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Varden R, Walker R, O'Callaghan A. No trend to rising rates: A review of Parkinson's prevalence studies in the United Kingdom. Parkinsonism Relat Disord 2024:107015. [PMID: 38876845 DOI: 10.1016/j.parkreldis.2024.107015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 04/15/2024] [Accepted: 05/19/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND Of the neurodegenerative diseases, Parkinson's disease is recognised to have the fastest growing prevalence. It is unclear whether this is due to the ageing global population alone, with several environmental factors increasingly implicated in changing prevalence rates. Large data sets have been used nationally and globally to help predict future disease burden. However, the reliability of such sources is yet unknown for Parkinson's disease. SUMMARY This review discusses the methods used in all published UK prevalence studies conducted to date. Direct comparison between prevalence figures obtained from the 10 to discussed prevalence studies is precluded due to differences in methodology for case ascertainment and diagnosis. Age adjusted estimates vary from 105/100,000 to 168/100,000. KEY MESSAGES These studies demonstrate no overall trend in changing prevalence figures between 1961 and 2007. No difference in prevalence trends were seen for those living in rural or urban areas. Differences between ethnic groups, for example, remains an under explored area.
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Affiliation(s)
- Rosanna Varden
- North Cumbria Integrated Care NHS Foundation Trust, Carlisle, United Kingdom; Newcastle University, Newcastle-upon-Tyne, United Kingdom.
| | - Richard Walker
- Northumbria Healthcare NHS Foundation Trust, North Tyneside, United Kingdom; Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Ailish O'Callaghan
- North Cumbria Integrated Care NHS Foundation Trust, Carlisle, United Kingdom
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Martínez-Castrillo JC, Martínez-Martín P, Burgos Á, Arroyo G, García N, Luquín MR, Arbelo JM. Prevalence of Advanced Parkinson's Disease in Patients Treated in the Hospitals of the Spanish National Healthcare System: The PARADISE Study. Brain Sci 2021; 11:brainsci11121557. [PMID: 34942858 PMCID: PMC8699428 DOI: 10.3390/brainsci11121557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/10/2021] [Accepted: 11/17/2021] [Indexed: 01/07/2023] Open
Abstract
Background: Advanced Parkinson’s disease (APD) has been recently defined as a stage in which certain symptoms and complications are present, with a detrimental influence on the overall patient’s health conditions and with a poor response to conventional treatments. However, historically, the term APD has been controversial, thus consequently, APD prevalence has not been previously studied. Objectives: The main objective was to determine the prevalence of APD in patients diagnosed with idiopathic PD in hospitals of the Spanish National Healthcare System. Secondary objectives were the prevalence and incidence of PD and the clinical and sociodemographic characteristics and quality of life of patients with APD or non-APD. Methods: This was a non-interventional, cross-sectional, multicenter, national study in the hospital setting. Results: The study population included 929 patients with PD (mean age 71.8 ± 10.1 years; 53.8% male) and a mean time since diagnosis of 6.6 ± 5.4 years. At the time of diagnosis, 613 patients (66.06%) reported having had premotor symptoms. The Hoehn and Yahr stage was 1 in 15.7% of the patients, 2 in 42.8%, 3 in 30.1%, 4 in 9.9%, and 5 in 1.4%; 46.9% of the patients had comorbidities (mean age-adjusted Charlson comorbidity index 3.5 ± 1.7; median 10-year survival 77%) and the mean 8-item Parkinson’s Disease Quality of Life Questionnaire was 27.8 ± 20.5. We found an APD prevalence of 38.21% (95%CI: 35.08–41.42%), a PD prevalence of 118.4 (95%CI: 117.3–119.6), and a PD incidence of 9.4 (95%CI: 5.42–13.4) all per 100,000 population. Among the APD population, a 15.2% were receiving some form of therapy for advanced stages of the disease (deep brain stimulation, levodopa/carbidopa intestinal gel, or apomorphine subcutaneous infusion). Conclusions: The percentage of patients with APD in the hospitals of the Spanish National Healthcare System was 38.2%.
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Affiliation(s)
- Juan Carlos Martínez-Castrillo
- Departamento de Neurología, Hospital Universitario Ramón y Cajal, Ctra. de Colmenar Viejo, km. 9100, 28034 Madrid, Spain
- Correspondence: ; Tel.: +34-91-336-8397
| | - Pablo Martínez-Martín
- Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III (ISCIII), Calle Valderrebollo, 5, 28031 Madrid, Spain;
| | - Ángel Burgos
- Pivotal, S.L.U. Calle Gobelas, 19, 28023 Madrid, Spain;
| | - Gloria Arroyo
- AbbVie Spain S.L.U. Avenida De Burgos 91, 28050 Madrid, Spain; (G.A.); (N.G.)
| | - Natalia García
- AbbVie Spain S.L.U. Avenida De Burgos 91, 28050 Madrid, Spain; (G.A.); (N.G.)
| | - María Rosario Luquín
- Servicio de Neurología, IdiSNA, Clínica Universidad de Navarra (CUN), Av. de Pío XII, 36, 31008 Pamplona, Spain;
| | - José Matías Arbelo
- Servicio de Neurología, Hospital Universitario San Roque Las Palmas, Calle Dolores de la Rocha 5, 35001 Las Palmas de Gran Canaria, Spain;
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Geographic variations of multiple sclerosis in Iran: A population based study. Mult Scler Relat Disord 2019; 28:244-249. [PMID: 30634104 DOI: 10.1016/j.msard.2019.01.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 10/22/2018] [Accepted: 01/01/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND The epidemiology of Multiple sclerosis (MS) has changed in recent decades. Considering that the incidence and geographical variations of MS is not well known in Iran. The present study was conducted to investigate the incidence of MS and its geographic variations in Iran. METHODS Data from a national registry, coordinated by the Ministry of Health (MOH), were collected for this study. In Iran, all MS patients are eligible to receive care and treatment services based on their records in this registry. Therefore, it seems that the related data are comprehensive with very high coverage, particularly in recent years. In this study, the annual incidence rates were calculated based on year of diagnosis of MS. RESULTS In this registry, 32,633 new cases were recorded between 2011 and 2016. After standardized for age, the mean annual incidence rate was 6.5 per 100,000 populations. It was 10.2 and 2.9 in women and men respectively. This incidence ranged from 1.7 to 12.8 in provincial level, with a higher intensity in the central part of the country. CONCLUSION It seems that the incidence rate of MS and its ratio in females and males are more or less comparable with the dominant patterns in developed countries, although its variation within the country is very considerable.
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Kadastik-Eerme L, Taba N, Asser T, Taba P. The increasing prevalence of Parkinson's disease in Estonia. Acta Neurol Scand 2018; 138:251-258. [PMID: 29707760 DOI: 10.1111/ane.12948] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2018] [Indexed: 01/03/2023]
Abstract
OBJECTIVES A previous epidemiological study of Parkinson's disease (PD) in the county of Tartu, Estonia, found an adjusted prevalence rate of 152/100 000 persons. We aimed to determine PD prevalence almost 20 years later, as well as evaluate any dynamic changes in disease frequency compared to the first study. METHODS A cross-sectional, community-based study was conducted over 2010-2016 in the county of Tartu, Estonia. Multiple case-finding sources, including information from neurologists, family doctors, the local PD Society, nursing institutions, and the database of the Estonian Health Insurance Fund were used to identify patients with PD of all ages. RESULTS Total crude PD prevalence was 283 and age-adjusted prevalence (standardized to the 2014 age structure of the Estonian population) 314/100 000. No significant differences in age-adjusted prevalence rates were found between men and women, nor people living in urban and rural areas. After adjustment to the same standard population used in the previous prevalence study, the overall age-adjusted prevalence rate was 197/100 000. Patients in the current study were older and often had a more severe form of PD and a longer disease duration, compared to those reported in the first epidemiological study 20 years ago. CONCLUSIONS The age-specific crude rates in oldest age-groups have risen substantially, and the age-adjusted prevalence has moderately increased compared to 20 years ago in Estonia. We hypothesize that the increased life expectancy of the Estonian population and improved diagnosis of PD contributed most to the increase in disease frequency.
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Affiliation(s)
- L. Kadastik-Eerme
- Department of Neurology and Neurosurgery; University of Tartu; Tartu Estonia
| | - N. Taba
- Estonian Genome Centre; Institute of Genomics; University of Tartu; Tartu Estonia
| | - T. Asser
- Department of Neurology and Neurosurgery; University of Tartu; Tartu Estonia
| | - P. Taba
- Department of Neurology and Neurosurgery; University of Tartu; Tartu Estonia
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Pitcher TL, Myall DJ, Pearson JF, Lacey CJ, Dalrymple-Alford JC, Anderson TJ, MacAskill MR. Parkinson's disease across ethnicities: A nationwide study in New Zealand. Mov Disord 2018; 33:1440-1448. [DOI: 10.1002/mds.27389] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 02/18/2018] [Accepted: 03/04/2018] [Indexed: 11/07/2022] Open
Affiliation(s)
- Toni L. Pitcher
- Department of Medicine; University of Otago; Christchurch New Zealand
- New Zealand Brain Research Institute; Christchurch New Zealand
- Brain Research New Zealand - Rangahau Roro Aotearoa
| | - Daniel J. Myall
- New Zealand Brain Research Institute; Christchurch New Zealand
| | - John F. Pearson
- Biostatistic and Computational Biology Unit; University of Otago; Christchurch New Zealand
| | - Cameron J. Lacey
- Māori and Indigenous Health Institute; University of Otago; Christchurch New Zealand
| | - John C. Dalrymple-Alford
- New Zealand Brain Research Institute; Christchurch New Zealand
- Brain Research New Zealand - Rangahau Roro Aotearoa
- Department of Psychology; University of Canterbury; Christchurch New Zealand
| | - Tim J. Anderson
- Department of Medicine; University of Otago; Christchurch New Zealand
- New Zealand Brain Research Institute; Christchurch New Zealand
- Brain Research New Zealand - Rangahau Roro Aotearoa
- Neurology Department; Canterbury District Health Board; New Zealand
| | - Michael R. MacAskill
- Department of Medicine; University of Otago; Christchurch New Zealand
- New Zealand Brain Research Institute; Christchurch New Zealand
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Eggers C, Holstein A, Schneider C, Pedrosa DJ, Dietlein M, Kobe C, Timmermann L, Schmidt M, Kahraman D. 123I-FP-CIT SPECT imaging of the dopaminergic state. Nuklearmedizin 2017; 51:244-51. [DOI: 10.3413/nukmed-0449-11-12] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Accepted: 04/17/2012] [Indexed: 11/20/2022]
Abstract
Summary123I-N-ω-fluoropropyl-2β-carbomethoxy-3β- (4-iodophenyl)nortropan (123I-FP-CIT) single photon emission computed tomography (SPECT) can be evaluated by both visual assessment and quantitative analysis to assess the striatal dopamine state in vivo. The aim of our study was to investigate if visual assessment according to a predefined image grading scale reflects the results of quantitative assessment techniques. Patients, methods: 195 patients with a clinical diagnosis of idiopathic Parkinson's disease (n = 134), atypical parkinsonian syndrome (n = 47) or essential tremor (n = 14) were examined with 123I-FP-CIT SPECT and included in this retrospective study. Results were analysed according to predefined visual patterns of dopaminergic degeneration and graded as normal (grade 5) or abnormal (grade 1–4) independently by three raters. Quantitative two-dimensional (2D) operator-dependent, manual and three-dimensional (3D) operator- independent, automated approaches were used for quantitative analysis of the specific 123I-FP-CIT tracer binding ratio (SBR) for caudate and putamen. Results: Sensitivity, specificity, PPV, NPV and diagnostic accuracy of visual assessment of 123I-FP-CIT SPECT for the diagnosis of a neuro degenerative Parkinson's syndrome were 99%, 86%, 99%, 86% and 98%, respectively. Visual assessment and quantitative analysis agreed well in evaluating the degree of dopaminergic degeneration. Significant differences (p < 0.001) were found between degeneration patterns. Only between the so-called eagle wing degeneration and the normal pattern no significant differences in SBR caudate and putamen were found, neither by the quantitative manual (p = 1.00; p = 0.196) nor by the quantitative automated method (p = 1.0; p = 0.785). Inter-rater agreement for visual assessment was substantial for all possible pairs of the three raters (κ = 0.70 to 0.74). Strong correlations were observed between the quantitative manual and quantitative automated methods for quantification of SBR caudatum (r = 0.920, r2 = 0.846, p < 0.001) and SBR putamen (r = 0.908, r2 = 0.824, p < 0.001). Conclusion: Visual assessment was highly consistent with the results obtained by quantitative analysis and showed a substantial inter-rater agreement between experienced and inexperienced raters. Our findings indicate that visual assessment might be a reliable analysis approach for clinical routine.
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Lin HF, Liao KF, Chang CM, Lin CL, Lai SW. Tamoxifen usage correlates with increased risk of Parkinson's disease in older women with breast cancer: a case-control study in Taiwan. Eur J Clin Pharmacol 2017; 74:99-107. [PMID: 28967041 DOI: 10.1007/s00228-017-2341-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Accepted: 09/22/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND OBJECTIVES Little is known about the association between tamoxifen usage and risk of Parkinson's disease in women with breast cancer. The present study aimed to evaluate the association between tamoxifen usage and Parkinson's disease in older women with breast cancer in Taiwan. METHODS We conducted a retrospective nationwide case-control study using the database of the Taiwan National Health Insurance Program. In total, 293 female subjects with breast cancer, aged 65 years and above, who were newly diagnosed with Parkinson's disease between 2000 and 2011 were included. Additionally, 1053 female subjects with breast cancer aged 65 years and above without Parkinson's disease were randomly selected as controls. Both cases and controls were matched for age and comorbidities. Ever use of tamoxifen was defined as subjects who had at least a prescription for tamoxifen before the index date, whereas never use of tamoxifen was defined as those who never had a prescription for tamoxifen before the index date. We used the unconditional logistic regression model to calculate the odds ratio (OR) and 95% confidence interval (CI) for the association between tamoxifen usage and risk of Parkinson's disease. RESULTS After adjusting for confounding variables, the adjusted OR of Parkinson's disease was 3.32 for subjects with ever use of tamoxifen (95% CI, 2.50-4.43), compared with nonusers. Further analysis showed that the adjusted ORs of Parkinson's disease were 3.21 (95% CI, 2.29-4.49), 3.95 (95% CI, 2.77-5.64), and 11.4 (95% CI, 2.63-49.7) for subjects with < 2, 2-6, and ≥ 6 years of cumulative tamoxifen usage, respectively, when compared with nonusers. CONCLUSIONS Tamoxifen usage was associated with a 3.32-fold increase in the likelihood of having Parkinson's disease among older women with breast cancer in Taiwan.
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Affiliation(s)
- Hsien-Feng Lin
- School of Chinese Medicine, China Medical University, Taichung, Taiwan.,Department of Family Medicine, China Medical University Hospital, No. 2, Yuh-Der Road, Taichung City, 404, Taiwan
| | - Kuan-Fu Liao
- Department of Internal Medicine, Taichung Tzu Chi General Hospital, Taichung, Taiwan.,College of Medicine, Tzu Chi University, Hualien, Taiwan.,Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
| | - Ching-Mei Chang
- Department of Nursing, Tungs' Taichung Metro Habor Hospital, Taichung, Taiwan
| | - Cheng-Li Lin
- College of Medicine, China Medical University, Taichung, Taiwan.,Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Shih-Wei Lai
- Department of Family Medicine, China Medical University Hospital, No. 2, Yuh-Der Road, Taichung City, 404, Taiwan. .,College of Medicine, China Medical University, Taichung, Taiwan.
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Myall DJ, Pitcher TL, Pearson JF, Dalrymple-Alford JC, Anderson TJ, MacAskill MR. Parkinson's in the oldest old: Impact on estimates of future disease burden. Parkinsonism Relat Disord 2017; 42:78-84. [PMID: 28693940 DOI: 10.1016/j.parkreldis.2017.06.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 06/21/2017] [Accepted: 06/26/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Traditionally the risk of Parkinson's has been considered to increase monotonically with age, although there is evidence that prevalence and incidence may decrease in the oldest old. To examine this further we estimated the national prevalence and incidence of Parkinson's in New Zealand, using drug-tracing methods, to examine the relationship of Parkinson's with sex and age up to 100+. METHODS Information on Parkinson's-related medications was extracted from the national pharmaceutical database of community-dispensed medications from 2005 to 2014. Diagnoses for a large subset of individuals were independently determined through national mortality and hospital admissions datasets. We used a Bayesian model, accommodating diagnostic uncertainty and bias, to estimate the number of people with Parkinson's. RESULTS The 2013 prevalence of Parkinson's in New Zealand was 210 per 100 000 population (95% uncertainty interval 208-212) with age-standardized prevalence rates higher for males (ratio 1.6:1). Incidence was 31 per 100 000 person-years (95% uncertainty interval 30-32), also higher in males (ratio 1.8:1). Incidence and prevalence by age increased exponentially until 75 years, peaked at 85 years, and then dropped sharply. CONCLUSIONS The prevalence of Parkinson's in New Zealand is expected to double over a 25-year period but then increase at a slower rate due to the drop-off in prevalence and incidence in the oldest old. The findings suggest that Parkinson's disease is not an aging-dependent but an age-dependent disorder.
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Affiliation(s)
- D J Myall
- New Zealand Brain Research Institute, 66 Stewart St, Christchurch 8011, New Zealand.
| | - T L Pitcher
- New Zealand Brain Research Institute, 66 Stewart St, Christchurch 8011, New Zealand; Department of Medicine, University of Otago, PO Box 4345, Christchurch, New Zealand
| | - J F Pearson
- Biostatistics and Computational Biology Unit, University of Otago, PO Box 4345, Christchurch, New Zealand
| | - J C Dalrymple-Alford
- New Zealand Brain Research Institute, 66 Stewart St, Christchurch 8011, New Zealand; Department of Medicine, University of Otago, PO Box 4345, Christchurch, New Zealand; Department of Psychology, University of Canterbury, Private Bag 4800, Christchurch 8140, New Zealand; Brain Research, New Zealand
| | - T J Anderson
- New Zealand Brain Research Institute, 66 Stewart St, Christchurch 8011, New Zealand; Department of Medicine, University of Otago, PO Box 4345, Christchurch, New Zealand; Brain Research, New Zealand; Department of Neurology, Christchurch Hospital, Private Bag 4710, Christchurch 8140, New Zealand
| | - M R MacAskill
- New Zealand Brain Research Institute, 66 Stewart St, Christchurch 8011, New Zealand; Department of Medicine, University of Otago, PO Box 4345, Christchurch, New Zealand
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Carriere N, Verloop D, Dupont C, Fontaine V, Tir M, Krystkowiak P, Blanchard A, Defebvre MM, Defebvre L. Descriptive study of the parkinsonian population in the north of France: Epidemiological analysis and healthcare consumption. Rev Neurol (Paris) 2017; 173:396-405. [DOI: 10.1016/j.neurol.2017.03.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 11/28/2016] [Accepted: 03/15/2017] [Indexed: 10/19/2022]
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Ylikotila P, Tiirikka T, Moilanen JS, Kääriäinen H, Marttila R, Majamaa K. Epidemiology of early-onset Parkinson's disease in Finland. Parkinsonism Relat Disord 2015; 21:938-42. [PMID: 26071818 DOI: 10.1016/j.parkreldis.2015.06.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Revised: 06/02/2015] [Accepted: 06/02/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The contribution of genetic causes to Parkinson's disease (PD) is strongest in early-onset cases. We ascertained a nationwide cohort of patients in order to study the genetic epidemiology of early-onset PD (EOPD) in Finland. METHODS By means of a search in a national database we ascertained all patients with EOPD. These patients had become eligible for reimbursement of PD drugs between the years 1995-2006 and were <55 years of age at the time of PD diagnosis. A total of 441 patients consented and provided clinical and genealogical information. RESULTS The incidence of EOPD increased 1.7-fold between the years 1995-2006, the mean annual incidence being 3.3/100,000. Fifty-two patients (11.8%) reported an affected first-degree relative. The birthplaces of patients with PD among first-degree relatives were clustered in certain regions in the southwestern and western coastal provinces of Finland and in the eastern province of Savo. Furthermore, the distance between the birthplaces of the patients' parents was smaller for patients, who had first-degree relatives with PD than for patients with no family history of PD. CONCLUSIONS Our data suggest that the incidence of EOPD is increasing. The birthplaces of patients with PD among first-degree relatives were clustered in certain provinces of Finland suggesting that monogenic forms of PD or genetic susceptibility of PD are present in the population.
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Affiliation(s)
- Pauli Ylikotila
- Institute of Clinical Medicine, Department of Neurology, University of Turku, Turku, Finland; Division of Clinical Neurosciences, Turku University Hospital, Turku, Finland
| | - Timo Tiirikka
- Department of Clinical Genetics, University of Oulu, Oulu, Finland
| | - Jukka S Moilanen
- Department of Clinical Genetics, University of Oulu, Oulu, Finland
| | | | - Reijo Marttila
- Institute of Clinical Medicine, Department of Neurology, University of Turku, Turku, Finland
| | - Kari Majamaa
- Division of Clinical Neurosciences, Neurology, University of Oulu, Oulu, Finland; Department of Neurology and Medical Research Center, Oulu University Hospital, Oulu, Finland.
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Thiriez C, Itti E, Fénelon G, Evangelista E, Meignan M, Cesaro P, Remy P. Clinical routine use of dopamine transporter imaging in 516 consecutive patients. J Neurol 2015; 262:909-15. [PMID: 25649832 DOI: 10.1007/s00415-014-7634-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 12/25/2014] [Accepted: 12/27/2014] [Indexed: 11/26/2022]
Abstract
[(123)I]-FP-CIT is a single photon emission computed tomography (SPECT) ligand showing in vivo the loss of dopaminergic terminals in the brain and is now available in the market. Despite several systematic studies in clinically inconclusive cases, the use of such imaging in clinical routine is scarcely reported. We analyzed 516 files of subjects with movement disorders who were consecutively examined using [(123)I]-FP-CIT scan and determined whether the use of imaging was appropriate and if it improved clinical diagnosis or care of the patient. In addition, we determined if appropriate use was related to subspecialties in Neurology, e.g., movement disorders' specialists vs. general neurologists, and if appropriate use was increasing over time. Among the 516 scans, 18% were in agreement with the license, 62% were classified as appropriate and 37% were considered inappropriate. A change of management was obvious in 60% of patients, but in 92% of those with an appropriate request vs. 13% of patients with an inappropriate request. Movement disorders' specialists had more appropriate requests than other practitioners. Eventually, comparing the first 100 vs. the last 100 quantified SPECT, performed more than 2.5 years apart, we found no difference for the appropriateness of the examination. The use of [(123)I]-FP-CIT imaging in clinical routine does not fit a restrictive license. An inappropriate use is seen in nearly 40% of cases, which reduces the real cost-effectiveness of the technique suggesting a need for continuing medical education on the topic.
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Affiliation(s)
- Claire Thiriez
- Centre Expert Parkinson, Service de neurologie, Hôpital Henri Mondor, 51 avenue du Maréchal de Lattre de Tassigny, 94010, Creteil Cedex, France,
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Detweiler MB, Sullivan K, Sharma TR, Kim KY, Detweiler JG. Case reports of neuroleptic malignant syndrome in context of quetiapine use. Psychiatr Q 2013; 84:523-41. [PMID: 23686527 DOI: 10.1007/s11126-013-9264-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
A retrospective analysis was followed on 20 case reports covering the possible correlation between the atypical antipsychotic, quetiapine, and neuroleptic malignant syndrome (NMS), determined by the study of 7 different NMS criteria guidelines. A great majority (19) of the case studies did not meet the requirements of all 7 guidelines, frequently due to unreported information. Nor was quetiapine proven to be the sole cause of the possible NMS in the two age groups investigated. Only one case was found to have no other medication or medical conditions confounding the relationship of quetiapine and NMS symptoms, and that case was in the context of a significant quetiapine overdose. The other 19 cases demonstrated the difficulty of identifying the cause of NMS when polypharmacy and other medical conditions are involved. The authors note the need for caution in deciding both the presence of NMS and the causal factors of the symptoms.
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Affiliation(s)
- Mark B Detweiler
- Psychiatry Service, Veterans Affairs Medical Center, 1970 Roanoke Boulevard (116A7), Salem, VA, 24153, USA,
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Bajaj N, Hauser RA, Grachev ID. Clinical utility of dopamine transporter single photon emission CT (DaT-SPECT) with (123I) ioflupane in diagnosis of parkinsonian syndromes. J Neurol Neurosurg Psychiatry 2013; 84:1288-95. [PMID: 23486993 PMCID: PMC3812862 DOI: 10.1136/jnnp-2012-304436] [Citation(s) in RCA: 137] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The diagnosis of movement disorders including Parkinson's disease (PD) and essential tremor is determined through clinical assessment. The difficulty with diagnosis of early PD has been highlighted in several recent clinical trials. Studies have suggested relatively high clinical diagnostic error rates for PD and essential tremor. This review was undertaken to clarify the utility of DaT-SPECT imaging with ((123)I)ioflupane (DaTSCAN or DaTscan or ((123)I)FP-CIT) in assisting practitioners in their clinical decision making by visualising the dopamine transporter in parkinsonian cases. In some patients with suspected parkinsonian syndromes, SPECT imaging with ((123)I)ioflupane is useful to assist in the diagnosis and to help guide prognosis and treatment decisions, including avoiding medications that are unlikely to provide benefit. Clinicians ordering ((123)I)ioflupane SPECT should be aware of its limitations and pitfalls and should order scans when there is diagnostic uncertainty or when the scan will be helpful in clinical decision making.
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Affiliation(s)
- Nin Bajaj
- Department of Clinical Neurology, National Parkinson's Foundation International Centre of Excellence, Nottingham University Hospitals NHS Trust and University of Nottingham, , Nottingham, UK
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Eggington S, Valldeoriola F, Chaudhuri KR, Ashkan K, Annoni E, Deuschl G. The cost-effectiveness of deep brain stimulation in combination with best medical therapy, versus best medical therapy alone, in advanced Parkinson's disease. J Neurol 2013; 261:106-16. [PMID: 24158271 PMCID: PMC3895185 DOI: 10.1007/s00415-013-7148-z] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 10/04/2013] [Accepted: 10/04/2013] [Indexed: 11/11/2022]
Abstract
Parkinson’s disease (PD) is a complex progressive movement disorder leading to motor and non-motor symptoms that become increasingly debilitating as the disease advances, considerably reducing quality of life. Advanced treatment options include deep brain stimulation (DBS). While clinical effectiveness of DBS has been demonstrated in a number of randomised controlled trials (RCT), evidence on cost-effectiveness is limited. The cost-effectiveness of DBS combined with BMT, versus BMT alone, was evaluated from a UK payer perspective. Individual patient-level data on the effect of DBS on PD symptom progression from a large 6-month RCT were used to develop a Markov model representing clinical progression and capture treatment effect and costs. A 5-year time horizon was used, and an incremental cost-effectiveness ratio (ICER) was calculated in terms of cost per quality-adjusted life-years (QALY) and uncertainty assessed in deterministic sensitivity analyses. Total discounted costs in the DBS and BMT groups over 5 years were £68,970 and £48,243, respectively, with QALYs of 2.21 and 1.21, giving an incremental cost-effectiveness ratio of £20,678 per QALY gained. Utility weights in each health state and costs of on-going medication appear to be the key drivers of uncertainty in the model. The results suggest that DBS is a cost-effective intervention in patients with advanced PD who are eligible for surgery, providing good value for money to health care payers.
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Affiliation(s)
- Simon Eggington
- Medtronic International Trading Sàrl, Route du Molliau 31, 1131, Tolochenaz, Switzerland,
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Moisan F, Gourlet V, Mazurie JL, Dupupet JL, Houssinot J, Goldberg M, Imbernon E, Tzourio C, Elbaz A. Prediction model of Parkinson's disease based on antiparkinsonian drug claims. Am J Epidemiol 2011; 174:354-63. [PMID: 21606234 DOI: 10.1093/aje/kwr081] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Drug claims databases are increasingly available and provide opportunities to investigate epidemiologic questions. The authors used computerized drug claims databases from a social security system in 5 French districts to predict the probability that a person had Parkinson's disease (PD) based on patterns of antiparkinsonian drug (APD) use. Clinical information for a population-based sample of persons using APDs in 2007 was collected. The authors built a prediction model using demographic variables and APDs as predictors and investigated the additional predictive benefit of including information on dose and regularity of use. Among 1,114 APD users, 320 (29%) had PD and 794 (71%) had another diagnosis as determined by study neurologists. A logistic model including information on cumulative APD dose and regularity of use showed good performance (c statistic = 0.953, sensitivity = 92.5%, specificity = 86.4%). Predicted PD prevalence (among persons aged ≥18 years) was 6.66/1,000; correcting this estimate using sensitivity/specificity led to a similar figure (6.04/1,000). These data demonstrate that drug claims databases can be used to estimate the probability that a person is being treated for PD and that information on APD dose and regularity of use improves models' performances. Similar approaches could be developed for other conditions.
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The health-related, social, and economic consequences of parkinsonism: a controlled national study. J Neurol 2011; 258:1497-506. [DOI: 10.1007/s00415-011-5969-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2010] [Revised: 02/20/2011] [Accepted: 02/21/2011] [Indexed: 10/18/2022]
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Hu MT, Butterworth R, Kumar V, Cooper J, Jones E, Catterall L, Ben-Shlomo Y. How common and what are the determinants of sub-optimal care for Parkinson’s disease patients: The Milton Keynes community study. Parkinsonism Relat Disord 2011; 17:177-81. [DOI: 10.1016/j.parkreldis.2010.12.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Revised: 12/06/2010] [Accepted: 12/17/2010] [Indexed: 10/18/2022]
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Szabó N, Kincses ZT, Vécsei L. Novel therapy in Parkinson's disease: adenosine A2Areceptor antagonists. Expert Opin Drug Metab Toxicol 2011; 7:441-55. [DOI: 10.1517/17425255.2011.557066] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Walker RW, Hand A, Jones C, Wood BH, Gray WK. The prevalence of Parkinson’s disease in a rural area of North-East England. Parkinsonism Relat Disord 2010; 16:572-5. [DOI: 10.1016/j.parkreldis.2010.07.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Revised: 06/23/2010] [Accepted: 07/05/2010] [Indexed: 10/19/2022]
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Kim JH, Cheong HK, Lee CS, Yi SE, Park KW. The validity and reliability of a screening questionnaire for Parkinson's disease in a community. J Prev Med Public Health 2010; 43:9-17. [PMID: 20185978 DOI: 10.3961/jpmph.2010.43.1.9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES Parkinson's disease is one of the most common neurodegenerative diseases in the elderly population. In order to estimate the prevalence of Parkinson's disease in the community, the application of a good screening tool is essential. We evaluated the validity and reliability of a Parkinson's disease screening questionnaire and propose an alternative measure to improve its validity for use in community surveys. METHODS We designed the study in a three-phase approach consisting of a screening questionnaire, neurologic examination, and confirmatory examination. A repeated survey was administered to patients with disease detected in the community and on 150 subjects. We examined internal consistency using Cronbach's alpha test, test-retest reliability using the kappa statistic, and validity using sensitivity, specificity, and ROC curves. Unadjusted odds ratios were utilized for the estimation of weights for each questionnaire item. RESULTS The Cronbach's alpha of the questionnaire was 0.708. The kappa statistic for test-retest reliability was good to generally fair in most of the items. When newly proposed weighting scores were used, the optimum cut-off value was 7/8. When cut-off value was 5/6 for surveying prevalence in a community, the sensitivity was 0.98, and the specificity was 0.61, with simultaneous improvement in reliability. CONCLUSIONS We recommend 5/6 as the ideal cut-off value for the survey of PD prevalence in community. This questionnaire designed for the Korean community could help future epidemiologic studies of PD.
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Affiliation(s)
- Jong Hun Kim
- Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Korea
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Kincses ZT, Vecsei L. Pharmacological therapy in Parkinson's disease: focus on neuroprotection. CNS Neurosci Ther 2010; 17:345-67. [PMID: 20438581 DOI: 10.1111/j.1755-5949.2010.00150.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Although the number of available therapeutic approaches in Parkinson's disease (PD) is steadily increasing the search for effective neuroprotective agent is continuing. Such research is directed at influencing the key steps in the pathomechanism: the mitochondrial dysfunction, the oxidative stress, the neuroinflammatory processes and the final common apoptotic pathway. Earlier-developed symptomatic therapies were implicated to be neuroprotective, and promising novel disease modifying approaches were brought into the focus of interest. The current review presents a survey of our current knowledge relating to the pathomechanism of PD and discusses the putative neuroprotective therapy.
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Affiliation(s)
- Zsigmond Tamas Kincses
- Department of Neurology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
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Wright Willis A, Evanoff BA, Lian M, Criswell SR, Racette BA. Geographic and ethnic variation in Parkinson disease: a population-based study of US Medicare beneficiaries. Neuroepidemiology 2010; 34:143-51. [PMID: 20090375 DOI: 10.1159/000275491] [Citation(s) in RCA: 263] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2009] [Accepted: 10/14/2009] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Parkinson disease is a common neurodegenerative disease. The racial, sex, age, and geographic distributions of Parkinson disease in the US are unknown. METHODS We performed a serial cross-sectional study of US Medicare beneficiaries aged 65 and older from the years 1995, and 2000-2005. Using over 450,000 Parkinson disease cases per year, we calculated Parkinson disease prevalence and annual incidence by race, age, sex, and county. Spatial analysis investigated the geographic distribution of Parkinson disease. RESULTS Age-standardized Parkinson disease prevalence (per 100,000) was 2,168.18 (+/-95.64) in White men, but 1,036.41 (+/-86.01) in Blacks, and 1,138.56 (+/-46.47) in Asians. The incidence ratio in Blacks as compared to Whites (0.74; 95% CI = 0.732-0.748) was higher than the prevalence ratio (0.58; 95% CI = 0.575-0.581), whereas the incidence ratio for Asians (0.69; 95% CI = 0.657-0.723) was similar to the prevalence ratio (0.62; 95% CI = 0.617-0.631). Bayesian mapping of Parkinson disease revealed a concentration in the Midwest and Northeast regions. Mean county incidence by quartile ranged from 279 to 3,111, and prevalence from 1,175 to 13,800 (per 100,000). Prevalence and incidence in urban counties were greater than in rural ones (p < 0.01). Cluster analysis supported a nonrandom distribution of both incident and prevalent Parkinson disease cases (p < 0.001). CONCLUSIONS Parkinson disease is substantially more common in Whites, and is nonrandomly distributed in the Midwest and Northeastern US.
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Affiliation(s)
- Allison Wright Willis
- Department of Neurology, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8111, St. Louis, MO 63110, USA.
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