Movemenr Disorders Vol. 7, No. 4, 1992, pp. 339-344 0 1992 Movement Disorder Society
Premorbid Smoking, Alcohol Consumption, and Coffee Drinking Habits in Parkinson’s Disease: A Case-Control Study FClix Javier Jimenez-JimCnez, Dolores Mateo, and Santiago Gimdnez-Roldan Department of Neurology, Hospital General Gregorio Maraiidn, Madrid, Spain
Summary: A number of studies have reported lower cigarette consumption in patients with Parkinson’s disease (PD) previous to onset of the disease. In an attempt to determine whether there existed a “premorbid attitude” by patients against the use of socially accepted “drugs,” the premorbid tobacco, alcohol, and coffee consumption habits were compared in 128 PD patients and 256 controls. Patients and controls were selected by case control method and were recruited from the same health area and socioeconomic stratum. In males, the habits of smoking more than 10 cigarettedday (p < 0.001) and drinking more than 50 g/day of alcohol (p < 0.001) were significantly less frequent in the PD patients than in the controls, but the differences in coffee consumption were nonsignificant. In females behavior did not differ significantly between the PD group and the controls for any of the three habits. There was no correlation between the amount of smoking and alcohol drinking and age at onset of PD or current Hoehn and Yahr’s staging. Our results suggest the existence of a premorbid personality in males with PD, possibly conditioning a restrictive attitude toward the consumption of such toxic substances as tobacco and alcohol, yet a more tolerant attitude toward habits more widely accepted socially, like coffee consumption. Key Words: Premorbid habits-Smoking-Alcohol drinking-Coffee drinking-Parkinson’s disease-Case control study.
such common substances may differ selectively among PD patients. We have therefore carried out a case control study with a view to detecting differences in the premorbid extent of these three habits.
Kahn (1) first suggested that Parkinson’s disease (PD) was less common among smokers than among nonsmokers. This has since been confirmed by most epidemiologic studies (2-21), though there have been some exceptions (22). However, despite the consistency of this finding, the reason for this negative association remains unexplained. Alcohol drinking habits in PD did not differ significantly from controls in some studies (8,18,23) as was less frequent in others (10,24,25). Coffee drinking habits in PD did not differ significantly from controls in a single study (8). Social permissiveness towards alcohol, cigarette, and coffee consumption differs, so premorbid attitudes of patients against the use of
PATIENTS AND METHODS
One hundred and twenty-eight PD patients, and 256 age- and sex-matched controls were studied. Unselected PD patients were recruited from outpatients making routine follow-up visits to the movement disorder clinic held by the Department of Neurology at the Hospital General Gregorio Maran6n in Madrid. Controls were recruited from among patients presenting in the emergency room at the same hospital complaining of minor nonneurological ailments. The PD patient group comprised 68 men and 60 women (mean age, 66.8 ? 9.1 years);
Address correspondence and reprint requests to Dr. F. J. JirnBnez-JimBnez at C1 Corregidor Jose de Pasamonte no. 24, 3-D, E-28030 Madrid, Spain.
339
F . J . JIMENEZ-JIMENEZ ET AL.
340
B
pco.001
100
1 1 M
80 60 40
20
0
tm
0 CIQARETTESIBAY PD MALES
=
aCONTROL MALES
PB FEMALES
60 60
pco.oo5
40
ao
*20
ll-20 CI QARETTEWDAY =CONTROL
FEMALES
FIG. 1. Cigarette smoking habits in the PD patient and control groups. A: Males. B: Females. C: Total series. p values refer to “moderate or heavy smokers” compared to “non or light smokers.” The statistical significance between the two groups in A and C was due to the relatively very low frequency of “heavy smokers” in the PD patient group.
11-61
20 10
0
0
1-m It20 CI(URETTES/DAY PD TOTALS
820
CONTROL TOMU
the control group consisted of 136 men and 120 women (mean age, 64.8 k 10.9 years). All patients and controls were interviewed personally by one of the investigators (F.J.J.J.), the premorbid habits of cigarette smoking and the alcohol and coffee drinking were assessed. For the purpose of this study, a definite habit was defined as the highest level of daily consumption for each of the substances for at least 5 consecutive years prior to disease onset. Members of both groups were classed as “non or light smokers” (those who never smoked or smoked < 10 cigarettedday) or “moderate or heavy smokers” (those who smoked >10 cigarettedday); “non or light drinkers” (those who never drank or drank 50 g/day of alcohol); and “non coffee drinkers” (those who never drank coffee) or “coffee drinkers” (those who drank at least one cup/day of coffee). Mean age at onset of PD was 59.4 & 10.4 years. The clinical staging of the disease was established ac-
Movement Disorders, Vol. 7, No. 4, 1992
cording to Hoehn and Yahr (26). Statistical analysis was performed by applying a x2 test and linear correlation coefficients were calculated where appropriate. RESULTS Smoking Results for the cigarette smoking habit are depicted in Fig. 1, with 58.9% of the male patients with PD and 27.9% of the male controls being “non or light smokers” (x2 = 18.31, p < O.OOl), and 93.4% of the female patients and 92.5% of the female controls being “non or light smokers” (difference nonsignificant). Overall, 75.0% of the PD patients and 58.2% of controls were “non or light smokers” (x2 = 10.42, p < 0.005). There was no significant correlation between premorbid levels of exposure to cigarette smoking and age at onset or the current Hoehn and Yahr staging in the PD group.
SMOKING, ALCOHOL, AND COFFEE HABITS IN PARKINSON’S
100
341 B
%
80 W 40
0
n o stm ALCOHOL (WDAY)
0
W
MALES
aCONTROL MALE8
=
n o stm ALCOHOL (WDAY)
PD T OW
n o ~n-mo ALCOHOL (WDAY) PD FEMALES
P
Premorbid Smoking, Alcohol Consumption, and Coffee Drinking Habits in Parkinson’s Disease: A Case-Control Study FClix Javier Jimenez-JimCnez, Dolores Mateo, and Santiago Gimdnez-Roldan Department of Neurology, Hospital General Gregorio Maraiidn, Madrid, Spain
Summary: A number of studies have reported lower cigarette consumption in patients with Parkinson’s disease (PD) previous to onset of the disease. In an attempt to determine whether there existed a “premorbid attitude” by patients against the use of socially accepted “drugs,” the premorbid tobacco, alcohol, and coffee consumption habits were compared in 128 PD patients and 256 controls. Patients and controls were selected by case control method and were recruited from the same health area and socioeconomic stratum. In males, the habits of smoking more than 10 cigarettedday (p < 0.001) and drinking more than 50 g/day of alcohol (p < 0.001) were significantly less frequent in the PD patients than in the controls, but the differences in coffee consumption were nonsignificant. In females behavior did not differ significantly between the PD group and the controls for any of the three habits. There was no correlation between the amount of smoking and alcohol drinking and age at onset of PD or current Hoehn and Yahr’s staging. Our results suggest the existence of a premorbid personality in males with PD, possibly conditioning a restrictive attitude toward the consumption of such toxic substances as tobacco and alcohol, yet a more tolerant attitude toward habits more widely accepted socially, like coffee consumption. Key Words: Premorbid habits-Smoking-Alcohol drinking-Coffee drinking-Parkinson’s disease-Case control study.
such common substances may differ selectively among PD patients. We have therefore carried out a case control study with a view to detecting differences in the premorbid extent of these three habits.
Kahn (1) first suggested that Parkinson’s disease (PD) was less common among smokers than among nonsmokers. This has since been confirmed by most epidemiologic studies (2-21), though there have been some exceptions (22). However, despite the consistency of this finding, the reason for this negative association remains unexplained. Alcohol drinking habits in PD did not differ significantly from controls in some studies (8,18,23) as was less frequent in others (10,24,25). Coffee drinking habits in PD did not differ significantly from controls in a single study (8). Social permissiveness towards alcohol, cigarette, and coffee consumption differs, so premorbid attitudes of patients against the use of
PATIENTS AND METHODS
One hundred and twenty-eight PD patients, and 256 age- and sex-matched controls were studied. Unselected PD patients were recruited from outpatients making routine follow-up visits to the movement disorder clinic held by the Department of Neurology at the Hospital General Gregorio Maran6n in Madrid. Controls were recruited from among patients presenting in the emergency room at the same hospital complaining of minor nonneurological ailments. The PD patient group comprised 68 men and 60 women (mean age, 66.8 ? 9.1 years);
Address correspondence and reprint requests to Dr. F. J. JirnBnez-JimBnez at C1 Corregidor Jose de Pasamonte no. 24, 3-D, E-28030 Madrid, Spain.
339
F . J . JIMENEZ-JIMENEZ ET AL.
340
B
pco.001
100
1 1 M
80 60 40
20
0
tm
0 CIQARETTESIBAY PD MALES
=
aCONTROL MALES
PB FEMALES
60 60
pco.oo5
40
ao
*20
ll-20 CI QARETTEWDAY =CONTROL
FEMALES
FIG. 1. Cigarette smoking habits in the PD patient and control groups. A: Males. B: Females. C: Total series. p values refer to “moderate or heavy smokers” compared to “non or light smokers.” The statistical significance between the two groups in A and C was due to the relatively very low frequency of “heavy smokers” in the PD patient group.
11-61
20 10
0
0
1-m It20 CI(URETTES/DAY PD TOTALS
820
CONTROL TOMU
the control group consisted of 136 men and 120 women (mean age, 64.8 k 10.9 years). All patients and controls were interviewed personally by one of the investigators (F.J.J.J.), the premorbid habits of cigarette smoking and the alcohol and coffee drinking were assessed. For the purpose of this study, a definite habit was defined as the highest level of daily consumption for each of the substances for at least 5 consecutive years prior to disease onset. Members of both groups were classed as “non or light smokers” (those who never smoked or smoked < 10 cigarettedday) or “moderate or heavy smokers” (those who smoked >10 cigarettedday); “non or light drinkers” (those who never drank or drank 50 g/day of alcohol); and “non coffee drinkers” (those who never drank coffee) or “coffee drinkers” (those who drank at least one cup/day of coffee). Mean age at onset of PD was 59.4 & 10.4 years. The clinical staging of the disease was established ac-
Movement Disorders, Vol. 7, No. 4, 1992
cording to Hoehn and Yahr (26). Statistical analysis was performed by applying a x2 test and linear correlation coefficients were calculated where appropriate. RESULTS Smoking Results for the cigarette smoking habit are depicted in Fig. 1, with 58.9% of the male patients with PD and 27.9% of the male controls being “non or light smokers” (x2 = 18.31, p < O.OOl), and 93.4% of the female patients and 92.5% of the female controls being “non or light smokers” (difference nonsignificant). Overall, 75.0% of the PD patients and 58.2% of controls were “non or light smokers” (x2 = 10.42, p < 0.005). There was no significant correlation between premorbid levels of exposure to cigarette smoking and age at onset or the current Hoehn and Yahr staging in the PD group.
SMOKING, ALCOHOL, AND COFFEE HABITS IN PARKINSON’S
100
341 B
%
80 W 40
0
n o stm ALCOHOL (WDAY)
0
W
MALES
aCONTROL MALE8
=
n o stm ALCOHOL (WDAY)
PD T OW
n o ~n-mo ALCOHOL (WDAY) PD FEMALES
P
