Rural or urban living and Parkinson's disease

Abstract

-Although the precise etiology of Parkinson's disease (PD) is as yet unknown, it appears that certain environmental factors are involved. Prior living in a rural area has been implicated as a possible risk factor for PD, particularly in the early onset type. We evaluated the role of previous living conditions in the clinical correlates and outcome characteristics of 118 PD patients. All of them were seen from January 1987 to October 1992. The Rural Group (RG) comprised 71 patients (60.2%) who had lived in the rural area for at least 10 years (mainly in early phase of life) and the Urban Group (UG) consisted of 47 patients (39.8%) who had lived their entire life in an urban environment. The average age at the beginning of the symptoms was 58.8 in the RG and 54.1 in the UG. The mixed form of the disease (tremor, rigidity and akinesia) was the most frequent in both groups. A minimum 6-month follow-up period was undertaken with 63 patients (average 20 months) and no difference in response to treatment or in progression of the illness was detected between the two groups. Our data show that the previous living environment does not appear to be a determining factor in either the clinical or outcome characteristics of PD.KEY WORDS: Parkinson's disease epidemiology, Parkinson's disease etiology, environmental factors. Antecedente de vida rural ou de vida urbana e doença de ParkinsonRESUMO -A etiologia da doença de Parkinson (DP) é ainda desconhecida mas parece que fatores ambientais podem estar envolvidos. A incidência da DP, particularmente a de início precoce, parece ser maior em indivíduos com antecedente de moradia na zona rural. Avaliamos as características clínicas e a progressão da DP em 118 pacientes segundo os antecedentes de área de moradia pregressa. Havia 71 pacientes (60,2%) com antecedente de no mínimo 10 anos na zona rural (especialmente nas fases iniciais da vida), o chamado Grupo Rural (GR), e 47 pacientes (39,8%) que tiveram antecedente de vida exclusivamente urbana, o chamado Grupo Urbano (GU). A média de idade de início dos sintomas foi 58,8 anos no GR e de 54,1 anos no GU. A forma mista da DP (com tremor, bradicinesia e rigidez) foi a mais frequente em ambos os grupos. Um período de acompanhamento de no mínimo 6 meses foi obtido em 63 pacientes (média de 20 meses de acompanhamento) e a progressão da sintomatologia foi semelhante nos dois grupos (GR e GU). Nossos dados indicam que o antecedente de moradia não parece ser determinante para o padrão de manifestação clínica e de evolução da DP.

Predicting Motor Decline and Disability in Parkinson Disease

“…Of 13 studies, 6 did not indicate whether they excluded patients developing atypical symptoms during the follow-up period. 5,[7][8][9]11,12 Patients with atypical symptoms may have distinct disorders with distinct prognostic factors, despite early clinical features entirely consistent with PD.…”

Epidemiology of Parkinson's disease

“…Numerous studies worldwide have identified rural living, farming, gardening and drinking well water as risk factors for PD (Semchuk et al, 1991;Butterfield et al, 1993;Hubble et al, 1993a;Morano et al, 1994;Ferraz et al, 1996;Gorell et al, 1998;Marder et al, 1998;Zorzon et al, 2002;Korell and Tanner, 2005), but the results are somewhat inconsistent because of differences in the way the studies assessed the effects of rural living. Overall, risk of PD appears to be increased in rural dwellers -especially in the USA.…”

Conjugal Parkinsonism and Parkinson disease: A case series with environmental risk factor analysis

“…Although many PD risk factors have been suggested in epidemiology studies, [1;4;11;21-25] there is very little direct evidence implicating the environment as the primary etiology in the pathophysiology of PD. This manuscript describes clinical features and exposures to previously described PD risk factor exposures in 18 cohabitating unrelated spouses with parkinsonism.…”

“…Proposed environmental risk factors for PD include industrialization, rural living, and pesticide or heavy metal exposure. [1-5] Twin studies do not support a genetic cause, especially in older onset subjects. [6;7] Environmental and occupational exposures have been associated with the development of atypical parkinsonism, and may provide clues to the etiology of idiopathic PD.…”