Risk factors of Parkinson disease: Simultaneous assessment, interactions, and etiologic subtypes

Daniele Belvisi; Roberta Pellicciari; Andrea Fabbrini; Matteo Costanzo; Sara Pietracupa; Maria De Lucia; Nicola Modugno; Francesca Magrinelli; Carlo Dallocchio; Tommaso Ercoli; Claudio Terravecchia; Alessandra Nicoletti; Paolo Solla; Giovanni Fabbrini; Michele Tinazzi; Alfredo Berardelli; Giovanni Defazio

doi:10.1212/WNL.0000000000010813

Risk factors of Parkinson disease: Simultaneous assessment, interactions, and etiologic subtypes

Daniele Belvisi, Roberta Pellicciari, Andrea Fabbrini, Matteo Costanzo, Sara Pietracupa, Maria De Lucia, Nicola Modugno, Francesca Magrinelli, Carlo Dallocchio, Tommaso Ercoli, Claudio Terravecchia, Alessandra Nicoletti, Paolo Solla, Giovanni Fabbrini, Michele Tinazzi, Alfredo Berardelli, Giovanni Defazio

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Abstract

OBJECTIVE: To perform a simultaneous evaluation of potential risk/protective factors of Parkinson disease (PD) to identify independent risk/protective factors, to assess interaction among factors, and to determine whether identified risk factors predict etiologic subtypes of PD.

METHODS: We designed a large case-control study assessing 31 protective/risk factors of PD, including environmental and lifestyle factors, comorbid conditions, and drugs. The study enrolled 694 patients with PD and 640 healthy controls from 6 neurologic centers. Data were analyzed by logistic regression models, additive interaction models, and cluster analysis.

RESULTS: The simultaneous assessment of 31 putative risk/protective factors of PD showed that only coffee consumption (odds ratio [OR] 0.6; 95% confidence interval [CI] 0.4-0.9), smoking (OR 0.7, 95% CI 0.6-0.9), physical activity (OR 0.8, 95% CI 0.7-0.9), family history of PD (OR 3.2, 95% CI 2.2-4.8), dyspepsia (OR 1.8, 95% CI 1.3-2.4), and exposure to pesticides (OR 2.3, 95% CI1.3-4.2), oils (OR 5.6, 95% CI 2.3-13.7), metals (OR 2.8, 95% CI 1.5-5.4), and general anesthesia (OR 6.1, 95% CI 2.9-12.7) were independently associated with PD. There was no evidence of interaction among risk/protective factors, but cluster analysis identified 4 subtypes with different risk factor profiles. In group 1, all patients had a family history of PD, while dyspepsia or exposure to toxic agents was present in 30% of patients. In groups 2 and 3, a family history of PD was lacking, while exposure to toxic agents (group 2) and dyspepsia (group 3) played major roles. Group 4 consisted of patients with no risk factors.

CONCLUSIONS: This study demonstrated that 9 factors independently modify PD risk by coexisting in the same patient rather than interacting with others. Our study suggests the need for future preventive strategies aimed at reducing the coexistence of different risk factors within the same participant.

Original language	English
Pages (from-to)	e2500-e2508
Journal	Neurology
Volume	95
Issue number	18
DOIs	https://doi.org/10.1212/WNL.0000000000010813
Publication status	Published - Nov 3 2020

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10.1212/WNL.0000000000010813

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Belvisi, D., Pellicciari, R., Fabbrini, A., Costanzo, M., Pietracupa, S., De Lucia, M., Modugno, N., Magrinelli, F., Dallocchio, C., Ercoli, T., Terravecchia, C., Nicoletti, A., Solla, P., Fabbrini, G., Tinazzi, M., Berardelli, A., & Defazio, G. (2020). Risk factors of Parkinson disease: Simultaneous assessment, interactions, and etiologic subtypes. Neurology, 95(18), e2500-e2508. https://doi.org/10.1212/WNL.0000000000010813

Belvisi, D, Pellicciari, R, Fabbrini, A, Costanzo, M, Pietracupa, S, De Lucia, M, Modugno, N, Magrinelli, F, Dallocchio, C, Ercoli, T, Terravecchia, C, Nicoletti, A, Solla, P, Fabbrini, G, Tinazzi, M, Berardelli, A & Defazio, G 2020, 'Risk factors of Parkinson disease: Simultaneous assessment, interactions, and etiologic subtypes', Neurology, vol. 95, no. 18, pp. e2500-e2508. https://doi.org/10.1212/WNL.0000000000010813

@article{97dadaa6d212456caa1047b71bfcba09,

title = "Risk factors of Parkinson disease: Simultaneous assessment, interactions, and etiologic subtypes",

abstract = "OBJECTIVE: To perform a simultaneous evaluation of potential risk/protective factors of Parkinson disease (PD) to identify independent risk/protective factors, to assess interaction among factors, and to determine whether identified risk factors predict etiologic subtypes of PD.METHODS: We designed a large case-control study assessing 31 protective/risk factors of PD, including environmental and lifestyle factors, comorbid conditions, and drugs. The study enrolled 694 patients with PD and 640 healthy controls from 6 neurologic centers. Data were analyzed by logistic regression models, additive interaction models, and cluster analysis.RESULTS: The simultaneous assessment of 31 putative risk/protective factors of PD showed that only coffee consumption (odds ratio [OR] 0.6; 95% confidence interval [CI] 0.4-0.9), smoking (OR 0.7, 95% CI 0.6-0.9), physical activity (OR 0.8, 95% CI 0.7-0.9), family history of PD (OR 3.2, 95% CI 2.2-4.8), dyspepsia (OR 1.8, 95% CI 1.3-2.4), and exposure to pesticides (OR 2.3, 95% CI1.3-4.2), oils (OR 5.6, 95% CI 2.3-13.7), metals (OR 2.8, 95% CI 1.5-5.4), and general anesthesia (OR 6.1, 95% CI 2.9-12.7) were independently associated with PD. There was no evidence of interaction among risk/protective factors, but cluster analysis identified 4 subtypes with different risk factor profiles. In group 1, all patients had a family history of PD, while dyspepsia or exposure to toxic agents was present in 30% of patients. In groups 2 and 3, a family history of PD was lacking, while exposure to toxic agents (group 2) and dyspepsia (group 3) played major roles. Group 4 consisted of patients with no risk factors.CONCLUSIONS: This study demonstrated that 9 factors independently modify PD risk by coexisting in the same patient rather than interacting with others. Our study suggests the need for future preventive strategies aimed at reducing the coexistence of different risk factors within the same participant.",

author = "Daniele Belvisi and Roberta Pellicciari and Andrea Fabbrini and Matteo Costanzo and Sara Pietracupa and {De Lucia}, Maria and Nicola Modugno and Francesca Magrinelli and Carlo Dallocchio and Tommaso Ercoli and Claudio Terravecchia and Alessandra Nicoletti and Paolo Solla and Giovanni Fabbrini and Michele Tinazzi and Alfredo Berardelli and Giovanni Defazio",

note = "{\textcopyright} 2020 American Academy of Neurology.",

year = "2020",

month = nov,

day = "3",

doi = "10.1212/WNL.0000000000010813",

language = "English",

volume = "95",

pages = "e2500--e2508",

journal = "Neurology",

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publisher = "Lippincott Williams and Wilkins",

number = "18",

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TY - JOUR

T1 - Risk factors of Parkinson disease

T2 - Simultaneous assessment, interactions, and etiologic subtypes

AU - Belvisi, Daniele

AU - Pellicciari, Roberta

AU - Fabbrini, Andrea

AU - Costanzo, Matteo

AU - Pietracupa, Sara

AU - De Lucia, Maria

AU - Modugno, Nicola

AU - Magrinelli, Francesca

AU - Dallocchio, Carlo

AU - Ercoli, Tommaso

AU - Terravecchia, Claudio

AU - Nicoletti, Alessandra

AU - Solla, Paolo

AU - Fabbrini, Giovanni

AU - Tinazzi, Michele

AU - Berardelli, Alfredo

AU - Defazio, Giovanni

PY - 2020/11/3

Y1 - 2020/11/3

N2 - OBJECTIVE: To perform a simultaneous evaluation of potential risk/protective factors of Parkinson disease (PD) to identify independent risk/protective factors, to assess interaction among factors, and to determine whether identified risk factors predict etiologic subtypes of PD.METHODS: We designed a large case-control study assessing 31 protective/risk factors of PD, including environmental and lifestyle factors, comorbid conditions, and drugs. The study enrolled 694 patients with PD and 640 healthy controls from 6 neurologic centers. Data were analyzed by logistic regression models, additive interaction models, and cluster analysis.RESULTS: The simultaneous assessment of 31 putative risk/protective factors of PD showed that only coffee consumption (odds ratio [OR] 0.6; 95% confidence interval [CI] 0.4-0.9), smoking (OR 0.7, 95% CI 0.6-0.9), physical activity (OR 0.8, 95% CI 0.7-0.9), family history of PD (OR 3.2, 95% CI 2.2-4.8), dyspepsia (OR 1.8, 95% CI 1.3-2.4), and exposure to pesticides (OR 2.3, 95% CI1.3-4.2), oils (OR 5.6, 95% CI 2.3-13.7), metals (OR 2.8, 95% CI 1.5-5.4), and general anesthesia (OR 6.1, 95% CI 2.9-12.7) were independently associated with PD. There was no evidence of interaction among risk/protective factors, but cluster analysis identified 4 subtypes with different risk factor profiles. In group 1, all patients had a family history of PD, while dyspepsia or exposure to toxic agents was present in 30% of patients. In groups 2 and 3, a family history of PD was lacking, while exposure to toxic agents (group 2) and dyspepsia (group 3) played major roles. Group 4 consisted of patients with no risk factors.CONCLUSIONS: This study demonstrated that 9 factors independently modify PD risk by coexisting in the same patient rather than interacting with others. Our study suggests the need for future preventive strategies aimed at reducing the coexistence of different risk factors within the same participant.

AB - OBJECTIVE: To perform a simultaneous evaluation of potential risk/protective factors of Parkinson disease (PD) to identify independent risk/protective factors, to assess interaction among factors, and to determine whether identified risk factors predict etiologic subtypes of PD.METHODS: We designed a large case-control study assessing 31 protective/risk factors of PD, including environmental and lifestyle factors, comorbid conditions, and drugs. The study enrolled 694 patients with PD and 640 healthy controls from 6 neurologic centers. Data were analyzed by logistic regression models, additive interaction models, and cluster analysis.RESULTS: The simultaneous assessment of 31 putative risk/protective factors of PD showed that only coffee consumption (odds ratio [OR] 0.6; 95% confidence interval [CI] 0.4-0.9), smoking (OR 0.7, 95% CI 0.6-0.9), physical activity (OR 0.8, 95% CI 0.7-0.9), family history of PD (OR 3.2, 95% CI 2.2-4.8), dyspepsia (OR 1.8, 95% CI 1.3-2.4), and exposure to pesticides (OR 2.3, 95% CI1.3-4.2), oils (OR 5.6, 95% CI 2.3-13.7), metals (OR 2.8, 95% CI 1.5-5.4), and general anesthesia (OR 6.1, 95% CI 2.9-12.7) were independently associated with PD. There was no evidence of interaction among risk/protective factors, but cluster analysis identified 4 subtypes with different risk factor profiles. In group 1, all patients had a family history of PD, while dyspepsia or exposure to toxic agents was present in 30% of patients. In groups 2 and 3, a family history of PD was lacking, while exposure to toxic agents (group 2) and dyspepsia (group 3) played major roles. Group 4 consisted of patients with no risk factors.CONCLUSIONS: This study demonstrated that 9 factors independently modify PD risk by coexisting in the same patient rather than interacting with others. Our study suggests the need for future preventive strategies aimed at reducing the coexistence of different risk factors within the same participant.

U2 - 10.1212/WNL.0000000000010813

DO - 10.1212/WNL.0000000000010813

M3 - Article

C2 - 32943485

VL - 95

SP - e2500-e2508

JO - Neurology

JF - Neurology

SN - 0028-3878

IS - 18

ER -

Risk factors of Parkinson disease: Simultaneous assessment, interactions, and etiologic subtypes

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