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Meta-analysis of early nonmotor features and risk factors for Parkinson disease†

  1. Alastair J. Noyce BMedSci, MRCP1,2,
  2. Jonathan P. Bestwick MSc3,
  3. Laura Silveira-Moriyama PhD, MD1,4,
  4. Christopher H. Hawkes MD, FRCP2,
  5. Gavin Giovannoni PhD, FRCP2,
  6. Andrew J. Lees MD, FRCP1,
  7. Anette Schrag PhD, FRCP1,*

Article first published online: 15 OCT 2012

DOI: 10.1002/ana.23687

Issue

Annals of Neurology

Annals of Neurology

Volume 72, Issue 6, pages 893–901, December 2012

Additional Information

How to Cite

Noyce, A. J., Bestwick, J. P., Silveira-Moriyama, L., Hawkes, C. H., Giovannoni, G., Lees, A. J. and Schrag, A. (2012), Meta-analysis of early nonmotor features and risk factors for Parkinson disease. Ann Neurol., 72: 893–901. doi: 10.1002/ana.23687

Author Information

  1. 1

    Institute of Neurology, University College London, London, United Kingdom

  2. 2

    Blizard Institute of Cell and Molecular Science, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom

  3. 3

    Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom

  4. 4

    Department of Neurology, State University of Campinas, Campinas, Brazil

*Department of Clinical Neurosciences, Institute of Neurology, Royal Free Campus, University College London, London NW3 2PF, United Kingdom

  1. †

    The data contained in this paper are from published studies only. There are no additional data available.

Publication History

  1. Issue published online: 31 DEC 2012
  2. Article first published online: 15 OCT 2012
  3. Accepted manuscript online: 10 JUL 2012 12:01PM EST
  4. Manuscript Accepted: 6 JUL 2012
  5. Manuscript Revised: 19 JUN 2012
  6. Manuscript Received: 11 MAY 2012

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Abstract

Objective:

To evaluate the association between diagnosis of Parkinson disease (PD) and risk factors or early symptoms amenable to population-based screening.

Methods:

A systematic review and meta-analysis of risk factors for PD.

Results:

The strongest associations with later diagnosis of PD were found for having a first-degree or any relative with PD (odds ratio [OR], 3.23; 95% confidence interval [CI], 2.65–3.93 and OR, 4.45; 95% CI, 3.39–5.83) or any relative with tremor (OR, 2.74; 95% CI, 2.10–3.57), constipation (relative risk [RR], 2.34; 95% CI, 1.55–3.53), or lack of smoking history (current vs never: RR, 0.44; 95% CI, 0.39–0.50), each at least doubling the risk of PD. Further positive significant associations were found for history of anxiety or depression, pesticide exposure, head injury, rural living, beta-blockers, farming occupation, and well-water drinking, and negative significant associations were found for coffee drinking, hypertension, nonsteroidal anti-inflammatory drugs, calcium channel blockers, and alcohol, but not for diabetes mellitus, cancer, oral contraceptive pill use, surgical menopause, hormone replacement therapy, statins, acetaminophen/paracetamol, aspirin, tea drinking, history of general anesthesia, or gastric ulcers. In the systematic review, additional associations included negative associations with raised serum urate, and single studies or studies with conflicting results.

Interpretation:

The strongest risk factors associated with later PD diagnosis are having a family history of PD or tremor, a history of constipation, and lack of smoking history. Further factors also but less strongly contribute to risk of PD diagnosis or, as some premotor symptoms, require further standardized studies to demonstrate the magnitude of risk associated with them. ANN NEUROL 2012

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