Prodromal Markers of Parkinson’s Disease in a Cohort of US Black Women
Yvette Cozier1, Mario Flores2, Cordelia Russell3, Virginia Cafferky1, Albert Hung4, Michael Schwarzschild4, Marianna Cortese2, Kjetil Bjornevik2, Alberto Ascherio2
1Epidemiology, Boston University School of Public Health, 2Harvard T.H. Chan School of Public Health, 3Slone Epidemiology at Boston University, 4Massachusetts General Hospital
Objective:

To estimate the prevalence of constipation, hyposmia, and REM sleep behavior disorder (RBD), and their association with Parkinson’s disease (PD) in a cohort of US Black women.

Background:
Studies conducted in predominantly White populations have shown that constipation, hyposmia, and RBD are major prodromal features of PD, which could help identify the disease at earlier stages. However, whether these features predict PD in other populations, such as Black women, is unknown. 
Design/Methods:

The BWHS is a prospective cohort of 59,000 US Black women aged 21-69 at enrollment in 1995.  Participants are followed biennially through postal and online questionnaires. Self-reported health conditions, including PD, are validated using physician records and supplemental questionnaires. The 2024 cohort questionnaire contained questions on constipation (bowel movement ≤ every other day, and/or laxative use ≥ weekly), hyposmia (perceived smell problems), and probable RBD (acting out of dreams).  We estimated age-adjusted odds ratios and 95% confidence intervals (CI) to examine the cross-sectional association of these features with PD.

Results:

To date, 14,272 women have completed the online questionnaire, including 24 with a previous diagnosis of PD.  Among them 32% reported constipation, 6% reported hyposmia, and 8% reported probable RBD; approximately 5% reported two or more features. All features examined were significantly associated with PD, with the strongest association observed for hyposmia (OR=13.55; 95% CI 6.04-30.38), followed by probable RBD (OR=8.39; 95% CI 3.76-18.75). Having all three features versus none was associated with OR of 179.43 (95% CI 46.67, 689.80).

Conclusions:
In this preliminary cross-sectional analysis, constipation, hyposmia, and probable RBD were strongly associated with PD in Black women with magnitudes similar to those previously observed in White women. These features could therefore contribute to detection of prodromal PD in this population. Longitudinal follow-up of this cohort will allow us to validate our findings. 
10.1212/WNL.0000000000212257
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