Did Grief Give Him Parkinson’s?

Jack Gernsheimer met my car at the bottom of the lane. He looked good this summery Sunday, rested and tan. The logo on his T-shirt was one he and his brother designed years ago, featuring the name of the town they grew up in, which at the time was celebrating its 150th birthday: “Bernville, Pennsylvania, 1851-2001.”

This is a beautiful part of the state, lush green farms in rolling countryside, the Blue Mountains vague in the distance. It’s Updike country; the town of Shillington memorialized in John Updike’s early short stories is less than half an hour away.

I had driven up to spend time with Jack, who has Parkinson’s disease, and his twin brother Jeff, who does not. Because they are identical twins with identical genomes, it may appear to be a mystery that only Jack is sick. Yet scientists have long known that genes alone cannot explain why some people get Parkinson’s and others don’t. While a handful of genetic mutations are linked to the disease, about 90 percent of cases of Parkinson’s are “sporadic,” meaning the disease does not run in the family. And twins, even identical twins, don’t usually get Parkinson’s in tandem. In one of the largest longitudinal twin studies of the disease, Swedish scientists reported in 2011 that of 542 pairs in which at least one twin had Parkinson’s, the majority were “discordant,” meaning that the second twin was unaffected. The discordance rate was higher for fraternal twins, who are no more alike genetically than any two siblings. But even identical twins had a discordance rate of 89 percent.

So if genes don’t explain most cases, how about the environment? Several environmental factors have been linked to Parkinson’s, which has been shown to occur at higher-than-expected rates in, for instance, people who were prisoners of war in World War II. There is also a higher rate in people who live on farms or who drink well water, probably because of exposure to certain pesticides.

But the environmental connection is precisely what makes Jack and Jeff so interesting. For almost all of their 68 years, they have lived no more than half a mile apart. They have been exposed to the same air, the same well water, the same dusty farm chores, the same pesticides. They built their homes a five-minute walk from each other, on two plots of their father’s 132-acre farm in eastern Pennsylvania. And since 1971 they have worked in the same office, their desks pushed together, at a graphic design firm they co-own. All this makes their particular discordancy tougher to explain.

The existence of a pair of twins with identical DNA and nearly identical environments in which only one is sick—that’s a researcher’s bonanza. Whatever difference can be untangled in the twins’ physiology probably relates directly to the disease and its origins. The genome can be held constant; environmental toxins and other exposures can be held constant; what remains, researchers are left