Daniele Belvisi1, Roberta Pellicciari1, Andrea Fabbrini1, Matteo Costanzo1, Sara Pietracupa1, Maria De Lucia1, Nicola Modugno1, Francesca Magrinelli1, Carlo Dallocchio1, Tommaso Ercoli1, Claudio Terravecchia1, Alessandra Nicoletti1, Paolo Solla1, Giovanni Fabbrini1, Michele Tinazzi1, Alfredo Berardelli2, Giovanni Defazio1. 1. From IRCCS Neuromed (D.B., A.F., S.P., M.D.L., N.M., G.F., A.B.), Pozzilli, IS; Department of Basic Medical Sciences, Neuroscience and Sense Organs (R.P.), "Aldo Moro," University of Bari; Department of Human Neurosciences (D.B., M.C., G.F., A.B.), Sapienza, University of Rome; Department of Neurosciences, Biomedicine and Movement Sciences (F.M., M.T.), University of Verona; Neurology Unit (C.D.), ASST Pavia-Ospedale Civile di Voghera; Department of Medical Sciences and Public Health (T.E., P.S., G.D.), University of Cagliari, Monserrato; and Department G.F. Ingrassia (C.T., A.N.), Neuroscience Section, University of Catania, Italy. 2. From IRCCS Neuromed (D.B., A.F., S.P., M.D.L., N.M., G.F., A.B.), Pozzilli, IS; Department of Basic Medical Sciences, Neuroscience and Sense Organs (R.P.), "Aldo Moro," University of Bari; Department of Human Neurosciences (D.B., M.C., G.F., A.B.), Sapienza, University of Rome; Department of Neurosciences, Biomedicine and Movement Sciences (F.M., M.T.), University of Verona; Neurology Unit (C.D.), ASST Pavia-Ospedale Civile di Voghera; Department of Medical Sciences and Public Health (T.E., P.S., G.D.), University of Cagliari, Monserrato; and Department G.F. Ingrassia (C.T., A.N.), Neuroscience Section, University of Catania, Italy. alfredo.berardelli@uniroma1.it.
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.
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.
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