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To the Editor: The article by Dr Ross and colleagues¹ was widely reported to show that coffee is an independent "protective factor" against the development of Parkinson disease (PD). Using a prospective longitudinal epidemiological database, the authors did, in fact, find an inverse association between higher caffeine intake and risk of developing PD. However, association does not prove causation. They did not consider another potential explanation of this association; namely, that incipient or preclinical PD causes decreased novelty-seeking behaviors.^2-3 Several studies have shown inverse associations between tobacco, alcohol, and coffee intake and PD,^1-3 and it is more plausible that these various substances (including other caffeinated beverages such as tea, cola, and chocolate) are underused by persons with incipient PD, rather than that each agent independently protects against PD.

Patients destined to develop clinical PD may have a presymptomatic period of 5 to 20 years, during which they may manifest early . . . [Full Text of this Article]

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