A late-onset Parkinson's disease in tribes in India – A case report
Dhivya Venkatesan, Mahalaxmi Iyer, Padmavathi Krishnan, Robert Wilson S, Balachandar Vellingiri
Abstract
Parkinson’s disease (PD) is a complex neurodegenerative disorder, where its prevalence do vary geographically. We observed a 54-year-old male who belongs to a tribal community from Tamil Nadu, India, was diagnosed with PD. Occupationally, he was a farmer exposed to pesticides in agricultural fields. The family history revealed that the patient's parents had a consanguineous marriage and that his father showed symptoms of tremor and bradykinesia along with memory loss. We initially examined the family history and assessed Unified Parkinson's Disease Rating Scale (UPDRS) and Hoehn and Yahr (HY) scaling which showed low UPDRS rate and stage 3 HY scaling. Further, we conducted the dopamine transporter imaging which revealed decreased tracer binding in the left caudate with negligible uptake in the left putamen. Furthermore, we found that the patient had low levels of uric acid (2.2 mg/dL) with SNCA mutation (A53T). Environmental factors such as pesticides and smoking might have contributed SNCA mutation with low levels of uric acid. Also, the chromosomal analysis using fluorescent in situ hybridization (FISH) technique showed 22q11.2 deletion which is very uncommon in late-onset PD. In conclusion, this case study revealed that there is a humongous role of both environmental exposures and genetics in the onset of the PD.