title: Screening for early detection of parkinsonism using a self-administered questionnaire: a cross-sectional epidemiologic study.
abstract: BACKGROUND
  Manganese (Mn) is a common component of welding fume. Exposure to Mn fume has been associated with parkinsonism. A simple and reliable screening tool to evaluate Mn exposed workers for neurotoxic injury would have broad occupational health application.
  
  
  METHODS
  This study investigated 490 occupational welders recruited from a trade union list. Subjects were examined by a movement disorders specialist using the Unified Parkinson Disease Rating Scale motor subsection 3 (UPDRS3). Parkinsonism, intermediate, and normal groups were defined as UPDRS3 score ≥ 15, 6-15, and <6, respectively. Workers completed a health status questionnaire (PDQ39) and a Parkinson disease (PD) Symptoms Questionnaire. Areas under receiver operator curve (AUC) were analyzed based on these scores, adjusted for age, smoking, race, gender, and neurologist, using normal as the reference.
  
  
  RESULTS
  The AUC was 0.79 (95% confidence interval [CI]=0.73-0.84) for PDQ39 and 0.78 (95% CI=0.72-0.85) for PD Symptoms Questionnaire score. At 70% sensitivity, the specificity for PDQ39 score and PD Symptoms Questionnaire score for the prediction of parkinsonism was 73.1% and 80.1%, respectively.
  
  
  CONCLUSIONS
  These results suggest the questionnaires have reasonably good sensitivity and specificity to predict parkinsonism in Mn exposed workers. These questionnaires could be a valuable first step in a tiered screening approach for Mn exposed workers.
authors.affiliation: University of Washington, Department of Environmental and Occupational Health Sciences, Seattle, WA, USA. Electronic address: jlundin2@uw.edu.
authors.forename: Jessica I
authors.initials: JI
authors.lastname: Lundin
authors.affiliation: University of California San Diego, Department of Family and Preventive Medicine, La Jolla, CA, USA. Electronic address: hcheckoway@ucsd.edu.
authors.forename: Harvey
authors.initials: H
authors.lastname: Checkoway
authors.affiliation: Washington University School of Medicine, Department of Neurology, St. Louis, MO, USA; American Parkinson Disease Association Advanced Center for Parkinson Research, St. Louis, MO, USA. Electronic address: criswells@neuro.wustl.edu.
authors.forename: Susan R
authors.initials: SR
authors.lastname: Criswell
authors.affiliation: Washington University School of Medicine, Department of Neurology, St. Louis, MO, USA. Electronic address: hobsona@neuro.wustl.edu.
authors.forename: Angela J
authors.initials: AJ
authors.lastname: Hobson
authors.affiliation: Washington University School of Medicine, Department of Neurology, St. Louis, MO, USA. Electronic address: rachel.harris.621@gmail.com.
authors.forename: Rachel C
authors.initials: RC
authors.lastname: Harris
authors.affiliation: Washington University School of Medicine, Department of Neurology, St. Louis, MO, USA; American Parkinson Disease Association Advanced Center for Parkinson Research, St. Louis, MO, USA. Electronic address: swisherl@neuro.wustl.edu.
authors.forename: Laura M
authors.initials: LM
authors.lastname: Swisher
authors.affiliation: Washington University School of Medicine, Department of Internal Medicine, St. Louis, MO, USA. Electronic address: bevanoff@dom.wustl.edu.
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Evanoff
authors.affiliation: Washington University School of Medicine, Department of Neurology, St. Louis, MO, USA; American Parkinson Disease Association Advanced Center for Parkinson Research, St. Louis, MO, USA; University of the Witwatersrand, School of Public Health, Faculty of Health Sciences, Parktown, Johannesburg, South Africa. Electronic address: racetteb@neuro.wustl.edu.
authors.forename: Brad A
authors.initials: BA
authors.lastname: Racette
mesh_terms: D003430:Cross-Sectional Studies; D042241:Early Diagnosis; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D020149:Manganese Poisoning / Q000150:complications*; D008875:Middle Aged; D009784:Occupational Diseases / Q000139:chemically induced / Q000175:diagnosis*; D016273:Occupational Exposure; D020734:Parkinsonian Disorders / Q000139:chemically induced / Q000175:diagnosis* / Q000453:epidemiology; D012372:ROC Curve; D011795:Surveys and Questionnaires; D014896:Welding
keywords: Epidemiology; Manganese; Neurodegenerative disease; Occupational exposure; Parkinson disease; Parkinsonism
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