such as tremor and postural instability. Several non-motor symptoms, including sleep disorders, neuropsychiatric disturbances, and sensory deficits, have also been reported in Parkinson’s patients at both the early and late stages of the disease.

Increasing evidence suggests that these non-motor symptoms can precede the onset of Parkinson’s motor manifestations and have a significant impact on patients’ quality of life.

Studies addressing the prevalence and nature of Parkinson’s non-motor symptoms have been widely discussed in the general Parkinson’s population, mainly in patients receiving anti-parkinsonian therapy. However, the presence of non-motor symptoms may be confounded by the fact that many of these symptoms arise as part of therapy-related side effects.

In this study, a team of researchers evaluated the prevalence of non-motor symptoms in 569 Chinese patients with Parkinson’s disease who had not yet been treated with any approved therapy.

“Untreated PD [Parkinson’s disease] patients represent a suitable model, which is good for exploring the clinical expression of NMS [non-motor symptoms] as well as motor symptoms,” the researchers wrote.

The team wanted to explore the gender and onset age-related non-motor symptom profiles and investigate the determinants of quality of life in these patients.

Participants were between the ages of 45 and 70 and had a mean disease duration of two years. Approximately 51.7% were women, 18.6% had early-onset disease, and overall patients showed bilateral disease without impairment of balance, as determined by a score of 1.9 on the modified Hoehn and Yahr (H&Y) staging scale.

The mean score on the Unified Parkinson’s Disease Rating Scale (UPDRS III), which assesses the motor signs of Parkinson’s disease, was 21.7, with men exhibiting significantly higher (worse) scores than females.

A total of 552 patients had at least one Parkinson’s non-motor symptom, with 74% reporting sleep disorder or fatigue and 62.7% attention or memory impairments. The rarest manifestation was perceptual problems or hallucinations, which affected 3.7% of patients.

Men showed a higher incidence of urinary and sexual dysfunction, and a significantly lower incidence of sleep issues or fatigue, mood changes or apathy, and attention or memory impairments than women.

The team also found that patients with late-onset disease had a significantly higher incidence of perceptual problems or hallucinations, attention or memory deficits, as well as gastrointestinal, urinary, and sexual dysfunctions than early-onset Parkinson’s patients.

Overall, patients who were depressed and those who had worse non-motor symptoms, in particular sleep problems or fatigue, mood alterations or apathy, attention or memory impairments, or gastrointestinal symptoms, were found to have a poorer quality of life.

“Our study suggests that NMS is common in drug-naïve PD patients,” the researchers wrote.

“NMS, especially sleep/ fatigue, mood/apathy, attention/memory, and gastrointestinal symptoms, are dramatic determinants on decreased QoL [quality of life] in PD patients,” they added. “Management of non-motor symptoms is of great importance to improve the quality of life of early stage Parkinson’s disease patients.”

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Study Outlines Risk Factors for Frequent Falls in Parkinson’s Patients

frequent falls risk

Motor fluctuations, treatment with antidepressants, disease severity, and deep brain stimulation (DBS) are among the risk factors that contribute to frequent falls in patients with Parkinson’s, a large-scale study reports.

According to researchers, identifying predictors that put Parkinson’s patients at the greatest risk for falls can aid in early intervention to prevent these occurrences.

The study, “What predicts falls in Parkinson disease?” appeared in the journal Neurology: Clinical Practice.

Parkinson’s patients may experience falls as a result of their motor symptoms, such as uncontrollable accelerations, impaired balance, and freezing of gait. Approximately 50 percent of these falls require medical care.

Although a history of falling is considered the major risk factor for future falls, research reported that even individuals without any previous occurrences had a considerable risk of future falls. Other risk factors include disease stage and duration, older age, absence of tremor at rest, severity of motor impairment, cognitive dysfunction, taking antidepressants, and DBS — a surgical procedure to treat motor symptoms in Parkinson’s.

Recent studies also pinpointed dopaminergic treatment — intended to restore the reduced level of the neurotransmitter dopamine in Parkinson’s patients — disease severity, and gait characteristics, as well as clinical tests, as predictors of falls among patients without any previous history.

Researchers in this study analyzed longitudinal data from the National Parkinson Foundation Quality Improvement Initiative (NPF-QII) registry (NCT01629043) to discover what factors set apart Parkinson’s patients who are most likely to become frequent fallers.

The study included 3,795 participants from 19 NPF Centers of Excellence. A total of 3,276 (86.3%) patients reported no or rare falls in the three months prior to the first visit, of which 382 (11.7%) became frequent fallers by the annual follow-up visit. This rate is similar to those reported in prior studies, the researchers noted.

Predictors of falls included motor fluctuations, treatment with levodopa and antidepressants, DBS, reduced health-related quality of life, less than 90% of Parkinson’s diagnostic certainty, female sex, and worse semantic fluency (part of verbal fluency).

Another risk factor for falls was being a stage 2 or 3 on the Hoehn and Yahr scale — which is used to describe the progression of Parkinson’s symptoms, where stage 2 refers to bilateral involvement without impaired balance, and 3 to mild to moderate bilateral disease with postural instability but physical independence.

Regarding the association with antidepressants, the investigators said that although they are a known risk factor for falls in older adults and could indicate a greater incidence of depression — also a risk factor — clinicians should consider nonpharmacological alternatives to treat depression in Parkinson’s patients at risk of falling.

Between visits, factors contributing to conversion to “frequent faller status” included the addition of amantadine for involuntary muscle movements, a referral to occupational therapy, diagnoses of cancer or osteoarthritis, newly implemented DBS, and an increased need for social and hospital services, including more emergency visits, which may indicate poorer global health, the researchers said.

As for the correlation between DBS and the risk of falling, according to the authors, this finding is in line with evidence showing that postural instability and falls may worsen within the first year after surgery.

“We have identified a number of associations between disease characteristics, treatments, and comorbidities and emergent falls in [Parkinson’s],” they wrote. “Such identifiers may help target patient subgroups for falls prevention intervention.”

However, the scientists cautioned that although the analysis provides associations between risk factors and falls in Parkinson’s patients, it does not prove causality.

The NPF-QII registry is still recruiting participants for an estimated total of 10,000. It aims to identify the best expert care practices for improved outcomes, including survival and quality of life. The study is being conducted across the U.S., Canada, and in the Netherlands and Israel. More details on locations and contacts can be found here.

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First-degree Relatives at Higher Risk of Parkinson’s, Other Neuropsychiatric Disorders, Study Finds

first-degree relatives risk

First-degree relatives of Parkinson’s patients are more likely to develop the disease and are at a higher risk for other neuropsychiatric disorders, a study shows.

The study, “Familial aggregation of Parkinson’s disease and coaggregation with neuropsychiatric diseases: a population-based cohort study,” was published in Clinical Epidemiology.

Most Parkinson’s cases are considered to be sporadic, but several studies have suggested that the disease results from a combination of genetic and environmental factors.

Several genes have been pinpointed as the cause of 6 to 7 percent of the clinical variability observed in Parkinson’s disease.

To better understand the impact of genetic and environmental factors on the development of Parkinson’s, researchers reviewed potential risk factors that could be linked to familial aggregation of the disease.

Clinical records of all individuals registered in the Taiwan National Health Insurance Research Database in 2015 were analyzed. Of the total registered population of 24,349,599 individuals, 112,037 were diagnosed with Parkinson’s disease.

This included 149,187 individuals who had a parent affected by Parkinson’s, 3,698 with an affected offspring, 3,495 with an affected sibling, and 15 individuals with an affected twin.

Researchers found that individuals who had a first-degree relative with Parkinson’s disease had a 1.69 times increased chance of also developing the disease. This risk was similar for both male and female relatives and was greater for twins, who were 63.12 times more likely to develop Parkinson’s.

The risk of developing Parkinson’s was 2.2 times higher for siblings, 1.86 times higher for offspring, 1.59 times higher for parents, and 1.46 times higher for spouses.

These results suggest that the clinical variability of Parkinson’s prevalence observed in the Taiwanese population is accounted for by genetic factors (heritability) at 11%, shared environmental factors at 9.1%, and non-shared environmental factors at 79.9%.

Additional analysis further showed that first-degree relatives of Parkinson’s patients are also at an increased risk for some other neuropsychiatric disorders than the general population. These include major depression, anxiety, multiple sclerosisAlzheimer’s disease, and amyotrophic lateral sclerosis, among others.

Researchers believe that Parkinson’s disease “should be considered an age-related multifactorial syndrome with mainly genetic and environmental components.”

“First-degree relatives of PD patients are more likely to develop PD and other neuropsychiatric diseases. Environmental factors account for a high proportion of the pheno- typic variance of PD,” they wrote.

“Our findings provide information useful for counseling families of Parkinson’s patients,” they also said.

Additional studies are still needed to identify the environmental causes responsible for Parkinson’s susceptibility, and the genetic contribution for disease variability remains to be determined in other populations.

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