Department of Neurology, University of Kentucky College of Medicine, Lexington, KY 40536, USA.
Ann Neurol. 2012 Dec;72(6):912-7. doi: 10.1002/ana.23697.
Parkinsonism has occasionally been reported as a consequence of infectious diseases. The present study examines the clinical and pathological correlates of parkinsonism across birth cohorts in relation to critical exposure to the encephalitis lethargica epidemic in the early 1900s.
The study population consisted of 678 participants in the Nun Study, of whom 432 died and came to autopsy. Qualitative indices of substantia nigra (SN) depigmentation were verified in a subset of 40 randomly selected subjects using quantitative stereological techniques. SN depigmentation, detected neuropathologically, was correlated with clinical parameters of Parkinson disease, age, and birth cohort.
SN depigmentation was detected in 57 (13.2%) of the cohort. Although qualitative SN depigmentation correlated modestly with age (p = 0.02), it correlated best with birth cohort (p = 0.009) for women born in the years 1895-1899. Quantitative measures of SN depigmentation were increased in this birth cohort compared to age matched subjects from flanking birth cohorts 1890-1894 and 1900-1904 (p < 0.001). SN depigmentation correlated with speed of 6- and 50-foot walk (p < 0.0001), up and go test (p < 0.0001), and hand coordination (p < 0.0001).
Subjects in the birth cohort 1895-1899 would have been in their late teens and 20s at the onset and during the peak of the encephalitis lethargica epidemic. These were precisely the age ranges of persons who were most often affected by the illness. These data suggest the possibility that the coexistence of parkinsonism and SN depigmentation in this birth cohort may have resulted from the yet undetermined infectious agent responsible for encephalitis lethargica.
帕金森病偶尔被报道为传染病的后果。本研究通过检查与 20 世纪初昏睡性脑炎流行相关的关键暴露的出生队列中的帕金森病的临床和病理相关性，来研究这一问题。
研究人群由纳努恩研究中的 678 名参与者组成，其中 432 人死亡并接受了尸检。使用定量立体学技术，在随机选择的 40 名受试者的亚组中验证了黑质（SN）退色的定性指数。SN 退色，通过神经病理学检测到，与帕金森病的临床参数、年龄和出生队列相关。
在队列中发现了 57 例（13.2%）SN 退色。尽管 SN 退色的定性分析与年龄有一定的相关性（p = 0.02），但它与出生队列的相关性最好（p = 0.009），尤其是在 1895-1899 年出生的女性中。与相邻出生队列 1890-1894 年和 1900-1904 年的年龄匹配受试者相比，这个出生队列的 SN 退色定量测量值增加（p < 0.001）。SN 退色与 6 英尺和 50 英尺行走速度（p < 0.0001）、上下移动测试（p < 0.0001）和手部协调能力（p < 0.0001）相关。
出生队列 1895-1899 年的人在昏睡性脑炎流行的开始和高峰期将处于青少年后期和 20 多岁。这正是大多数人患病的年龄范围。这些数据表明，在这个出生队列中，帕金森病和 SN 退色共存的可能性是由导致昏睡性脑炎的未确定的感染因子引起的。
