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From the Department of Neurology (Dr. Benito-León), Móstoles General Hospital, Department of Neurology (Drs. Bermejo-Pareja and Porta-Etessam, R. Trincado), University Hospital "12 de Octubre," and Department of Research (Dr. Morales), Ministry of Labor and Social Affairs, Madrid, and Arévalo Health Center (Dr. Vega), Avila, Spain; and the G.H. Sergievsky Center and Department of Neurology (Dr. Louis), College of Physicians and Surgeons, Columbia University, New York, NY.
Address correspondence and reprint requests to Dr. J. Benito-León, Avda. de la Constitución 73, portal 3, 7° Izquierda, E-28820 Coslada, Madrid, Spain; e-mail: jbenitol{at}meditex.es
Background: A two-phase investigation method (screening followed by detailed examination) is the most accurate epidemiologic approach to estimate the epidemiology of Parkinson disease (PD) and secondary parkinsonism. The scarcity of statistics on the incidence of PD and other types of parkinsonism using this methodology led the authors to estimate them in three elderly populations.
Methods: A Spanish elderly parkinsonism-free cohort was followed for an average of 3 years. At the end of the follow-up, the cohort survivors were contacted by way of screening and clinical examination.
Results: The cohort consisted of 5,160 subjects (ages 65 to 85 and over): Eight hundred twenty-eight died before the examination, 3,685 completed the screening procedure, and 647 could not be screened because they refused (108) or were unreachable (539). Sixty-eight incident cases of parkinsonism were found: 30 PD (44.1%), 22 drug-induced parkinsonism (32.3%), 8 parkinsonism with associated features (11.7%), and 3 vascular parkinsonism (4.4%). The remaining five cases (7.3%) were classified as unspecified parkinsonism. Average annual incidence rate (per 100,000 person-years) in the population aged 65 to 85 and over years, adjusted to the standard European population, was 409.9 (95% CI 299.0 to 520.8) for parkinsonism and 186.8 (95% CI 110.4 to 263.2) for PD. Incidence rates of parkinsonism increased with advancing age. For PD, incidence rates increased with age in men but decreased beyond the age of 79 in women. Age-adjusted relative risk in men compared with women was 1.56 (95% CI 0.97 to 2.51) for parkinsonism and 2.55 (95% CI 1.21 to 5.37) for PD. Sixteen (53.3%) patients with PD were detected through the screening and had not been diagnosed previously.
Conclusions: Incidence estimates of PD based on two-phase investigation methodology are higher than those based on other approaches. Men had a risk of developing PD that was twice that of women. A large proportion of PD patients may never seek neurologic attention.
Received July 24, 2003. Accepted in final form November 13, 2003.
*See Appendix 1 on page 740 for a list of Group members.
Presented in part at the 54th annual meeting of the American Academy of Neurology, Denver, CO, April 13 to 20, 2002.
This article has been cited by other articles:
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