Parkinson disease phenotype in Ashkenazi jews with and without LRRK2 G2019S mutations

Roy N. Alcalay, Anat Mirelman, Rachel Saunders-Pullman, Ming X. Tang, Helen Mejia Santana, Deborah Raymond, Ernest Roos, Martha Orbe-Reilly, Tanya Gurevich, Anat Bar Shira, Mali Gana Weisz, Kira Yasinovsky, Maayan Zalis, Avner Thaler, Andres Deik, Matthew James Barrett, Jose Cabassa, Mark Groves, Ann L. Hunt, Naomi LubarrMarta San Luciano, Joan Miravite, Christina Palmese, Rivka Sachdev, Harini Sarva, Lawrence Severt, Vicki Shanker, Matthew Carrington Swan, Jeannie Soto-Valencia, Brooke Johannes, Robert Ortega, Stanley Fahn, Lucien Cote, Cheryl Waters, Pietro Mazzoni, Blair Ford, Elan Louis, Oren Levy, Llency Rosado, Diana Ruiz, Tsvyatko Dorovski, Michael Pauciulo, William Nichols, Avi Orr-Urtreger, Laurie Ozelius, Lorraine Clark, Nir Giladi, Susan Bressman, Karen S. Marder

Research output: Contribution to journalArticlepeer-review

113 Scopus citations


The phenotype of Parkinson's disease (PD) in patients with and without leucine-rich repeat kinase 2 (LRRK2) G2019S mutations reportedly is similar; however, large, uniformly evaluated series are lacking. The objective of this study was to characterize the clinical phenotype of Ashkenazi Jewish (AJ) PD carriers of the LRRK2 G2019S mutation. We studied 553 AJ PD patients, including 65 patients who were previously reported, from three sites (two in New York and one in Tel-Aviv). Glucocerebrosidase (GBA) mutation carriers were excluded. Evaluations included the Montreal Cognitive Assessment (MoCA), the Unified Parkinson's Disease Rating Scale (UPDRS), the Geriatric Depression Scale (GDS) and the Non-Motor Symptoms (NMS) questionnaire. Regression models were constructed to test the association between clinical and demographic features and LRRK2 status (outcome) in 488 newly recruited participants. LRRK2 G2019S carriers (n=97) and non-carriers (n=391) were similar in age and age at onset of PD. Carriers had longer disease duration (8.6 years vs. 6.1 years; P<0.001), were more likely to be women (51.5% vs. 37.9%; P=0.015), and more often reported first symptoms in the lower extremities (40.0% vs. 19.2%; P<0.001). In logistic models that were adjusted for age, disease duration, sex, education, and site, carriers were more likely to have lower extremity onset (P<0.001), postural instability and gait difficulty (PIGD) (P=0.043), and a persistent levodopa response for >5 years (P=0.042). Performance on the UPDRS, MoCA, GDS, and NMS did not differ by mutation status. PD in AJ LRRK2 G2019S mutation carriers is similar to idiopathic PD but is characterized by more frequent lower extremity involvement at onset and PIGD without the associated cognitive impairment.

Original languageEnglish (US)
Pages (from-to)1966-1971
Number of pages6
JournalMovement Disorders
Issue number14
StatePublished - Dec 2013
Externally publishedYes


  • Genetics
  • LRRK2
  • Parkinson
  • Postural instability and gait difficulty

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology


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