Dear Ray and James

I have always loved neuroepidemiology because of its close relationship with culture and lifestyle. I have always love to learn about how people in every parts of the world live their life in their own unique ways. 

But nowadays my attention has shifted to the Parkinson's community in this world - how they live and think, and respond to their illness. I even have this wild idea of going to many countries in this world to visit some Parkinson's patients. 

Yes, the Amish are very unique people. For such as stable population, neuroepidemiological study will be helpful in revealing any risk factors for PD. In fact, once I was planning to carry out a neuroepidemiological study on PD at a district in Malaysia, where there was a relatively high prevalence of PD and stable population (minimal migration into and out of the district). Unfortunately, I could not even start it due to lack of time and funding.

This forum is interesting because Ray and Diane are familiar with the relevant and hot topics in Parkinson's. Thanks to them. 

Dr Chew

> Date: Mon, 10 Aug 2009 00:10:42 -0700
> From: [log in to unmask]
> Subject: Re: Amish got PD
> To: [log in to unmask]
> 
> It is amazing to me how much interest this post has generated.   But the 
> Amish have always been a source of academic interest because they have to a 
> great extent preserved their way of life in a control culture which is very 
> powerful.  I recall studying them as a grad student in Social Work at UCLA 
> and in anthropology classes.
> 
> Ray
> 
> Rayilyn Brown
> Director AZNPF
> Arizona Chapter National Parkinson Foundation
> [log in to unmask]
> 
> --------------------------------------------------
> From: "chew nee kong" <[log in to unmask]>
> Sent: Sunday, August 09, 2009 11:27 PM
> To: <[log in to unmask]>
> Subject: Re: Amish got PD
> 
> > Dear James
> >
> > Thanks for sharing the very interesting information. I can't comment on 
> > the link between PD and religious group as I do not have no such 
> > experience in Malaysia.
> >
> > As far as my country is concerned, overall, genetic factor seems to play 
> > only a minor role in the causation of PD. The percentage of patients with 
> > family history is very small (about 1-2%). And even in familial cases of 
> > PD, it may not be necessarily be genetic factor which is responsible - it 
> > could be a common exposure to the same environmental factor / s.
> >
> > I am more in favour of an environmental cause for PD.
> >
> > I'd like to share with you the story of two Malaysian Chinese ladies who 
> > developed (idiopathic) Parkinson's after working in a joss paper shop for 
> > about 20 years. Both these ladies were married to the same man (the 
> > manager of the shop). They have no genetic relationship at all.
> >
> > Till today, the burning of joss papers is widely practised by the Chinese 
> > for religious purpose. The joss paper has a layer of metallic leaf in the 
> > centre (attached). I sent the metallic leaf to the laboratory at SIRIM 
> > (Standard and Industrial Research Institute of Malaysia), which confirmed 
> > that the metallic leaf contained heavy metals such as lead, copper, zinc 
> > and mercury, which has been implicated in the pathogenesis of Parkinson's. 
> > This case report was subsequently published (Neurological Journal of South 
> > East Asia. Dec 2003. Vol 8. 117-120).
> >
> > Dr Chew, Malaysia.
> >
> >> Date: Mon, 10 Aug 2009 12:06:28 +1000
> >> From: [log in to unmask]
> >> Subject: Re: Amish got PD
> >> To: [log in to unmask]
> >>
> >> (Please ignore the previous copy of this posting - It got away from me 
> >> before it
> >> could be edited)
> >>
> >> I have not seen any data linking any particular religious group to PD, 
> >> but there
> >> is data on familial types of PD for Sardinian and Japanese groups. If 
> >> indeed
> >> there is a higher incidence of PD among the Amish, it is possibly a 
> >> familial
> >> type. On the other hand, it could be just a statistical anomaly. When 
> >> discussing
> >> prevalence and incidence, it is necessary to not only know the total 
> >> number of
> >> the subject group who have the disorder, but their age range, and the 
> >> total
> >> number and age range of the non-PD group. The Amish may be under- or
> >> over-represented, relevant to the general population. They could just 
> >> have more
> >> members in the most common PD age-group, i.e., 80+.
> >>
> >> The current general theory for the cause of Parkinson's Disease, at least 
> >> for
> >> the Idiopathic ("unknown cause") variety is that there is a genetic
> >> pre-disposition to the disease, and that, coupled with a "toxic event", 
> >> triggers
> >> the development of PD. The so-called toxic event could be a severe blow 
> >> to the
> >> head, a bout of pneumonia, exposure to agricultural chemicals etc.
> >>
> >> In part, this idea came about because of several studies involving a 
> >> number of
> >> twins. In some cases both twins developed PD, but in other cases, only 
> >> one did.
> >> If genetics was the only causative factor, then, went the theory, both 
> >> twins
> >> should develop PD.
> >>
> >> Then there were studies of extended families living in the same 
> >> environment.
> >> Sometimes more than one of the family got PD, sometimes only the one. If
> >> environmental causes were the only causative factor, then more than one 
> >> person
> >> in the family should have developed PD.
> >>
> >> So there had to be an explanation that satisfied both genetic and 
> >> environmental
> >> criteria, thus the proposition of "genetic predisposition" PLUS "toxic 
> >> event".
> >> There is no substantive proof of this theory.
> >>
> >> However, when we consider other types of PD, such as juvenile onset 
> >> (about 15 to
> >> 20) and early onset (about 20 to 40), there has been evidence that there 
> >> are
> >> autosomal (non-sex) chromosomes involved, both dominant (one copy only of 
> >> the
> >> altered gene in each cell is sufficient to cause the disorder) and 
> >> recessive
> >> (two copies of the gene in each cell have been altered).
> >>
> >> Several genes have been found to be involved in PD, including  the GBA, 
> >> LRRK2,
> >> PARK2, PARK7, PINK1, SNCA, SNCAIP, and UCHL1 genes.
> >>
> >> Among other factors, the herbicides 2,4-D and 2,4,5-T have been 
> >> implicated in
> >> causing PD.
> >>
> >> But before we get too far ahead of ourselves in attributing one cause or
> >> another, we must ask ourselves the question "What causative agents were 
> >> around
> >> when Dr. James Parkinson (1755-1824), first described the disease in 
> >> Western
> >> medical terms?"
> >>
> >> Not to mention the Ayurveda, the Indian medical doctrine which described 
> >> PD
> >> about 5000 BC. Then there is the Chinese text "Huang di nei jing su wen" 
> >> about
> >> 500 BC, the Ancient Greeks Homer 8 BC and  Erasistratus , 310-250 BC, 
> >> and
> >> writers
> >> such as Celsus, Galen,  Dioscorides and several more. It is even said to 
> >> be
> >> mentioned in the Bible.
> >>
> >> Jim
> >> (Dr James F Slattery PhD Soc Sc)
> >>
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