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Carvajal-Oliveros A, Dominguez-Baleón C, Sánchez-Díaz I, Zambrano-Tipan D, Hernández-Vargas R, Campusano JM, Narváez-Padilla V, Reynaud E. Parkinsonian phenotypes induced by Synphilin-1 expression are differentially contributed by serotonergic and dopaminergic circuits and suppressed by nicotine treatment. PLoS One 2023; 18:e0282348. [PMID: 36857384 PMCID: PMC9977059 DOI: 10.1371/journal.pone.0282348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 02/13/2023] [Indexed: 03/02/2023] Open
Abstract
Synphilin-1 is a protein encoded by the human SNCAIP gene whose function has yet to be fully understood. However, it has been linked to familial Parkinson's disease (PD). Synphilin-1 is a major component of the Lewy bodies found in neurons in the substantia nigra pars compacta of PD patients. Synphilin-1 expression in serotonergic and/or dopaminergic neurons of Drosophila melanogaster induces neurodegeneration, as well as motor and non-motor PD like symptoms. In this work, we examined the contribution of the serotonergic and dopaminergic circuits in the development of PD-like phenotypes. We found that olfactory and visual symptoms are majorly contributed by the serotonergic system, and that motor symptoms and reduction in survival are mainly contributed by the dopaminergic system. Chronic nicotine treatment was able to suppress several of these symptoms. These results indicate that both the serotonergic and dopaminergic systems contribute to different aspects of PD symptomatology and that nicotine has beneficial effects on specific symptoms.
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Affiliation(s)
- Angel Carvajal-Oliveros
- Departamento de Genética del Desarrollo y Fisiología Molecular, Instituto de Biotecnología, Universidad Nacional Autónoma de México, Cuernavaca, México
| | - Carmen Dominguez-Baleón
- Departamento de Genética del Desarrollo y Fisiología Molecular, Instituto de Biotecnología, Universidad Nacional Autónoma de México, Cuernavaca, México
| | - Iván Sánchez-Díaz
- Departamento de Genética del Desarrollo y Fisiología Molecular, Instituto de Biotecnología, Universidad Nacional Autónoma de México, Cuernavaca, México
| | - Diego Zambrano-Tipan
- Departamento de Genética del Desarrollo y Fisiología Molecular, Instituto de Biotecnología, Universidad Nacional Autónoma de México, Cuernavaca, México
| | - René Hernández-Vargas
- Departamento de Genética del Desarrollo y Fisiología Molecular, Instituto de Biotecnología, Universidad Nacional Autónoma de México, Cuernavaca, México
| | - Jorge M. Campusano
- Facultad de Ciencias Biológicas, Departamento de Biología Celular y Molecular, Laboratorio Neurogenética de la Conducta, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Verónica Narváez-Padilla
- Centro de Investigación en Dinámica Celular, Universidad Autónoma del Estado de Morelos, Cuernavaca, Morelos, México
| | - Enrique Reynaud
- Departamento de Genética del Desarrollo y Fisiología Molecular, Instituto de Biotecnología, Universidad Nacional Autónoma de México, Cuernavaca, México
- * E-mail:
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Fjaeldstad AW, Ovesen T, Hummel T. The Association Between Smoking on Olfactory Dysfunction in 3,900 Patients With Olfactory Loss. Laryngoscope 2020; 131:E8-E13. [PMID: 32096874 DOI: 10.1002/lary.28552] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 12/28/2019] [Accepted: 01/17/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVES/HYPOTHESIS The association between smoking and olfactory loss remains a conundrum. Prior studies have found negative and positive effects of smoking on olfactory function in the general population. However, smoking cessation seems to improve both rated and measured olfactory function. The purpose of this study was to investigate the olfactory function and smoking habits in patients with olfactory loss caused by different etiologies to unveil underlying patterns related to smoking. STUDY DESIGN Retrospective observational study. METHODS Patients were included from two specialized taste and smell centers. Patients underwent olfactory testing, clinical examination including rhinoscopy, and the underlying etiology was identified. Patterns of olfactory test scores, demographics, and etiologies were analyzed. RESULTS In total, 3,900 patients with olfactory loss were included. Of these, 521 were current smokers, and 316 were former smokers. Patients with a history of smoking did not have significantly lower olfactory function. Current smokers were more often affected by posttraumatic olfactory loss, but not sinonasal, postviral, or idiopathic olfactory loss. CONCLUSIONS Current smoking, but not former smoking, was associated with posttraumatic olfactory loss. In relation to measured olfactory function, a history of smoking was not associated to lower olfactory scores. Our findings suggest that the general recommendations of smoking cessation for patients with olfactory loss are especially relevant for patients with posttraumatic olfactory loss. The nature of this association between current smoking and posttraumatic olfactory loss has yet to be elucidated. LEVEL OF EVIDENCE 2b Laryngoscope, 131:E8-E13, 2021.
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Affiliation(s)
- Alexander W Fjaeldstad
- Department of Clinical Medicine, Aarhus University, Flavour Institute, Aarhus, Denmark.,Flavour Clinic, Department of Otorhinolaryngology, Holstebro Regional Hospital, Holstebro, Denmark.,Hedonia Research Group, Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Therese Ovesen
- Department of Clinical Medicine, Aarhus University, Flavour Institute, Aarhus, Denmark.,Flavour Clinic, Department of Otorhinolaryngology, Holstebro Regional Hospital, Holstebro, Denmark
| | - Thomas Hummel
- Interdisciplinary Center for Smell and Taste, Department of Otorhinolaryngology, Dresden, Germany
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Abstract
Despite recent successes in understanding the genetics of Parkinson’s disease (PD), the causes of late-onset sporadic PD remain elusive. Many of the epidemiologic findings on PD etiology have been challenged by alternative explanations such as reverse causation. This is mainly because PD often takes decades to develop before it can be diagnosed late in life. Convincing evidence shows that this prodromal stage of PD is characterized by various prodromal symptoms such as olfactory impairment and rapid-eye-movement sleep behavior disorder (RBD). As they likely reflect PD pathogenesis years, if not decades, before nigrostriatal involvement, research on these symptoms may represent an unprecedented opportunity to dissect the etiology of PD. Using PD prodromal symptoms as intermediate phenotypes, we may be able to identify factors that contribute to the development of these symptoms and factors that modify their progression to clinical PD. Further, this line of research will also enable examinations of novel etiological hypotheses of PD development such as the microbiome and prion hypotheses. In this article, the author used olfactory impairment and RBD as examples to illustrate the promises and challenges of epidemiologic research on prodromal symptoms to understand PD etiology.
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Affiliation(s)
- Honglei Chen
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI, USA
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Smoking and age-at-onset of both motor and non-motor symptoms in Parkinson's disease. Parkinsonism Relat Disord 2017; 45:94-96. [PMID: 28988683 DOI: 10.1016/j.parkreldis.2017.09.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 09/17/2017] [Accepted: 09/28/2017] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Several evidence suggest that smoking may decrease the risk of Parkinson's disease and is associated with an older age-at-onset of motor signs. The relation between smoking and age-at-onset of non-motor symptoms has never been analyzed. Objective of the study is to evaluate whether smoking habit and pack-years of smoking are associated with a delay of age-at-onset of motor signs, and of some non-motor symptoms. METHODS The study population consisted of 262 consecutive parkinsonian patients. Information on relevant demographic/clinical data focused on motor signs, REM sleep behavior disorder, constipation, depression, and hyposmia. Patients were stratified according to smoking habit (ever-versus never-smoker) and number of pack-years of smoking was computed. Repeatability of data on age-at-onset was checked 6 months after the initial interview in a randomly recruited subsample. RESULTS Smoking habit and number of pack-years smoked were associated with an older in age-at-onset of motor signs, REM sleep behavior disorder and depression. By contrast, smoking did not affect age-at-onset of hyposmia and constipation. CONCLUSION information from this study confirms that smoking may be associated with an older age-at-onset of motor signs, and that a similar effect can be observed on some non-motor symptoms like REM sleep behavior and depression.
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Moccia M, Mollenhauer B, Erro R, Picillo M, Palladino R, Barone P. Non-Motor Correlates of Smoking Habits in de Novo Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2016; 5:913-24. [PMID: 26485426 DOI: 10.3233/jpd-150639] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Parkinson's disease (PD) subjects are less likely to ever smoke and are more prone to quit smoking, as compared to controls. Therefore, smoking habits can be considered part of the non-motor phenotype, preceding the onset of motor PD by several years. OBJECTIVE To explore non-motor symptom (NMS) correlates of smoking habits in de novo PD. METHODS This cross-sectional study included 281 newly diagnosed, drug-naïve PD subjects, recruited in Naples (Italy) and in Kassel (Germany). All subjects completed the NMS Questionnaire (NMSQ), and were investigated for smoking status (never, current and former smokers) and intensity (pack-years). RESULTS 140 PD subjects never smoked, 20 currently smoked, and 121 had quit smoking before PD diagnosis. NMSQ total score did not associate with smoking status, but with smoking intensity (p = 0.028; coefficient = 0.088). A multinomial logistic regression stepwise model presenting never smoking as reference, selected as NMSQ correlates of current smoking: sex difficulties (p = 0.002; OR = 5.254), daytime sleepiness (p = 0.046; OR = 0.085), insomnia (p = 0.025; OR = 0.135), and vivid dreams (p = 0.040; OR = 3.110); and of former smoking: swallowing (p = 0.013; OR = 0.311), nausea (p = 0.027; OR = 7.157), unexplained pains (p = 0.002; OR = 3.409), forgetfulness (p = 0.005; OR = 2.592), sex interest (p = 0.007; OR = 0.221), sex difficulties (p = 0.038; OR = 4.215), and daytime sleepiness (p = 0.05; OR = 0.372). An ordinal logistic regression stepwise model selected as NMSQ correlates of smoking intensity: nocturnal restlessness (p = 0.027; coefficient = 0.974), and leg swelling (p = 0.004; coefficient = 1.305). CONCLUSIONS Certain NMSs are associated with different smoking status and intensity, suggesting a variety of adaptive mechanisms to cigarette smoking.
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Affiliation(s)
- Marcello Moccia
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Federico II University, Naples, Italy
| | - Brit Mollenhauer
- Paracelsus-Elena-Klinik, Klinikstraße 16, Kassel, Germany.,Department of Neurosurgery, University Medical Center Goettingen, Goettingen, Germany.,Department of Neuropathology, University Medical Center Goettingen, Goettingen, Germany
| | - Roberto Erro
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, Queen Square, London, UK.,Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
| | - Marina Picillo
- Center for Neurodegenerative Diseases (CEMAND), Neuroscience Section, Department of Medicine, University of Salerno, Salerno, Italy
| | - Raffaele Palladino
- Department of Primary Care and Public Health, Imperial College, South Kensington Campus, London, UK.,Department of Public Health, Federico II University, Naples, Italy
| | - Paolo Barone
- Center for Neurodegenerative Diseases (CEMAND), Neuroscience Section, Department of Medicine, University of Salerno, Salerno, Italy
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Millar Vernetti P, Rossi M, Cerquetti D, Perez Lloret S, Merello M. Comparison of Olfactory Identification Patterns among Parkinson’s Disease Patients from Different Countries. Chem Senses 2015; 41:77-83. [DOI: 10.1093/chemse/bjv062] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Islam MA, Fagundo AB, Arcelus J, Agüera Z, Jiménez-Murcia S, Fernández-Real JM, Tinahones FJ, de la Torre R, Botella C, Frühbeck G, Casanueva FF, Menchón JM, Fernandez-Aranda F. Olfaction in eating disorders and abnormal eating behavior: a systematic review. Front Psychol 2015; 6:1431. [PMID: 26483708 PMCID: PMC4588114 DOI: 10.3389/fpsyg.2015.01431] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Accepted: 09/07/2015] [Indexed: 11/13/2022] Open
Abstract
The study provides a systematic review that explores the current literature on olfactory capacity in abnormal eating behavior. The objective is to present a basis for discussion on whether research in olfaction in eating disorders may offer additional insight with regard to the complex etiopathology of eating disorders (ED) and abnormal eating behaviors. Electronic databases (Medline, PsycINFO, PubMed, Science Direct, and Web of Science) were searched using the components in relation to olfaction and combining them with the components related to abnormal eating behavior. Out of 1352 articles, titles were first excluded by title (n = 64) and then by abstract and fulltext resulting in a final selection of 14 articles (820 patients and 385 control participants) for this review. The highest number of existing literature on olfaction in ED were carried out with AN patients (78.6%) followed by BN patients (35.7%) and obese individuals (14.3%). Most studies were only conducted on females. The general findings support that olfaction is altered in AN and in obesity and indicates toward there being little to no difference in olfactory capacity between BN patients and the general population. Due to the limited number of studies and heterogeneity this review stresses on the importance of more research on olfaction and abnormal eating behavior.
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Affiliation(s)
- Mohammed A Islam
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL Barcelona, Spain ; CIBER de Fisiopatologia de la Obesidad y Nutrición -ISCIII Barcelona, Spain
| | - Ana B Fagundo
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL Barcelona, Spain ; CIBER de Fisiopatologia de la Obesidad y Nutrición -ISCIII Barcelona, Spain
| | - Jon Arcelus
- Leicester Eating Disorder Service, Bennion Centre, Leicester Glenfield Hospital Leicester, UK ; Division of Psychiatry and Applied Psychology, Faculty of Medicine and Health Sciences, University of Nottingham Nottingham, UK
| | - Zaida Agüera
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL Barcelona, Spain ; CIBER de Fisiopatologia de la Obesidad y Nutrición -ISCIII Barcelona, Spain
| | - Susana Jiménez-Murcia
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL Barcelona, Spain ; CIBER de Fisiopatologia de la Obesidad y Nutrición -ISCIII Barcelona, Spain ; Department of Clinical Sciences, School of Medicine, University of Barcelona Barcelona, Spain
| | - José M Fernández-Real
- CIBER de Fisiopatologia de la Obesidad y Nutrición -ISCIII Barcelona, Spain ; Department of Diabetes, Endocrinology and Nutrition, Institut d'Investigació Biomèdica de Girona (IdlBGi) Hospital Dr Josep Trueta Girona, Spain
| | - Francisco J Tinahones
- CIBER de Fisiopatologia de la Obesidad y Nutrición -ISCIII Barcelona, Spain ; Department of Diabetes, Endocrinology and Nutrition, Hospital Clínico Universitario Virgen de Victoria Málaga, Spain
| | - Rafael de la Torre
- CIBER de Fisiopatologia de la Obesidad y Nutrición -ISCIII Barcelona, Spain ; Facultat de Ciencies de la Salut i de la Vida, Universitat Pompeu Fabra (CEXS-UPF) Barcelona, Spain ; Integrative Pharmacology and Neurosciences Systems Research Group, Neuroscience Research Program, IMIM (Hospital del Mar Medical Research Institute) Barcelona, Spain
| | - Cristina Botella
- CIBER de Fisiopatologia de la Obesidad y Nutrición -ISCIII Barcelona, Spain ; Department of Basic Psychology, Clinic and Psychobiology, University Jaume I Castelló, Spain
| | - Gema Frühbeck
- CIBER de Fisiopatologia de la Obesidad y Nutrición -ISCIII Barcelona, Spain ; Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, University of Navarra, IdiSNA Pamplona, Spain
| | - Felipe F Casanueva
- CIBER de Fisiopatologia de la Obesidad y Nutrición -ISCIII Barcelona, Spain ; Endocrine Division, Complejo Hospitalario Universitario de Santiago Santiago de Compostela, Spain
| | - José M Menchón
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL Barcelona, Spain ; Department of Clinical Sciences, School of Medicine, University of Barcelona Barcelona, Spain ; CIBER de Salud Mental (CIBERSAM) Madrid, Spain
| | - Fernando Fernandez-Aranda
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL Barcelona, Spain ; CIBER de Fisiopatologia de la Obesidad y Nutrición -ISCIII Barcelona, Spain ; Department of Clinical Sciences, School of Medicine, University of Barcelona Barcelona, Spain
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Sharer JD, Leon-Sarmiento FE, Morley JF, Weintraub D, Doty RL. Olfactory dysfunction in Parkinson's disease: Positive effect of cigarette smoking. Mov Disord 2015; 30:859-62. [PMID: 25545729 PMCID: PMC4439272 DOI: 10.1002/mds.26126] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 11/10/2014] [Accepted: 11/18/2014] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND There is compelling evidence from over 60 epidemiological studies that smoking significantly reduces the risk of Parkinson's disease (PD). In general, those who currently smoke cigarettes, as well as those with a past history of such smoking, have a reduced risk of PD compared to those who have never smoked. Recently it has been suggested that a cardinal nonmotor sensory symptom of PD, olfactory dysfunction, may be less severe in PD patients who smoke than in PD patients who do not, in contrast to the negative effect of smoking on olfaction described in the general population. METHODS We evaluated University of Pennsylvania Smell Identification Test (UPSIT) scores from 323 PD patients and 323 controls closely matched individually on age, sex, and smoking history (never, past, or current). RESULTS Patients exhibited much lower UPSIT scores than did the controls (P < 0.0001). The relative decline in dysfunction of the current PD smokers was less than that of the never- and past-PD smokers (respective Ps = 0.0005 and 0.0019). Female PD patients outperformed their male counterparts by a larger margin than did the female controls (3.66 vs. 1.07 UPSIT points; respective Ps < 0.0001 and 0.06). Age-related declines in UPSIT scores were generally present (P < 0.0001). No association between the olfactory measure and smoking dose, as indexed by pack-years, was evident. CONCLUSIONS PD patients who currently smoke do not exhibit the smoking-related decline in olfaction observed in non-PD control subjects who currently smoke. The physiological basis of this phenomenon is yet to be defined.
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Affiliation(s)
- James D. Sharer
- Smell and Taste Center, Department of Otorhinolaryngology: Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Fidias E. Leon-Sarmiento
- Smell and Taste Center, Department of Otorhinolaryngology: Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - James F. Morley
- Parkinson’s Disease Research, Education and Clinical Center, Philadelphia Veterans Administration Medical Center
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Daniel Weintraub
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Richard L. Doty
- Smell and Taste Center, Department of Otorhinolaryngology: Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Moccia M, Erro R, Picillo M, Vassallo E, Vitale C, Longo K, Amboni M, Santangelo G, Palladino R, Nardone A, Triassi M, Barone P, Pellecchia MT. Quitting smoking: an early non-motor feature of Parkinson's disease? Parkinsonism Relat Disord 2014; 21:216-20. [PMID: 25547948 DOI: 10.1016/j.parkreldis.2014.12.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Revised: 10/30/2014] [Accepted: 12/09/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Epidemiological studies report a 60-70% reduced risk of Parkinson's disease (PD) in smokers as compared to non-smokers. However, relationships between former smoking and PD have been poorly investigated. METHODS We recruited 116 de novo PD subjects, and investigated current, former and never smoking, and reasons for smoking cessation among former smokers. Two hundred and thirty-two controls were matched by Propensity Score. RESULTS PD subjects and controls were found to be current smokers (7.7 vs. 39.6%), former smokers (43.9 vs. 6.5%) and never smokers (48.2 vs. 53.9%). Logistic regression showed that current smokers were less likely to have PD (p < 0.001; OR: 0.22; 95% CI: 0.10-0.46), while former smokers were more likely to have PD (p < 0.001; OR: 7.6; 95% CI: 4.09-15.75), as compared to never smokers. Fifty-one PD patients reported quitting smoking before PD diagnosis (mean time since cessation 9.4 ± 7.3 years). Most important reasons to quit smoking in PD group were illness different from PD (26 subjects, 51.0%), knowledge of the harmful effects of smoking (24 subjects, 47.0%), and physician's advice (1 subject, 2.0%). CONCLUSION The reduced prevalence of current smokers among PD subjects as compared to healthy controls is consistent with previous findings, suggesting a possible neuroprotective effect of smoking. However, it could be due, at least in part, to the increased prevalence of former smokers among PD patients, that were more prone to quit smoking as compared to healthy controls. We suggest that smoking cessation could be an early preclinical condition occurring in PD.
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Affiliation(s)
- Marcello Moccia
- Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Naples, Italy
| | - Roberto Erro
- Sobell Department of Motor Neuroscience and Movement Disorders, University College London (UCL) Institute of Neurology, London, United Kingdom; Department of Neurological and Movement Sciences, University of Verona, Policlinico Borgo Roma, Verona, Italy
| | - Marina Picillo
- Center for Neurodegenerative Diseases (CEMAND), Neuroscience Section, Department of Medicine, University of Salerno, 84131, Italy
| | - Edoardo Vassallo
- Center for Neurodegenerative Diseases (CEMAND), Neuroscience Section, Department of Medicine, University of Salerno, 84131, Italy
| | - Carmine Vitale
- IDC Hermitage Capodimonte, Naples, Italy; Department of Motor Sciences, University Parthenope, Naples, Italy
| | | | | | - Gabriella Santangelo
- Neuropsychology Laboratory, Department of Psychology, Second University of Naples, Caserta, Italy
| | - Raffaele Palladino
- Department of Primary Care and Public Health, Imperial College, London, United Kingdom; Department of Public Health, Federico II University, Naples, Italy
| | - Antonio Nardone
- Department of Public Health, Federico II University, Naples, Italy
| | - Maria Triassi
- Department of Public Health, Federico II University, Naples, Italy
| | - Paolo Barone
- Center for Neurodegenerative Diseases (CEMAND), Neuroscience Section, Department of Medicine, University of Salerno, 84131, Italy.
| | - Maria Teresa Pellecchia
- Center for Neurodegenerative Diseases (CEMAND), Neuroscience Section, Department of Medicine, University of Salerno, 84131, Italy
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