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. 2018 May 8;90(19):e1646-e1653.
doi: 10.1212/WNL.0000000000005473. Epub 2018 Apr 11.

Integration of risk factors for Parkinson disease in 2 large longitudinal cohorts

Iris Y Kim  1 , Éilis J O'Reilly  2 , Katherine C Hughes  2 , Xiang Gao  2 , Michael A Schwarzschild  2 , Marian T Hannan  2 , Rebecca A Betensky  2 , Alberto Ascherio  2
Affiliations

Integration of risk factors for Parkinson disease in 2 large longitudinal cohorts

Iris Y Kim et al. Neurology. .

Abstract

Objective: To prospectively examine how selected lifestyle factors and family history of Parkinson disease (PD) combine to determine overall PD risk.

Methods: We derived risk scores among 69,968 women in the Nurses' Health Study (NHS) (1984-2012) and 45,830 men in the Health Professionals Follow-up Study (HPFS) (1986-2012). Risk scores were computed for each individual based on the following factors previously associated with PD risk: total caffeine intake, smoking, physical activity, and family history of PD for the NHS, and additionally total flavonoid intake and dietary urate index for the HPFS. Hazard ratios were estimated using Cox proportional hazards models. In addition, we performed tests of interactions on both the multiplicative and additive scale between pairs of risk factors.

Results: We documented 1,117 incident PD cases during follow-up. The adjusted hazard ratios comparing individuals in the highest category of the reduced risk score to those in the lowest category were 0.33 (95% confidence interval: 0.21, 0.49; ptrend < 0.0001) in the NHS and 0.18 (95% confidence interval: 0.10, 0.32; ptrend < 0.0001) in the HPFS. Results were similar when applying the risk scores computed by summing the predictors weighted by the log of their individual effect sizes on PD risk in these cohorts. Additive interaction was present between no family history of PD and caffeine in men and between caffeine and physical activity in women.

Conclusions: Our results suggest that known protective factors for PD tend to have additive or superadditive effects, so that PD risk is very low in individuals with multiple protective risk factors.

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Figures

Figure 1
Figure 1. Associations of individual and combined risk factors and Parkinson disease risk among (A) men (HPFS) and (B) women (NHS)
CI = confidence interval; HPFS = Health Professionals Follow-up Study; NHS = Nurses' Health Study; PMH = postmenopausal hormone.
Figure 2
Figure 2. Relative risk of Parkinson disease for the (A) HPFS and (B) NHS according to quintiles of their respective log-weighted risk scores
ptrend < 0.0001 for both. HPFS = Health Professionals Follow-up Study; NHS = Nurses' Health Study.
See this image and copyright information in PMC

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