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Pugacheva Viktoriya Sergeevna, Karpov Sergey Mikhaylovich, Vishlova Irina Andreevna, Dolgova Irina Nikolaevna, Karpova Elena Nikolaevna, Stavropol State Medical University, Russia, Department of neurology, neurosurgery and medical genetics E-mail: [email protected]
Parkinsom's disease: prevslence of the disorder in the view of medical statistics
Abstract: Parkinsonism — a neurological syndrome characterized by a combination of akinesia, rigidity, resting tremors, and postural instability, it is a progressive degenerative disease of the central nervous system. Quoted in reports alarming figures make you think that in the last two decades, the incidence of parkinsonism increased. In all countries of the world has been an increase of vascular brain lesions caused by hypertension and atherosclerosis. Changes in the blood vessels of the brain are one of the main causes of Parkinson's disease development. Parkinsonism is usually sad "privilege" elderly. Most often the first symptoms appear between 50-60 years
Keywords: Parkinson's disease, epidemiology, statistics.
Parkinsonism is a neurologic syndrome, which can be characterized as the combination of akinesia, rigidity, resting tremor and postural instability; it is considered to be an advanced degenerative disease of central system. Taking statistical data into account, we can conclude that the disease incidence has grown for the last two centuries. In all countries throughout the world, the prevalence ofvascular disorders of brain cord, caused by hypertony and atherosclerosis, is observed. Alterations of brain cord are one of the main reasons of Parkinson's disease. It is commonly spread among aged people. In most cases, the first signs of the disease appear at the age of 50-60 years old. According to the epidemiological research, Parkinson's disease is observed in all ethnical groups, with equal frequency among males and females. WHO states, that more than 4 million people all over the world suffer from Parkinsonism [19]. In addition, the number of people at the age of30-40 years old, who suffer from the disease, is constantly growing. The growth of the disease frequency is stipulated by life expectancy, but some other factors (e. g. ecological) can also play role. There are about 100 thousand patients, suffering from the disease, in Russia. Low rate of the disease incidence and mortality is noted. There are some difficulties with the diagnosis of disease, especially with early stage, as it can be diagnosed primarily with reference to clinical disease and the course of the disease.
The objective of the research is to define the disease incidence in the world.
Results, methods and debates
Parkinsonism is one of widely spread neurodegenerative disease in the world, which can be compared in this respect only with Alzheimer's disease. Parkinsonism comes with deterioration in condition of corticobasal systems of activation and suppression, which turn to be contravolitional characteristics of the disease. Parkinson's disease is caused by the developing break-down of structure and function of dopaminergic neurons in ventralteg-mental area and substantia nigra pars compacta in brain cord with the following alteration of basal ganglia of telencephalon. The data of the research, being collected, prove the hypothesis, that Parkinsonism is the result of a complex interaction of genetic deficits, toxins of the environment and mitochondrial dysfunctions. The mechanisms of neuronal degeneration, typical for Parkinsonism, have been studied; these include interaction of some pathogenic processes, including oxidative stress, protein aggregation, excy-totoxic and axonal transport. In critical incidents of the disease, a growing number of genes and proteins destruct complex net of molecular pathways, engaged in its etiology. The common mechanisms account for two main forms of Parkinson's disease: familial and sporadical. Sporadical one is mostly spread (90-95 % of cases), while 5-10 % is accounted for familial form.
Epidemiological data differs greatly from one country to another. The range of the disease frequency per 100 000 of population is the following (the data from background papers):
Parkinsom's disease: prevslence of the disorder in the view of medical statistics
Ethiopia — 7, Libya — 31, Poland — 66, Norway — 102, Sweden — 115, Taiwan — 130, England — 139, Finland — 166, Italy — 168, Spain — 170, Germany — 183, Russia — 238, Israel — 240, Canada — 244, Singapore — 300, Japan — 306, France — 320, India — 328, USA — 329, Brazil — 330, Korea — 370, Australia — 414, China — 522, Argentina — 657 [1, 21]. The difference can be explained by some reasons, where the influence of ecological and genetic factors, different methodological approaches, research design and age grouping of the population can be mentioned. Disease frequency can differ within the borders of one country and depends on the place where the research is carried out and the type of the research. Following low-calorie diet significantly decreases the exposure to the disease. The low percentage of the disease prevalence in Libya and other countries of Africa serves as the proof of the fact. But the dependence of the disease prevalence and the age is evident, i. e. the increased index is observed in certain age groups of population; in this case, the increase of the disease incidence index in the countries of Europe, Eastern Asia, North and South America can serve as an example.
For instance, the research, carried out in Spain (Bergareche A., 2004), demonstrate the increasing of the index with age: by 0.3 % in the age group of 65-74 years old, by 2.5 % and 2 % in the age groups of 75-84 and above 85 years old correspondingly. The lower index in the age group of the patients above 85 years old, can be explained by the decrease of the group size [11]. The research, carried out in other regions of the world, show the same tendencies as in European countries. The research, carried out in Yonago, a city in Japan, (Yamawaki M., 2009) in 2004 was based on the information about the total number of visits to the health institutions registered; it showed, that the index of disease prevalence was higher in the age group of the patients of 75-79 years old (1 256.9 cases per 105 people) in comparison with the age group of 70-74 years old (562.3 cases per 105 people), while it decreased in the age group of the patients above 90 years old (871.5 cases per 105 people) [22]. According to the research, carried out in Sydney, Australia, within the period from 1997 to 1999 (Mehta P., 2007) the index of Parkinsonism prevalence reached its maximum in the group of the patients aged 70-79 years (820 cases per 105 people) and it decreased in the group of the patients above 80 years old (560 per 105 people) [17].
Different tendencies can be distinguished in the research of the disease prevalence with gender factor taken into account. The burden of Parkinsonism differs among males and females. The majority of the research state an earlier start of the disease among men. In Spanish province Navarre the average age of the disease is 67.5 years among males and 72.6 years among females [17]. In Japan the average age of the disease is 68.08 years among men and 69.08 years among females [18]. The least average age is observed in Sweden, but still the earlier start of the disease is noted among men, with the average age 65.2 years old, while it is 66,1 years among women [12]. In the research, carried out in Estonia, the average age of the disease is 68.8 years old, but no difference was found with reference to gender factor from the time the first symptoms of the disease appeared [16]. According to Haaxma C. A. (2007), the results of the epidemiological research on a lower rate and an older age of the disease among females can be explained by physiologically higher level of dopamine in striatum and estrogen activity [14].
In Russia the only significant research of Parkinson's disease was carried out in the USSR during 1969-1971 in 6 cities, belonging to different geographical zones [6]. The data were collected on the base of all visits to the health institutions and sampled medical
examinations. The disease prevalence was 63.9 cases per 105 people and 184.6 cases per 105 people in the age group of the patients above 40 years old. The results of the research of the disease prevalence in different regions of Russia during the last 10 years are presented in Table 1. The maj ority of the research were carried out on the ground of visits to the health institutions and only one full-design study of the whole population was conducted in Solnechnogorsky region of Moscow territory [4]. The index of the disease prevalence varies in different regions. The maximum was observed in Tomsk (238 cases per 105 people), the minimum was manifested in Moscow in 1975 (27 cases per 105 people) [2; 6]. The index significantly varies in the latest research, from 55.15 cases per 105 people in Irkutsk territory up to 198 cases 105 people in Smolensk [7; 9]. The analysis with the respect to the disease prevalence in accordance with age and gender factors also give ambiguous data. In Solnechnogorsky region of Moscow territory Parkinsonism among men at the age of 65 went beyond the same among women more than twice, along with the situation in Krasnoyarsky region (54.5 % among men, 45.5 % among women) [3; 5]. At the same time, in Smolensk the predominance of the disease prevalence among women of employable age was noted, the index was the same among the patients of both genders in the group of the patients above 60 years old, while there was the predominance of male patients in the age group of patients above 80 years old [9]. In the research, carried out in Russia, the index of the disease prevalence depends not only on territories, but also on the time of the research. Thus, in Krasnodar the index increased 1.3 times (from 89.6 to 114.4 cases per 105 people) within the period 1975-2007. The disease prevalence possesses a great range of indexes [8]. The minimal index is observed in Karelia (188 cases per 105 people), while maximal one in Solnechnogorsky region of Moscow territory (16.3 cases per 105 people a year within the period from 2001 to 2003) [6, 10]. The wave curve of the index in Chukotka Autonomous Region with the absence of prior disease registered is worth mentioning. In North Ossetia-Alania the increase of the sick rate and decrease ofprior disease was registered in 2010-2011. The same tendency is noted in Tatarstan in 2009-2010, in Altai Territory in 2010-2011 and some other constituents of the Russian federation. There were registered neither prior disease nor fatal case as the result of Parkinsonism in Chukotka Autonomous Region, though there were the patients, suffering from the disease, under the medical observation [19; 22]. The fact is considered to be connected with the efficient neurologist service density in the region (1.96 per 10 000 people). According to the Medical research and information center, 1275 patients, suffering from Parkinsonism, were registered in Stavropolsky krai in 2015, 735 of them were under the medical observation. In 2013 — 1256 patients, suffering from Parkinsonism, were registered, with 726 of them under the medical observation; in 2014 the total number of registered patients was 1236, with 756 of them under the medical observation. The results of the research of Parkinson's disease in Stavropolsky krai is presented in Table 2. Variability of the indexes of the disease prevalence is stipulated by different methodology of the research and non-compliance with the standards of epidemiological research (it makes the further comparison region-wise study difficult), rather than territorial difference. In some cases non-sufficient population base or the lack of the results standardization is observed; that results in jumping to conclusions, wrong compilation of the results per total population.
Conclusion
The research showed that Parkinson's disease is one of the widely spread neurodegenerative disease all around the world in whole and in Russia in particular.
Table 1. - The results of Parkinson's disease prevalence in Russia
The territory under research Parkinson's disease prevalence Disease prevalence per 100 000 people Disease prevalence per 100 000 people a year
Smolensk 21 198 Males — 1.4; Females — 3.5
Solnechnogorsky region of Moscow territory 12 139.9 16.3
Krasnoyarsk 653 62.72 n/a
Petrozavodsk 537 n/a 1.88
Tomsk n/a 238 n/a
Bashkortostan 1622 68.6 3
Voronezh 155 75 n/a
Krasnodar n/a 114.4 8.6
Irkutsk territory n/a 55.15 n/a
Ivanovo n/a 102.8 n/a
Mogilev 108.7 108.7 n/a
North Ossetia-Alania n/a 173.3 20.6
Samarskaya territory n/a 125 8.2
Tatarstan n/a 120.4 8.2
.Altai Territory n/a 122.2 13.5
Yamalo-Nenets Autonomous Okrug n/a 40.7 4.9
Magadan territory n/a 38.4 4.8
Tyva n/a 16.9 3
Chukotka Autonomous Region n/a 7.8 0
Table 2. - The results of Parkinson's disease prevalence in Stavropolsky krai
Year The total number of the patients, suffering from Parkinson's disease The total number of the patients under the medical observation
2013 1256 726
2014 1236 756
2015 1275 735
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Inheritance in patients with multiple sclerosis
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Muhadzhieva Liana Alievna, Kudrya Viktoria Sergeevna, Ibragimov Magomed Magomedovich, Karpov Sergey Michailovich, Vyshlova Irina Andreevna, Stavropol State Medical University, Russia, Department of neurology, neurosurgery and medical genetics
E-mail: [email protected]
Inheritance in patients with multiple sclerosis
Abstract: The problem of heredity of multiple sclerosis (MS) is an important practical issue, as the etiology and pathogenesis of this disease isn't well understood. The urgency of this problem stems from the fact that the number of multiple sclerosis patients is increasing every year, with the proportion of women among the infected is 52 %, while the share of men is 48 % [1; 2].
Keywords: multiple sclerosis, inheritance.
The incidence of multiple sclerosis most highly prevalent among the white population of the globe, especially in areas inhabited by immigrants from Northern and Central Europe as well as Scandinavia. The number of patients among the small ethnic groups of the population, are still not considered to be involved in the disease. Among the Slavic population in the republics of the Caucasus and Central Asia, the prevalence of MS was much less than in the European part of Russia [6]. Objective
To analyze the genetic predisposition to multiple sclerosis. Results
Multiple sclerosis — a chronic, progressive disease that affects the brain and spinal cord, that result in violations of muscle control, blurred vision, disturbance of body balance, sensory disturbances [8].
Multiple Sclerosis is not a hereditary disease, but observations indicate the presence of certain hereditary (genetic) predisposition [1; 2; 3]. These assumptions are based on the results of epidemiological studies that multiple sclerosis affects mainly people with white skin, as evidenced not only data on the prevalence of the disease in terms of its geographical distribution, but also the difference in the incidence rate between the white and black population countries in the Americas and South Africa [1].
It is assumed that a predisposition to the disease multiple sclerosis is caused by the presence of several genes (polygenic inheritance). It is also possible genetic polymorphism [4]. This is indicated by twin data and genealogical research, as well as non-linear reduction in the risk of the disease among relatives of the patient
with a decrease in the degree of kinship. For siblings of the patient the probability of the disease in their lifetime is 2-5 %, while it is slightly lower [5] for parents and children.
Genetic susceptibility to multiple sclerosis, presumably associated with a given individual a combination of several genes that determine disorders, especially in immunoregulation system.
The data obtained from the analysis of different populations suggests that patients with multiple sclerosis significantly increased frequency of antigen HLA-A3, HLA-B7, HLA-DR2, HLA-DR3, HLA-DQ6 and other [1; 3]. In multiple sclerosis, also noted the association of the disease with certain haplotypes of HLA, including specific combinations of loci allelic MHC.
In multiple sclerosis, there is damage to the nervous system's own immune system cells. These cells enter the brain, destroy the myelin sheath of nerve fibers and lead to scarring. This nervous tissue are replaced by connective [8].
Multiple sclerosis is the most difficult demielinizirute disease of the Central nervous system with predominant autoimmune mechanism of development, remitting disseminated over, affecting people of young age and inevitably resulting in disability. Over the last three decades of domestic and foreign scientists (Schmidt E., Khondkarian A. O., Leonovich A. L., Gusev E. I., Boiko A. N., Zavalishin I. A., Demina T. L., Jerusalem A. P, Pohorski A. M., Shevchenko P. P., Stolyarov I. D, Poser C. M., McDpnald W. I., Ebers G. C., Lauer K., Sadovnick A. D. and others) enormous work has been done on the standardization and systematization of methods of epidemiological analysis in multiple sclerosis, which contributed to the accumulation of the volume of objective
