Epidemiological study of neurodegenerative Parkinsonism in “Hazratbal block” A specific region of Kashmir valley - North India - A longitudinal cohort study

Background: Parkinson’s disease (PD) is the second most common neurodegenerative disorder, commonly found in males above the age of 60. Increased life expectancy due to better health care and aging population will see a proportional rise in case of PD in India during next three decades making it a major health problem. Objectives: There was no well designed longitudinal study on PD from Kashmir, North-India. Therefore, we planned to determine the prevalence, type of PD & associated probable risk factor for PD in the Kashmir valley, North India, on a stratified random sampling through a door-to-door survey. Material and Method: A prospective community - based study was conducted over a period of three years from May 2010 – May 2013 after obtaining approval from the Institutional Ethical Committee & informed written consent. The study population consisted of all subjects above 7 years of age. The screening was conducted in 2 stages, initially a validated questionnaire was pretested and subjects were interviewed & clinically examined by team of Doctors. In later stage, cases with both typical and atypical features of PD underwent detailed examination by a neurologist at SMHS Hospital, a tertiary referral centre and requisite investigation done wherever deemed necessary. Results: The total number of subjects screened were 13710, out of them 39 were found to have PD, with overall prevalence of 0.28 % (280/100,000). The peak prevalence of PD was in the age group of 70-79 years with male prepondance M:F ratio (1.4:1) , Predominant symptom was Tremor (74.4%) followed by bradykinesia. The distribution of parkinsonism in our study was idiopathic PD 59%, drug induced PD 17.9%, Parkinson plus syndrome 15.4% and vascular Parkinsonism in 7.7%. The Prevalence of PD was more in rural population compared to urban. Exposure to agricultural chemicals, Pesticides, and prolonged well water consumption were also possible risk factors for PD. Conclusion: The prevalence of PD in our part of world is less as compared to Europe and western world. This study documents the epidemiological data of PD in Kashmir valley (Hazratbal Block). It represents varied geographical, social, economic, cultural ethnicity among rural/urban population. There is low literacy rate, predominant rural population and insufficient health infrastructure where PD poses an invisible but major health problem for policy makers.