Original Paper

Neuroepidemiology 2011;37:222–230 Received: April 29, 2011

Accepted: October 19, 2011
DOI: 10.1159/000334440
Published online: December 1, 2011

A National Registry to Determine the Distribution

and Prevalence of Parkinson’s Disease in Thailand:
Implications of Urbanization and Pesticides as
Risk Factors for Parkinson’s Disease
Roongroj Bhidayasiri a, e Natnipa Wannachai a Sudaratana Limpabandhu d
     

Supaporn Choeytim d Yolsilp Suchonwanich b Samart Tananyakul c Chanvit Tharathep d

       

Pornpet Panjapiyakul d Renu Srismith b Kanittha Chimabutra c Kammant Phanthumchinda a

       

Thanin Asawavichienjinda a  

on behalf of Thailand Parkinson’s Disease Registry Collaborative Network 

a
Chulalongkorn Center of Excellence for Parkinson’s Disease and Related Disorders, Faculty of Medicine,
 

Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, b National Health 

Security Office, and c Medical Service Department, Bangkok Metropolitan Administration, Bangkok , and d Bureau of
   

Health Administration, Ministry of Public Health, Nonthaburi, Thailand; e Department of Neurology, Geffen School
 

of Medicine at UCLA, Los Angeles, Calif., USA

Key Words
Parkinson’s disease ⴢ Parkinson’s disease registry ⴢ
Prevalence ⴢ Capture-recapture method
Abstract
Background: Parkinson’s disease (PD) occurs worldwide but
prior to this review of data from the Thailand Parkinson’s Dis-
ease Registry there had been no nationwide PD registry re-
ported globally. Objective: To determine the distribution
and prevalence of PD in Thailand and related risk factors in
order to more adequately develop and allocate prevention
and treatment resources where they are most needed and
to ascertain risk factors that are specific to the Thai popula-
tion. Design: The Thailand Parkinson’s Disease Registry is a
new resource, and data collection began in March 2008. Data
is collected by the Registry from physicians, and a mecha-
nism is also provided for patients to self-report. This data was
further analyzed by the capture-recapture methodology
(CRM) to assess reporting biases. Methods: The three main
sources of data input to the Registry, i.e. (1) public hospitals,
(2) private hospitals and (3) self-registration, require check-
ing for duplicates and also allow estimation of completeness
of recording (the degree of underreporting) in this disease
registry. There is underreporting because of poor record
keeping and administrative procedures in some facilities,
and there is an unknown number of persons with PD who are
not properly diagnosed because of inadequate facilities and
staffing in some areas. Since our data sources should be
overlapping in some way, and assuming that the likelihood
of being detected in one system is independent of the oth-
ers, we estimated these data sources’ actual coverage and
the expected total number of patients utilizing the ‘capture-
recapture’ statistical technique. Results: As of March 2011,
the Thailand PD Registry had identified 40,049 PD patients.
Employing log-linear modeling, the CRM analysis based on
the three data sets estimated underreporting of 20,516 cas-
es. The revised estimated total is thus 60,565 cases, resulting
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© 2011 S. Karger AG, Basel Roongroj Bhidayasiri, MD, FRCP, FRCPI

0251–5350/11/0374–0222$38.00/0 Chulalongkorn Center of Excellence for Parkinson’s Disease and Related Disorders
Fax +41 61 306 12 34 Division of Neurology, Chulalongkorn University Hospital
E-Mail karger@karger.ch Accessible online at: 1873 Rama 4 Road, Bangkok 10330 (Thailand)
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in a crude and age-adjusted prevalence of 95.34 and 424.57
PD cases/100,000 population, respectively. The prevalence
of PD was 126.83/100,000 in urban areas and 90.82/100,000
in rural areas (p ! 0.001). Preliminary regional comparisons
revealed a higher prevalence of PD in residents of the central
plain valley of Thailand, an area with a large amount of pes-
ticide use. Conclusions: The combination of a passive regis-
try and the CRM technique allowed us to derive population
prevalence estimates for PD in Thailand. Thai PD prevalence
estimates were similar to previous ones published for Asian
countries; in addition, they suggested that urbanization and
exposure to pesticides may both be risk factors for PD in the
Thai population. Copyright © 2011 S. Karger AG, Basel
Introduction
Although population growth rates are higher in Asia
than in any other region and half of the world’s aging
populations are living in Asia, there are only a limited
number of Parkinson’s disease (PD) studies on preva-
lence, spread, genetic susceptibility and environmental
factors focused on Asian populations. This is particu-
larly true for Thailand, where there have been no nation-
wide epidemiological surveys or registries in the past.
Because most Thais work in various aspects of the agri-
cultural industry and most likely have different genetic
backgrounds and environmental exposures compared to
Western populations, epidemiological studies of PD in
Thai populations will likely provide additional clues re-
garding potential contributions of these factors to the
etiology of PD.
The Kingdom of Thailand lies in the middle of main-
land Southeast Asia and consists of 76 provinces in 6 geo-
graphical regions based on natural features and human
cultural patterns. As of 2010, Thailand had a total popu-
lation of 63.5 million and there were only 3 urban prov-
inces, including Bangkok and the 2 contiguous provinces
that had a population density of more than 1,000/km2 [1].
64.1% of Thai citizens live in rural areas [1, 2] and ap-
proximately 40% of the labor force is employed in agri-
culture, concentrated in the rice-growing areas of the
central, northeastern and northern regions [2]. In recent
years, concern has been growing that improper agro-
chemical use has created hazards for both humans and
the environment in Thailand. This concern was prompt-
ed by a report of a sharp increase in pesticides used in
Thailand over the past two decades [3–5]. Furthermore,
environmental studies have found pesticide contamina-
National Registry for PD in Thailand
tion of the soil and water throughout the country, par-
ticularly in the central region [6, 7].
Interactions between genetic susceptibilities and envi-
ronmental exposures are believed to be the main causes
of PD [8]. Pesticide exposures are believed to be an im-
portant environmental risk factor for PD, supported by a
number of in vitro [9], in vivo [10] and case-control stud-
ies conducted in Western countries [11, 12]. Despite a
growing collection of evidence supporting this associa-
tion, very few epidemiological studies of PD have been
conducted in Southeast Asia with an emphasis on the pat-
tern of pesticide use in this region. Since Asian and non-
Asian populations have different genetic characteristics,
cultural patterns, occupations and environmental expo-
sures, a nationwide epidemiological study of PD in Thai-
land may provide important information concerning the
distribution and prevalence of PD in this region as well
as a support or a lack of support for the use of pesticides
being regarded as a risk factor. Furthermore, collecting
and analyzing this information will help determine if ad-
equate health care resources are available for all patients.
As a result, a nationwide PD Registry was initiated by the
Chulalongkorn Center of Excellence for Parkinson’s Dis-
ease and Related Disorders (ChulaPD) as a representative
of the Thai Red Cross (TRC) society in collaboration with
the Ministry of Public Health (MoPH) of Thailand, the
Thai National Health Security Office (NHSO), and Bang-
kok Metropolitan Administration (BMA). ChulaPD was
selected as a project leader of this registry based on its
extensive experience in PD-related research and being
the only established tertiary clinical and research center
dedicated to PD in Thailand [13]. The distribution and
prevalence of PD and the amount of pesticides bought
and used in the various areas were then compared in an
exploratory ecological analysis. As far as we are aware
from the literature review, the Thailand PD Registry is
currently the only national registry, currently being re-
ported after the Nebraska State PD registry [14].
Subjects and Methods
The Thailand PD Registry was initiated by ChulaPD on March
1, 2008, and was formalized with the signing of a memorandum
of understanding between TRC, MoPH, NHSO and BMA on July
2, 2010. Data is gathered by the Registry from physicians and hos-
pitals, and a mechanism is also provided for patients to self-re-
port. MoPH, BMA and TRC approached all neurologists and in-
ternists who treat PD patients and facilitated the formation of a
PD registry collaborative network. Official invitations were also
sent to the medical directors of all public (provincial, army and
university hospitals) and private hospitals in Thailand addressed
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to neurologists or internists who treat PD patients at each facility.
More information about the PD Registry was made available at
the national meeting of the Royal College of Physicians of Thai-
land, which is an annual event attracting a large number of inter-
nists and neurologists from throughout the country. At the same
time, patients are encouraged to self-register through various
campaigns which have been conducted regularly since ChulaPD
had been established in 2005.
The primary intent of the registry is to gather clinical informa-
tion for descriptive epidemiology and to study the accessibility
and availability of PD treatment in various regions of Thailand.
Collected information includes standard demographics and iden-
tifying information: name, national identification number, date
of birth, gender and address. This is essential for the Registry but
also allows unique identification of subjects for capture-recapture
methodology (CRM) calculations. Illness-related information in-
cludes the date of diagnosis, physicians seen, symptoms and re-
sponses to medications. The sources of reporting on the patient
are also recorded.
The Registry advisory board comprises the Registry manager
(N.W.), neurologists (R.B., S.T. and K.P.), the epidemiologist
(T.A.), support group leaders, and representatives from MoPH
(S.L., S.C., C.T. and P.P.), NHSO (Y.S. and R.S.) and BMA (K.C.).
Strict confidentiality is a high priority of the Registry. All data are
managed with encryption protection and stored in a secure data-
base maintained by the TRC society. A limited number of trained
Registry staff have access to the data for purposes of maintaining
the Registry and creating summary public health reports, and are
required to adhere to strict security procedures.
Analytical Methods
The three data resources from public and private hospitals
and self-registrations were used to conduct CRM analyses in the
combined set. With the unique identified information in each
source, first the degree of overlap between all the data sets can be
established; using CRM we can estimate the number of PD pa-
tients who are not included in any of these three data bases, i.e.
assess underreporting. Furthermore, an estimate of the expected
total number of patients and the prevalence of disease in the pop-
ulation can be derived. The CRM may be one of only a few tech-
niques to accurately assess disease spread and frequency in de-
veloping countries like Thailand. This technique has been ap-
plied in many settings to estimate the distribution and prevalence
of such disorders as type 2 diabetes, fetal alcohol syndrome and
PD [14–17].
In order to establish the validity of the estimate, the follow-
ing assumptions are required: (1) there is no significant change in
the population during the investigation; (2) individuals can be
matched for capture to recapture; (3) each individual has the same
chance of being included in the sample, and (4) the two or more
samples are independent [18]. We believe that a determination of
PD distribution and prevalence in Thailand is possible with the
CRM since the majority of elderly Thai population is relatively
stable without a significant migration in or out. Secondly, with
more than 90% of the Thai population being beneficiaries of pub-
licly financed health insurance plans [19], there is a nearly equal
probability of patients appearing in any of the three lists. Most
importantly, patients in our registry through the memorandum
of understanding agreement are identified by a unique national
identification number as well as first name, last name and date of
224 Neuroepidemiology 2011;37:222–230
PD Registry in Thailand
Self-registration Public hospital
3,691
2,975
294
30,754
219
481
1,635
Private hospital Missed cases = 20,516
Fig. 1. Venn diagram illustrating PD patients from each data
source and their overlap.
birth. Therefore, they can be matched on all lists, and redundan-
cy can then be calculated.
Since there are three sources of data for the Thai PD Registry,
this allows for greater accuracy and reduces the difficulties of list
dependence and independence [18, 20]. In order to calculate mul-
tiple-list CRM, we utilize Poisson log-linear modeling by select-
ing the best-fitted model to the data set and estimate the struc-
tural zero cells under SPSS version 17.0 (SPSS Inc., Chicago, Ill.,
USA) [21, 22]. The structural zero expected numbers (those are
not reported by any of the three sources) were added to the re-
ported numbers for an estimate of total prevalence. Age-stan-
dardized prevalence estimates were directly age adjusted to the
last census in Thailand in 2010 [2]. We calculated 95% CIs using
the asymptotic method (95% CI = N^ 8 1.96 standard error). The
␹2 test was used for statistical significance (p ! 0.05).
Results
As of March 2011, a total of 40,049 PD patients were
registered in the Thai PD Registry. 831 physicians were
approached to participate in the Registry, and 814 physi-
cians responded, resulting in a 98% participation rate.
Figure 1 shows case numbers reported according to the
source. The majority of PD patients were treated in public
hospitals that employ the majority of neurologists and
internists in Thailand. By using Poisson log-linear mod-
eling, the number not reported by any of the three sourc-
es can be estimated from those numbers to be 20,516,
resulting in a total estimated prevalence of 60,565 (ta-
ble 1). This results in a crude prevalence of 95.34/100,000
(95% CI: 90.16–100.52), with the denominator being the
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total Thai population [2]. When applying the criterion of
urban city [1], there are only three provinces in Thailand,
including Bangkok, Nonthaburi and Samutprakarn,
which have a population density of above 1,000/km2, re-
sulting in an estimated prevalence of PD in urban areas
of 126.83/100,000 (95% CI: 124.35–129.29), in compari-
son with 90.82/100,000 (95% CI: 90.03–91.61) in rural ar-
eas (p ! 0.001).
Given that the total population includes many who are
not at immediate risk of PD, we calculated the age-adjust-
ed prevalence for those over the age of 40 years based on
the age distribution of the Thailand 2010 census of 424.57/
100,000 (table 1) [2]. Furthermore, we calculated rates in
different regions of Thailand and mapped them in figure
2. Small numbers do not allow the estimation of CRM-
derived estimated total numbers for individual provinc-
es. However, there was considerable variation in age-ad-
justed prevalence rates by geographical regions. In par-
ticular, prevalence rates are consistently higher in the
central plain region of Thailand. Figure 2 shows the vari-
ation of prevalence rates of PD in individual provinces in
Thailand with reference to the amount of pesticide use in
each province. Two provinces (Chainat and Singburi) in
the central plain region of Thailand with the highest
prevalence rate of PD were also reported to use a large
amount of pesticides – more than 230 USD per farm per
crop year [4].
Discussion
While several methods have been used to count PD
patients in a community, no methodology is perfect with
each method having its own limitations and there is no
real gold standard [23, 24]. Traditional methods of
counting PD patients in a given population are not fea-
sible in Thailand due to financial and time restraints.
Using CRM to estimate the total number of PD patients
is an attractive alternative and has been previously em-
ployed in a state PD registry in Nebraska; the results have
been shown to be comparable to other prevalence studies
that were analyzed with different methodologies [14].
We applied CRM on a nationwide scale in Thailand for
the first time. The main advantage of this technique is
that it allows one to estimate the degree of undercount-
ing of patients when calculating prevalence rates [25, 26].
As we realize that the PD cases from each of our data
sources may not be completely independent (possibly
due to migration of cases to specialists), we employed the
log-linear method, which allows determination of the
National Registry for PD in Thailand
Table 1. Age-adjusted prevalence of PD in Thailand
a Total number of cases and crude prevalence
Age Prevalence per 100,000
<40 years 6.56 (6.30–6.82)
40–49 years 32.43 (31.32–33.54)
50–59 years 111.14 (108.7–113.58)
60–69 years 384.12 (378.0–390.24)
70–79 years 939.82 (927.48–952.16)
≥80 years 1,073.38 (1,052.10–1,094.66)
Figures in parentheses indicate CI. Total number of cases (es-
timated from CRM) = 60,565; crude prevalence = 95.34/100,000
(CI: 90.16–100.52)
b Prevalence of PD patients per 100,000 in urban versus rural
areas of Thailand
Urban Rural p value
126.83 (124.35–129.29) 90.82 (90.03–91.61) <0.001
Urban area is defined by a population density of more than
1,000/km2. Figures in parentheses indicate CI.
missing data from a Venn diagram [27]. Since we relied
on three sources, we did not have to require indepen-
dence but can be dependent [25]. The overlapping re-
ports allow for an estimation of the completeness of as-
sessment of PD in the population and calculation of
prevalence. Furthermore, the CRM can be used to deter-
mine the confidence interval of the number of PD cases
[27].
Although estimates of prevalence of PD may vary
according to the applied methodology, our age-adjusted
prevalence using the Thailand 2010 census was 424.57,
which is comparable to or even higher than the reported
prevalence of PD in Western and Asian countries (ta-
ble 2) [14, 28–35]. Even though the prevalence of PD in
Asian countries has been considered to be slightly lower
than in Western countries [28], recent studies in Beijing,
Xian and Shanghai [30] as well as Kinmen, Taiwan [31],
and our study have challenged this notion with the re-
ported prevalences close to those from developed coun-
tries. The discrepancies may certainly be due to different
case-finding strategies, particularly the undercount of
PD cases in which the proportions of incident cases were
first identified by the screening ranging from 24 to 42%
[36–40]. This estimation of undercount is similar to the
percentage of the estimation of the undercount of PD cas-
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Fig. 2. Map of the Kingdom of Thailand
showing the prevalence of PD in each
province as well as the amount of pesti-
cides used, classified in ranges.
es in our study (33.8%), supporting the assertion that the
CRM is a reliable method of including the undercount in
the prevalence rate.
Although rural living has long been recognized as a
risk factor for PD [12, 41–43], some of the literature did
not support this similarly to our own data, i.e. a higher
prevalence of PD was reported for persons living in urban
226 Neuroepidemiology 2011;37:222–230
Thailand
# PD prevalence >200/100,000
X PD prevalence 100–200/100,000

PD prevalence <100/100,000

Pesticide use 230–730 USD/farm

Pesticide use 130–230 USD/farm

Pesticide use 30–130 USD/farm

Pesticide use <30 USD/farm
0 90 180 360 540 720
areas than in rural areas in London [44], Italy [45] and
Estonia [46]. Indeed, very few studies have specifically
compared the difference between rural and urban areas.
One recent population-based study in Taiwan indicated
that the prevalence of PD in the urban areas was twice as
high as in the rural areas (p ! 0.001) [47]. By applying the
US Census 2000 urban and rural classification [1], our
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Table 2. Selected studies on the prevalence of PD with emphasis on the studies in Asia (per 100,000 population)

Authors Location Design PD cases Prevalence

Strickland and Bertoni [14],
2004
Our study
Zhang et al. [30], 2005
Wang et al. [31], 1996
Tan et al. [32], 2004
Bharucha et al. [33], 1988
Moriwaka et al. [35], 1996
Kimura et al. [34], 2002
Nebraska, USA passive PD registry 5,179 crude prevalence = 329.3
Thailand passive PD registry 60,565 crude prevalence = 95.34
age-adjusted = 424.57
Beijing, Xian, door-to-door survey with 277 crude prevalence = 1,070 (≥55 years)
Shanghai, China reexamination age-adjusted = 1,340 (≥55 years)
Kinmen, Taiwan door-to-door survey 23 crude prevalence = 587 (≥50 years)
age-adjusted = 119
Singapore door-to-door 46 crude prevalence = 290 (≥50 years)
age-adjusted = 250 (≥50 years)
Bombay, India door-to-door 46 crude prevalence = 328.3
age-adjusted = 192
Hokkaido, Japan record-based survey 5,342 crude prevalence = 94.7
age-adjusted = 71.2
Japan record-based survey 963 crude prevalence = 118.7
age-adjusted = 76.6

results also indicated that the prevalence of PD in urban
cities in Thailand is 1.4 times higher than those in rural
cities (p ! 0.001). While a disparity can be due to the dif-
ferences in studied populations, the effect of age cohorts,
environmental factors and types of urbanization, the
risks associated with rural living observed in the univar-
iate analysis may be confounded by exposure to pesti-
cides, used in rural homes and farming [12]. The latter
possibility was supported by a case-cohort study in Tai-
wan indicating that the increased risk of PD associated
with rural residence was no longer statistically significant
when applying multiple conditional logistic regression
analysis to adjust for previous occupational pesticide use
[48].
Pesticides have been consistently implicated as one of
the most likely major environmental risk factors for PD
[12, 49–51]. This potential link has been particularly
strong for organophosphates, organochlorines, rotenone
and paraquat, partly due to a structural similarity be-
tween the neurotoxin 1-methyl-4-phenylpyridinium and
these pesticides [52]. Pesticide imports to Thailand have
increased rapidly over the past decade, and total tonnage
has more than doubled between 2010 and 1996 [4, 5]. Pes-
ticide residues, especially organophosphate compounds,
have been found in soil, water and agricultural products
throughout the country [6] and there are mounting con-
cerns that increased pesticide use in Thailand may partly
be responsible for the increased numbers of patients with
neurodegenerative disorders such as PD [13, 53]. There-
fore, we have estimated the prevalence of PD in individ-
ual provinces in Thailand with reference to the amount
of pesticide use in each province as shown in figure 2.
The results from this ecologic comparison indicated that
two provinces (Chainat and Singburi) in the central plain
region of Thailand that have the highest prevalence of
PD were also reported to use the largest amount of pesti-
cides – more than 230 USD per farm per crop year. Fur-
thermore, a recent study also demonstrated the high in-
door air concentration of organochlorine pesticides in
urban homes in the Bangkok Metropolitan Region [3].
This may play a role in the higher prevalence of PD in ur-
ban areas in Thailand. The finding of high pesticide use
in the areas of high prevalence of PD in Thailand is con-
sistent with a growing body of information linking pesti-
cide exposures and PD and should be followed up in a
population-based case-control study with individual lev-
el exposure data.
Our results provide additional interesting findings
implicating urbanization and pesticide use as risk factors
of PD in Thailand. Nevertheless, the CRM is not without
limitations, and additional methodological and concep-
tual research needs to be devoted in its refinement. What
is critical in our PD Registry is that the CRM will not
count cases that have never been diagnosed due to lim-
ited access to health care; rather it provides relatively ac-
curate estimates of PD cases that have been diagnosed but
were not captured by our systems [18]. Therefore, since
our technique counts only diagnosed cases of PD and
does not count undiagnosed PD, we may still underesti-
mate the prevalence of PD in Thailand. Another limita-
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tion is the possibility of overcounting, that is inclusion of
patients with conditions called parkinsonism which are
mimicking PD; common misdiagnoses of PD in Thai-
land are drug-induced parkinsonism, essential tremor
and parkinsonism-plus syndromes [13]. However, based
on a recent study determining the diagnostic accuracy of
referral of PD patients to ChulaPD, the diagnostic accu-
racy according to United Kingdom Parkinson’s Disease
Society Brain Bank clinical diagnostic criteria was esti-
mated to be approximately 90% [13]. Lastly, the difference
in prevalence in urban and rural areas may be due to ur-
ban patients having better health care than people living
in small rural communities.
This is currently the only nationwide epidemiological
study of PD in Thailand. Moreover, it is probably the only
national registry being reported globally. Prevalence es-
timates based upon this CRM registry are comparable
with those reported previously for Asian populations and
the higher rates we observed may be due to better mea-
surement tools. In the future, as more patients are being
registered with a date of first diagnosis recorded, it should
be possible to estimate the incidence of PD in Thailand.
The Registry will also serve as the case resource for future
case-control studies, for example one to study the epide-
miology of PD in Thailand due to pesticide use. Since the
multifactorial etiology of PD involves a complex cascade
of environmental factors acting on genetically suscepti-
ble hosts and persons in different areas which may be ex-
posed to different pathogenic factors of PD, a study of a
large cohort of Thai PD populations may give novel in-
sights into its pathogenesis, which may be distinct from
that of Caucasian populations. Clinical demographic da-
ta as well as insight into patterns of medication uses are
essential information to establish a PD collaborative net-
work for resource allocation, which are obviously still
lacking in Thailand.
Appendix
List of the Committee Members of the Thailand PD
Registry Collaborative Network
Thailand PD Registry Working Committee
(1) The TRC Society
Mr. Phan Wannamethee; Assoc. Prof. Roongroj Bhidayasiri;
Prof. Adisorn Phatharadul; Ms. Nonthiya Kaewket; Dr. Priya Ja-
gota; Dr. Surat Singmaneesakulchai; Ms. Nutthaporn Simsiriwat;
Ms. Surasa Kongprasert; Ms. Lalita Kaewwilai; Ms. Kamolwan
Boonpeng; Mr. Neil Brenden; Ms. Sudaluk Inpom; Prof. Kam-
mant Phanthumjinda; Ms. Krongthong Petwong; Ms. Suwaree
Leelasethakul; Dr. Natlada Limotai; Dr. Suthida Boonyawairoj;
228 Neuroepidemiology 2011;37:222–230
Ms. Natnipa Wannachai; Ms. Wannipat Buated; Ms. Rattana-
reudee Devahasdin; Ms. Nongluck Boonrod; Ms. Nattawadee
Torsanit; Ms. Jongwadee Chatrungrueng.
(2) The MoPH
Dr. Pichit Warachit; Dr. Thanongsan Suthathum; Dr. Boonru-
eng Triruengworawat; Dr. Akrawut Viriyavejkul; Dr. Pornpet
Panjapiyakul; Ms. Sudaratana Limpabandhu; Ms. Sukanya Rob-
changwat; Dr. Seree Hongyok; Dr. Rewat Wisarutvej; Dr. Maiyad-
hat Samsen; Dr. Chanvit Tharathep; Dr. Veerapong Pengwanich;
Ms. Supaporn Choeytim; Dr. Naiyana Phaesrisakul.
(3) The BMA
Dr. Malinee Sukvejaworakij; Dr. Monthira Thongsari; Dr.
Kanittha Chimabutra; Dr. Duangporn Pinjesechikul; Ms. Piyarat
Panrungsri; Dr. Sarawut Sonthikaew; Dr. Samart Tanariyakul;
Dr. Sunthorn Sunthornchat; Ms. Supaporn Jirakiatcharoen.
(4) The NHSO
Dr. Vinai Sawadhivorn; Dr. Yolsilp Suchonwanich; Dr. Renu
Srismith; Ms. Chuensuk Lerkngam.
(5) Parkinson’s Disease Society of Thailand
Assist. Prof. Suwanna Sethawacharavanich.
(6) The Neurological Society of Thailand
Prof. Kammant Phanthumchinda.
(7) The Royal College of Physicians of Thailand
Prof. Kammant Phanthumchinda.
Acknowledgements
The study was supported by a research grant from the TRC
society, a Ratchadapiseksompoj Faculty Grant of Chulalongkorn
University, research unit grant No. GRU 52-026-30-005 of Chula-
longkorn University, and a Parkinson’s Disease Awareness project
grant from the Ministry of Public Health, Thailand. The authors
would like to thank all committee members of the Thailand PD
Registry collaborative network (see Appendix) and all physicians
participating in this registry. The authors appreciate Dr. Beate
Ritz for her critical comments of the manuscript.
Disclosure Statement
The authors have no conflicts of interest.
References 1 United States Census Bureau: Census 2000
urban and rural classification. United States
Census, 2000.
2 2010 Thailand statistical yearbook, Special
Edition. Bangkok, Statistical Forecasting
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