Fluoride Exposure as a Possible Environmental Modifier of Idiopathic Parkinson's Disease: Insights from a Rural North...

Environmental factors may influence Parkinson's disease (PD) severity and progression. This study investigated the impact of chronic fluoride exposure on the clinical characteristics and short-term progression of idiopathic PD (IPD) in a rural North Indian cohort.

A prospective observational study enrolled 52 IPD patients from fluoride-endemic (n = 25) and nonendemic (n = 27) regions. Baseline assessments included demographics, disease severity through the movement disorder society unified Parkinson's disease rating scale (MDS-UPDRS), and cognitive function using the Hindi mental state examination (HMSE). Patients were followed for 6 months to evaluate clinical progression.

At baseline, patients from fluoride-endemic areas had higher total MDS-UPDRS scores (68.2 ± 15.4 vs. 58.1 ± 14.3, P = 0.017), with significant differences in Part III motor scores (50.0 ± 10.4 vs. 42.5 ± 9.4, P = 0.008) and Part II activities of daily living (11.4 ± 4.0 vs. 9.4 ± 3.2, P = 0.05). During follow-up, the endemic group showed greater worsening in total MDS-UPDRS scores (4.0 ± 3.2 vs. 2.2 ± 3.0, P = 0.08) and a significant increase in nonmotor symptoms (Part I) compared to the nonendemic group (0.14 ± 0.36 vs. -0.40 ± 0.20, P = 0.036). Cognitive decline did not differ significantly.

Chronic fluoride exposure is associated with increased disease severity and may accelerate short-term progression in IPD. These findings highlight the potential role of environmental neurotoxins as modifiable factors influencing PD outcomes and underscore the need for targeted public health interventions in fluoride-endemic regions.