Goldsmith J R, Herishanu Y O, Podgaietski M, Kordysh E
Soroka Hospital Medical Center, Ben Gurion University, Beer Sheva, 84 120, Israel.
Environ Res. 1997;73(1-2):156-61. doi: 10.1006/enrs.1997.3696.
From serial studies of clinical findings and Webster's scores, we determined the incidence of Parkinson's disease and the pattern of progression of the components of parkinsonism in residents older than 40 in rural settlements with unusually high rates of Parkinson's disease in southern Israel (Negev). In 1988, the authors reported on three adjacent kibbutzim at which were identified 13 cases of Parkinson's disease in a population of 413 persons older than 50 years. In the region as a whole, there were 143 additional cases among a population of 64,185 who were 40 years of age or older. The age-standardized prevalence ratio for the kibbutz population was 5.43. By 1993, 2 of the persons with Parkinson's disease had died, and 8 new cases had been diagnosed. The age-standardized prevalence ratio in 1993 was 8.09. The crude incidence ratio for persons older than 40 was 3.4 per 1000 per year. Webster's score is used as an estimator of the severity of pre-parkinsonism. In the normal population of elderly persons from other areas in the Negev, only 20 of 110 had a score greater than 0 (11, 8, and 1 scored 1, 2, and 3, respectively). When the Webster's score was first applied systematically-in 1989 to asymptomatic persons from the kibbutzim who were older than 40-46 of 104 had scores of 2 or more, and some subjects also had impaired vibration sense. The tests were repeated by different observers on a casual sample in 1991 and 1993. Of the persons older than 60 in 1989 (n = 14), the scores increased from an average of 2.3 in 1989 to 3.9 in 1991 and to 5.7 in 1993. In a younger sample (n = 7), the mean scores were 2.3 in 1989, 3.6 in 1991, and 2.9 in 1993. These results are evidence of an age-specific peak in incidence and prevalence in the 70- to 79-year-old age group and may represent a cohort exposure phenomenon. The results may also reflect the critical role of age in the transformation of pre-parkinsonism to Parkinson's disease. Finally, in this population with high initial rates of Parkinson's disease, there was evidence of pre-parkinsonism in about half of those older than 40, and active progression of pre-parkinsonism in those older than 60. Therefore, this group is an ideal population to test for effects of preventive interventions.
通过对临床发现和韦伯斯特评分的系列研究，我们确定了以色列南部（内盖夫）帕金森病发病率异常高的农村定居点中40岁以上居民帕金森病的发病率以及帕金森综合征各组成部分的进展模式。1988年，作者报告了相邻的三个基布兹，在50岁以上的413人中有13例帕金森病患者。在整个地区，40岁及以上的64185人中有另外143例病例。基布兹人群的年龄标准化患病率为5.43。到1993年，2例帕金森病患者死亡，8例新病例被诊断出来。1993年的年龄标准化患病率为8.09。40岁以上人群的粗发病率为每年每1000人中有3.4例。韦伯斯特评分被用作帕金森病前期严重程度的估计指标。在内盖夫其他地区的老年正常人群中，110人中只有20人评分大于0（分别有11人、8人和1人评分为1、2和3）。1989年首次系统应用韦伯斯特评分时，对基布兹40岁以上无症状人群进行检测，104人中有46人评分达到2分或更高分，一些受试者还存在振动觉受损。不同观察者在1991年和1993年对随机样本重复进行了检测。1989年60岁以上的人群（n = 14），评分从1989年的平均2.3分增加到1991年的3.9分和1993年的5.7分。在一个较年轻的样本（n = 7）中，平均评分在1989年为2.3分，1991年为3.6分，1993年为2.9分。这些结果证明了在70至79岁年龄组发病率和患病率存在特定年龄峰值，这可能代表了一种队列暴露现象。这些结果也可能反映了年龄在帕金森病前期转变为帕金森病过程中的关键作用。最后，在这个帕金森病初始发病率较高的人群中，40岁以上人群中约有一半存在帕金森病前期迹象，60岁以上人群中帕金森病前期有活跃进展。因此，该群体是测试预防干预效果的理想人群。
