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Big health data and Parkinson's disease epidemiology: Challenges and opportunities

  • Kjetil Bjornevik
    Correspondence
    Corresponding author. Department of Nutrition, Harvard T.H. Chan School of Public Health, 665 Huntington Ave, Boston, MA, 02115, USA.
    Affiliations
    Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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  • Michael A. Schwarzschild
    Affiliations
    Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
    Harvard Medical School, Boston, MA, USA
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  • Alberto Ascherio
    Affiliations
    Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
    Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
    Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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      The apparently paradoxical association of tobacco use with a lower risk of Parkinson's disease (PD) is well-established [
      • Li X.
      • Li W.
      • Liu G.
      • Shen X.
      • Tang Y.
      Association between cigarette smoking and Parkinson's disease: a meta-analysis.
      ], although whether nicotine or other tobacco constituents reduce the risk of PD remains uncertain. Nicotine has neuroprotective properties in some animal models [
      • Quik M.
      • O'Neill M.
      • Perez X.A.
      Nicotine neuroprotection against nigrostriatal damage: importance of the animal model.
      ], but transdermal nicotine failed to show any beneficial effects on PD progression in a recent randomized trial (NIC-PD) [
      • Oertel W.
      • Müller H.
      • Schade-Brittinger C.
      • et al.
      The NIC-PD-study - a randomized, placebo-controlled, double-blind, multi-centre trial to assess the disease-modifying potential of transdermal nicotine in early Parkinson‘s disease in Germany and N. America.
      ]. Only a few other of tobacco's myriad constituents have been investigated preclinically as candidate neuroprotectants (e.g., naphthoquinone-based monoamine oxidase inhibitors [
      • Castagnoli K.
      • Petzer J.B.
      • Steyn S.J.
      • van der Schyf C.J.
      • Castagnoli Jr., N.
      Inhibition of human MAO-A and MAO-B by a compound isolated from flue-cured tobacco leaves and its neuroprotective properties in the MPTP mouse model of neurodegeneration.
      ,
      • Fowler J.S.
      • Volkow N.D.
      • Wang G.J.
      • et al.
      Inhibition of monoamine oxidase B in the brains of smokers.
      ]) and none has yet advanced to PD trials. Less consistent results have been obtained for alcohol consumption. In a meta-analysis of observational studies, a significantly lower PD risk was reported among beer drinkers, but not wine or liquor drinkers [
      • Zhang D.
      • Jiang H.
      • Xie J.
      Alcohol intake and risk of Parkinson's disease: a meta-analysis of observational studies.
      ], which suggests that factors other than ethanol could be influential. One possibility is that the reduced PD risk observed in beer drinkers is due to the urate-elevating effect of beer, which is stronger than those of other alcoholic beverages [
      • Nishioka K.
      • Sumida T.
      • Iwatani M.
      • et al.
      Influence of moderate drinking on purine and carbohydrate metabolism.
      ,
      • Choi H.K.
      • Atkinson K.
      • Karlson E.W.
      • Willett W.
      • Curhan G.
      Alcohol intake and risk of incident gout in men: a prospective study.
      ]. Urate remains one of the most consistent protective factors for PD [
      • Ascherio A.
      • Schwarzschild M.A.
      The epidemiology of Parkinson's disease: risk factors and prevention.
      ]. Relatively little is known about the interplay between tobacco use and alcohol consumption. These two factors could act through similar mechanisms, which could lead to a positive (synergistic) or a negative (antagonistic) interaction, or independently. This question is challenging to address in prospective studies, as it requires a larger sample size than typically available in prospective studies.

      Keywords

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