Association Between Use of Any of the Drugs Prescribed in Norway and the Subsequent Risk of Parkinson Disease: A Drug-wide Association Study.

BACKGROUND AND OBJECTIVES: The incidence rate of Parkinson disease (PD) has been increasing rapidly during the past years. Yet, no treatments exist to prevent or slow the progression of the disease. Moreover, we are unable to detect early disease stages during which intervention with disease-modifying therapies is most likely to succeed. The objective of this study was to perform an agnostic drug-wide association study estimating the association between the use of any of the drugs prescribed in Norway and the subsequent risk of PD. METHODS: This registry-based cohort study use data from the entire Norwegian population between 2004 and 2019 linked to the Norwegian Prescription Registry, with more than 600 million individual prescriptions. Drug classes were screened according to Anatomical Therapeutic Chemical codes at level 2, corresponding to therapeutic subgroups. We used Cox regression models to estimate hazard ratios (HRs) and 95% CIs for the associations between drug classes and PD risk. All p values were corrected for multiple testing using the false discovery rate. In addition, we conducted sensitivity analyses of exposure definition as well as time-lag and dose-response analyses. RESULTS: The study population comprised 3,223,672 individuals, 15,849 of whom developed PD during the follow-up. We identified 31 drug classes that were statistically significantly associated with PD risk in Norway during the follow-up. Drugs acting on the renin-angiotensin system (HR 0.92, 95% CI 0.89-0.95), corticosteroids for systemic use (0.88, 95% CI 0.84-0.93), and vaccines (0.89, 95% CI 0.82-0.96) were associated with a decreased risk of PD even up to 10 years before PD onset. Drug classes used to treat symptoms related to prodromal signs of PD, such as constipation, urological issues, and depression, were associated with an increased risk of subsequent diagnosis of PD with HRs of 1.6 (95% CI 1.49-1.73), 1.48 (1.42-1.53), and 1.94 (1.87-2.01), respectively. DISCUSSION: This drug-wide study identified 31 drug classes that were associated with the PD risk change. It reveals the links of renin-angiotensin system medications, vaccines, and corticosteroids with PD risk and suggests that monitoring drug usage using pharmacoepidemiology may allow identifying individuals with prodromal PD.

Balanced difficulty task finder: an adaptive recommendation method for learning tasks based on the concept of state of flow.

An adaptive task difficulty assignment method which we reckon as balanced difficulty task finder (BDTF) is proposed in this paper. The aim is to recommend tasks to a learner using a trade-off between skills of the learner and difficulty of the tasks such that the learner experiences a state of flow during the learning. Flow is a mental state that psychologists refer to when someone is completely immersed in an activity. Flow state is a multidisciplinary field of research and has been studied not only in psychology, but also neuroscience, education, sport, and games. The idea behind this paper is to try to achieve a flow state in a similar way as Elo's chess skill rating (Glickman in Am Chess J 3:59-102) and TrueSkill (Herbrich et al. in Advances in neural information processing systems, 2006) for matching game players, where "matched players" should possess similar capabilities and skills in order to maintain the level of motivation and involvement in the game. The BDTF draws analogy between choosing an appropriate opponent or appropriate game level and automatically choosing an appropriate difficulty level of a learning task. This method, as an intelligent tutoring system, could be used in a wide range of applications from online learning environments and e-learning, to learning and remembering techniques in traditional methods such as adjusting delayed matching to sample and spaced retrieval training that can be used for people with memory problems such as people with dementia.