{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T17:21:36Z","timestamp":1787764896855,"version":"build-2784847793"},"reference-count":16,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>Environmental factors may influence Parkinson\u2019s 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods:<\/jats:title>\n                    <jats:p>\n                      A prospective observational study enrolled 52 IPD patients from fluoride-endemic (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 25) and nonendemic (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 27) regions. Baseline assessments included demographics, disease severity through the movement disorder society unified Parkinson\u2019s 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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      At baseline, patients from fluoride-endemic areas had higher total MDS-UPDRS scores (68.2 \u00b1 15.4 vs. 58.1 \u00b1 14.3,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.017), with significant differences in Part III motor scores (50.0 \u00b1 10.4 vs. 42.5 \u00b1 9.4,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.008) and Part II activities of daily living (11.4 \u00b1 4.0 vs. 9.4 \u00b1 3.2,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.05). During follow-up, the endemic group showed greater worsening in total MDS-UPDRS scores (4.0 \u00b1 3.2 vs. 2.2 \u00b1 3.0,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.08) and a significant increase in nonmotor symptoms (Part I) compared to the nonendemic group (0.14 \u00b1 0.36 vs. \u22120.40 \u00b1 0.20,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.036). Cognitive decline did not differ significantly.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/ijabmr.ijabmr_402_25","type":"journal-article","created":{"date-parts":[[2026,2,21]],"date-time":"2026-02-21T06:00:15Z","timestamp":1771653615000},"page":"51-57","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Fluoride Exposure as a Possible Environmental Modifier of Idiopathic Parkinson\u2019s Disease: Insights from a Rural North Indian Cohort"],"prefix":"10.4103","volume":"16","author":[{"given":"Saubhagya Kumar","family":"Rout","sequence":"first","affiliation":[{"name":"Department of General Medicine, All India Institute of Medical Sciences, Raebareli, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashutosh Kumar","family":"Mishra","sequence":"additional","affiliation":[{"name":"Department of Neurology, All India Institute of Medical Sciences, Raebareli, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruchi","family":"Shukla","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, All India Institute of Medical Sciences, Raebareli, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Archana","family":"Verma","sequence":"additional","affiliation":[{"name":"Department of Neurology, All India Institute of Medical Sciences, Raebareli, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mukesh","family":"Shukla","sequence":"additional","affiliation":[{"name":"Department of Community Medicine, All India Institute of Medical Sciences, Raebareli, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anirudh","family":"Mukherjee","sequence":"additional","affiliation":[{"name":"Department of General Medicine, All India Institute of Medical Sciences, Raebareli, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koushik","family":"Biswas","sequence":"additional","affiliation":[{"name":"Department of Biochemistry, All India Institute of Medical Sciences, Raebareli, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,2,20]]},"reference":[{"key":"R1-20260420","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1016\/S1474-4422(18)30499-X","article-title":"Global, regional, and national burden of neurological disorders, 1990\u20132016: A systematic analysis for the Global Burden of Disease Study 2016","volume":"18","year":"2019","journal-title":"Lancet 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neurons","volume":"236","author":"Zhang","year":"2007","journal-title":"Toxicology"},{"key":"R14-20260420","doi-asserted-by":"crossref","first-page":"422","DOI":"10.3390\/biom10030422","article-title":"Chronic exposure to fluoride affects GSH level and NOX4 expression in rat model of this element of neurotoxicity","volume":"10","author":"Dec","year":"2020","journal-title":"Biomolecules"},{"key":"R15-20260420","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1186\/s13195-019-0490-3","article-title":"Exposure to fluoride aggravates the impairment in learning and memory and neuropathological lesions in mice carrying the APP\/PS1 double-transgenic mutation","volume":"11","author":"Cao","year":"2019","journal-title":"Alzheimers Res Ther"},{"key":"R16-20260420","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1001\/jamapediatrics.2024.5542","article-title":"Fluoride exposure and children\u2019s IQ scores: A systematic review and 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