Skip to main content
Download PDF

Parkinson’s disease in China: a forty-year growing track of bedside work

Translational Neurodegeneration volume 8, Article number: 22 (2019) Cite this article

Abstract

The number and health burden of Parkinson’s disease increase rapidly in China. It is estimated that China will have nearly half of the Parkinson’s disease population in the world in 2030. In this review, we present an overview of epidemiology and health economics status of Parkinson’s disease across China and discuss the risk factors of Parkinson’s disease and related complications. From the view of clinical research, we also discuss the current status of clinical trials, diagnostic biomarkers, treatment of Parkinson’s disease, tertiary network and post-occupation education in Chinese Parkinson’s disease clinics.

Background

China, a multiethnic developing country with the largest population of the world, is stepping into an aging era [1]. It is estimated that nearly 23.9–26.9% of the population will be over 65 years old in 2050, due to a surge of aging population [2]. As the result, the population of neurodegenerative disease will increase as along and probably bring a huge burden to Chinese economics and healthcare system [3]. It is estimated that by 2030, Chinese Parkinson’s disease (PD) patients will increase to 4.94 million, accounting for a half of the worldwide PD patients [4].

Since 1978, the year of “reform and opening”, economy has boomed in China. The researches in PD have also developed rapidly both in clinical and basic science, with the number of publications increasing from zero to the second largest country in the world. (Fig. 1) Chinese government has paid more and more attention to PD. For example, severe PD insurance has been covered by major disease insurance from Chinese government insurance system since 2007 [5]. Thanks to this policy, the economic burden of families with PD patients has been relieved significantly. For mild or moderate PD, diagnosis and treatment processes has been standardized in PD specialist training and costs of PD patients has been reduced since 2016 [6,7,8].

Fig. 1
figure 1

Publications related with Parkinson’s disease. Publications related to Parkinson’s disease since January 1, 1978 to November 1, 2018 listed on PubMed with the medical subject heading “Parkinson’s disease” and country in “all fields”

Full size image

In this review, we discuss several facts of PD in China, including prevalence, incidence, mortality and risk factors, and health economics. We also discuss the status of clinical PD research in the recent 40 years, aiming to improve the future work of PD in China.

Epidemiological study

Prevalence, incidence, mortality

Many PD prevalence studies have been performed in China, covering 9 provinces [9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27] (Fig. 2, Additional file 1: Table S1). The average prevalence of PD in China was about 3.8756‰ (≥50 years) in Han population. The prevalence was 1.234% in Uygur ethnicity [18, 22, 28], 1.208% in Kazak, and 1.224% in Hui ethnicity respectively [22]. In veterans over 60 years old, prevalence of PD increased to a much higher figure of 2.237%, which was much higher than 4.048‰ (≥60 years) [29,30,31]. However, only one incidence study was performed in China, which is in the Ilan county of Taiwan. In this study, the incidence was 10.4 per 100, 000, 11.1 per 100,000 in men and 9.8 per 100,000 in women [12].

Fig. 2
figure 2

Statistic map of prevalence in China. Statistic map of prevalence in China. Darker color indicated higher prevalence of PD

Full size image

PD mortality study in China is rare. In Ilan county of Taiwan, 5-year cumulative survival rate was 78.85%. [12] In a Shanghai PD cohort, the 5-year and 10-year standardized mortality ratio (SMR) was 0.62 and 0.87 respectively [32, 33]. In Hong Kong, the 10-year SMR was 1.1 [34]. In addition, it was found that older age at onset and postural instability gait disorder (PIGD) type had a negative impact of survival of Chinese PD patients [33, 34]. It is a remarkable fact that most of these researches are in Han ethnicity which accounts for 91.60% of population in mainland China (6th Nationwide census, National Bureau of Statistics) [35]. The rest 55 minor ethnicities are scattered in different areas and not covered in current epidemiological studies.

Several prevalence studies focused on motor and non-motor complications of PD. A multi-center survey of 28 movement disorders clinics in tertiary hospitals investigated PD patients on levodopa treatment and reported that the prevalence of wearing-off phenomenon and dyskinesia was 46.5 and 10.3% respectively [36]. Another single center study reported that the prevalence of wearing-off phenomenon were only 29.0% (≤ 1 year), 33.5% (1–2.5 years), 50.2% (2.5–5 years), 60.3% (5–10 years) and 68.3% (≥ 10 years), respectively. For dyskinesia, disease duration related prevalence was 3.1, 5.5, 13.1, 12.8 and 19.3% respectively. Overall, 70.8% PD patients suffered non-motor symptoms [37]. The prevalence of depression and anxiety in PD patients were 11.17–21.7% and 25.81–33.3% respectively [38, 39]. For visual hallucinations, the prevalence was about 19.4% [40]. In patients with visual hallucinations, 26.4% of them experienced minor hallucinations, and the rest of them had complex visual hallucinations. The presence of visual hallucinations was associated with longer disease duration, dopaminergic agonist usage, poor sleep quality and cognitive dysfunction [40]. For cognitive dysfunction, 21.4% of PD patients met the criteria for PD dementia, and 22.8% met the criteria for PD--mild cognitive impairment [41]. About 54.10% of PD patients suffered from constipation, and 47.59% of them reported constipation before onset of the motor symptoms [42]. A cross-sectional survey in Chinese PD patients in Hoehn-Yahr stage I-III revealed that 29.9% patients suffered from PD-related pain, associated with dyskinesias, and/or depression [43]. Screened by interview according to the criteria of international restless legs syndrome study group, the prevalence of restless legs syndrome in PD was 10.7% [44].

Health economics, costs

In the year of 2004–2005, the overall mean annual cost of PD in Shanghai was 925 USD, and the direct medical care cost was 519 USD (56.1%) [45]. In the year of 2015, the overall mean annual cost of PD increased to 3,225.94 USD, and the direct medical care cost was 1,737.93 USD (53.9%) in Tianjin [46]. However, The percentage of overall mean annual cost of PD in GDP per capita was only increased slightly (2004: 16.21%; 2015: 17.46%). Sourcing from China Entrepreneur Investment Club (CEIC, https://www.ceicdata.com/en), a database of macroeconomics, the gross domestic product (GDP) per capita in Shanghai in 2004 was 5,708.00 USD (47,244 RMB, 1 USD = 8.2768 RMB) and GDP per capita in Tianjin in 2015 was 18,472.32 USD (115,053 RMB, 1USD = 6.2284 RMB). Many anti-PD drugs have been covered in the government health insurance, and deep brain stimulation (DBS) has been covered partly in a few cities recently.

Risk factors

Common risk factors have been found, such as rapid eye movement sleep behavior disorder (RBD), olfactory dysfunction, constipation, family history of PD and pesticide exposure [47]. In addition, regular tea drinking habit and smoking were protective factors of PD [48].

Several studies focused on risk factors for motor and non-motor complications of PD. Young age of onset, severe depressive symptoms, female, RBD, autonomic dysfunction and muscle cramps were risk factors of anxiety in PD patients [49]. Tumor history, currently single marital status, severe motor dysfunction, dyskinesia, poor sleep quality, anxiety, AA genotype of rs1545843 and AC genotype of rs78162420 were risk factors of depression in PD patients [38, 50]. Long duration of PD and levodopa treatment, high daily levodopa dosage and high scores in the 39-item PD Questionnaire were risk factors of dyskinesia and motor fluctuations [51]. Patient without psychiatric symptoms, younger age and more education were shown less cognitive impairment [41].

Clinical research

The number of PD scientific publications is being a steady increased in China (Fig. 1), exceeding over other countries except for the United States. However, poor quality might come along with the growing amount of publications.

Clinical trials

According to ClinicalTrials.gov, there are 110 studies in China registered on this website, 56 of them in mainland, 2 in Hong Kong and 52 studies in Taiwan. Due to historical reasons, the development of clinical trials are uneven among mainland China, Hong Kong, Macau, and Taiwan. The number of clinical trials that we took part in was much less than that in developed countries, such as United States, Canada, United Kingdom and Japan. ClinicalTrials.gov is not widely used in mainland China. With the socioeconomic and medical care developments in past 40 years, clinical trials in China have been paid more attention than before. More and more Chinese hospitals have been invited to participate high-quality international multicentral clinical trials (Table 1, Additional file 1: Table S2).

Table 1 Number of clinical trials and publications in progress for Parkinson’s disease
Full size table

Clinical research

Diagnostic biomarkers

Diagnostic biomarker study is an important part in clinical PD research. Genetic associations of single nucleotide polymorphisms (SNPs) in Chinese Han population were identified and replicated quickly. However, how these genetic risk loci contribute to the adult-onset PD pathogenesis remains largely unknown. In Table 2, odds ratios of confirmed genes were depicted (Table 2, Additional file 1: Data S3). Genetic techniques, such as Next-Generation Sequencing (NGS), genetic testing, which could pinpoint the culprit gene, have been put into use to assist the diagnosis of juvenile parkinsonism.

Table 2 Risk variants validated in Parkinson’s disease in Chinese population
Full size table

The regulations of several non-coding RNAs, such as down-regulation of miR-15b, up-regulation of miR-24, have been validated as biomarkers of PD [52,53,54,55,56,57]. Besides non-coding RNAs, α-synuclein oligomer level in erythrocytes, P2Y6R mRNA level in peripheral blood mononuclear cells and several epigenetic changes (e.g. NPAS2 hypomethylation) were also confirmed as diagnostic biomarkers in Chinese population [58,59,60]. In other body fluids, potential biomarkers for making a diagnosis or monitoring disease progression were also found. In cerebrospinal fluid, exosomal miRNAs were found valuable for making a diagnosis of PD, such as miR-1, miR-153, miR-409-3p, miR-19b-3p, and miR-10a-5p or the combination of miR-153 and miR-409-3p [61]. Salivary DJ-1 was proven as a potential biomarker for monitoring disease progression [62].

Besides rapid eye movement sleep behavior disorder, constipation and hyposmia, clinical biomarkers are paid attention by Chinese neurologists. Radiological methods, such as 99mTc-TRODAT-1 single photon emission computed tomography (SPECT) [63], 18F-fluorodeoxyglucose positron emission tomography imaging (18F-FDG-PET) [64], functional magnetic resonance imaging [65] and Iodine-123-meta-iodobenzylguanidine (131I-MIBG) [66] have been put into use. The combinations of several biomarkers in PD have been set up, such as the combination of ‘swallow-tail’ sign and putaminal hypointensity [67]. Transcranial sonography (TCS), a non-invasive method of diagnostic test for its high positive predictive value, has been used into assisting clinical diagnosis [68].

However, the validation, sensitivity and specificity of these biomarkers among different ethnicities and the combination of these biomarkers are warranted. Biomarkers in prodromal stage are needed, as well as a nationwide multi-center Chinese prodromal PD cohort.

Treatments

Drug therapy

Most drugs for PD are available except for apomorphine and Levodopa-carbidopa intestinal gel, inhalation form of L-dopa, droxydopa, pimavanserin, safinamide, extended release amantadine in mainland China. The Chinese PD and Movement Disorders Society (CMDS) published guidelines of PD and PDD treatment in 2006, and updated in 2009 and 2014 [69,70,71]. Treatment concepts from CMDS are different compared to other guidelines. Firstly, high-risk population screened by prodromal PD biomarkers is recommended to non-drug therapy first, aiming for possible delaying the disease progression. Secondly, combined therapy is highly recommended, such as drug and non-drug therapies (exercise, rehabilitation, surgery and psychotherapy etc.), aiming to improve motor symptoms and non-motor symptoms simultaneously and probably delay the progress of PD to some degree. Thirdly, as for drug therapy, compared to treatment concepts of “full and rapid dose” in western countries, combination of multiple drugs with minimal dosage to achieve optimal clinical effect is widely accepted, which might explain the reason why the prevalence of short-term and long-term complications is much lower than western countries, as well as the prevalence of dyskinesia (China, 6.2%; US, 27.8%) [72, 73]. This treatment regimen is also reported with less side-effect and better tolerance. For example, severity of motor and non-motor PD complications was milder than patients in western countries [72].

Surgical treatment

In 1950s, stereotactic surgeries such as posteroventral pallidotomy (PVP) and unilateral subthalamotomy were adopted in clinical treatment of PD. However, they were abandoned because of severe adverse effects since 1968, the year of levodopa introduction in China [74]. With the development of medical imaging and technique of micro-electronode records, and the complications of long-term dopaminergic medication, stereotactic surgery was back to the stage in 1980s [75]. Due to loose management of indications and contraindications of stereotactic surgery, especially the use of bilateral stereotactic surgery, new severe adverse effects emerged, which taught us a lesson of the importance for the control of indications and contraindications. DBS was put into use since the beginning of twenty-first century. Expert consensus for DBS and programming brought up by CMDS has been established and put into use to regulate the use of DBS from pre-surgery to post-surgery. In several hospitals, multidisciplinary collaboration has been performed for DBS treatment, such as department of neurology, department of functional neurosurgery and department of rehabilitation. However, high cost of DBS implantation and unable to improve all symptoms restrict the wide use of DBS. Now, the focused ultrasound therapy has just been introduced for PD.

Traditional Chinese medicine

In traditional Chinese medicine (TCM), PD can be categorized into three syndromes based on the main symptoms. Most tremorous PD belongs to “tremor syndrome”. [76]. Treatment to these syndromes are different in TCM. For motor fluctuations, Yanggan Xifeng recipe could provide the synergistic effect along with levodopa and reduce the side effect of levodopa [77]. Zishenpingchan granules could alleviate motor symptoms and side effects of dopaminergic agents [78]. The striatal TH activity and expression of TH mRNA were significantly higher in PD rat models who received levodopa accompanied with Bushen Yanggan recipe than PD rat models who just received levodopa treatment [79]. Besides recipes, acupuncture and massage are two complementary ways to alleviate PD symptoms. The seven acupoints of the cranial base (SACB) can alleviate rigidity [80]. Acupoint massage can alleviate constipation and sleep dysfunction [81, 82].

Rehabilitation

Rehabilitation is considered as a complementary therapy in PD. It can improve the functional abilities and decrease complications. Physical therapy, occupational therapy and speech therapy are major parts of rehabilitation. Traditional Chinese activities, such as Qigong, Tai Chi and Baduanjin, have been drawn attention because of their benefits, probably due to rehabilitation effect. Tai Chi could improve motor function, balance and gait in PD [83]. Blood HIP2 mRNA, a biomarker for PD, could be reversed after Tai Chi training [84]. Baduanjin improved the gait performance, functional mobility, sleep quality and prevented falls [85, 86]. Rhythmic auditory stimulation with visual stimuli to PD were effective to Chinese population [87]. There are several classes of Tai Chi or dancing for PD in China. Recently, several multi-center cohorts on traditional Chinese rehabilitation were established in different cities.

Clinical work

Clinical diagnosis

A survey conducted in Shanghai revealed that the median time from the onset of motor symptom to the first clinical visit was 1.0 month (0–51.5 months) [88]. The median time from the onset of motor symptom to the clinical diagnosis was 10.0 months (0.5–118.0 months). The median time from the onset of motor symptom to the treatment of dopaminergic drugs was 12.00 months (0.5–146.0 months). The misdiagnosis rate was 23.53%. The onset motor symptom was tremor, rigidity, bradykinesia and gait abnormalities sequentially. PD patients with the onset of rigidity or gait abnormalities were more easily misdiagnosed (misdiagnosis rate: 34.78, 35.71%, respectively). As for the retired elderly, the time from the onset of motor symptom to the clinical diagnosis was shorter compared to people who were at work. Compared to UK, the median time from the onset of motor symptom to clinical visit was shorter (UK: 11 months) [89]. Different health management and healthcare system may contribute to this difference.

A study aiming to compare UK-Criteria versus MDS-PD Criteria in the clinical diagnosis of Parkinson disease in a single center was conducted [90]. In this study, 66 subjects (66%) were diagnosed as PD according to the UK-Criteria and 81 subjects (81%) according the MDS-PD Criteria from 100 subjects with parkinsonism, showing higher sensitivity of MDS-PD Criteria. The differences between the diagnostic results of these two criteria were statistically significant tested by paired Chi-square test. Besides, it was found that levodopa-induced dyskinesia had a good positive predictive value, while early bulbar impairment and inspiratory dysfunction had a negative predictive value. However, this study did not evaluate the diagnostic value of olfactory test, TCS, MIBG and DAT-PET due to high missing data of these tests.

Patient education and education of PD in general

Like other chronic diseases such as diabetes, hypertension and cerebral vascular disease, it is important to educate physicians and patients for PD management. Health education is an effective way for local physician and patients to acquire knowledge of PD, which could improve the early diagnosis and management of PD [91]. Tan et al. performed a study on awareness status of PD among elderly veterans in Beijing. In this study, 80.3% subjects heard the name of PD. As for the prevention knowledge, the awareness rate was 62.1%. In those veterans with prevention knowledge of PD, 52.7% of them learned from media, 72.1% of them learned from word of mouth, and only 11.8% learned from health care professionals [92]. Thanks to communication tools through smartphone, such as Weibo and WeChat, it is much easier to perform patient education. Personal health education and health education to caregivers are effective and need more attention [93, 94].

Palliative care has a late start in China. There is no currently available palliative care for PD in China. Caregivers often regard palliative care as hospice care [95]. Besides, there are limited amount of hospitals providing palliative care. Effective palliative care for PD patients can reduce burden of caregivers and medicals. Palliative care methods, such as support to caregivers and multidisciplinary approach, are warranted [95]. To increase the awareness of palliative care for PD, it is warranted to encourage the medical education of palliative care to patients and caregivers.

Tertiary network of China

The health system of China, i.e. the tertiary network, is different from the health system of western countries. The primary hospitals, which are mainly located in communities, are for prevention, diagnosis and treatment of common illness. The secondary hospitals serve for several communities and are in charge of teaching and researching. The tertiary hospitals are for the diagnosis and treatment of difficult cases and are in charge of teaching and researching. As patients are self-referred in Chinese health system and there is an inequivalent development between the gross economic growth and the service of hospitals, patients prefer to choose tertiary hospitals for the first clinical visit rather than primary or secondary hospitals. Dual referral system of this network is not well developed. Experienced neurologists are overworked in tertiary hospitals [96]. In contrast with that, doctors in primary hospitals have less chance to deal with the first clinical visit of patients, and neither do in secondary hospitals. Compared to specialists, general practitioners usually see PD patients earlier. They should recognize the symptoms of PD and refer them to PD specialists for confirming diagnosis. Actually, health education and follow-up to PD patients could be easily done in communities [97]. It is warranted to train more experienced family doctors in primary and secondary hospitals, and follow the dual referral system in tertiary network. Health document of PD patient information needs to be shared in all tertiary networks.

PD clinics

Clinics to specific diseases have been set up to help the patients see specialists. The first PD clinics, started in seven hospitals in China, including Beijing Hospital, Ruijin Hospital and other 5 hospitals in 1978. Later, the Chinese Movement Disorder Study Group was established. Specialists in PD clinics are experienced doctors in the PD diagnosis and treatment. Besides, it is much easier to perform health education to PD patients and caregivers in the PD clinics. Clinics of neuromodulation and neurorehabilitation were set up recently. In April 2007, club of PD patients were organized by Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine, for the purpose of better education and management [98].

Wearable devices improved the quality of PD patients’ life and helped PD diagnosis to some extent. Researches on wearable devices in China have just started. In PD clinics, more and more wearable devices could be applied. PD-Monitor applied with evolutionary algorithm could differentiate early stage PD patients with normality [99]. Spoons to help people with tremor eat food have been on the market. Visual aiding devices have been applied into use to prevent the freezing of gait in PD.

Post-occupation education

Team of PD and movement disorders, Chinese Society of Neurology

The Chinese PD and Movement Disorders Society was established in 2002, which is affiliated to Chinese Medical Association (CMA). The diagnostic criteria and therapeutic guidelines of PD have been published by this society, including Chinese diagnostic criteria of PD [100], guideline of PD treatment in China [69, 70], diagnosis and treatment of PD dementia [101], Chinese consensus of diagnosis and treatment of vascular parkinsonism [102], Chinese diagnostic and treatment guideline of PD depression, anxiety and psychosis [103], Chinese expert consensus on clinical database construction of PD and movement disorders [104], Chinese expert consensus on DBS and programming of DBS of PD [105, 106], and Chinese expert consensus document on the therapeutic uses of botulinum toxin [107]. These guidelines are useful to guide clinical diagnosis and treatment of PD in China.

Post-occupation educational class and online training

Besides adaptive reading literatures, guidelines and expert consensus, many meetings and post-occupation educational classes were organized every year to update the knowledge of PD. There are 3 meetings related to PD held by national association, i.e. annual conference of the CMDS, annual conference of Chinese Neurology Society, annual conference of Chinese Neurologist Association [108, 109]. Senior movement disorder specialists share the update of PD and experience of PD on these conferences.

There are only about 150 board-certified movement disorder specialists in CMDS currently among nearly 100,000 neurologists in China. Thanks to the development of Internet, online learning courses have been a common way for practitioners who do not have enough grant for attending the meetings. The biggest medical forum, Dingxiangyuan, provides a lot of open online courses for PD. Mobile learning via applications such as WeChat has been introduced recently and soon becomes popular among doctors.

Conclusions and recommendations

Since 1978, the development of clinical research and bedside work of PD in China is fascinating. The amount of publications increases from zero to the second place in the world. The bedside work develops from personal experience to standardized diagnosis and treatment. By 2030, there will be a half of worldwide PD patients in China. There are more and more doctors paying attention to PD. Clinical researches provide important data for amending health policies of PD, such as cost for DBS could be reimbursed in health insurance for PD. However, several problems remain to be solved. Huge burden of tertiary hospital doctors, lack of experienced doctors in primary and secondary hospitals in PD, and the lack of dual referral system in tertiary network are the current major issues. Lack of standardized PD database is another issue. Chinese expert consensus on clinical database construction of PD and movement disorders brought up by CMDS has been published recently to standardize the construction on clinical database [104]. Due to uneven disease education level of PD, visiting rate and treatment rate are low and imbalanced among different areas. High quality clinical research articles are few currently. Noted, most articles are focused in Han ethnicity. The 55 minor ethnicities are seldomly covered in most researches. There are slightly different beliefs and lifestyles of these minor ethnicities. But few researches focused on minor ethnicities. More researches focused on PD in minor ethnicities are warranted.

Availability of data and materials

The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

CEIC:

China entrepreneur Investment Club

CMA:

Chinese Medical Association

CMDS:

Chinese Parkinson’s disease and Movement Disorders Society

DBS:

Deep brain stimulation

FDG:

Fluorodeoxyglucose

GDP:

Gross domestic product

MDS:

Movement disorders society

MIBG:

Meta-iodobenzylguanidine

NGS:

Next-generation sequencing

NHC:

National Health Commission

PD:

Parkinson’s disease

PET:

Positron emission tomography

PIGD:

Postural instability gait disorder

PVP:

Posteroventral pallidotomy

RBD:

Rapid eye movement sleep behavior disorder

SACB:

Seven acupoints of the cranial base

SMR:

Standardized mortality ratio

SNP:

Single nucleotide polymorphisms

SPECT:

Single photon emission computed tomography

TCM:

Traditional Chinese medicine

TCS:

Transcranial sonography

UK:

United Kingdom

References

  1. CIA. The World Factbook. 2018; Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/ch.html.

    Google Scholar 

  2. Zeng Y. Towards deeper research and better policy for healthy aging --using the unique data of Chinese longitudinal healthy longevity survey. China Economic J. 2012;5(2–3):131–49.

    Article  PubMed  Google Scholar 

  3. Fan L, et al. Breast cancer in China. Lancet Oncol. 2014;15(7):e279–89.

    Article  PubMed  Google Scholar 

  4. Dorsey ER, et al. Projected number of people with Parkinson disease in the most populous nations, 2005 through 2030. Neurology. 2007;68(5):384–6.

    Article  CAS  PubMed  Google Scholar 

  5. CIRC. Major disease insurance in China. 2019; Available from: http://bxjg.circ.gov.cn/web/site47/tab4386/info196985.html.

    Google Scholar 

  6. National Health Commission of the People’s Republic of China. Notice of the National Health and Family Planning Commission Office on the implementation of clinical pathways for 24 diseases such as Alzheimer’s disease. 2016; Available from: http://www.moh.gov.cn/yzygj/s3593/201604/efa3826fbde44dc789e4420c6c57daeb.shtml.

    Google Scholar 

  7. National Health Commission of the People’s Republic of China. Notice of the General Office of the National Health and Family Planning Commission on the Basic Standards and Recommended Standards for Medical Service Capabilities of County Hospitals. 2016; Available from: http://www.moh.gov.cn/yzygj/s3594q/201605/b2b3a61a9382473f92ff949fcb817912.shtml.

    Google Scholar 

  8. National Health Commission of the People’s Republic of China. Identification and management of standardized training base for general practitioners. 2012; Available from: http://www.moh.gov.cn/yzygj/s3590/201201/2f88fa6beb8e4198a32c29fac42a845f.shtml.

    Google Scholar 

  9. Wang SJ, et al. A door-to-door survey of Parkinson's disease in a Chinese population in Kinmen. Arch Neurol. 1996;53(1):66–71.

    Article  CAS  PubMed  Google Scholar 

  10. Wang SJ, et al. Parkinson's disease in kin-Hu, Kinmen: a community survey by neurologists. Neuroepidemiology. 1994;13(1–2):69–74.

    Article  CAS  PubMed  Google Scholar 

  11. Zhang ZX, et al. Prevalence of Parkinson’s disease and related disorders in the elderly population of greater Beijing, China. Mov Disord. 2003;18(7):764–72.

    Article  PubMed  Google Scholar 

  12. Chen RC, et al. Prevalence, incidence, and mortality of PD: a door-to-door survey in Ilan county, Taiwan. Neurology. 2001;57(9):1679–86.

    Article  CAS  PubMed  Google Scholar 

  13. Li SC, et al. A prevalence survey of Parkinson’s disease and other movement disorders in the People’s Republic of China. Arch Neurol. 1985;42(7):655–7.

    Article  CAS  PubMed  Google Scholar 

  14. Woo J, et al. Prevalence of Parkinson's disease in a Chinese population. Acta Neurol Scand. 2004;109(3):228–31.

    Article  CAS  PubMed  Google Scholar 

  15. Zhang L, et al. The prevalence of PD in a nutritionally deficient rural population in China. Acta Neurol Scand. 2005;112(1):29–35.

    Article  CAS  PubMed  Google Scholar 

  16. Zhang ZX, et al. Parkinson’s disease in China: prevalence in Beijing, Xian, and Shanghai. Lancet. 2005;365(9459):595–7.

    Article  PubMed  Google Scholar 

  17. Chen CC, et al. Different prevalence rates of Parkinson's disease in urban and rural areas: a population-based study in Taiwan. Neuroepidemiology. 2009;33(4):350–7.

    Article  PubMed  Google Scholar 

  18. Liu Y, et al. Investigation on prevalence rate of Parkinson’s disease in population aged 55 years old and above in Kashi, Xinjiang between 2008 and 2009. Chin J Neurol. 2010;43(12):863–5.

    Google Scholar 

  19. Yingxu M, et al. Analysis of related factors Parkinson's disease in Beihai of Guangxi area. J Brain Nerv Dis. 2018;8:503–6.

    Google Scholar 

  20. Mengqing S, et al. Analysis of the prevalence and risk factors for Parkinson's disease in middle-aged and elderly residents of aerospace center hospital adjacent communities. Neural Inj Funct Reconstr. 2017;1:28–31.

    Google Scholar 

  21. Yuxia C. Research on Parkinson's disease morbidity and Coorelation between treatment time and rehabilitation of elderly patients in Jiaxing. J Jiaxing Univ. 2007;3:90–2.

    Google Scholar 

  22. Jianlong Z, et al. Analysis of prevalence and related factors in different national Parkinson's disease in Yili of Xinjiang area. J Xinjiang Med Univ. 2013;3:273–7.

    Google Scholar 

  23. Guochuan Z, et al. A survey of prevalence of senile dementia and Parkinson's disease. J Clin Psychol Med. 2001;3:143–5.

    Google Scholar 

  24. Hongqing Y, et al. Study on the prevalence of Parkinson's disease and its relationship with metabolic syndrome among the elderly in Luoxing street Mawei District. Chin J Pract Nerv Dis. 2017;24:79–82.

    Google Scholar 

  25. Xiaorong G, et al. A cross-sectional study of Parkinson’s disease in northern Shanxi. Chin J Pract Nerv Dis. 2016;3:82–3.

    Google Scholar 

  26. Bin Z, et al. Prevalence of Parkinson's disease in Shanghai urban and rural area. J Brain Nerv Dis. 2001;6:330–2.

    Google Scholar 

  27. Luning W, et al. Study on the prevalence and relative factors of the Parkinson's disease in residents aged 35 years or older in Urumqi city. J Xinjiang Med Univ. 2013;3:278–281,286.

    Google Scholar 

  28. Yang XL, et al. Related factors and prevalence of Parkinson’s disease among Uygur residents in Hetian, Xinjiang Uygur autonomous region. Genet Mol Res. 2015;14(3):8539–46.

    Article  CAS  PubMed  Google Scholar 

  29. Wang LN, et al. A cross-sectional study of neurological disease in the veterans of military communities in Beijing. Zhonghua Nei Ke Za Zhi. 2010;49(6):463–8.

    PubMed  Google Scholar 

  30. Zou YM, et al. The prevalence of Parkinson’s disease continues to rise after 80 years of age: a cross-sectional study of Chinese veterans. Eur Rev Med Pharmacol Sci. 2014;18(24):3908–15.

    PubMed  Google Scholar 

  31. Baocheng Y, et al. Prevalence of Parkinson's disease in elderly veterans. China Healthc Innov. 2007;19:102–3.

    Google Scholar 

  32. Wang G, et al. Mortality from Parkinson’s disease in China: findings from a five-year follow up study in Shanghai. Can J Neurol Sci. 2015;42(4):242–7.

    Article  PubMed  Google Scholar 

  33. Zhang Y, et al. Mortality from Parkinson’s disease in China: findings from a ten-year follow up study in Shanghai. Parkinsonism Relat Disord. 2018;55:75–80.

    Article  PubMed  Google Scholar 

  34. Auyeung M, et al. Ten year survival and outcomes in a prospective cohort of new onset Chinese Parkinson's disease patients. J Neurol Neurosurg Psychiatry. 2012;83(6):607–11.

    Article  PubMed  Google Scholar 

  35. National Bureau of Statistics. Tabulation on the 2010 Population Census of the People's Republic of China. 2010; Available from: http://www.stats.gov.cn/tjsj/pcsj/rkpc/6rp/indexch.html.

    Google Scholar 

  36. Chen W, et al. Prevalence of wearing-off and dyskinesia among the patients with Parkinson’s disease on levodopa therapy: a multi-center registry survey in mainland China. Transl Neurodegener. 2014;3(1):26.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Zhang TM, et al. Nonmotor symptoms in patients with Parkinson disease: a cross-sectional observational study. Medicine (Baltimore). 2016;95(50):e5400.

    Article  Google Scholar 

  38. Cui SS, et al. Prevalence and risk factors for depression and anxiety in Chinese patients with Parkinson disease. BMC Geriatr. 2017;17(1):270.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Li R, et al. Prevalence and risk factors of Parkinson’s disease comorbid anxiety and depression. Henan Med Res. 2019;28(1):31–3.

    Google Scholar 

  40. Zhu J, et al. Prevalence and risk factors for visual hallucinations in Chinese patients with Parkinson's disease. J Neurol Sci. 2017;372:471–6.

    Article  PubMed  Google Scholar 

  41. Wang Q, et al. Assessment of cognitive impairment in patients with Parkinson's disease: prevalence and risk factors. Clin Interv Aging. 2014;9:275–81.

    PubMed  PubMed Central  Google Scholar 

  42. Gan J, et al. A survey of subjective constipation in Parkinson’s disease patients in shanghai and literature review. BMC Neurol. 2018;18(1):29.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  43. Wen HB, et al. Epidemiology and clinical phenomenology for Parkinson's disease with pain and fatigue. Parkinsonism Relat Disord. 2012;18(Suppl 1):S222–5.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Zhu XY, et al. Clinical characteristics of leg restlessness in Parkinson's disease compared with idiopathic restless legs syndrome. J Neurol Sci. 2015;357(1–2):109–14.

    Article  PubMed  Google Scholar 

  45. Wang G, et al. Economic burden of Parkinson's disease in a developing country: a retrospective cost analysis in Shanghai, China. Mov Disord. 2006;21(9):1439–43.

    Article  PubMed  Google Scholar 

  46. Yang JX, Chen L. Economic burden analysis of Parkinson's disease patients in China. Parkinsons Dis. 2017;2017:8762939.

    PubMed  PubMed Central  Google Scholar 

  47. Chan DK, et al. Genetic and environmental risk factors for Parkinson's disease in a Chinese population. J Neurol Neurosurg Psychiatry. 1998;65(5):781–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Li X, et al. Association between cigarette smoking and Parkinson's disease: a meta-analysis. Arch Gerontol Geriatr. 2015;61(3):510–6.

    Article  CAS  PubMed  Google Scholar 

  49. Chen YK, et al. Anxiety disorders in Chinese patients with Parkinson's disease. Int J Psychiatry Med. 2010;40(1):97–107.

    Article  PubMed  Google Scholar 

  50. Zheng J, et al. Association between gene polymorphism and depression in Parkinson's disease: a case-control study. J Neurol Sci. 2017;375:231–4.

    Article  CAS  PubMed  Google Scholar 

  51. Kum WF, et al. Risk factors in development of motor complications in Chinese patients with idiopathic Parkinson's disease. J Clin Neurosci. 2009;16(8):1034–7.

    Article  PubMed  Google Scholar 

  52. Chen S, et al. Circulating exosomal miRNAs as diagnostic biomarkers in Parkinson's disease. Eur Rev Med Pharmacol Sci. 2018;22(16):5278–83.

    Google Scholar 

  53. Ding H, et al. Identification of a panel of five serum miRNAs as a biomarker for Parkinson's disease. Parkinsonism Relat Disord. 2016;22:68–73.

    Article  PubMed  Google Scholar 

  54. Chen Y, et al. MicroRNA-4639 is a regulator of DJ-1 expression and a potential early diagnostic marker for Parkinson's disease. Front Aging Neurosci. 2017;9:232.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  55. Cao XY, et al. MicroRNA biomarkers of Parkinson's disease in serum exosome-like microvesicles. Neurosci Lett. 2017;644:94–9.

    Article  CAS  PubMed  Google Scholar 

  56. Dong H, et al. A panel of four decreased serum microRNAs as a novel biomarker for early Parkinson's disease. Biomarkers. 2016;21(2):129–37.

    Article  CAS  PubMed  Google Scholar 

  57. Ma W, et al. Serum miR-221 serves as a biomarker for Parkinson's disease. Cell Biochem Funct. 2016;34(7):511–5.

    Article  CAS  PubMed  Google Scholar 

  58. Wang X, et al. Detection of alpha-synuclein oligomers in red blood cells as a potential biomarker of Parkinson's disease. Neurosci Lett. 2015;599:115–9.

    Article  CAS  PubMed  Google Scholar 

  59. Yang X, et al. Microglia P2Y6 receptor is related to Parkinson's disease through neuroinflammatory process. J Neuroinflammation. 2017;14(1):38.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  60. Mao W, et al. Pyrosequencing analysis of methylation levels of clock genes in leukocytes from Parkinson’s disease patients. Neurosci Lett. 2018;668:115–9.

    Article  CAS  PubMed  Google Scholar 

  61. Gui Y, et al. Altered microRNA profiles in cerebrospinal fluid exosome in Parkinson disease and Alzheimer disease. Oncotarget. 2015;6(35):37043–53.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Kang WY, et al. Salivary DJ-1 could be an indicator of Parkinson's disease progression. Front Aging Neurosci. 2014;6:102.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  63. Geng Y, et al. Investigating the role of 99mTc-TRODAT-1 SPECT imaging in idiopathic Parkinson's disease. J Zhejiang Univ Sci B. 2005;6(1):22–7.

    Article  PubMed  CAS  Google Scholar 

  64. Jin R, et al. Validation of abnormal glucose metabolism associated with Parkinson's disease in Chinese participants based on 18F-fluorodeoxyglucose positron emission tomography imaging. Neuropsychiatr Dis Treat. 2018;14:1981–9.

    Article  PubMed  PubMed Central  Google Scholar 

  65. Zhang D, et al. Widespread increase of functional connectivity in Parkinson's disease with tremor: a resting-state FMRI study. Front Aging Neurosci. 2015;7:6.

    PubMed  PubMed Central  Google Scholar 

  66. Xu D, et al. Validation of Iodine-131-meta-iodobenzylguanidine cardiac scintigraphy in parkinsonism: a preliminary study. Parkinsonism Relat Disord. 2018;50:69–73.

    Article  PubMed  Google Scholar 

  67. Wang N, et al. Using ‘swallow-tail’ sign and putaminal hypointensity as biomarkers to distinguish multiple system atrophy from idiopathic Parkinson's disease: a susceptibility-weighted imaging study. Eur Radiol. 2017;27(8):3174–80.

    Article  PubMed  Google Scholar 

  68. Li DH, et al. Transcranial sonography of the substantia nigra and its correlation with DAT-SPECT in the diagnosis of Parkinson's disease. Parkinsonism Relat Disord. 2015;21(8):923–8.

    Article  PubMed  Google Scholar 

  69. CMA. China guideline of treatment Parkinson's disease (3rd edition). Chin J Neurol. 2014;6:428–33.

    Google Scholar 

  70. Chen S, et al. The recommendations of Chinese Parkinson's disease and movement disorder society consensus on therapeutic management of Parkinson's disease. Transl Neurodegener. 2016;5:12.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  71. CMDS. Guideline of treatment of Parkinson’s disease. Chin J Neurol. 2006;39(6):409–12.

    Google Scholar 

  72. Zhang ZX, et al. Chinese culture permeation in the treatment of Parkinson disease: a cross-sectional study in four regions of China. BMC Res Notes. 2014;7:65.

    Article  PubMed  PubMed Central  Google Scholar 

  73. Katzenschlager R, et al. Fourteen-year final report of the randomized PDRG-UK trial comparing three initial treatments in PD. Neurology. 2008;71(7):474–80.

    Article  CAS  PubMed  Google Scholar 

  74. Hu X, et al. The different ablative procedures for Parkinson's disease and their effects. Shanghai Med J. 2002;25(2):69–72.

    Google Scholar 

  75. Wu X, Cao X. Development and current situation of functional neurosurgery in treatment of Parkinson disease. Chin J Clin Med. 2017;24(6):839–44.

    Google Scholar 

  76. Wenming Y, et al. Clinical routes of traditional Chinese medicine of Parkinson's disease. Clin J Tradit Chin Med. 2012;24(11):1122–4.

    Google Scholar 

  77. Xiqun C, Dingfang C, zhen Z. Influence of Liver-Nourishing and wind-extinguishing formulas and drugs on rotating behavior in Parkinson rats. Acta Universitatis Traditionis Medicalis Sinensis Pharmacologiaeque Shanghai. 2001;15(2):41–3.

    Google Scholar 

  78. Ye Q, et al. Zishenpingchan granules for the treatment of Parkinson's disease: a randomized, double-blind, placebo-controlled clinical trial. Neural Regen Res. 2018;13(7):1269–75.

    Article  PubMed  PubMed Central  Google Scholar 

  79. Dingfang C, et al. Effect of Bushen Yanggan recipe on nigrostriatal function in parkinsonian model rats after long-term levodopa treatment. Zhongguo Zhong Xi Yi Jie He Za Zhi. 2002;22(1):43–6.

    Google Scholar 

  80. Feng C, et al. Clinical research of the seven Acupoints of the Cranial Base (SACB) treatment to 114 Parkinson's disease patients. Chin J Basic Med Tradit Chin Med. 2013;5:547–548,573.

    Google Scholar 

  81. Jingjing M, Wei W. Evaluation of massage and Yisanwuqi walking treatment to sleep disorders of Parkinson's disease. Chin J Pract Nurs. 2012;28(31):18–9.

    Google Scholar 

  82. Zhihong G, et al. Influence of massage of abdominal acupoints to functional constipation of Parkinson's disease. Nurs J Chin PLA. 2013;30(5):72–73,76.

    Google Scholar 

  83. Yang Y, et al. Tai chi for improvement of motor function, balance and gait in Parkinson's disease: a systematic review and meta-analysis. PLoS One. 2014;9(7):e102942.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  84. Su J, et al. Reduction of HIP2 expression causes motor function impairment and increased vulnerability to dopaminergic degeneration in Parkinson's disease models. Cell Death Dis. 2018;9(10):1020.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  85. Xiao CM, Zhuang YC. Effect of health Baduanjin qigong for mild to moderate Parkinson's disease. Geriatr Gerontol Int. 2016;16(8):911–9.

    Article  PubMed  Google Scholar 

  86. Xiao C, Zhuang Y, Kang Y. Effect of health qigong Baduanjin on fall prevention in individuals with Parkinson's disease. J Am Geriatr Soc. 2016;64(11):e227–8.

    Article  PubMed  Google Scholar 

  87. Song JH, et al. Rhythmic auditory stimulation with visual stimuli on motor and balance function of patients with Parkinson's disease. Eur Rev Med Pharmacol Sci. 2015;19(11):2001–7.

    PubMed  Google Scholar 

  88. Yingying Z, et al. Potential influencing factors of time from onset to clinical diagnosis and misdiagnosis rate of Parkinson's patients in Shanghai. Chin J Neurol. 2015;48(11):995–9.

    Google Scholar 

  89. Breen DP, et al. Determinants of delayed diagnosis in Parkinson’s disease. J Neurol. 2013;260(8):1978–81.

    Article  PubMed  Google Scholar 

  90. Li J, et al. MDS clinical diagnostic criteria for Parkinson's disease in China. J Neurol. 2017;264(3):476–81.

    Article  CAS  PubMed  Google Scholar 

  91. Jing X. The effect of health education in patients with Parkinson's disease. China Health Stand Manag. 2015;16:27–8.

    Google Scholar 

  92. Tan JP, et al. Awareness status of chronic disabling neurological diseases among elderly veterans. Chin Med J. 2015;128(10):1293–300.

    Article  PubMed  PubMed Central  Google Scholar 

  93. Ruiyun L. Effects of family synchronization health education on rehabilitation and quality of life in Parkinson disease patients. Chin J Mod Nurs. 2016;22(18):2625–9.

    Google Scholar 

  94. Cuiping W. Observation on personalized education to Parkinson's disease. Int J Nurs. 2011;30(1):108–10.

    Google Scholar 

  95. Ng JSC. Palliative care for Parkinson's disease. Ann Palliat Med. 2018;7(3):296–303.

    Article  PubMed  Google Scholar 

  96. Hu Y, Zhang Z. Skilled doctors in tertiary hospitals are already overworked in China. Lancet Glob Health. 2015;3(12):e737.

    Article  PubMed  Google Scholar 

  97. Mochang Q, Yihu F, Changhe C. Role of community physicians in early diagnosis of Parkinson's disease. Chin Gen Pract. 2014;27:3171–3173,3174.

    Google Scholar 

  98. Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine. Patients club of Parkinson's disease.; Available from: http://www.rjh.com.cn/pages/shenjingneike/ylxk/ylts/70475.shtml. Cited 2007 April

  99. Gao C, et al. Objective assessment of bradykinesia in Parkinson's disease using evolutionary algorithms: clinical validation. Transl Neurodegener. 2018;7:18.

    Article  PubMed  PubMed Central  Google Scholar 

  100. CMA. China Diagnostic criteria of Parkinson's disease (2016 Version). Chin J Neurol. 2016;49(4):268–71.

    Google Scholar 

  101. CMA. Guideline of diagnosis and treatment of Parkinson's disease dementia. Chin J Neurol. 2011;44(9):635–7.

    Google Scholar 

  102. CMA. Chinese experts consensus of diagnosis and treatment of vascular parkinsonism. Chin J Neurol. 2017;50(5):326–31.

    Google Scholar 

  103. CMA. Guideline of diagnosis and treatment of dementia, anxiety and psychosis of Parkinson's disease. Chin J Neurol. 2013;46(1):56–60.

    Google Scholar 

  104. CMA. Chinese expert consensus on clinical database construction of PD and movement disorders. Chin J Neurol. 2016;15(7):649–53.

    Google Scholar 

  105. Chinese Expert Group on Deep Brain Stimulation of Parkinson's Disease. Chinese expert consensus on deep brain stimulation of Parkinson's disease. Chin J Neurol. 2012;45(7):541–3.

    Google Scholar 

  106. Chinese Expert Group on Deep Brain Stimulation of Parkinson's Disease. Chinese expert consensus on programming of deep brain stimulation of Parkinson's disease. Chin J Neurosurg. 2016;32(12):1192–8.

    Google Scholar 

  107. CMA. Chinese expert consensus document on the therapeutic uses of botulinum toxin. Chin J Neurol. 2018;51(10):779–86.

    Google Scholar 

  108. Chinese Society of Neurology. Available from: http://www.cmancn.org.cn/.

  109. Chinese neurologist association. Available from: http://www.cnaweb.cn/.

Download references

Acknowledgements

This work was supported by grants from the National Natural Science Foundation of China [grant numbers 81430022, 91332107, 81371407]. We thank all researchers who contributed to Chinese PD research in this review.

Search strategy and selection criteria

We searched PubMed, the China National Knowledge Infrastructure database and Wanfang Database with the terms “Parkinson’s disease” and “China”. Articles published between January, 1978, and October, 2018, were included.

Funding

This work was supported by grants from the National Natural Science Foundation of China [grant numbers 81430022, 91332107, 81371407].

Author information

Author notes

  1. Gen Li and Jianfang Ma contributed equally to this work.

Authors and Affiliations

  1. Department of Neurology & Collaborative Innovation Center for Brain Science, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China

    Gen Li, Jianfang Ma, Shishuang Cui, Yixi He, Qin Xiao, Jun Liu & Shengdi Chen

  2. Co-innovation Center of Neuroregeneration, Nantong University, Jiangsu Province, China

    Shengdi Chen

Authors
  1. Gen Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jianfang Ma
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shishuang Cui
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yixi He
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Qin Xiao
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jun Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Shengdi Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

GL and JFM performed the statistical analysis and drafted the manuscript. SSC and YXH collected information of epidemiological studies. JL and QX revised the manuscript. SDC concepted this review, double-checked the statistical analysis and revised the manuscript. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Qin Xiao, Jun Liu or Shengdi Chen.

Ethics declarations

Ethics approval and consent to participate

This review does not involve the use of any animal or human data or tissue, or any individual person’s data. Ethics approval and consent for publication are not applicable.

Consent for publication

This review does not contain any individual person’s data in any form. Thus there is no need of consent for publication obtained from individual person, or legal guardian.

Competing interests

The authors declare that they have no competing interests.

Additional file

Additional file 1:

Table S1. Epidemiology of PD in China. Table S2. Status of Clinical Trials. Data S3. Meta analysis of genetic variants for Parkinson’s disease in Chinese population. (DOCX 38298 kb)

Rights and permissions

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Li, G., Ma, J., Cui, S. et al. Parkinson’s disease in China: a forty-year growing track of bedside work. Transl Neurodegener 8, 22 (2019). https://doi.org/10.1186/s40035-019-0162-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s40035-019-0162-z

Keywords

Translational Neurodegeneration

ISSN: 2047-9158

Contact us