Objective: To study the clinical profile and risk factors of Parkinson’s disease (PD) in India.

Background: The current knowledge of clinical and epidemiological profile of PD is from European-origin populations. A considerable knowledge gap exists regarding PD in the Indian population.

Method: A multi-institutional network of movement disorder specialists and neurologists from 18 tertiary-care hospitals across India recruited prospectively, PD patients of Asian- Indian origin. Controls were ethnicity-matched, healthy subjects from the same geographical areas. Uniform protocol, questionnaire and proforma were applied.¹ Corrections were applied for multiple comparisons and P<0.007 was considered significant.

Results: 7918 cases and 6640 gender-matched controls were studied. In age and gender- adjusted comparisons, agricultural jobs, exposure to insecticides/pesticides and head injury carried increased risk for PD. Surprisingly, smoking and caffeine intake were not protective. Co-morbidities of diabetes, hypertension, hypercholesterolemia, coronary artery disease, anxiety, and depression were higher in cases. Stratification based on age of onset into EOPD (<50 years) and LOPD (>50 years), showed that age- at- study and disease duration were higher in LOPD. Similarly, risk exposures, co-morbidities  were more in LOPD and family history in EOPD. Rest tremor and non-motor symptoms (NMS) were more in LOPD. Motor fluctuations, dyskinesias, depression and cognitive scores were worse in EOPD. In gender-based comparisons, men were older, had more frequent family history, increased exposure to risk factors and co-morbidities.  Cognitive and depression scores were worse in women while other NMS were more in men. There was no difference in UPDRS I to III but motor fluctuations and dyskinesias were commoner in men. Finally, the motor phenotypes² were predominantly postural instability gait disorder (PIGD=47.1%), followed by tremor-dominant (TD=33.3%), and indeterminate (IT =19.5%) types. Age at study, age at onset and disease duration were higher in PIGD than TD. Agricultural jobs and exposure to risk factors were more in PIGD. Scores of UPDRS I to IV, cognition and depression were worse and NMS was reported more in PIGD.

Conclusion: Our study is the first to provide a comprehensive assessment of PD in India which will be required for the practice of precision medicine for PD in India.

References: 1. Rajan R, Divya KP, Kandadai RM3, Yadav R, Satagopam VP, Madhusoodanan UK et al. Genetic architecture of Parkinson’s disease in the Indian population: harnessing
genetic diversity to address critical gaps in Parkinson’s disease research. Front in Neurol 2020; 11:1-11.
2. Jankovic, J., McDermott, M., Carter, J., Gauthier, S., Goetz, C., Golbe, L., et al. Variable expression of Parkinson’s disease: a base-line analysis of the DATATOP cohort. The
Parkinson Study Group. Neurology 1990;40: 1529–1534

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MDS Abstracts - https://www.mdsabstracts.org/abstract/clinical-and-epidemiological-profile-of-parkinsons-disease-in-india/