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October 14, 2014; 83 (16) Article

Parkinson disease and smoking revisited

Ease of quitting is an early sign of the disease

Beate Ritz, Pei-Chen Lee, Christina F. Lassen, Onyebuchi A. Arah
First published September 12, 2014, DOI: https://doi.org/10.1212/WNL.0000000000000879
Beate Ritz
From the Department of Epidemiology (B.R., O.A.A.), University of California at Los Angeles School of Public Health; Department of Neurology (B.R.), School of Medicine, University of California at Los Angeles; Department of Health Care Management (P.-C.L.), College of Healthcare Administration and Management, National Taipei University of Nursing Health Sciences, Taiwan; and Danish Cancer Society Research Center (C.F.L.), Danish Cancer Society, Copenhagen, Denmark.
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Pei-Chen Lee
From the Department of Epidemiology (B.R., O.A.A.), University of California at Los Angeles School of Public Health; Department of Neurology (B.R.), School of Medicine, University of California at Los Angeles; Department of Health Care Management (P.-C.L.), College of Healthcare Administration and Management, National Taipei University of Nursing Health Sciences, Taiwan; and Danish Cancer Society Research Center (C.F.L.), Danish Cancer Society, Copenhagen, Denmark.
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Christina F. Lassen
From the Department of Epidemiology (B.R., O.A.A.), University of California at Los Angeles School of Public Health; Department of Neurology (B.R.), School of Medicine, University of California at Los Angeles; Department of Health Care Management (P.-C.L.), College of Healthcare Administration and Management, National Taipei University of Nursing Health Sciences, Taiwan; and Danish Cancer Society Research Center (C.F.L.), Danish Cancer Society, Copenhagen, Denmark.
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Onyebuchi A. Arah
From the Department of Epidemiology (B.R., O.A.A.), University of California at Los Angeles School of Public Health; Department of Neurology (B.R.), School of Medicine, University of California at Los Angeles; Department of Health Care Management (P.-C.L.), College of Healthcare Administration and Management, National Taipei University of Nursing Health Sciences, Taiwan; and Danish Cancer Society Research Center (C.F.L.), Danish Cancer Society, Copenhagen, Denmark.
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Citation
Parkinson disease and smoking revisited
Ease of quitting is an early sign of the disease
Beate Ritz, Pei-Chen Lee, Christina F. Lassen, Onyebuchi A. Arah
Neurology Oct 2014, 83 (16) 1396-1402; DOI: 10.1212/WNL.0000000000000879

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Abstract

Objective: To assess whether being able to quit smoking is an early marker of Parkinson disease (PD) onset rather than tobacco being “neuroprotective,” we analyzed information about ease of quitting and nicotine substitute use.

Methods: For this case-control study, we identified 1,808 patients with PD diagnosed between 1996 and 2009 from Danish registries, matched 1,876 population controls on sex and year of birth, and collected lifestyle information. We estimated odds ratios and 95% confidence intervals with logistic regression adjusting for matching factors and confounders.

Results: Fewer patients with PD than controls ever established a smoking habit. Among former smokers, those with greater difficulty quitting or using nicotine substitutes were less likely to develop PD, with the risk being lowest among those reporting “extremely difficult to quit” compared with “easy to quit.” Nicotine substitute usage was strongly associated with quitting difficulty and duration of smoking, i.e., most strongly among current smokers, followed by former smokers who had used nicotine substitutes, and less strongly among former smokers who never used substitutes.

Conclusions: Our data support the notion that patients with PD are able to quit smoking more easily than controls. These findings are compatible with a decreased responsiveness to nicotine during the prodromal phase of PD. We propose that ease of smoking cessation is an aspect of premanifest PD similar to olfactory dysfunction, REM sleep disorders, or constipation and suggests that the apparent “neuroprotective” effect of smoking observed in epidemiologic studies is due to reverse causation.

GLOSSARY

CI=
confidence interval;
GWAS=
genome-wide association study;
OR=
odds ratio;
PD=
Parkinson disease

Footnotes

  • Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Editorial, page 1392

  • Supplemental data at Neurology.org

  • Received November 10, 2013.
  • Accepted in final form June 16, 2014.
  • © 2014 American Academy of Neurology
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  • Response to "Parkinson disease and smoking revisited..."
    • Elizabeth R Sunderman, Neurohospitalist, Intermountain Medical Centerersunderman@gmail.com
    Submitted November 05, 2014
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