Occupational pesticide exposure and screening tests for neurodegenerative disease among an elderly population in Costa Rica.
Occupational pesticide exposure and screening tests for neurodegenerative disease among an elderly population in Costa Rica.
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DOI：
10.1016/j.envres.2012.08.014
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发表时间：
2013
影响因子：
8.3
通讯作者：
Kyle Steenland;C. Wesseling;Norbel Román;Indiana Quirós;Jorge L. Juncos
中科院分区：
文献类型：
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作者：
Kyle Steenland;C. Wesseling;Norbel Román;Indiana Quirós;Jorge L. Juncos
在许多研究中，农药与帕金森病（PD）和阿尔茨海默病（AD）有关。方法：我们对哥斯达黎加两家政府诊所的400名老年人进行了神经系统疾病和职业性农药使用的筛查试验；361名未通过初始筛选的受试者接受了迷你精神状态测试（MMSE）和改良版的10项联合帕金森病评定运动量表（UPDRS）。在两项测试均未通过的受试者中，144人随后由神经科医生进行检查。结果18%的调查对象有职业性农药暴露史。接触者在MMSE上的表现比未接触者差（平均24.5比25.9,p=0.01，经年龄、性别和教育程度调整）。暴露者在两个UPDRS项目，静止震颤（OR 2.58, 1.28-5.23）和手指敲击（OR=2.94, 95% CI 1.03-8.41）上得分异常的风险显著升高。经神经科医生检查的患者中有33人（23%）被诊断为可能/可能的PD，是国际数据预期的3-4倍；这些病例中有85%以前未被诊断。在接受UPDRS的受试者中，暴露者患PD的风险增加（OR=2.57, 95% CI 0.91-7.26）。没有发现诊断为阿尔茨海默病或轻度认知障碍的额外风险。结论：既往职业性农药暴露的老年受试者在痴呆和帕金森病筛查试验中的表现明显较差，最终诊断为帕金森病的风险增加。筛查可能特别适合于有农药接触史的老年受试者。
BACKGROUNDPesticides have been associated with Parkinson's disease (PD) in many studies, and with Alzheimer's disease (AD) in a few.METHODSWe conducted screening tests for neurologic disease and occupational pesticide use in a population-based sample of 400 elderly subjects at two government-run clinics in Costa Rica; 361 subjects who failed the initial screen were given both the Mini-mental States Exam (MMSE) and a modified version of a 10-item United Parkinson's Disease Rating Motor Subscale (UPDRS). Among subjects who failed either test, 144 were then examined by a neurologist.RESULTSPast occupational pesticide exposure was reported by 18% of subjects. Exposed subjects performed worse on the MMSE than the non-exposed (mean 24.5 versus 25.9, p=0.01, adjusted for age, sex, and education). The exposed had significantly elevated risks of abnormal scores on two UPDRS items, tremor-at-rest (OR 2.58, 1.28–5.23), and finger-tapping (OR=2.94, 95% CI 1.03–8.41). Thirty-three (23%) of those examined by the neurologist were diagnosed with possible/probable PD, 3–4 times the expected based on international data; 85% of these cases had not been previously diagnosed. Among subjects who took the UPDRS, the exposed had an increased risk of PD (OR=2.57, 95% CI 0.91–7.26). No excess risk was found for a diagnosis of AD or mild cognitive impairment.CONCLUSIONSElderly subjects with past occupational pesticide exposure performed significantly worse on screening tests for dementia and PD, and had an increased risk of an eventual PD diagnosis. Screening may be particularly appropriate among elderly subjects with past pesticide exposure.