Objectif
In this study we followed a sequential process aimed at: 1) reviewing reported studies on Parkinson's Disease (PD) occurrence in European populations as well as strategies for case-finding in PD surveys; 2) evaluating gross sales of levodopa in multiple European regions and prescriptions for such drugs in specific areas of high etiological interest; 3) reanalysing prevalence and incidence of PD in European populations; 4) reviewing and discussing risk factors and etiological hypotheses for PD; 5) working out diagnostic criteria for PD; 6) combining reanalysed PD incidence data with specific information in order to generate etiological hypotheses; and, 7) identifying human and population resources for EC Concerted Action on PD risk factors in Europe.
From published reports, it was concluded that Parkinson's disease (PD) is widely distributed in Europe and that most geographical differences in reported disease occurrence in 22 prevalence and 7 incidence surveys can be explained by methodological variations in measurements. Prevalent PD underdiagnosis, as seen in screening studies in Europe, ranged from 30% to 71%. The sensitivity and specificity of various screening tests used in door to door studies are not well known.
The reanalysis of detailed PD prevalence data from 13 selected studies showed that differences in prevalences could be explained by methodology. Within each population, differences in prevalences as between the sexes were small. Age stratified comparisons of PD survey prevalences disclosed frequent, statistically significant heterogeneity in prevalence ratios across age strata, rendering interpretation of results problematic.
A method for evaluation of levodopa sales was developed, and used for evaluation of sales levodopa in 92 European regions. The highest sales were found in Greenland, the Faroe Islands and Iceland: 2.3 2.2 and 1.7 times higher respectively than those in Sweden. A consistent Icelandic birth cohort pattern was seen for the age specific curves of prevalences among levodopa users in the period 1990 to 1991, cumulative incidences during the period 1954 to 1963 and prevalences in 1963.
Analysis of the results suggested that age at pertussis infection is associated with risk for PD.
Risk factors selected to be preferentially studied were: familial aggregation for PD and a few specific disorders, smoking history, life in rural environment, and age at measles and pertussis infections. In a feasibility study in Segovia, Spain, based on a structured self administered questionnaire, the ages at measles and pertussis infection were reported to be known by the subjects themselves or their relatives for 94% and 52% of 48 individuals aged 40 to 59 years.
A set of diagnostic criteria for epidemiological observational studies on PD was worked out.
The causes of Parkinson's Disease (PD) are not known. This project essentially consists of the convergent development of two major research lines bent on: 1) an efficient comparison of descriptive data on the epidemiology of PD in Europe; 2) the generation of nonspeculative etiological hypotheses for PD; and, 3) the identification of appropriate resources for Concerted Action on PD Risk Factors. One of these fields of work consisted of applying analytical methods to the task of comparing reported survey data on PD occurrence and evaluating sales of drugs specifically used by PD patients for their treatment, a collaborative approach initiated during 1989 with EC support. The other research line - incorporated during the preparatory activity development stage and based on prior experience in EURODEM - was mainly aimed at reanalysing European data on PD incidence and prevalence and identifying research resources.
Original objectives of the preparatory activity:
1 Description of geographical differences in PD occurrence (prevalence and, eventually, incidence) in three steps.
1.1 Using exploratory methods: data on levodopa use and cause-of-death.
1.2 Conducting and reanalysing PD surveys in selected populations.
2 Generation of casual hypotheses for PD from the above- mentioned and other relevant data.
3 Development of strategies and instruments - including diagnostic criteria - in order to conduct morbidity surveys.
4 Recruitment of researchers from European countries able to contribute with appropriate material to the person-based analytical research involved in a Concerted Course of Action.
Champ scientifique (EuroSciVoc)
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CORDIS classe les projets avec EuroSciVoc, une taxonomie multilingue des domaines scientifiques, grâce à un processus semi-automatique basé sur des techniques TLN. Voir: Le vocabulaire scientifique européen.
- lettres histoire et archéologie histoire
- sciences médicales et de la santé sciences de la santé santé publique et environnementale épidémiologie
- sciences médicales et de la santé médecine fondamentale neurologie parkinson
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