Prevalence and incidence of Parkinson's disease in Europe☆
Introduction
Parkinson's disease (PD) is characterised by bradykinesia, tremor, rigidity and impaired postural reflexes. In addition to the motor symptoms, mental disorders like depression or psychosis, and autonomic and gastrointestinal dysfunction may occur; all of these disorders considerably impair the quality of life of PD patients (Schrag et al., 2000b). Although the cerebral structures undergoing neurodegeneration in PD are well characterised, the underlying mechanisms of the disease are still unknown. PD is one of the most common neurodegenerative diseases and its relentless progression results in severe disability.
Data on the prevalence and incidence of PD are of particular interest for several reasons: (1) epidemiological studies can provide insights into suspected risk factors, protective factors, and primary causes of disease, and may be used to investigate the natural history of PD; (2) by providing critical information on the burden of a particular disease to the population, epidemiological data can inform public health planning. The latter has become of pivotal interest in recent years as longevity of the population increases and the incidence of PD rises with age. Its high financial burden adds to the need for accurate information on its epidemiology (Spottke et al., in press). To date, epidemiological studies of PD have not been published for all European countries (Table 1). Crude incidence rates reported in various studies and populations range from 5/100,000 to 26/100,000 (Twelves et al., 2003). Environmental and genetic factors are discussed as reasons for variations in these data; however, other differences, such as methodological diversity, may also play a role.
This survey will provide an overview on the prevalence and incidence of PD in the following European countries: Austria (A), Czech Republic (CZ), France (F), Germany (G), Italy (I), The Netherlands (NL), Portugal (P), Spain (E), Sweden (S), and the United Kingdom (UK). In particular, we focus on the methodologies used in the respective studies (Fig. 1).
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Literature search and inclusion criteria
We performed a systematic literature search in eight electronic databases using a combined search strategy that included the following terms: “Parkinson,” “Parkinson's disease,“ “Epidemiology,” “Incidence,” “Prevalence,” and the following countries: Austria, Czech Republic, France, Germany, Italy, Portugal, The Netherlands, Spain, Sweden, and the United Kingdom. The search was performed on the following databases: MEDLINE (1966 until 2004), PREMEDLINE (1966 until September 2002), CURRENT
Included studies
The systematic literature search yielded 234 hits in MEDLINE. Incremental searches in the other 7 databases resulted in additional 342 hits. Out of 576 identified hits, 44 studies estimated prevalence or incidence rates of PD. Five studies could not be obtained as full articles (Briz, 1988, Dias, 1993, Lima, 1989, López, 1993, Manubens, 1993). A detailed list of the European countries where epidemiological data were available is provided in Table 1.
Discussion
This study reviewed the prevalence and incidence studies available for PD in Europe. We characterised studies as “high-quality” when the following criteria were explicitly stated: use of established diagnostic criteria; inclusion of the entire age range of the population; and screening by an experienced neurologist. The high-quality studies estimated prevalence and incidence rates of approximately 108 to 257/100,000 and 11 to 19/100,000 per year, respectively.
When only older age groups (> 60
Acknowledgments
This study was supported by a grant from the European Union for the European Co-operative Network for Research, Diagnosis, and Therapy in Parkinson disease (EuroPa), and by the Competence Network Parkinson Syndromes (funded by the Bundesministerium für Bildung und Forschung German/BMBF 01GI9901/2).
The following persons were members of EuroPa: Paolo Barone, Napoli, Italy; Klaus Leenders, Groningen, The Netherlands; Andrew Lees, London, GB; Olle Lindvall, Lund, Sweden; E. Melamed, Tel Aviv,
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This paper was prepared in the framework of the European College of Neuropsychopharmacology (ECNP) Task Force project on “Size and Burden of Mental Disorders in Europe” (PI: Hans-Ulrich Wittchen). The paper also serves as input for the European Brain Council (EBC; http://www.ebc-eurobrain.net) Initiative “Cost of Disorders of the Brain” (Steering committee: Jes Olesen, Bengt Jönsson, Hans-Ulrich Wittchen).