Mutations in the glucocerebrosidase gene are associated with Parkinson's disease and Lewy body dementia. However, whether these alterations have any effect on the clinical course of Parkinson's disease is not clear. The glucocerebrosidase coding region was fully sequenced in 225 Parkinson's disease patients, 17 pathologically confirmed Lewy body dementia patients, and 186 controls from Spain. Twenty-two Parkinson's disease patients (9.8%) and 2 Lewy body dementia patients (11.8%) carried mutations in the glucocerebrosidase gene, compared with only 1 control (0.5%); P = .016 and P = .021 for Parkinson's disease and Lewy body dementia, respectively. The N370S and the L444P mutations represented 50% of the alterations. Two novel variants, L144V and S488T, and 7 previously described alterations were also found. Alterations in glucocerebrosidase were associated with a significant risk of dementia during the clinical course of Parkinson's disease (age at onset, years of evolution, and sex-adjusted odds ratio, 5.8; P = .001). Mutation carriers did not show worse motor symptoms, had good response to L-dopa, and tended to present the intermediate parkinsonian phenotype. Our findings suggest that mutations in the glucocerebrosidase gene not only increase the risk of both Parkinson's disease and Lewy body dementia but also strongly influence the course of Parkinson's disease with respect to the appearance of dementia.

This 10-year (1991 to 2000) prospective study of MG in the county of Osona (Barcelona, Spain) reveals an annual incidence rate of 21.27 cases per million inhabitants (95% CI 13.89 to 31.16). Incidence increased from 5.03 x 10(6) in the age group of 0 to 14 years to 14.68 x 10(6) in the age group of 15 to 64 years and to 63.38 x 10(6) in the older population. These results, the highest reported to date, may be explained by the population aging.

The process of learning requires morphological changes in the neuronal connections and the formation of new synapses. Due to the importance of memory and learning in our species, it has been suggested that the synaptic plasticity in a number of association areas is higher in the human brain than in other primates. Cortical neurons in mammals are characterized by higher metabolism, activity, and synaptic plasticity during development and the juvenile stage than in the adult. In Homo sapiens, brain development is retarded compared with other primates, especially in some association areas. These areas are characterized by the presence of neurons, which remain structurally immature throughout their lifespans and show an increase in the expression of the genes, which deal with metabolism and the activity and synaptic plasticity in adulthood. The retention of juvenile features in some adult neurons in our species has occurred in areas, which are related to episodic memory, planning, and social navigation. The increase of the aerobic metabolism in these neurons may lead, however, to higher levels of oxidative stress, therefore, favoring the development of neurodegenerative diseases which are exclusive, or almost exclusive, to humans, such as Alzheimer's disease.