Tremor, restless legs syndrome, schizophrenia among the risk factors linked to PD

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November 21, 2022

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Schrag reports receiving a salary from the Biomedical Research Council of the National Institute for Health and Care Research during the conduct of the study; grants from the NIHR for investigator-led trials, the development of the Movement Disorders Society Non-Motor Rating Scale from the Movement Disorders Society, and the European Commission for studies on anxiety in Parkinson’s disease and aspects of attention in Parkinson’s disease; AbbVie consultant and speaker fees; salary from University College London; and book royalties from Oxford University Press outside of the submitted work. She consulted the study for relevant financial disclosures from all other authors.

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According to a study in NEVER Neurology.

The prodromal features of Parkinson’s disease can begin more than a decade before the typical clinical symptoms allow a diagnosis. Annette Schrag, MD, PhD, of University College London’s department of clinical and movement neurosciences, and colleagues wrote. “In addition, there is increasing evidence of a number of potential risk factors that may predispose to disease manifestation or facilitate the development or spread of pathologic lesions.”

The increased risk of developing Parkinson’s disease was associated with a wide range of factors, some of which may appear 5 to 10 years before clinical symptoms. Source: Adobe Stock

Schrag and his fellow investigators sought to understand the link between risk factors and prodromal features, including lifestyle factors, comorbidities and potential extracerebral manifestations, and subsequent diagnosis of PD.

In a case-control study, researchers used insurance claims from outpatient clinics of patients with German mandatory health insurance between January 2011 and December 2020 to identify 138,345 people diagnosed with PD (mean age, 75.1 years ; 53.3% men) and 276,690 controls matched by age, sex, region, and first year of outpatient visit. All participants were monitored for a mean of 6 years.

Based on the results, risk factors and prodromal features associated with PD included traumatic brain injury (OR, 1.62; 95% CI, 1.36-1.92), alcohol abuse (OR, 1.32; 95% CI, 1.21-1.44), hypertension (OR, 1.29; 95% CI, 1.26-1.31), anosmia (OR, 2.16; 95% CI, 1, 59-2.93) and parasomnias (including rapid eye movement sleep behavior disorder; OR, 1.62; 95% CI, 1.42-1.84).

The investigators also identified links to restless legs syndrome (OR, 4.19; 95% CI, 3.91-4.5), sleep apnea (OR, 1.45; 95% CI, 1.37 -1.54), epilepsy (OR, 2.26; 95% CI, 2.07-2.46), migraine (OR, 1.21; 95% CI, 1.12-1.29), disorder bipolar (OR, 3.81; 95% CI, 3.11-4.67) and schizophrenia (OR, 4.48; 95% CI, 3.82-5.25).

Conditions associated with PD 5 to 10 years before diagnosis included tremor (OR, 4.49; 95% CI, 3.98-5.06), restless legs syndrome (OR, 3.73; 95% CI, 3.39-4.09), bipolar disorder (OR, 3.8; 95% CI, 2.82-5.14) and schizophrenia (OR, 4; 95% CI, 3.31-4.85). Positive associations were also made with skin disorders, gastrointestinal disorders, conditions with a potential inflammatory component, and type 1 and 2 diabetes.

“Given the size and period of the study, we believe this case-control study has generated valuable hypotheses about the associations found between PD and certain risk factors, comorbidities, and prodromal symptoms in a representative population,” Schrag and colleagues wrote. .

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