It looks like this article will be the source of some discussion, so here's
a copy that can be used by those people without web browsers.

Thank you, Helen, for alerting us; Judith for identifying the source.


Oregon leads nation in Parkinson's deaths

Medical experts say they're puzzled by high death rates for both
Parkinson's and Alzheimer's diseases as reported by state health officials

Saturday, January 30 1999

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By Patrick O'Neill of The Oregonian staff


New figures from the state Health Division show that Oregon leads the
nation in the rate of deaths from Parkinson's disease and has the
third-highest death rate from Alzheimer's disease.

Experts in both diseases say they are surprised by the statistics and that
the numbers should be viewed with caution. Oregon's ranking might be
artificially high because of more accurate reporting of causes of death in
Oregon than in other states. Also, research into both diseases in Oregon
might have made physicians in the state more aware of the illnesses and
thus more likely to recognize them.

Nonetheless, they say, more studies should be done to determine more
precisely the extent of Parkinson's and Alzheimer's disease in the state.

Both diseases are caused by largely unknown factors, and both involve
irreversible degeneration of nerve cells in the brain.

David Hopkins, a research analyst with the Health Division's Office of
Health Statistics, said that since 1979, the national death rate from
Parkinson's disease has risen markedly -- from 1.56 cases per 100,000
population to 4.46 cases per 100,000 in 1996. In Oregon, the figures have
increased dramatically -- from 2.2 cases per 100,000 population in 1979 to
7.4 in 1996.

Oregon has a greater proportion of elderly residents than the nation as a
whole, Hopkins said. But even when age is eliminated as a factor, Oregon's
Parkinson's death rate is 63 percent higher than the nation's. Health
Division records show that 236 Oregonians died of Parkinson's disease in
1996, up from 102 in 1986.

In preparing the report, Hopkins relied on information from death
certificates, which list the cause of death.

States vary widely in the accuracy of the information placed on death
certificates. Oregon health officials often return death certificates to
physicians who list unclear causes of death, asking for more details.

Hopkins said he thinks the Oregon figures are accurate.

"One question is whether the figures from other states accurately reflect
what's going on there," he said.

But for Haydeh Payami, an associate professor of neurology and genetics at
Oregon Health Sciences University, the state's figures are far too
ambiguous. Payami, director of the university's Neurogenetics Program, is
affiliated with both the Alzheimer's Center of Oregon and the Parkinson's
Center of Oregon.

"It could be simply that Parkinson's is being better recognized in Oregon
than anywhere else," she said. "I think that's the most likely explanation.
For a small state like Oregon, we have a very prominent Parkinson's center,
and we do a lot of outreach."

One of the most important unanswered questions in Payami's mind is whether
the incidence of Parkinson's is higher in Oregon than in other states. The
Health Division figures don't answer that question.

No one knows exactly what causes the disease, which destroys brain cells
that produce an important neurochemical called dopamine. The loss of those
cells causes a garbling of nerve messages between the brain and the muscles.

Dr. John Nutt, professor of neurology at OHSU and medical director of the
Parkinson's Center of Oregon, said the state report is "a real stimulus for
looking to see if we have a higher incidence" of the diseases.

Death reports for both Parkinson's and Alzheimer's diseases are unreliable,
he said, because people rarely die of the illnesses themselves. "It (the
diseases) really sets you up for other medical problems -- pneumonia,
falls, fractured hips and all the medical complications that flow from
that," he said.

Peter S. Spencer, an OHSU professor of neurology and director of the Center
for Research on Occupational and Environmental Toxicology, has written
extensively on the possibility that the disease is caused by complex
interactions between genetic and environmental factors.

Spencer said he, too, thinks much of the difference between the Oregon and
national statistics in both Parkinson's and Alzheimer's diseases could be
due to differences in how the cases are counted from state to state.

Spencer said numerous studies have found that Parkinson's disease is more
prevalent in rural than urban areas. Researchers are studying the
possibility that both manmade and natural toxins found in rural areas might
trigger the disease in people who are genetically susceptible.

The Health Division's figures show a need to perform more epidemiological
studies that would show for certain how many Oregonians get Parkinson's
disease. "We are in a position in Oregon, with the Parkinson's Center and
the Alzheimer's Center and the Center for Research on Occupational and
Environmental Toxicology, to tackle this in a very, very significant way,"
he said.

The problem, he said, lies in a lack of federal funding for epidemiological
research.

Liz McKinney, executive director of the Oregon Trail Chapter of the
Alzheimer's Association, said she was not aware that Oregon's death rate
from Alzheimer's disease was so high. "I can only speculate that in Oregon,
advocates have been more insistent on death certificates accurately
reflecting Alzheimer's disease as the cause of death," she said.




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You can reach Patrick O'Neill at 503-221-8233 or by e-mail at
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