title: Helicobacter pylori infection is associated with worse severity of Parkinson's disease.
abstract: BACKGROUND
  Some studies have suggested that chronic Helicobacter pylori (HP) infection can aggravate the neurodegenerative process in Parkinson's disease (PD), and targeted intervention could potentially modify the course of this disabling disease. We aimed to study the impact of HP infection on motor function, gastrointestinal symptoms, and quality of life in a large cohort of PD patients.
  
  
  METHODS
  102 consecutive PD patients underwent (13)C urea breath testing and blinded evaluations consisting of the Unified Parkinson's Disease Rating Scale (UPDRS) including "On"-medication motor examination (Part III), objective and quantitative measures of bradykinesia (Purdue Pegboard and timed gait), Leeds Dyspepsia Questionnaire, and PDQ-39 (a health-related quality of life questionnaire).
  
  
  RESULTS
  32.4% of PD patients were HP-positive. HP-positive patients were older (68.4 ± 7.3 vs. 63.8 ± 8.6 years, P = 0.009) and had worse motor function (UPDRS Part III 34.0 ± 13.0 vs. 27.3 ± 10.0, P = 0.04; Pegboard 6.4 ± 3.3 vs. 8.0 ± 2.7 pins, P = 0.04; and timed gait 25.1 ± 25.4 vs. 15.5 ± 7.6 s, P = 0.08). In the multivariate analysis, HP status demonstrated significant main effects on UPDRS Part III and timed gait. The association between HP status and these motor outcomes varied according to age. Gastrointestinal symptoms and PDQ-39 Summary Index scores did not differ between the two groups.
  
  
  CONCLUSIONS
  This is the largest cross-sectional study to demonstrate an association between HP positivity and worse PD motor severity.
authors.affiliation: Division of Neurology and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Ai Huey
authors.initials: AH
authors.lastname: Tan
authors.affiliation: Department of Medicine (Division of Gastroenterology), University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Sanjiv
authors.initials: S
authors.lastname: Mahadeva
authors.affiliation: Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, Canada.
authors.forename: Connie
authors.initials: C
authors.lastname: Marras
authors.affiliation: Department of Medicine (Division of Gastroenterology), University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Abdul Malik
authors.initials: AM
authors.lastname: Thalha
authors.affiliation: Division of Neurology and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Chiun Khang
authors.initials: CK
authors.lastname: Kiew
authors.affiliation: Division of Neurology and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Chia Ming
authors.initials: CM
authors.lastname: Yeat
authors.affiliation: Division of Neurology and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Sheang Wen
authors.initials: SW
authors.lastname: Ng
authors.affiliation: Division of Neurology and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Sheau Phing
authors.initials: SP
authors.lastname: Ang
authors.affiliation: Division of Neurology and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Siew Kian
authors.initials: SK
authors.lastname: Chow
authors.affiliation: Department of Medical Microbiology, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Mun Fai
authors.initials: MF
authors.lastname: Loke
authors.affiliation: Department of Medical Microbiology, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Jamunarani S
authors.initials: JS
authors.lastname: Vadivelu
authors.affiliation: Department of Medicine (Division of Neurology), Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
authors.forename: Norlinah
authors.initials: N
authors.lastname: Ibrahim
authors.affiliation: Institute of Biological Sciences, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Hoi Sen
authors.initials: HS
authors.lastname: Yong
authors.affiliation: Division of Neurology and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Chong Tin
authors.initials: CT
authors.lastname: Tan
authors.affiliation: Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, Canada.
authors.forename: Susan H
authors.initials: SH
authors.lastname: Fox
authors.affiliation: Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, Canada.
authors.forename: Anthony E
authors.initials: AE
authors.lastname: Lang
authors.affiliation: Division of Neurology and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, University of Malaya, Kuala Lumpur, Malaysia. Electronic address: limshenyang@ymail.com.
authors.forename: Shen-Yang
authors.initials: SY
authors.lastname: Lim
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001944:Breath Tests; D005260:Female; D016481:Helicobacter Infections / Q000503:physiopathology*; D016480:Helicobacter pylori / Q000472:pathogenicity*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000382:microbiology* / Q000503:physiopathology*; D011237:Predictive Value of Tests; D011788:Quality of Life; D012720:Severity of Illness Index; D013055:Spectrophotometry, Infrared; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires
keywords: Gastrointestinal dysfunction; Helicobacter pylori; Parkinson's disease