title: Environmental and occupational risk factors for progressive supranuclear palsy: Case-control study.
abstract: The cause of progressive supranuclear palsy (PSP) is largely unknown. Based on evidence for impaired mitochondrial activity in PSP, we hypothesized that the disease may be related to exposure to environmental toxins, some of which are mitochondrial inhibitors.
  
  
  
  This multicenter case-control study included 284 incident PSP cases of 350 cases and 284 age-, sex-, and race-matched controls primarily from the same geographical areas. All subjects were administered standardized interviews to obtain data on demographics, residential history, and lifetime occupational history. An industrial hygienist and a toxicologist unaware of case status assessed occupational histories to estimate past exposure to metals, pesticides, organic solvents, and other chemicals.
  
  
  
  Cases and controls were similar on demographic factors. In unadjusted analyses, PSP was associated with lower education, lower income, more smoking pack-years, more years of drinking well water, more years living on a farm, more years living 1 mile from an agricultural region, more transportation jobs, and more jobs with exposure to metals in general. However, in adjusted models, only more years of drinking well water was significantly associated with PSP. There was an inverse association with having a college degree.
  
  
  
  We did not find evidence for a specific causative chemical exposure; higher number of years of drinking well water is a risk factor for PSP. This result remained significant after adjusting for income, smoking, education and occupational exposures. This is the first case-control study to demonstrate PSP is associated with environmental factors. © 2016 International Parkinson and Movement Disorder Society.
authors: Division of Movement Disorders, Department of Neurology, University of Louisville School of Medicine, Louisville, Kentucy, USA.|Movement Disorder Center, Department of Neurosciences, University of California San Diego, San Diego, California, USA.
authors: Irene
authors: I
authors: Litvan
authors: Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
authors: Peter S J
authors: PS
authors: Lees
authors: Division of Movement Disorders, Department of Neurology, University of Louisville School of Medicine, Louisville, Kentucy, USA.
authors: Christopher R
authors: CR
authors: Cunningham
authors: Department of Bioinformatics and Biostatistics, University of Louisville, Louisville, Kentucky, USA.
authors: Shesh N
authors: SN
authors: Rai
authors: Department of Bioinformatics and Biostatistics, University of Louisville, Louisville, Kentucky, USA.
authors: Alexander C
authors: AC
authors: Cambon
authors: Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors: David G
authors: DG
authors: Standaert
authors: Morto and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Research, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.
authors: Connie
authors: C
authors: Marras
authors: Department of Neurology, Emory University, Atlanta, Georgia, USA.
authors: Jorge
authors: J
authors: Juncos
authors: InMotion, Warrensville Heights, Ohio, USA.
authors: David
authors: D
authors: Riley
authors: Department of Neurology, University of Maryland, Baltimore, Maryland, USA.
authors: Stephen
authors: S
authors: Reich
authors: Department of Neurological Sciences, Rush University, Chicago, Illinois, USA.|Department of Neurology, University of Colorado, Denver, Colorado, USA.
authors: Deborah
authors: D
authors: Hall
authors: Department of Neurology, University of Colorado, Denver, Colorado, USA.
authors: Benzi
authors: B
authors: Kluger
authors: Department of Neurology, University of California Los Angeles, California, USA.
authors: Yvette
authors: Y
authors: Bordelon
authors: Department of Neurology, University of Utah, Salt City, Utah, USA.
authors: David R
authors: DR
authors: Shprecher
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D004781:Environmental Exposure / Q000009:adverse effects* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009656:North America / Q000453:epidemiology; D009784:Occupational Diseases / Q000453:epidemiology / Q000209:etiology*; D016273:Occupational Exposure / Q000009:adverse effects; D012307:Risk Factors; D013494:Supranuclear Palsy, Progressive / Q000453:epidemiology / Q000209:etiology*; D060986:Water Wells
keywords: case-control study; epidemiology; parkinsonism; progressive supranuclear palsy; risk factors