Annonaceae fruits such as soursop (Annona muricata) may worsen symptoms of Parkinson's disease (PD) in tropical regions. Here, we investigate whether PD is more severe in an Annonaceae-exposed compared with a nonexposed population. Motor and cognitive symptoms of two PD groups (Caribbean, N = 74; mainland France, N = 104) were compared after imputation, propensity matching, and multivariate adjustment according to age, disease duration, education, and dopaminergic therapy. Ninety-six percent of Caribbean (71/74) but none of interviewed mainland France (0/20) PD patients had been exposed to Annonaceae fruits. Caribbean PD patients exhibited more severe motor and cognitive symptoms than mainland France PD patients (Unified PD Rating Scale - 3 = 24.39 [± 14.06] vs. 18.50 [± 11.13], p < 0.001; Mattis Dementia Rating Scale = 127.21 [±14.30] vs. 130.80 [± 11.15], p = 0.005). Given the growing evidence supporting Annonaceae fruits toxicity, health policy makers should raise public awareness about the risks of such consumption. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03368300.