Assessment of Risk Factors and Early Presentations of Parkinson Disease in Primary Care in a Diverse UK Population

Abstract

IMPORTANCEEarly features of Parkinson disease (PD) have been described through population-based studies that overrepresent White, affluent groups and may not be generalizable.OBJECTIVE To investigate the association between risk factors and prediagnostic presentations of PD in an ethnically diverse UK population with high socioeconomic deprivation but universal access to health care. DESIGN, SETTING, AND PARTICIPANTSA nested case-control study was conducted using electronic health care records on 1 016 277 individuals from primary care practices in East London to extract clinical information recorded between 1990 and February 6, 2018. The data were analyzed between September 3, 2020, and September 3, 2021. Individuals with a diagnosis of PD were compared with controls without PD or other major neurological conditions. MAIN OUTCOMES AND MEASURESA matched analysis (10 controls matched for each patient with PD according to age and sex) and an unmatched analysis (adjusted for age and sex) were undertaken using multivariable logistic regression to determine associations between risk factors and prediagnostic presentations to primary care with subsequent diagnosis of PD. Three time periods (<2, 2-<5, and 5-10 years before diagnosis) were analyzed separately and together.RESULTS Of 1 016 277 individuals included in the data set, 5699 were excluded and 1055 patients with PD and 1 009 523 controls were included in the analysis. Patients with PD were older than controls (mean [SD], 72.9 [11.3] vs 40.3 [15.2] years), and more were male (632 [59.9%] vs 516 862 [51.2%]). In the matched analysis (1055 individuals with PD and 10 550 controls), associations were found for tremor (odds ratio [OR], 145.96; 95% CI, 90.55-235.28) and memory symptoms (OR, 8.60; 95% CI, 5.91-12.49) less than 2 years before the PD diagnosis. The associations were also found up to 10 years before PD diagnosis for tremor and 5 years for memory symptoms. Among midlife risk factors, hypertension (OR, 1.36; 95% CI,) and type 2 diabetes (OR, 1.39; 95% CI, 1.19-1.62) were associated with subsequent diagnosis of PD. Associations with early nonmotor features, including hypotension (OR, 6.84; 95% CI, 3.38-13.85), constipation (OR, 3.29; 95% CI, 2.32-4.66), and depression (OR, 4.69; 95% CI, 2.88-7.63), were also noted. Associations were found for epilepsy (OR, 2.5; 95% CI, 1.63-3.83) and hearing loss (OR, 1.66; 95% CI, 1.06-2.58), which have not previously been well reported. These findings were replicated using data from the UK Biobank. No association with future PD diagnosis was found for ethnicity or deprivation index level. CONCLUSIONS AND RELEVANCEThis study provides data suggesting that a range of comorbidities and symptoms are encountered in primary care settings before PD diagnosis in an ethnically diverse and deprived population. Novel temporal associations were observed for epilepsy and hearing loss with subsequent development of PD. The prominence of memory symptoms suggests an excess of cognitive dysfunction in early PD in this population or difficul...

Widening the Spectrum of Risk Factors, Comorbidities, and Prodromal Features of Parkinson Disease

“…Although an association of hearing loss with Alzheimer disease has long been recognized, this has only rarely been reported for PD. Subjective visual complaints, which are also common in PD, were not a common feature associated with subsequent PD. Unspecified pain, another common sensory feature of PD, was present in a large number of patients before the diagnosis of PD and more common than in controls in all examined time periods as has been previously reported.…”

Development of Parkinson Disease and Its Relationship with Incidentally Discovered White Matter Disease and Covert Brain Infarction in a Real‐World Cohort

“…Hypertension too, while generally showing an inverse association with PD in retrospective case–control studies, has been shown to be associated with future PD in some settings 44 . The relationship between cholesterol and other lipids and PD remains unclear.…”

“…43 Hypertension too, while generally showing an inverse association with PD in retrospective case-control studies, has been shown to be associated with future PD in some settings. 44 The relationship between cholesterol and other lipids and PD remains unclear. Combining many of these factors into a concept of a metabolic syndrome has been done and suggests that metabolic syndrome and its components may be risk factors for PD.…”

Association Between Antiepileptic Drugs and Incident Parkinson Disease

“…here is evidence for an association between Parkinson disease (PD) and epilepsy. [1][2][3] Recent observational studies have also established a temporal association between epilepsy and incident PD. 3,4 The mechanism underlying this association remains unclear.…”