Epidemiology of Parkinson's disease.

This chapter discusses the epidemiology of Parkinson's disease (PD). Classically, PD refers to progressive parkinsonism caused by loss of pigmented aminergic brainstem neurons without an identifiable cause, while parkinsonism refers simply to the syndrome of bradykinesia, resting tremor, rigidity and postural reflex impairment. Over nearly two centuries, Parkinson's clinical description has provided the framework for clinical investigations, including epidemiologic ones. Descriptions of PD were limited to selected clinical settings until the middle of the 20th century. Since then, epidemiologic approaches have been used not only to investigate the population distribution of PD, but also as a way to glean clues as to the cause of this “idiopathic” disorder. Because PD is relatively infrequent, a large base population must be surveyed to identify sufficient numbers of cases for a study. In some instances, PD cases can be identified through health service rosters within defined geographic areas or in enumerated populations. In others, cases of PD are sought independently of the health care system, such as through door-to-door surveys. While the latter approach is theoretically least likely to exclude cases, the time and cost involved are also greatest using this approach.