Important differences in Parkinson’s disease in the Western Pacific Regions

 

Parkinson’s disease in the Western Pacific Region

Lim S-Y, Tan AH, Ahmad-Annuar A, Klein C, Tan LCS, Rosales RL, Bhidayasiri R, Wu Y-R, Shang H-F, Evans AH, Pal PK, Hattori N, Tan CT, Jeon B, Tan E-K, Lang AE
Lancet Neurol 2019; Jun 4. doi: 10.1016/S1474-4422(19)30195-4 [Epub ahead of print]

Introduction

An ageing population is a major contributor to the growing incidence of Parkinson’s disease.  The Western Pacific Region (Figure 1) is expected to account for the majority of Parkinson’s disease cases by 2030,1 with China alone projected to account for 60% of Parkinson’s disease patients. As a result, increasing numbers of studies have revealed important differences in Parkinson’s disease between the Western Pacific Region compared with Europe and North America. The review addresses the differences found in epidemiology, causative factors and clinical presentation, as well as management, between these regions.

 

Figure 1

Map of the Western Pacific Region

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The Western Pacific Region is expected to account for the majority of Parkinson’s disease cases by 2030

lower prevalence rates of Parkinson’s disease among 70–79 year olds in Asia compared to Europe and North America

Differences in epidemiology

A meta-analysis of 47 studies found lower prevalence rates of Parkinson’s disease among 70–79 year olds in Asia compared to Europe and North America,2 consistent with studies conducted in the USA and New Zealand showing a lower incidence and prevalence of Parkinson’s disease in Asian, Pacific and Maori ethnic groups than white and Hispanic groups.3,4 Furthermore, a higher prevalence of Parkinson’s disease has been reported in women in Japan and Korea compared to the well-known global predominance in men.

Pesticides, a strong risk factor for Parkinson’s disease, are widely used within the Western Pacific Region

Causative factors

Differences in causative factors have been identified between the Western Pacific Region and Europe and North America, most notably ethnic-specific genetic variations that are rare or absent in white and Indian people.5,6  Pesticides, a strong risk factor for Parkinson’s disease, are widely used within the Western Pacific Region and the effects of these on Parkinson’s disease incidence may only come to light in the next generation.  Further risk factors for Parkinson’s disease, including reduced physical activity, diabetes, hepatitis C infection and Helicobacter pylori infection, also have an epidemiological impact in this region.  In contrast, protective factors common to the region include high rates of smoking among men, high tea consumption and lower consumption of dairy products.

Studies in the Western Pacific Region have reported higher rates of asthenia8 and constipation9 but lower rates of impulsive–compulsive behaviours10 and restless legs syndrome11 than studies in Europe and North America.

Clinical presentation and co-morbidities

Lower rates of motor fluctuations and dyskinesias have been reported in Western Pacific populations, which may be due to the generally lower dose of levodopa given to patients compared to Europe and North America.7  A high incidence of non-motor symptoms has been observed in studies across the Western Pacific Region, as seen in Europe and North America, but with some possible variation in their presentation.  Studies in the Western Pacific Region have reported higher rates of asthenia8 and constipation9 but lower rates of impulsive–compulsive behaviours10 and restless leg syndrome11 than studies in Europe and North America.

Management of Parkinson’s disease

Poor knowledge of Parkinson’s disease throughout the Western Pacific Region, from patients and caregivers to health-care professionals and the general public, has been described, with consequences for treatment seeking, access to treatment and patient adherence.12,13  Additionally, there are few specialists with advanced training in Parkinson’s disease and reports of multidisciplinary management of Parkinson’s disease are scare.  Oral levodopa is still not widely available in some countries, and is generally used at lower doses than in Europe and North America.  Low-cost anticholinergics are preferred for symptoms such as tremor, possibly contributing to the reported lower rates of dyskinesias.14  Furthermore, access to expensive device-aided therapies, such as deep brain stimulation, is poor for most patients.  The popularity of complementary and alternative medicine treatments, such as acupuncture and herbal preparations, is high in this region.

References
  1. GBD Parkinson’s Disease Collaborators.  Lancet Neurol 2018; 17: 939–953.
  2. Pringsheim T et al.  Mov Disord 2014; 29: 1583–1590.
  3. Marras C et al.  NPJ Parkinsons Dis 2018; 4: 21.
  4. Pitcher TL et al.  Mov Disord 2018; 33: 1440–1448.
  5. Xie CL et al.  Neurol Sci 2014; 35: 1495–1504.
  6. Zhang Y et al.  Parkinsons Dis 2017; 2017: 8093124.
  7. Zhang ZX et al.  BMC Res Notes 2014; 7: 65.
  8. Parkinson Study Group.  Clin Neuropharmacol 2007; 30: 72–85.
  9. Knudsen K et al.  Mov Disord 2017; 32: 94–105.
  10. Chiang HL et al.  Eur J Neurol 2012; 19: 494–500.
  11. Yang X et al.  Sleep Med 2018; 43: 40–46.
  12. Bhidayasiri R et al.  Neurology 2014; 82: 2238–2240.
  13. Li J et al.  Clin Neurol Neurosurg 2014; 118: 16–20.
  14. Lee JY et al.  Neurol Asia 2010; 15: 137–143.
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