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Descriptive Epidemiology of 
Parkinson’s Disease and 
associated risk factors 
By 
Rana Das, 
(Bsc. Hons. Medical biotech)
How we view the world….. 
• Pessimist: The glass is half 
empty. 
• Optimist: The glass is half full. 
• Epidemiologist: As compared to 
what?
RIP..!!
Definition of Epidemiology*
Md. Ali affected with 
Parkinson’s
Pope John Paul II
Origins of Parkinson’s 
• Parkinson's disease was first formally described 
in "An Essay on the Shaking Palsy," published in 
1817 by a London physician named James 
Parkinson 
• It has probably existed for many thousands of 
years 
• Symptoms and potential therapies mentioned in: 
• Ayurveda, the system of medicine practiced in India as 
early as 5000 BC 
• First Chinese medical text, Nei Jing, which appeared 
2500 years ago
Etiology 
• The cause of Parkinson’s disease is unknown. 
• Many researchers believe that several factors 
combined are involved: free radicals, accelerated 
aging, environmental toxins, and genetic 
predisposition.
What Causes Parkinson's? 
• Why an individual develops Parkinson's 
disease remains unclear. 
• The cause is probably a combination of 
genetic and environmental factors, and may 
vary from person to person. 
• Although the cause of Parkinson's remains 
unknown, scientists have identified factors 
that contribute to Parkinson's in some 
patients. 
• People over age 60 have a two-to-four percent risk 
of developing Parkinson's disease, compared with 
the one-to-two percent risk in the general 
population.
Causes of Parkinson’s
On a cellular level 
• Studies have shown that the accumulation of a protein alpha 
synuclein in the neurons lead to the formation of lewy bodies 
which inhibit the transmission of dopamine from one neuron 
to other. 
• Over production of alpha synuclein is related to mutaion in 
the SYNCA gene.
Inhibition of Dopamine
Prevalence 
How many people have PD? 
 Estimated 1 million patients in US 
 Second most common age-related 
neurodegenerative disorder 
 Second in frequency only to Alzheimer’s disease 
 World-wide estimates vary 
15/100,000 in China 
657/100,000 in Argentina 
100 - 250/100,000 in North America and Europe 
 Prevalence is predicted to triple over the next 50 
years as average age of population increases.
Incidence 
 Quantifies the number of individuals who 
are newly diagnosed with PD in a given time 
period 
 Unaffected by factors affecting disease 
survival 
 Accurate measurements of the incidence of 
PD are relatively difficult 
Clinical manifestations of PD may be preceded by a long 
latent stage and have a slow clinical progression
Incidence 
Difficult to know how many people are diagnosed each year: 
 Symptoms may develop and progress slowly 
 Diagnostic criteria may vary 
 Patient populations vary with respect to doctor visits
Incidence 
 China: 1.5/100,000 
 Finland: 14.8/100,000 
 US: 20/100,000 
 Variations may be due to different diagnostic criteria and 
methods of case ascertainment in studies 
 Lifetime risk of PD: 1 in 40
Age 
The incidence of PD increases with age 
Symptoms of Parkinson’s disease may appear at any age 
The median age of onset for idiopathic PD is 62.4 years 
Onset before age 30 is rare, but up to 10% of cases of 
idiopathic PD begin by age 40
Age 
• Prevalence increases with age from age 50-90 
• Affects 0.3% of general US population 
• Affects 3% of those older than 65 
• Aging alone does not cause PD 
• May increase susceptibility to other factors or allow 
them to be expressed
Gender 
 Slightly more common in men than in women 
Estimated 12-15 men for every 10 
women
Ethnicity 
 Present worldwide, in all populations 
 No region found to be free of PD 
 More common in white people in Europe 
and North America 
(100-350/100,000) 
 Lower rates in China, Nigeria and Sardinia 
 The disorder occurs in all races but is 
somewhat more prevalent among Caucasians
Ethnicity 
 Generally less common among African- 
Americans and Asians 
one-fifth to one-tenth as prevalent as in whites 
 In Africa less common among blacks than 
whites 
 Door-to-door screening in Mississippi 
PD prevalence was not significantly different in whites and 
blacks after adjusting for age differences (poor diagnostic 
criteria) 
Higher prevalence in whites with stronger diagnostic 
criteria
Ethnicity 
 Two other studies conducted 
 PD incidence in African-Americans and in Asian- 
Americans was similar to rates for European- 
Americans 
 Door-to-door survey in Taiwan 
Prevalence of PD =119/100,000 
Similar to that of a white population and much 
higher than that of previous studies of Asian 
populations
Ethnicity 
 Differences in findings 
 Suggest environmental factors 
more important than racial factors 
 Further studies needed 
Other factors? 
Differences in access to 
healthcare?
Ethnicity 
• The disease was once thought to affect 
primarily whites, but recent studies have 
demonstrated equal prevalence in African 
Americans and whites living in the same 
geographic area. 
• Comparative epidemiologic studies performed 
in various major cities have yielded 
contradictory information. 
• Variations in the prevalence of the disease in 
individual racial groups in different geographic 
areas have suggested an increased risk 
associated with rural living.
Time 
 Hard to evaluate 
 Few studies that track over long period of time 
 Studies might use different methods or have 
different diagnostic criteria 
 Two studies  different conclusions 
 Greater awareness - well-known people have 
developed PD
Time 
 Study in Olmsted, Minnesota 
1935-1988 
 Tracked number of people diagnosed with 
PD each year 
1935-1944: 9.2/100,000 diagnosed 
1975-1984: 16.3/100,000 diagnosed
Time 
 NIH study of world-wide PD trends 
 Statistically controlled for age differences 
 Concluded that the prevalence and incidence of PD appear to 
have remained unchanged over the past 40 years.
Definition of a risk factor- 
Risk factor is anything that increases your chances of getting 
sick or having a problem. The onset of Parkinson’s disease is a 
multi factorial process. However even if you have several 
known risk factors, you might still not have PD(Parkinson’s 
disease).
In July 2004, THE NATIONAL INSTITUTE OF HEALTH 
(NIH)reported that more than two dozen genetic risk factors 
involved in PD have been identified, among which 6 were such 
which were reported for the first time. In a small number of 
cases worldwide, there is a strong inheritance pattern for the 
disease. In such cases the development of the disease is 
basically due to an environmental toxin present or trauma or 
an illness.
• Age 
• Sex 
• Family history 
• Declining oestrogen level 
• Agricultural work 
• Levels of B vitamin folate 
• Head trauma 
• Free radicals
FFAACCTTOORRSS AASSSSOOCCIIAATTEEDD WWIITTHH 
PPAARRKKIINNSSOONN’’SS DDIISSEEAASSEE 
Advancing age- 
Cases of young age development of the disease 
has been noticed although the actual symptoms 
occurs at a later age and keeps on getting worse 
as one gets older. Researches have shown that 
people with Parkinson’s have neural defects 
which keeps getting worse as one gets older.
FFAACCTTOORRSS AASSSSOOCCIIAATTEEDD WWIITTHH 
PPAARRKKIINNSSOONN’’SS DDIISSEEAASSEE 
Sex- 
Males are at higher risk of getting Parkinson’s disease than 
females. Reason for this being that males are most exposed to 
factors such as-head trauma or environmental toxins. 
Researches have shown that oestrogen have neuro-protective 
functions hence females are at lesser risk.
FFAACCTTOORRSS AASSSSOOCCIIAATTEEDD WWIITTHH 
PPAARRKKIINNSSOONN’’SS DDIISSEEAASSEE 
Familial history- 
Having one or more closely related family member affected 
by the disease increases your risk of developing the disease 
too. But to a minimal degree. This lends support to the idea 
that Parkinson’s Disease has a genetic link.
FFAACCTTOORRSS AASSSSOOCCIIAATTEEDD WWIITTHH 
PPAARRKKIINNSSOONN’’SS DDIISSEEAASSEE 
Declining oestrogen level- 
• As a woman attains menopausal age, the levels of 
oestrogen in the body decreases. 
• As it known that oestrogen has neuro-protective functions, 
low levels of oestrogen might result in the development of the 
disease. Women not opting for hormone replacement 
therapies are particularly ar risk.
FFAACCTTOORRSS AASSSSOOCCIIAATTEEDD WWIITTHH 
PPAARRKKIINNSSOONN’’SS DDIISSEEAASSEE 
Agriculture work- 
Agricultural work expose you to several environmental toxins 
which may cause PD as they inhibit dopamine production and 
promote free radical damage. Farmers are at high risk due use 
of pesticides and other chemicals.
FFAACCTTOORRSS AASSSSOOCCIIAATTEEDD WWIITTHH 
PPAARRKKIINNSSOONN’’SS DDIISSEEAASSEE 
Low levels of B vitamin folate- 
Researchers have studied that mice which have a low level of 
this vitamin develop severe Parkinson’s Disease whereas mice 
with a normal level do not develop.
FFAACCTTOORRSS AASSSSOOCCIIAATTEEDD WWIITTHH 
PPAARRKKIINNSSOONN’’SS DDIISSEEAASSEE 
Head trauma- 
Recent studies have found a link between injury to the head, 
neck and cervical spine and Parkinson’s disease. In 2007,60 
patients show trauma-induced upper cervical damage. Some 
patients remembered a particular incident others did not. In 
some cases Parkinson’s symptoms took decades to appear.
FFAACCTTOORRSS AASSSSOOCCIIAATTEEDD WWIITTHH 
PPAARRKKIINNSSOONN’’SS DDIISSEEAASSEE 
Free radicals- 
Usually free radicals are formed in body and brain but they 
eventually they are flushed out of the body due to mechanisms of 
the brain and body. People with Parkinson’s disease don’t have 
such mechanisms to flush out such free radicals. Environmental 
toxins contribute to abnormal increase in free radicals and increase 
in risk of Parkinson’s Disease.
THANK YOU

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Epidemiology of Parkinson's Disease

  • 1. Descriptive Epidemiology of Parkinson’s Disease and associated risk factors By Rana Das, (Bsc. Hons. Medical biotech)
  • 2. How we view the world….. • Pessimist: The glass is half empty. • Optimist: The glass is half full. • Epidemiologist: As compared to what?
  • 5. Md. Ali affected with Parkinson’s
  • 7. Origins of Parkinson’s • Parkinson's disease was first formally described in "An Essay on the Shaking Palsy," published in 1817 by a London physician named James Parkinson • It has probably existed for many thousands of years • Symptoms and potential therapies mentioned in: • Ayurveda, the system of medicine practiced in India as early as 5000 BC • First Chinese medical text, Nei Jing, which appeared 2500 years ago
  • 8. Etiology • The cause of Parkinson’s disease is unknown. • Many researchers believe that several factors combined are involved: free radicals, accelerated aging, environmental toxins, and genetic predisposition.
  • 9. What Causes Parkinson's? • Why an individual develops Parkinson's disease remains unclear. • The cause is probably a combination of genetic and environmental factors, and may vary from person to person. • Although the cause of Parkinson's remains unknown, scientists have identified factors that contribute to Parkinson's in some patients. • People over age 60 have a two-to-four percent risk of developing Parkinson's disease, compared with the one-to-two percent risk in the general population.
  • 11. On a cellular level • Studies have shown that the accumulation of a protein alpha synuclein in the neurons lead to the formation of lewy bodies which inhibit the transmission of dopamine from one neuron to other. • Over production of alpha synuclein is related to mutaion in the SYNCA gene.
  • 13. Prevalence How many people have PD?  Estimated 1 million patients in US  Second most common age-related neurodegenerative disorder  Second in frequency only to Alzheimer’s disease  World-wide estimates vary 15/100,000 in China 657/100,000 in Argentina 100 - 250/100,000 in North America and Europe  Prevalence is predicted to triple over the next 50 years as average age of population increases.
  • 14. Incidence  Quantifies the number of individuals who are newly diagnosed with PD in a given time period  Unaffected by factors affecting disease survival  Accurate measurements of the incidence of PD are relatively difficult Clinical manifestations of PD may be preceded by a long latent stage and have a slow clinical progression
  • 15. Incidence Difficult to know how many people are diagnosed each year:  Symptoms may develop and progress slowly  Diagnostic criteria may vary  Patient populations vary with respect to doctor visits
  • 16. Incidence  China: 1.5/100,000  Finland: 14.8/100,000  US: 20/100,000  Variations may be due to different diagnostic criteria and methods of case ascertainment in studies  Lifetime risk of PD: 1 in 40
  • 17. Age The incidence of PD increases with age Symptoms of Parkinson’s disease may appear at any age The median age of onset for idiopathic PD is 62.4 years Onset before age 30 is rare, but up to 10% of cases of idiopathic PD begin by age 40
  • 18. Age • Prevalence increases with age from age 50-90 • Affects 0.3% of general US population • Affects 3% of those older than 65 • Aging alone does not cause PD • May increase susceptibility to other factors or allow them to be expressed
  • 19. Gender  Slightly more common in men than in women Estimated 12-15 men for every 10 women
  • 20. Ethnicity  Present worldwide, in all populations  No region found to be free of PD  More common in white people in Europe and North America (100-350/100,000)  Lower rates in China, Nigeria and Sardinia  The disorder occurs in all races but is somewhat more prevalent among Caucasians
  • 21. Ethnicity  Generally less common among African- Americans and Asians one-fifth to one-tenth as prevalent as in whites  In Africa less common among blacks than whites  Door-to-door screening in Mississippi PD prevalence was not significantly different in whites and blacks after adjusting for age differences (poor diagnostic criteria) Higher prevalence in whites with stronger diagnostic criteria
  • 22. Ethnicity  Two other studies conducted  PD incidence in African-Americans and in Asian- Americans was similar to rates for European- Americans  Door-to-door survey in Taiwan Prevalence of PD =119/100,000 Similar to that of a white population and much higher than that of previous studies of Asian populations
  • 23. Ethnicity  Differences in findings  Suggest environmental factors more important than racial factors  Further studies needed Other factors? Differences in access to healthcare?
  • 24. Ethnicity • The disease was once thought to affect primarily whites, but recent studies have demonstrated equal prevalence in African Americans and whites living in the same geographic area. • Comparative epidemiologic studies performed in various major cities have yielded contradictory information. • Variations in the prevalence of the disease in individual racial groups in different geographic areas have suggested an increased risk associated with rural living.
  • 25. Time  Hard to evaluate  Few studies that track over long period of time  Studies might use different methods or have different diagnostic criteria  Two studies  different conclusions  Greater awareness - well-known people have developed PD
  • 26. Time  Study in Olmsted, Minnesota 1935-1988  Tracked number of people diagnosed with PD each year 1935-1944: 9.2/100,000 diagnosed 1975-1984: 16.3/100,000 diagnosed
  • 27. Time  NIH study of world-wide PD trends  Statistically controlled for age differences  Concluded that the prevalence and incidence of PD appear to have remained unchanged over the past 40 years.
  • 28. Definition of a risk factor- Risk factor is anything that increases your chances of getting sick or having a problem. The onset of Parkinson’s disease is a multi factorial process. However even if you have several known risk factors, you might still not have PD(Parkinson’s disease).
  • 29. In July 2004, THE NATIONAL INSTITUTE OF HEALTH (NIH)reported that more than two dozen genetic risk factors involved in PD have been identified, among which 6 were such which were reported for the first time. In a small number of cases worldwide, there is a strong inheritance pattern for the disease. In such cases the development of the disease is basically due to an environmental toxin present or trauma or an illness.
  • 30. • Age • Sex • Family history • Declining oestrogen level • Agricultural work • Levels of B vitamin folate • Head trauma • Free radicals
  • 31. FFAACCTTOORRSS AASSSSOOCCIIAATTEEDD WWIITTHH PPAARRKKIINNSSOONN’’SS DDIISSEEAASSEE Advancing age- Cases of young age development of the disease has been noticed although the actual symptoms occurs at a later age and keeps on getting worse as one gets older. Researches have shown that people with Parkinson’s have neural defects which keeps getting worse as one gets older.
  • 32. FFAACCTTOORRSS AASSSSOOCCIIAATTEEDD WWIITTHH PPAARRKKIINNSSOONN’’SS DDIISSEEAASSEE Sex- Males are at higher risk of getting Parkinson’s disease than females. Reason for this being that males are most exposed to factors such as-head trauma or environmental toxins. Researches have shown that oestrogen have neuro-protective functions hence females are at lesser risk.
  • 33. FFAACCTTOORRSS AASSSSOOCCIIAATTEEDD WWIITTHH PPAARRKKIINNSSOONN’’SS DDIISSEEAASSEE Familial history- Having one or more closely related family member affected by the disease increases your risk of developing the disease too. But to a minimal degree. This lends support to the idea that Parkinson’s Disease has a genetic link.
  • 34. FFAACCTTOORRSS AASSSSOOCCIIAATTEEDD WWIITTHH PPAARRKKIINNSSOONN’’SS DDIISSEEAASSEE Declining oestrogen level- • As a woman attains menopausal age, the levels of oestrogen in the body decreases. • As it known that oestrogen has neuro-protective functions, low levels of oestrogen might result in the development of the disease. Women not opting for hormone replacement therapies are particularly ar risk.
  • 35. FFAACCTTOORRSS AASSSSOOCCIIAATTEEDD WWIITTHH PPAARRKKIINNSSOONN’’SS DDIISSEEAASSEE Agriculture work- Agricultural work expose you to several environmental toxins which may cause PD as they inhibit dopamine production and promote free radical damage. Farmers are at high risk due use of pesticides and other chemicals.
  • 36. FFAACCTTOORRSS AASSSSOOCCIIAATTEEDD WWIITTHH PPAARRKKIINNSSOONN’’SS DDIISSEEAASSEE Low levels of B vitamin folate- Researchers have studied that mice which have a low level of this vitamin develop severe Parkinson’s Disease whereas mice with a normal level do not develop.
  • 37. FFAACCTTOORRSS AASSSSOOCCIIAATTEEDD WWIITTHH PPAARRKKIINNSSOONN’’SS DDIISSEEAASSEE Head trauma- Recent studies have found a link between injury to the head, neck and cervical spine and Parkinson’s disease. In 2007,60 patients show trauma-induced upper cervical damage. Some patients remembered a particular incident others did not. In some cases Parkinson’s symptoms took decades to appear.
  • 38. FFAACCTTOORRSS AASSSSOOCCIIAATTEEDD WWIITTHH PPAARRKKIINNSSOONN’’SS DDIISSEEAASSEE Free radicals- Usually free radicals are formed in body and brain but they eventually they are flushed out of the body due to mechanisms of the brain and body. People with Parkinson’s disease don’t have such mechanisms to flush out such free radicals. Environmental toxins contribute to abnormal increase in free radicals and increase in risk of Parkinson’s Disease.