Objective: We explored the association between self-reported exposure to caffeine, smoking, and environmental toxins (pesticides, chemical solvents, heavy metals, other chemicals, and fumes) with Aao and severity of PD in a Malaysian cohort.

Background: Caffeine and cigarette smoke exposure are associated with reduced Parkinson’s disease (PD) risk, while various toxins increase the risk of PD. However, whether these factors influence the age at onset (Aao) or severity of PD remains unclear.

Method: The Mini Environmental Risk Questionnaire for PD (MERQ-PD-B) was completed by patients. This included seven items on past (before PD diagnosis) and current exposure to caffeine and cigarette smoking. PD severity was evaluated by neurologists using the Clinical Impression of Severity Index for PD (CISI-PD), covering motor signs, disability, motor complications, and cognition. Spearman correlation was used to investigate the relationship between lifestyle/ environmental factors with Aao and severity of PD.

Results: Among the 686 patients (55.2% male; median age=67[11] years; 82.7% late-onset PD[LOPD] with Aao>50years), prior history of caffeine intake or smoking exposure, as well as quantity of past caffeine intake or cigarette pack-years did not correlate with Aao. Current caffeine drinking status correlated with better CISI- total score (r=-0.17, P<0.001) and sub-scores for motor signs (r=-0.13, P=0.001) and disability (r=-0.17, P<0.001). However, among current caffeine consumers, the quantity of caffeine intake did not correlate with PD severity. Heavy metal exposure correlated weakly with worse CISI-total score (r=0.08, p<0.05) and subscores for motor complications (r=0.12, p<0.05) and cognition (r=0.08, p<0.05). Chemical solvent exposure correlated weakly with motor complications (r=0.09, p<0.05). Pesticides, other chemicals, and fumes showed no significant correlation with PD severity. Meanwhile, exposure to these environmental toxins showed no correlation with Aao.

Conclusion: Current caffeine intake was associated with lesser, whereas heavy metals and chemical solvents with greater disease severity. We observed no association between lifestyle/ environmental factors and PD Aao.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/association-between-lifestyle-and-environmental-factors-with-disease-severity-and-age-at-onset-in-multi-ethnic-malaysian-parkinsons-disease-patients/