The Portland SEEQ: A Harmonizable Questionnaire for Environmental Exposome Profiling in Prodromal Synucleinopathy
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Objective
To describe development of the Portland Suspected Environmental Exposures Questionnaire (SEEQ) and its initial application for environmental exposome profiling in isolated REM sleep behavior disorder (iRBD).
Background
Environmental exposures may contribute to Parkinson disease and related synucleinopathies, yet existing instruments variably capture specific agents, co-exposures, exposure uncertainty, timing, and mitigating factors.
Methods
SEEQ was iteratively developed to assess pesticides, solvents/industrial chemicals, welding fumes, heavy metals, residential and occupational exposures, and relevant lifestyle factors. Direct exposures were classified as definite, probable, possible, or uncertain/unlikely, with additional assessment of frequency/duration, life stage, and protective-equipment use. SEEQ was administered to participants with polysomnography-confirmed iRBD. Exposure prevalence, co-exposure patterns, and exploratory associations with clinical phenotypes and longitudinal progression were examined.
Results
Eighty-three participants completed SEEQ; 81 (97.6%) completed all four direct exposure domains. Definite/probable exposure was reported for pesticides in 38.6%, solvents/industrial chemicals in 43.4%, welding fumes in 21.0%, and heavy metals in 34.1%. Among complete responders, 60.5% reported ≥1 and 42.0% ≥2 direct exposure domains. Forty-five participants identified ≥1 named agent or mixture. Greater exposure burden was cross-sectionally associated most consistently with greater autonomic symptom burden, but was not associated with longitudinal clinical worsening.
Conclusion
SEEQ provides a practical, multidomain framework for structured environmental exposome profiling in prodromal synucleinopathy. Larger studies with external exposure validation and longitudinal follow-up are needed.
