Physical activity and participation in competitive sports, as well as coffee, caffeinated tea or moderate alcohol consumption before diagnosis, protect against worsening motor and cognitive function in Parkinson’s patients, according to a new population-based study.
In contrast, smoking and heavy alcohol consumption — or never consuming alcohol — correlated with higher risks of mortality and cognitive and motor decline.
The research, “The Association Between Lifestyle Factors and Parkinson’s Disease Progression and Mortality,” was published in the journal Movement Disorders.
Lifestyle factors such as coffee and moderate alcohol consumption, physical activity, and cigarette smoking have been linked with lower risk of Parkinson’s disease. Whether they affect disease progression remains undetermined, although small studies have shown that smoking and drinking coffee do not affect motor progression in Parkinson’s.
In turn, nonpaharmacologic approaches such as physical activity may benefit physical functioning, balance and gait, as well as protect against dementia.
Researchers at the UCLA Fielding School of Public Health and the David Geffen School of Medicine, in Los Angeles, California, assessed whether diverse lifestyle factors before a Parkinson’s diagnosis in adults affect motor progression, cognitive decline, and survival.
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A total of 360 patients were enrolled within three years of diagnosis (average 2.1 years), as part of the population-based Parkinson’s Environment and Gene study in central California. The patients lived in one of three central California counties — Kern, Fresno or Tulare — and were followed from 2001 to 2016.
From the 252 patients not lost to follow-up (mean follow-up 5.3 years; 64 patients deceased, six were too ill, 17 withdrew, and 21 could not be contacted), 244 individuals — 139 men, mean age at diagnosis 66.9 years, mean duration of disease at baseline 2.1 years — provided data for analysis of disease progression.
The team also included 341 control participants from the same communities for analysis of mortality, who had been living in California for at least five years.
Telephone interviews were conducted to obtain self-reports of history of smoking, caffeinated coffee/tea or alcohol (beer, wine and liquor) consumption, overall physical activity level, and participation in competitive sports.
The participants were asked to report at what age they started and stopped drinking the beverages, as well as their average consumption per day during four age groups: 18-24, 25-44, 45-64, and 65 years or older.
Also, patients were asked about the average number of days per week and hours per day they participated in mild, moderate, or vigorous physical activity at the same age groups. Participation in competitive sports also was addressed, including basketball (20.6% of participants), baseball (18.1%), football (18.1%), track and field (12.5 %), and softball (8.3%).
Physical examinations were performed at each visit to assess motor function — Hoehn & Yahr (H&Y) stages — and cognition, with the Mini-Mental State Exam (MMSE). Cognitive decline was defined as a 4-point decrease from baseline MMSE examination.
In total, 209 patients (58%) and 67 controls (20%) died during follow-up. Fifty of the 244 patients (21%) assessed for progression experienced a 4-point or greater decline on the MMSE, while 77 (32%) progressed to H&Y stage 3 — transition from mild to moderate motor dysfunction, with loss of balance — or worse.
Coffee, caffeinated tea, moderate (below the median drinks per day), beer or liquor consumption, and participation in competitive sports were protective against mortality. In contrast, smoking and never drinking coffee or alcohol correlated with increased risk of mortality. Of note, the higher risk with smoking contrasts with prior studies showing protection against disease onset, the scientists noted.
In controls, alcohol and coffee consumption also were protective, while smoking conferred greater mortality risk.
The data further showed that engaging in competitive sports was associated with a history of head trauma in Parkinson’s patients, but not in controls. Head trauma also was linked with shorter time from diagnosis to death in this subset of patients.
Ever coffee consumption, participating in competitive sports and physical activity were protective against both motor function worsening and cognitive decline. Compared to moderate drinkers, patients who never drank liquor and those who drank more heavily were at greater risk for motor dysfunction. Also, never drinking and current cigarette smoking were associated with increased risk of cognitive decline.
Comparing patients who never drank coffee to those who have ever drank it, the findings also showed that never consuming coffee was associated with younger age at diagnosis (62.6 vs 67.6 years), longer disease duration at baseline (2.7 vs. 1.9 years) and less weekly alcohol consumption at some point (44% vs 69%).
“Although replication is needed,” researchers wrote, “our study suggests that multiple lifestyle factors potentially modify the rate of symptom progression.”