Population-based studies implicate environmental factors in the etiology of PD. It is possible that very specific toxins within complex exposures are the primary cause of PD in most patients. Occupational exposures to farming, pesticides/herbicides, metals, and welding fumes have all been implicated although, for each positive study, there are studies that refute these associations. Study design limitations including small sample size and lack of dose reconstruction are consistent limitations of PD-environmental epidemiologic studies. Future studies need to include sample sizes that are an order of magnitude greater than previous studies. In addition, much more detailed dose reconstruction techniques are necessary to detect individual toxin exposures, and this may require development of new methods of cumulative toxin dose reconstruction.
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