Blood profile holds clues to role of infection in a premonitory state for idiopathic parkinsonism and of gastrointestinal infection in established disease

Table 1 Inclusion and exclusion criteria for probands.

Inclusion
1.	Independently-living subjects with clinically-definite^a idiopathic parkinsonism
2.	Caucasian with English as first language and living in UK^b
Exclusion
1.	Secondary parkinsonism, "parkinsonism-plus" syndromes and other wider clinical entities [32]
2.	Clinical depression [64], dementia [65, 66], or other mental illness.
3.	Other specific neurological condition
4.	Exposure to specific antimicrobial/anti-secretory therapy against Helicobacter
5.	Inflammatory bowel disease or history of major gastrointestinal surgery
6.	Other progressive or resolving disorders affecting physical ability or performance^c or sufficient underlying incapacity to prevent assessments (e.g. use of walking aid)
7.	Cardiovascular/respiratory symptoms during normal activities
8.	UK MRC muscle strength score <4/5
9.	Arthropathy, mucsulo-skeletal disorder or overt abnormalities of/history of orthopaedic surgery to joints of spine or lower limbs
10.	Concurrent therapy with drugs which might be anti-dopaminergic or with hypnotics or sedatives
11.	Recent change in life situation (e.g. bereavement or change in marital status/domicile)

^aAny combination of three of the cardinal features: resting tremor, rigidity, bradykinesia or impairment of postural reflexes. Alternatively sufficient two of the four features, with one of first three asymmetrical [32]. Responsiveness to a dopaminergic drug challenge not a requirement. Excluded were:-
• clinically-probable parkinsonism. Combination of any two cardinal features. Alternatively, asymmetrical resting tremor, rigidity, or bradykinesia sufficient.
• clinically-possible. Presence of any one: tremor, rigidity, or bradykinesia. Tremor must be of recent onset, may be postural or resting.
N.B. In controls in Phase 1, presence/absence of following features [53, 67] judged (unilateral being sufficient) by two physicians:-
(i) hand bradykinesia* (obvious slowing pronation/supination).
(ii) rigidity* at rest and/or activation phenomenon (rigidity evoked by voluntary movement of contralateral limb).
(iii) rest tremor* and/or postural tremor (over a 20 m walk).
(iv) forward displacement of occiput after standing for 1 minute, with buttocks and heels against a wall (posture abnormal if distance >10 cm).
*evaluated in upper limbs, with seated subject's head, trunk and lower limbs screened.
^bTo constrain ethnic and/or geographical influences.
^cAssessments and blood sampling avoided during acute intercurrent illness.

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