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Review

Free Access

Parkinson's Disease in the Gulf Countries: An Updated Review

Alamri Y.a-c · MacAskill M.a, c · Anderson T.a,c,d · Benamer H.e, f

Author affiliations

aNew Zealand Brain Research Institute, bCanterbury District Health Board, cDepartment of Medicine, University of Otago, and dDepartment of Neurology, Christchurch Public Hospital, Christchurch, New Zealand; eNeurology Department, New Cross Hospital, Wolverhampton, and fDepartment of Neurology, Queen Elizabeth Neuroscience Centre, Birmingham, UK

Corresponding Author

Yassar Alamri

The New Zealand Brain Research Institute

66 Stewart Street

Christchurch Central, 8011 (New Zealand)

E-Mail Yassar.alamri@nzbri.org

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Eur Neurol 2015;74:222-225

Abstract

Background: The Arabian Gulf region is a rapidly developing part of the world. With the increase in average life-expectancy, idiopathic Parkinson's disease (PD), is also expected to increase in prevalence. Furthermore, the high rate of consanguinity among Arabs probably makes familial cases of PD more likely to be encountered than other areas in the world. This review provides an update on the published literature on sporadic and familial PD in Gulf Arabs. Summary: Although the Arab population of this region shares religious beliefs and demographic characteristics with other Arabs, their environmental exposures and genetic makeup may be different. This could account for the relatively low prevalence of PD reported in the Al-Thugba study (27 per 100,000) compared with prevalence rates by most other studies on Arab (mainly North African) populations (31.4-557.4 per 100,000). Key Messages: Gulf countries are considered rich countries, which makes conducting nation-wide or even international studies logistically easier than it is in many other countries. Such multinational research can be organized by the existing Gulf Cooperation Council, or through a collaboration of the Ministries of Health. This would, hopefully, culminate in the introduction of more research centers, as well as the implementation of better health care policies and practices for the ageing community.

© 2015 S. Karger AG, Basel


Introduction

The Arabian Gulf countries, or simply the Gulf countries, are 6 countries that make up most of the Arabian Peninsula: Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and United Arab Emirates. Also known as countries of the Gulf Cooperation Council (GCC; [1]), they comprise a rapidly developing part of the world, with an estimated collective population of just under 49 million [2]. They share socioeconomic qualities, religious beliefs and demographic characteristics. With the help of globalization and oil discovery, there has been a relatively recent surge in these countries' incomes, making them some of the wealthiest countries in the world (average gross national income per capita of $68,792 in 2012 [2]). For the most part, this has led to improvements in lifestyle overall, specifically in health care [3]. For example, the average life expectancy has increased from 71.2 years in 1990 to 76.2 years in 2012 [4]. Unlike the political unrest in some of the neighboring countries since the ‘2011 Arab Spring', the situation in the GCC countries remains largely stable.

Parkinson's disease (PD) is the second most common neurodegenerative disorder in the elderly, and the most commonly seen movement disorder in neurology clinics [5]. Likely due to methodological and sociodemographic differences and time since publication, reported prevalence rates of PD vary widely in the published literature. For example, PD prevalence was reported to be as low as 18 per 100,000 in a Chinese population [6] and as high as 65-125 per 100,000 among the Europeans [7]. A study from England in 1992 revealed a prevalence of 121 per 100,000 [8]. It is expected that PD incidence will further increase in the future, as there are far more people surviving beyond 65 years of age than in the past [9]. With the improved life expectancy in countries of the GCC, PD in the area is likely to mirror the increase observed elsewhere. This article aims to review data about PD in GCC countries (see table 1 for a summary).

Table 1

Published studies on PD in countries of the GCC

http://www.karger.com/WebMaterial/ShowPic/487611

Genetic Studies

Arab families generally tend to be large units with a high rate of consanguineous marriages (up to 30% of all marriages in some populations [10]), thereby increasing the risk of genetic and familial disorders. Familial PD accounts for less than 10% of all cases of PD [11]. More than 13 loci and nine genes have been implicated in causing familial PD. With such a high rate of inter-marriages and several candidate genetic defects causing PD, one would expect a much higher rate of familial PD in these populations. However, only 2 reports (parkin and PINK1 defects) have been published from GCC countries, suggesting that more research on potential genetic causes of PD in the region should be undertaken.

Only a handful of studies have specifically investigated the prevalence of PD in Arabs who mostly have their origin in North African Arab countries. A genetic study of familial PD in Tunisia [12] identified autosomal dominant with incomplete penetrance and autosomal recessive modes of inheritance. It is striking that causes of familial PD, such as LRRK2 G2019S, which are very prevalent in North African Arabs, have not been reported from GCC Arabs [13,14]. This could be attributed to the ancestral differences between GCC Arabs and North African Arabs, the latter community being much more closely associated with Berber ancestry [13]. The absence of LRRK2 G2019S mutations in the Saudi population studied by Al-Mubarak et al. [15] further demonstrates the genetic distinction between GCC Arabs and North African Arabs. These findings, however, do not prove the specificity of LRRK2 G2019S mutations to North African Arabs, and are a reminder of the need for further exploration of the role of the genetics of PD in the GCC.

Epidemiological and Clinical Studies

It is surprising that a solitary epidemiological study on neurological disorders in such a populated region has been published [16]. Of the few clinical studies, a number of knowledge deficiencies still exist. For example, not one study has stratified PD patients according to their cognitive state upon presentation/screening. The association of PD and cognitive decline may be of particular relevance to Arab patients, given that North African carriers of LRRK2 G2019S mutations were found to have higher rates of depression, hallucination and sleep disorders [17].

While crude prevalence rates of idiopathic PD in Arab countries are reported to be similar to the value of 27 per 100,000 in Saudi Arabia [16] in some studies, others have reported considerably different rates. One study conducted in 3 tertiary referral centers in Irbid, Jordan, reported prevalence of 37.4 per 100,000 [18]; a second 1986 population Libyan study reported a prevalence rate of 31.4 per 100,000 [19]; and a third Tunisian study reported a crude prevalence of 43 per 100,000 [20]. In contradistinction, Khedr et al. [21] found a PD prevalence of 557.4 per 100,000 in a recent cross-sectional survey of the Egyptian district of Assiut, a rate much higher than the rate previously observed in the Arab world. The authors of that study highlighted that their study population was rural, possibly explaining this difference, with the majority of other studies comprising urban populations [18,19,21].

Conclusion

Future interventions should focus on uniting efforts in the region, and conducting well-designed incidence and prevalence studies, as well as genetic analyses (e.g. identifying LRRK2 G2019S mutation in GCC Arabs). The GCC countries are considered among the richer countries, which should make conducting nation-wide or even international studies logistically easier than it is in many other countries within the region. Such multinational research can be organized by the existing GCC, or through a collaboration of the Ministries of Health. This would, hopefully, culminate in the training of Arab movement disorders researchers and the introduction of more specialized research centers, as well as the implementation of better health care policies and practices for the aging community.

Disclosure Statement

The authors report no financial disclosures or conflicts of interest.


References

  1. Gulf Cooperation Council (GCC). 1981. http://www.gcc-sg.org/eng/ (accessed May 15, 2015).
  2. World Health Organization (WHO): Country-specific statistics. 2015. http://www.who.int/countries/en/ (accessed May 15, 2015).
  3. Benamer HT, de Silva R, Siddiqui KA, Grosset DG: Parkinson's disease in Arabs: a systematic review. Mov Disord 2008;23:1205-1210.
  4. United Nations Children's Fund (UNICEF): Information by country and prgramme. 2012. http://www.unicef.org/infobycountry/ (accessed May 15, 2015).
  5. Mehta P, Kifley A, Wang JJ, Rochtchina E, Mitchell P, Sue CM: Population prevalence and incidence of Parkinson's disease in an Australian community. Intern Med J 2007;37:812-814.
  6. Marras C, Tanner CM: Epidemiology of Parkinson's Disease; in Watts RL, Koller WC (eds): Movement disorders: neurologic principle and practice. New York, McGraw-Hill, 2004, pp 177-195.
  7. von Campenhausen S, Bornschein B, Wick R, Bötzel K, Sampaio C, Poewe W, et al: Prevalence and incidence of Parkinson's disease in Europe. Eur Neuropsychopharmacol 2005;15:473-490.
  8. Sutcliffe RL, Meara JR: Parkinson's disease epidemiology in the Northampton district, England, 1992. Acta Neurol Scand 1995;92:443-450.
  9. Pringsheim T, Jette N, Frolkis A, Steeves TD: The prevalence of Parkinson's disease: a systematic review and meta-analysis. Mov Disord 2014;29:1583-1590.
  10. Tadmouri GO, Nair P, Obeid T, Al Ali MT, Al Khaja N, Hamamy HA: Consanguinity and reproductive health among Arabs. Reprod Health 2009;6:17.
  11. McInerney-Leo A: Genetic testing in Parkinson's disease. Mov Disord 2005;20:908-909.
  12. Gouider-Khouja N, Belal S, Hamida MB, Hentati F: Clinical and genetic study of familial Parkinson's disease in Tunisia. Neurology 2000;54:1603-1609.
  13. Benamer HT, de Silva R: LRRK2 G2019S in the North African population: a review. Eur Neurol 2010;63:321-325.
  14. Jasinska-Myga B, Kachergus J, Vilariño-Güell C, Wider C, Soto-Ortolaza AI, Kefi M, et al: Comprehensive sequencing of the LRRK2 gene in patients with familial Parkinson's disease from North Africa. Mov Disord 2010;25:2052-2058.
  15. Al-Mubarak BR, Bohlega SA, Alkhairallah TS, Magrashi AI, AlTurki MI, Khalil DS, et al: Parkinson's disease in Saudi patients: a genetic study. PLoS One 2015;10:e0135950.
  16. Al Rajeh S, Bademosi O, Ismail H, Awada A, Dawodu A, al-Freihi H, et al: A community survey of neurological disorders in Saudi Arabia: the Thugbah study. Neuroepidemiology 1993;12:164-178.
  17. Belarbi S, Hecham N, Lesage S, Kediha MI, Smail N, Benhassine T, et al: LRRK2 G2019S mutation in Parkinson's disease: a neuropsychological and neuropsychiatric study in a large Algerian cohort. Parkinsonism Relat Disord 2010;16:676-679.
  18. Alrefai A, Habahbih M, Alkhawajah M, Darwish M, Batayha W, Khader Y, et al: Prevalence of Parkinson's disease in Northern Jordan. Clin Neurol Neurosurg 2009;111:812-815.
  19. Ashok PP, Radhakrishnan K, Sridharan R, Mousa ME: Epidemiology of Parkinson's disease in Benghazi, North-East Libya. Clin Neurol Neurosurg 1986;88:109-113.
  20. Attia Romdhane N, Ben Hamida M, Mrabet A, Larnaout A, Samoud S, Ben Hamda A, et al: Prevalence study of neurologic disorders in Kelibia (Tunisia). Neuroepidemiology 1993;12:285-299.
  21. Khedr EM, Al Attar GS, Kandil MR, Kamel NF, Abo Elfetoh N, Ahmed MA: Epidemiological study and clinical profile of Parkinson's disease in the Assiut Governorate, Egypt: a community-based study. Neuroepidemiology 2012;38:154-163.
  22. Jones AC, Yamamura Y, Almasy L, Bohlega S, Elibol B, Hubble J, et al: Autosomal recessive juvenile parkinsonism maps to 6q25.2-q27 in four ethnic groups: detailed genetic mapping of the linked region. Am J Hum Genet 1998;63:80-87.
  23. Chishti MA, Bohlega S, Ahmed M, Loualich A, Carroll P, Sato C, et al: T313M PINK1 mutation in an extended highly consanguineous Saudi family with early-onset Parkinson disease. Arch Neurol 2006;63:1483-1485.
  24. Al-Rajeh S, Awada A, Bademosi O, Ismail H: Spectrum of movement disorders in a Saudi University Hospital. Saudi Med J 1993;15:138-142.
  25. Ogunniyi A, Daif AK, Al-Rajeh S, AbdulJabbar M, Al-Tahan AR, Al-Bunyan M, et al: Dementia in Saudi Arabia: experience from a university hospital. Acta Neurol Scand 1998;98:116-120.
  26. Al-Bunyan MA: Parkinson's disease. Clinical and electrophysiological evaluation. Saudi Med J 2000;21:72-75.
  27. Hamad AI, Ibrahim MA, Sulaiti EM: Dementia in Qatar. Saudi Med J 2004;25:79-82.

Author Contacts

Yassar Alamri

The New Zealand Brain Research Institute

66 Stewart Street

Christchurch Central, 8011 (New Zealand)

E-Mail Yassar.alamri@nzbri.org


Article / Publication Details

First-Page Preview
Abstract of Review

Received: July 27, 2015
Accepted: November 08, 2015
Published online: November 28, 2015
Issue release date: December 2015

Number of Print Pages: 4
Number of Figures: 0
Number of Tables: 1

ISSN: 0014-3022 (Print)
eISSN: 1421-9913 (Online)

For additional information: http://www.karger.com/ENE


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References

  1. Gulf Cooperation Council (GCC). 1981. http://www.gcc-sg.org/eng/ (accessed May 15, 2015).
  2. World Health Organization (WHO): Country-specific statistics. 2015. http://www.who.int/countries/en/ (accessed May 15, 2015).
  3. Benamer HT, de Silva R, Siddiqui KA, Grosset DG: Parkinson's disease in Arabs: a systematic review. Mov Disord 2008;23:1205-1210.
  4. United Nations Children's Fund (UNICEF): Information by country and prgramme. 2012. http://www.unicef.org/infobycountry/ (accessed May 15, 2015).
  5. Mehta P, Kifley A, Wang JJ, Rochtchina E, Mitchell P, Sue CM: Population prevalence and incidence of Parkinson's disease in an Australian community. Intern Med J 2007;37:812-814.
  6. Marras C, Tanner CM: Epidemiology of Parkinson's Disease; in Watts RL, Koller WC (eds): Movement disorders: neurologic principle and practice. New York, McGraw-Hill, 2004, pp 177-195.
  7. von Campenhausen S, Bornschein B, Wick R, Bötzel K, Sampaio C, Poewe W, et al: Prevalence and incidence of Parkinson's disease in Europe. Eur Neuropsychopharmacol 2005;15:473-490.
  8. Sutcliffe RL, Meara JR: Parkinson's disease epidemiology in the Northampton district, England, 1992. Acta Neurol Scand 1995;92:443-450.
  9. Pringsheim T, Jette N, Frolkis A, Steeves TD: The prevalence of Parkinson's disease: a systematic review and meta-analysis. Mov Disord 2014;29:1583-1590.
  10. Tadmouri GO, Nair P, Obeid T, Al Ali MT, Al Khaja N, Hamamy HA: Consanguinity and reproductive health among Arabs. Reprod Health 2009;6:17.
  11. McInerney-Leo A: Genetic testing in Parkinson's disease. Mov Disord 2005;20:908-909.
  12. Gouider-Khouja N, Belal S, Hamida MB, Hentati F: Clinical and genetic study of familial Parkinson's disease in Tunisia. Neurology 2000;54:1603-1609.
  13. Benamer HT, de Silva R: LRRK2 G2019S in the North African population: a review. Eur Neurol 2010;63:321-325.
  14. Jasinska-Myga B, Kachergus J, Vilariño-Güell C, Wider C, Soto-Ortolaza AI, Kefi M, et al: Comprehensive sequencing of the LRRK2 gene in patients with familial Parkinson's disease from North Africa. Mov Disord 2010;25:2052-2058.
  15. Al-Mubarak BR, Bohlega SA, Alkhairallah TS, Magrashi AI, AlTurki MI, Khalil DS, et al: Parkinson's disease in Saudi patients: a genetic study. PLoS One 2015;10:e0135950.
  16. Al Rajeh S, Bademosi O, Ismail H, Awada A, Dawodu A, al-Freihi H, et al: A community survey of neurological disorders in Saudi Arabia: the Thugbah study. Neuroepidemiology 1993;12:164-178.
  17. Belarbi S, Hecham N, Lesage S, Kediha MI, Smail N, Benhassine T, et al: LRRK2 G2019S mutation in Parkinson's disease: a neuropsychological and neuropsychiatric study in a large Algerian cohort. Parkinsonism Relat Disord 2010;16:676-679.
  18. Alrefai A, Habahbih M, Alkhawajah M, Darwish M, Batayha W, Khader Y, et al: Prevalence of Parkinson's disease in Northern Jordan. Clin Neurol Neurosurg 2009;111:812-815.
  19. Ashok PP, Radhakrishnan K, Sridharan R, Mousa ME: Epidemiology of Parkinson's disease in Benghazi, North-East Libya. Clin Neurol Neurosurg 1986;88:109-113.
  20. Attia Romdhane N, Ben Hamida M, Mrabet A, Larnaout A, Samoud S, Ben Hamda A, et al: Prevalence study of neurologic disorders in Kelibia (Tunisia). Neuroepidemiology 1993;12:285-299.
  21. Khedr EM, Al Attar GS, Kandil MR, Kamel NF, Abo Elfetoh N, Ahmed MA: Epidemiological study and clinical profile of Parkinson's disease in the Assiut Governorate, Egypt: a community-based study. Neuroepidemiology 2012;38:154-163.
  22. Jones AC, Yamamura Y, Almasy L, Bohlega S, Elibol B, Hubble J, et al: Autosomal recessive juvenile parkinsonism maps to 6q25.2-q27 in four ethnic groups: detailed genetic mapping of the linked region. Am J Hum Genet 1998;63:80-87.
  23. Chishti MA, Bohlega S, Ahmed M, Loualich A, Carroll P, Sato C, et al: T313M PINK1 mutation in an extended highly consanguineous Saudi family with early-onset Parkinson disease. Arch Neurol 2006;63:1483-1485.
  24. Al-Rajeh S, Awada A, Bademosi O, Ismail H: Spectrum of movement disorders in a Saudi University Hospital. Saudi Med J 1993;15:138-142.
  25. Ogunniyi A, Daif AK, Al-Rajeh S, AbdulJabbar M, Al-Tahan AR, Al-Bunyan M, et al: Dementia in Saudi Arabia: experience from a university hospital. Acta Neurol Scand 1998;98:116-120.
  26. Al-Bunyan MA: Parkinson's disease. Clinical and electrophysiological evaluation. Saudi Med J 2000;21:72-75.
  27. Hamad AI, Ibrahim MA, Sulaiti EM: Dementia in Qatar. Saudi Med J 2004;25:79-82.
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