Parkinson-PEST: protocol for a case-control study on environmental risk factors and Parkinson's disease.

introductionGrowing evidence suggests that a part of the burden of Parkinson's disease (PD) can be explained by exposure to environmental factors, including pesticides, heavy metals, solvents, and air pollution. However, several questions remain unanswered, pertaining to the associations with PD of environmental factors that are still in use today; the added risks of co-exposure to multiple environmental factors and gene-environment interactions. Additional questions remain on the relevant time window, duration, and level of environmental exposures in relation to PD risk. Furthermore, it is unclear whether these exposures are associated with clinical progression of PD.

methodsPD-PEST (Parkinson's Disease-Preventing Emergence of Symptoms by environmental Toxicants) is a nationwide hospital-based case-control study conducted in the Netherlands. The study population consists of 1500 persons with a recent PD diagnosis and 3000 age- and sex-matched controls. Participants will be recruited from four regions across the Netherlands to ensure a representative geographical distribution in terms of urbanisation, industry, and agricultural activity. Cases must have a PD diagnosis, established by a neurologist in the Netherlands according to standard diagnostic criteria. Controls are outpatients with a different neurological condition that is unlikely to be associated with the environmental factors of interest or the risk of PD. We will collect detailed information on historical and current environmental exposures at an individual level. This includes occupational and residential histories (via questionnaires and nationwide registries) and measurements (blood, saliva, faeces, hair, and via silicone wristbands). Based on these multimodal data, we will estimate participants' individual lifetime exposure to environmental factors. Then, we will examine the associations between these exposures and the risk of PD. In addition, we will assess longitudinal associations between exposures and clinical progression of individuals with PD over 36 months. Analyses will be adjusted for possible confounders and multiple hypothesis testing. DISCUSSION: The PD-PEST study aims to overcome the limitations of previous studies by examining a large, representative study population, incorporating detailed information on clinical PD diagnosis, conducting extensive assessments of historical and current environmental risk factors and collecting detailed information on possible confounders. The results are expected to enhance our understanding of the role of environmental factors in the aetiology of PD and inform preventive strategies. ETHICS AND DISSEMINATION: The Medical Ethical Committee Oost-Nederland approved this study (NL86526.091.24). Informed consent will be obtained from each participant prior to participation in any of the study procedures. Findings of this study will be disseminated through publications, conferences, stakeholder briefings, and tailored communication materials for participants and the wider Parkinson community. REGISTRATION: Open Science Framework, January 2025 (osf.io/4q9vs).