Parkinsonism and Parkinson’s Disease in the Elderly: A Community-Based Survey in Brazil (the Bambuı ´ Study) Maira Tonidandel Barbosa, MD, PhD, 1 Paulo Caramelli, MD, PhD, 1 De ´bora Palma Maia, MD, 2 Mauro Ce ´sar Quinta ˜o Cunningham, MD, 2 Henrique Leonardo Guerra, MD, PhD, 3 Maria Fernanda Lima-Costa, MD, PhD, 2,3 and Francisco Cardoso, MD, PhD 2 * 1 Sa ˜o Paulo University School of Medicine, Sa ˜o Paulo, Brazil 2 Federal University of Minas Gerais Medical School, Belo Horizonte, Brazil 3 Oswaldo Cruz Foundation Rene ´ Rachou Research Center, Belo Horizonte, Brazil Abstract: Several community-based surveys on the prevalence of Parkinsonism and Parkinson’s disease have been conducted worldwide, with variations on their methodology and results. The objective of this study is to assess the prevalence of Parkinsonism and its causes in a cohort of individuals age 64 years or older in Bambuı ´, a Brazilian town. In phase I, 1,186 people older than 64 years responded to a 9-question screening questionnaire for Parkinsonism. In phase II, all subjects who scored  2 points on the test were examined independently by at least 2 movement disorder-trained physicians. A movement disorder senior specialist excluded or confirmed the diagnosis in all suspected cases. The response rate was high for both phases (96% for phase I and 94% for phase II). The prevalence rate per 100 population over 64 years of age in this group was 7.2% for Parkinsonism of all types (n = 86). The most frequent causes were idiopathic Parkinson’s disease and drug-induced Parkinsonism, with prevalence rates of 3.3% (n = 39) and 2.7% (n = 32), respectively. The prevalence of vascular Parkinson- ism was 1.1% (n = 13). We found 1 case of posttraumatic Parkinsonism and another with multiple system atrophy. In this first population-based study of Parkinsonism conducted in Bra- zil, the prevalence in a cohort of elderly subjects was higher than the observed in other populations worldwide, especially because of the high rates of drug-induced and vascular Parkin- sonism. The prevalence of Parkinson’s disease was similar to that observed in elderly people in door-to-door surveys in other American, European, and Eastern countries. © 2006 Movement Disorder Society Key words: epidemiology; Parkinsonism; Parkinson’s dis- ease; drug-induced Parkinsonism; vascular Parkinsonism Parkinsonism is one of the most prevalent chronic neurological syndromes in the elderly, and it constitutes the second most frequent type of movement disorders in this group, after essential tremor. 1,2 Over the past 2 decades, several investigations of the prevalence of Par- kinsonism, Parkinson’s disease (PD), and their specific age distributions among different populations have been carried out. 3–7 PD is usually the most commonly identified cause of Parkinsonism, with prevalence estimates reported from various studies and different populations ranging from 50 to 260 cases per 100,000 persons in the general population. The prevalence of PD in the population over 60 years of age has been reported as approximately 1.6%, with little variation between different European countries, 7–13 and more variable in other American and Eastern countries. 14 –18 It increases sharply with age, and most surveys show a slight male preponderance. 6 Com- parison of the results of prevalence surveys carried out to date is difficult, owing to methodological differences in case-finding, diagnostic criteria and accuracy, the geo- graphical location, and the age-distribution of popula- tions. 6,7,19 –21 There may be ethnic variations, the preva- lence being lower in Blacks, Japanese, and Asians. 18,22–30 The previously observed differences in prevalence rates could be the result of genetic and environmental factors, as well as of ethnic-based differences, which have been widely investigated. The ethnic differences in the genetic *Correspondence to: Dr. Francisco Cardoso, Neurology Service– UFMG, Av Pasteur 89/1107, 30150-290 Belo Horizonte, MG, Brazil. E-mail: cardosofe@terra.com.br Received 23 May 2005; Revised 23 August 2005; Accepted 9 September 2005 Published online 15 February 2006 in Wiley InterScience (www. interscience.wiley.com). DOI: 10.1002/mds.20806 Movement Disorders Vol. 21, No. 6, 2006, pp. 800 – 808 © 2006 Movement Disorder Society 800