The Clinical Effect of Annonaceae Fruit Consumption on Caribbean Parkinson′s Disease Severity

Annonaceae fruits such as soursop (Annona muricata) may worsen symptoms of Parkinson's disease (PD) in tropical regions. Here, we investigate whether PD is more severe in an Annonaceae-exposed compared with a nonexposed population. Motor and cognitive symptoms of two PD groups (Caribbean, N = 74; mainland France, N = 104) were compared after imputation, propensity matching, and multivariate adjustment according to age, disease duration, education, and dopaminergic therapy. Ninety-six percent of Caribbean (71/74) but none of interviewed mainland France (0/20) PD patients had been exposed to Annonaceae fruits. Caribbean PD patients exhibited more severe motor and cognitive symptoms than mainland France PD patients (Unified PD Rating Scale - 3 = 24.39 [± 14.06] vs. 18.50 [± 11.13], p < 0.001; Mattis Dementia Rating Scale = 127.21 [±14.30] vs. 130.80 [± 11.15], p = 0.005). Given the growing evidence supporting Annonaceae fruits toxicity, health policy makers should raise public awareness about the risks of such consumption. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03368300.