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Oveisgharan S, Yu L, Poole VN, Evia AM, Barnes LL, Schneider JA, Arfanakis K, Bennett DA, Buchman AS. Association of White Matter Hyperintensities With Pathology and Progression of Parkinsonism in Aging. JAMA Neurol. 2021 Dec 1;78(12):1494-1502. PubMed.
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Rush University Medical Center
The second most common neurodegenerative disease of the brain, PD manifests mostly by motor phenotypes including tremor, rigidity, bradykinesia, and postural instability. PD is associated with adverse health outcomes, including a higher risk of death.
Like other major neurodegenerative diseases, no disease-modifying treatment is currently available for PD. Physical activity is a modifiable risk factor associated with a lower risk of PD. However, few studies have examined the association of physical activity in PD patients with risk of death. Using a national registry, Seo Yeon Yoon and colleagues showed that more vigorous physical activity was associated with a lower risk of death in PD patients. Moreover, PD patients who remained physically active over years had a lower risk of death compared with patients who remained in or turned into an inactive state. While findings are promising, several limitations should be considered. The study findings are based on a national registry that did not include patients’ PD severity (such as the Unified PD Rating Scale score). Therefore, it is possible that PD patients who could not be active had more severe PD stages, which in turn was associated with a higher risk of death. Therefore, future randomized clinical trials are required to confirm these findings.
Infectious diseases have been implicated in the pathogenesis of many diseases including PD. Using the Danish National Patient Registry, Noelle Cocoros and colleagues examined the history of influenza and other infectious diseases with odds of PD. They found that the history of influenza was associated with higher odds of PD if influenza had occurred more than 15 years prior to PD diagnosis. However, this finding was in contrast to the association of other infections with PD, where the association held if infections had occurred less than five years before the PD diagnosis. In addition, the authors did not assess association of influenza vaccine with PD. This requires further studies to rule out a possibility of reverse causality that PD patients are more vulnerable for infections during the prodromal phases of PD.
Using the U.S. National Vital Statistics System, Shuang Rong and colleagues examined trends of PD mortality in the last 20 years. They found that mortality from PD was increasing by an average 2.4 percent per year, which resulted the number to increase from 5.4 to 8.8 per 100,000 population from 1999 to 2019. This increase was not due to aging, as numbers were age-standardized. With subgroup analysis, they found that the PD mortality had increased in all states, in both men and women, in urban and rural citizens, and in all ethnicities. This study highlights the urgency of more investments finding disease-modifying treatments for PD and other neurodegenerative diseases of brain.
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