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Aspects of Parkinson's disease. Epidemiology, risk factors and ECT in advanced disease
Linköping University, Department of Clinical and Experimental Medicine, Geriatric. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Geriatric Medicine.
1999 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The purpose was to investigate some aspects of epidemiology, risk factors and treatment with ECT in advanced Parkinson’s disease (PD).

In study I, we performed a descriptive epidemiologic population-based survey in the Central Health Care District in Östergötland in south-east Sweden, with a population of almost 150,000 inhabitants 1989. The case finding was accomplished in three ways: 1. Collection of all prescriptions for Parkinson’s disease. 2. Search in medical files. 3. Checking with all nursing homes in the area. The crude prevalence was found to be 115 per 100,000 inhabitants. When we used the European Standard Population as a tool for easy comparisons of PD prevalence between different areas and time periods 76 PD-cases per 100,000 inhabitants were found. The corresponding incidences were 11.0 (crude) and 7.9 (age standardised) per 100,000 person-years. Mean age at onset was 65.6. A low prevalence and a high age at onset suggested that e.g. environmental factors could influence the occurrence of PD, and the results implies that only few such factors were present in the investigated area.

The findings led to study II, a case-control study which investigated the possible impact of nutritional and environmental risk factors for idiopathic Parkinson’s disease (IP), including 113 cases and 263 control subjects. Dietary, drinking, and smoking habits, as well as previous occupation, were requested in a structured questionnaire. No increased risk was found for any of the nutrients. A reduced risk was found for coffee, wine, and spirits but also for broiled meat, smoked ham or meat, eggs, French loaf or white bread, and tomatoes. These findings could indicate an antioxidant effect. Frequency of preceding and present smoking was reduced in IP patients. Possible mechanisms are discussed. Various occupational groups and exposures were analysed and increased risks of IP in men were found for agricultural work, pesticide exposure, male carpenters, and in female cleaners.

In advanced PD there is a need for further therapeutic improvements, and electroconvulsive therapy (ECT) is one insufficiently explored and evaluated method. In study III ECT 16 non-depressed, nondemented PD patients with advanced disease were treated with ECT. In all patients an antiparkinsonian effect of ECT was seen, lasting between a few days and 18 months. Five patients, all with signs of blood brain barrier damage, developed transitory mental confusion after ECT. The results indicated that ECT could cause increased dopaminergic activity, which led us to study IV. Single photon emission computed tomography (SPECT) with the cocaine analogue [123I]-β-CIT was used in order to visualise dopaminergic neurones in the brain. Six patients with PD were examined before and after a series of ECT, and in three cases SPECT was also repeated after one year. The side-to-side difference in the radiotracer uptake was found to be significantly lower in striatum located contralaterally to the part of the body with most pronounced symptomatology. No significant change in uptake of [123I]-β-CIT was seen after ECT, although all patients improved and the most pronounced improvement was seen in patients with less advanced PD.

Study V points at two new positive observations with maintenance ECT (MECT). i.e. repeated ECT treatment of PD. One patient had either severe mental side effects on higher L-dopa doses or intolerable parkinsonian symptoms on lower doses. MECT implied marked improvement in parkinsonian symptoms without mental side effects. Another PD patient, who also had a mental depression, showed slight improvement of motor symptoms on a series of ECT. When treated with MECT further antiparkinsonian effects were seen.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 1999. , 61 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 593
Keyword [en]
Parkinson's disease, PD, treatment, epidemiology, electroconvulsive therapy, ECT
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-5011ISBN: 91-7219-336-0 (print)OAI: oai:DiVA.org:liu-5011DiVA: diva2:20922
Public defence
1999-05-17, Berzeliussalen, Campus US, Linköpings universitet, Linköping, 09:00 (English)
Opponent
Supervisors
Note
On the day of the public defence the status of the article IV was: Submitted; articel V was: Accepted for publication after revision.Available from: 1999-05-28 Created: 1999-05-28 Last updated: 2012-01-24Bibliographically approved
List of papers
1. Age standardised incidence and prevalence of Parkinson´s disease in a Swedish community
Open this publication in new window or tab >>Age standardised incidence and prevalence of Parkinson´s disease in a Swedish community
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1996 (English)In: Journal of Clinical Epidemiology, ISSN 0895-4356, Vol. 49, no 6, 637-641 p.Article in journal (Refereed) Published
Abstract [en]

Parkinson's disease (PD) shows a geographical variation. All prescriptions for anti-parkinsonian drugs were recorded for a half-year in a region with low -dopa consumption. Hospital and outpatient records were studied and physicians were asked to supply details of PD patients in the region, with 147,777 inhabitants. The crude prevalence was 115 PD per 100,000 inhabitants, based on 170 cases. In contrast to other studies we report an age-standardized prevalence, which was 76 per 100,000, using the European Standard Population as reference. The corresponding approximate incidences were 11.0 (crude) and 7.9 (age-standardized) per 100,000 person-years. Male preponderance appeared in all age groups. Mean age at onset was 65.6 years, the highest figure reported. Variation between studies for age at onset, differences in prevalence, and male preponderance suggest environmental risk factors to be of importance for PD.

Keyword
Parkinson's disease, epidemiological study, age standardization, age at onset, male preponderance, low risk
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13530 (URN)10.1016/0895-4356(96)00003-0 (DOI)
Available from: 1999-05-28 Created: 1999-05-28 Last updated: 2009-08-18
2. Nutritional and occupational factors influencing the risk of Parkinson's disease: a case-control study in southeastern Sweden
Open this publication in new window or tab >>Nutritional and occupational factors influencing the risk of Parkinson's disease: a case-control study in southeastern Sweden
1999 (English)In: Movement Disorders, ISSN 0885-3185, Vol. 14, no 1, 28-37 p.Article in journal (Refereed) Published
Abstract [en]

PURPOSE AND METHODS: To investigate the possible impact of nutritional and environmental risk factors for idiopathic Parkinson's disease (IP), a case-control study was performed in the county of Ostergötland in southeastern Sweden. The study involved 113 cases of IP and 263 control subjects. Dietary, drinking, and smoking habits, as well as previous occupation, were requested in a structured questionnaire.

RESULTS: No increased risk was found for any of the nutritional items in which information was requested. A reduced risk was found for coffee, wine, and liquor at various consumption levels but also for fried or broiled meat, smoked ham or meat, eggs, French loaf or white bread, and tomatoes. All these food and drink items contain niacin. As in many studies, the frequency of preceding and present smoking was reduced in IP patients. Various occupational groups and exposures were analyzed and increased risks of IP in men were found for agricultural work along with pesticide exposure; this was also the case for male carpenters and female cleaners.

CONCLUSIONS: The findings indicate that nutritional factors and occupational exposures, especially to pesticides, could be of etiologic importance in IP.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13531 (URN)
Available from: 1999-05-28 Created: 1999-05-28 Last updated: 2009-08-18
3. ECT in Parkinson's disease: Changes in motor symptoms, monoamine metabolites and neuropeptides
Open this publication in new window or tab >>ECT in Parkinson's disease: Changes in motor symptoms, monoamine metabolites and neuropeptides
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1995 (English)In: Journal of Neural Transmission. Parkinson's disease and dementia section., ISSN 0936-3076, Vol. 10, no 2-3, 129-140 p.Article in journal (Refereed) Published
Abstract [en]

Electroconvulsive therapy (ECT) was given to 16 non-depressed, non-demented patients with advanced Parkinson's disease (PD). In all the patients an antiparkinsonian effect was seen, lasting for 18 months in one patient, 3-5 months in seven patients, and a few days to four weeks in eight patients. After ECT the levels of homovanillic acid and neuropeptide Y in cerebrospinal fluid (CSF) were significantly increased. The eight patients with long lasting motor improvement after ECT had significantly lower CSF-3-methoxy-4-hydroxyphenylglycol compared to the group with short lasting improvement. Five patients developed transitory mental confusion after ECT. In these patients, and in no others, a high albumin-ratio was found already before ECT was given - an indication of blood CSF barrier damage. Our results suggest that ECT is valuable in patients with drug refractory PD or PD with intolerance to antiparkinsonian drugs.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13532 (URN)
Available from: 1999-05-28 Created: 1999-05-28 Last updated: 2009-08-18
4. ECT in Parkinson's disease-dopamine transporter visualised by [123I]-beta-CIT SPECT
Open this publication in new window or tab >>ECT in Parkinson's disease-dopamine transporter visualised by [123I]-beta-CIT SPECT
2000 (English)In: Journal of Neural Transmission, ISSN 0300-9564, Vol. 107, no 8-9, 997-1008 p.Article in journal (Refereed) Published
Abstract [en]

Parkinson's disease (PD) is characterised by a loss of dopaminergic neurones in the basal ganglia. These neurones may be visualised by single photon emission computed tomography (SPECT) with the cocaine analogue 2β-carboxymethyl-3-β-(4-iodophenyl)tropane ([123I]β-CIT), which labels the dopamine reuptake sites in the nerve terminals. In order to evaluate the possibility to predict the outcome of ECT a prospective study was per-formed with six PD patients in whom the [123I]β-CIT uptake was measured before and after an electroconvulsive therapy (ECT) series. The side-to-side difference in the radiotracer uptake was found to be significantly lower in striatum located contralaterally to the part of the body with the most pronounced symptomathology. No significant change in uptake of the radioligand was seen after ECT. Patients with best uptake and thus with less advanced PD improved most after ECT. The possibility to use the [123I]β-CIT uptake to predict the outcome of ECT treatment has to be further evaluated.

Keyword
Parkinson's disease, electroconvulsive therapy, single photon emission computerized tomography (SPECT), [123I]β-CIT
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13533 (URN)10.1007/s007020070048 (DOI)
Available from: 1999-05-28 Created: 1999-05-28 Last updated: 2009-08-18
5. Maintenance ECT in Parkinson's disease
Open this publication in new window or tab >>Maintenance ECT in Parkinson's disease
1999 (English)In: Journal of Neural Transmission, ISSN 0300-9564, Vol. 106, no 7-8, 737-741 p.Article in journal (Refereed) Published
Abstract [en]

Electroconvulsive therapy (ECT) has an anti-Parkinsonian effect. In two cases repeated single ECT, i.e. maintenance ECT (MECT), caused different, hitherto unreported positive effects. One patient had either severe mental side effects from higher L-dopa doses or intolerable parkinsonian symptoms on lower doses. MECT entailed a marked improvement in parkinsonian symptoms without mental side effects. Another patient with depression as well as Parkinson's disease who showed a slight improvement of motor symptoms after a series of ECT presented further anti-parkinsonian effects on MECT.

Keyword
Parkinson's disease, paranoid symptoms, hallucination, maintenance ECT
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13534 (URN)10.1007/s007020050194 (DOI)
Available from: 1999-05-28 Created: 1999-05-28 Last updated: 2009-08-18

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