Parkinson's disease (PD) is a progressive neurodegenerative disorder clinically defined by the presence of cardinal motor features like bradykinesia, rigidity and resting tremor. The mainstay of PD treatment is pharmacol...Parkinson's disease (PD) is a progressive neurodegenerative disorder clinically defined by the presence of cardinal motor features like bradykinesia, rigidity and resting tremor. The mainstay of PD treatment is pharmacological dopamine substitution and responsiveness of motor symptoms to levodopa is a supporting diagnostic feature of this illness. Although the armentarium of drugs to treat the motor symptoms of PD and their efficacy on a variety of motor problems are overall impressive, significant unmet needs persist, particularly in the advanced stages of PD. These include situations of poorly responsive tremor, motor complications associated with sustained levodopa exposure, disorders of gait and balance as well as impairments of posture, speech and swallowing. This review provides an overview of available treatment strategies for these areas of unmet need and emerging therapies under development. Future perspectives include novel pharmacological targets, new modes of drug delivery, combination therapies and the integration of real-time monitoring and wearable technologies to tailor treatments.
SummaryThis study is the first large-scale, head-to-head comparison suggesting that sodium-glucose cotransporter-2 inhibitors (SGLT2is) may offer greater neuroprotection against Parkinson's disease (PD) compared to metfo...SummaryThis study is the first large-scale, head-to-head comparison suggesting that sodium-glucose cotransporter-2 inhibitors (SGLT2is) may offer greater neuroprotection against Parkinson's disease (PD) compared to metformin in patients with type 2 diabetes mellitus (T2DM). Utilizing a 20-year real-world dataset and propensity score matching, we found that SGLT2i users had a 28% lower adjusted hazard ratio (aHR) for PD (0.72; 95% CI, 0.62-0.84) and reduced all-cause mortality. Unlike previous studies suggesting a potential increased PD risk with SGLT2is, our robust study design, stringent exclusion criteria, and competing risk adjustments support a protective association. The findings highlight the need for further prospective research to explore the neuroprotective benefits of SGLT2is, which may justify prioritizing their use in T2DM patients at risk for neurodegeneration.BackgroundType 2 diabetes mellitus (T2DM) is linked to an increased risk of Parkinson's disease (PD), likely mediated by insulin resistance, inflammation, and mitochondrial dysfunction. While metformin has shown neuroprotective effects, sodium-glucose cotransporter-2 inhibitors (SGLT2is) have emerging benefits in neurodegeneration. This study provides the first real-world head-to-head comparison of SGLT2is and metformin on PD risk in T2DM patients.MethodsUsing the TriNetX platform, we analyzed a 20-year dataset (2005-2025) from 142 healthcare organizations, identifying 913,428 T2DM patients (96,018 SGLT2i, 817,410 metformin users). Patients with prior PD, neurodegenerative diseases, or exposure to neuroprotective/neurotoxic antidiabetic drugs were excluded. Propensity score matching (1:1) balanced cohorts across demographic, clinical, and pharmacological variables. Cox proportional hazards models estimated adjusted hazard ratios (aHRs), validated by positive and negative controls.ResultsSGLT2i use was associated with a 28% lower PD risk than metformin (aHR = 0.72; 95% CI, 0.62-0.84; p < 0.0001). Dementia, a positive control, also showed reduced risk (aHR = 0.73; 95% CI, 0.68-0.78; p < 0.0001), reinforcing the neuroprotective effect. Negative controls confirmed specificity. SGLT2i users had significantly lower all-cause mortality (aHR = 0.85; 95% CI, 0.83-0.89; p < 0.0001).ConclusionsThis first large-scale comparison suggests SGLT2is provide superior neuroprotection against PD compared to metformin in T2DM patients, warranting further investigation.
Parkinson's disease (PD) is a chronic neurodegenerative disorder which can impair patients' ability to complete complex motor skills, such as driving. There is currently a lack of research into the effectiveness of polic...Parkinson's disease (PD) is a chronic neurodegenerative disorder which can impair patients' ability to complete complex motor skills, such as driving. There is currently a lack of research into the effectiveness of police officers discerning PD symptoms from those exhibited by alcohol intoxication during traffic stops. We conducted a survey on 58 PD patients and 52 age-matched controls to investigate experiences with police interactions during traffic stops. PD patients had statistically significant ( = 0.03204) higher perceptions of mistreatment and misclassification of intoxication. We propose the need for additional training and support on PD for law enforcement officers to ensure fair evaluation.
A definitive diagnostic test for Parkinson's disease (PD) remains elusive, so identification of potential biomarkers can facilitate diagnosis and early intervention. Two dogs were trained to distinguish between dry skin...A definitive diagnostic test for Parkinson's disease (PD) remains elusive, so identification of potential biomarkers can facilitate diagnosis and early intervention. Two dogs were trained to distinguish between dry skin swabs obtained from people with Parkinson's (PwP) and control participants. After 38-53 weeks of training on 205 samples, the dogs were tested in a double-blind trial using 60 control and 40 target (drug-naïve PwP) samples. They each showed high sensitivity (70% and 80%) and specificity (90% and 98%). This supports previous findings that dogs can be trained to reliably detect the odor of PD.
Parkinson's disease (PD) is a neurological disorder that is characterized by the death of dopaminergic neurons in the substantia nigra. Despite extensive research, the exact cause of PD is unknown, and current treatment...Parkinson's disease (PD) is a neurological disorder that is characterized by the death of dopaminergic neurons in the substantia nigra. Despite extensive research, the exact cause of PD is unknown, and current treatment options are centered on symptom management rather than disease modification. Most, though not all, epidemiologic studies have demonstrated reduced risk of development of PD among smokers, generating interest in nicotine, a key component of tobacco. Many preclinical investigations have investigated nicotine's neuroprotective properties, especially through its interaction with nicotinic acetylcholine receptors in the central nervous system. Nicotine has been linked to a variety of cellular activities, including neurotransmitter release, neuronal survival, and anti-inflammatory responses. Animal studies in PD models have indicated that nicotine administration can attenuate the degeneration of dopaminergic neurons and ameliorate behavioral abnormalities. Clinical investigations evaluating nicotine as a treatment for PD have yielded mixed results in terms of efficacy. Thus, central questions remain about the effects of nicotine in patients with established PD, and neither nicotine nor smoking are recommended for treatment or prevention of PD. Further research on the multiple proposed mechanisms of nicotine is required, with particular emphasis on elucidating symptomatic versus neuroprotective effects. The aim of this scoping review is to provide a comprehensive discussion of the proposed mechanisms of neuroprotection for nicotine in Parkinson's disease.
BackgroundMultiple system atrophy (MSA) is a progressive neurodegenerative disorder characterized by parkinsonism, cerebellar ataxia, and autonomic dysfunction. Putaminal hypointensities on T2 magnetic resonance imaging...BackgroundMultiple system atrophy (MSA) is a progressive neurodegenerative disorder characterized by parkinsonism, cerebellar ataxia, and autonomic dysfunction. Putaminal hypointensities on T2 magnetic resonance imaging (MRI) are commonly observed in the parkinsonian variant of MSA (MSA-P).ObjectiveTo report a neuropathologically confirmed case of MSA-P with an atypical MRI presentation, characterized by progressive T2 hyperintensity in the putamen, without significant iron accumulation.MethodsWe present the clinical course, imaging findings, and neuropathological results of a 57-year-old woman with MSA-P. Diagnostic evaluations included serial brain MRI, cerebrospinal fluid analysis, magnetic resonance spectroscopy, and post-mortem pathological examination.ResultsThe patient initially presented with L-dopa-responsive bradykinesia and right-dominant rigidity, followed by progressive motor decline, orthostatic hypotension, and urinary retention. Serial T2-weighted MRI revealed diffuse and progressively increasing hyperintensity in the putamen, accompanied by atrophy predominantly on the left side. Autopsy confirmed the diagnosis of MSA, revealing severe neuronal loss, marked gliosis, and abundant glial cytoplasmic inclusions in the putamen, with only mild iron deposition as shown by Prussian blue staining.ConclusionsThis case demonstrates that severe putaminal neurodegeneration in advanced MSA can be associated with progressive T2 hyperintensity on MRI, reflected by the absence of substantial iron deposition. These findings indicate that iron-independent mechanisms contribute to the pathophysiology of MSA-related putaminal damage in patients with MSA.
Planned discontinuation or acute unplanned cessation of oral dopaminergic medications might result in a severe relapse of Parkinson's symptoms or, sporadically, in life-limiting withdrawal syndromes. Unplanned cessation...Planned discontinuation or acute unplanned cessation of oral dopaminergic medications might result in a severe relapse of Parkinson's symptoms or, sporadically, in life-limiting withdrawal syndromes. Unplanned cessation may occur due to dysphagia or decreased alertness, amongst other reasons. Planned acute discontinuation occurs during surgery or a medical necessity for a 'nil per os' policy (such as hospitalizations for gastrointestinal diseases). Non-oral alternatives are available, such as transdermal rotigotine, subcutaneous apomorphine, and levodopa delivered subcutaneously or via an enteral tube. Selecting the best treatment can be difficult and should be based upon clinical considerations, patient preference and be tailored to the care setting. These considerations will differ during the course of disease. For example, more invasive treatment options can be considered in hospitalized persons with early to moderate-stage disease, whereas symptomatic palliative treatments are more appropriate towards the end of life. Here, we discuss several practical considerations for three, partially overlapping, but conceptually distinct moments at which acute discontinuation or cessation events occur: during hospitalization (including surgery), late-stage disease and end of life. We stress the need for prevention and early advance care planning and present a stepwise pharmacological approach to address unplanned acute cessation or planned discontinuation.
Hadad R, Alcalay RN, Senderova I
… +10 more, Nassar M, Milicic A, Peretz JA, Allen IE, Ben-Hayun R, Chasnyk N, Morani I, Elkoshi N, Valcour V, Schlesinger I
Mutations in the leucine-rich repeat kinase 2 () gene associate with familial and sporadic Parkinson's disease (PD). While various allelic variants have been studied, characteristics of R1441C carriers remain underexplo...Mutations in the leucine-rich repeat kinase 2 () gene associate with familial and sporadic Parkinson's disease (PD). While various allelic variants have been studied, characteristics of R1441C carriers remain underexplored. We compared PD patients carrying the R1441C mutation (90% Israeli Arabs) to those carrying the G2019S (70% Ashkenazi Jews) and R1441G (42% Basque) variants. R1441C carriers exhibited a distinct clinical phenotype characterized by severe motor and non-motor symptoms and worse scores on the Montreal Cognitive Assessment. These findings highlight the importance of ethnic diversity and genetic stratification in PD research. These results need confirmation in larger, more diverse samples.
The understanding of the pathobiology of Parkinson's disease (PD) is evolving, based largely on genetic discoveries. Despite a rich pipeline of potential therapies addressing aspects of the underlying biology of the dise...The understanding of the pathobiology of Parkinson's disease (PD) is evolving, based largely on genetic discoveries. Despite a rich pipeline of potential therapies addressing aspects of the underlying biology of the disease, there is currently no available disease-modifying therapy for PD. In this short commentary, we review the status of the relevant pipeline and highlight areas where alternative or complementary approaches could also be advanced to the stage of clinical trials, with the ultimate goal of providing meaningful clinical benefit to patients and their families. The further evolution of biomarkers, cellular and animal models of the disease and delivery methods will be crucial to this end.
BackgroundEarly onset Parkinson's disease (EOPD), defined as Parkinson's disease (PD) diagnosed before age 50, often presents unique challenges compared to late-onset PD, particularly with regard to non-motor symptoms. P...BackgroundEarly onset Parkinson's disease (EOPD), defined as Parkinson's disease (PD) diagnosed before age 50, often presents unique challenges compared to late-onset PD, particularly with regard to non-motor symptoms. Psychosis in EOPD is associated with increased functional impairment and may lead to a higher mortality risk.ObjectiveOur study is aimed to determine the prevalence of psychosis in EOPD patients and its impact on all-cause mortality, along with examining the effects of antipsychotic medications and Selective Serotonin Reuptake Inhibitors (SSRIs) on mortality in EOPD patients.MethodsOur retrospective cohort included EOPD patients diagnosed between 1990 and 2022 at Mayo Clinic, Rochester, Minnesota. Psychosis was defined using the National Institute of Neurological Disorders and Stroke/the National Institute of Mental Health (NINDS/NIMH) Work Group criteria. Cox proportional hazards models were used to analyze the association of psychosis and medications with mortality.ResultsOf 829 patients with EOPD, 158 (19.1%) developed psychosis at a median of 12.1 years after PD motor symptom onset. Psychosis was significantly associated with increased mortality in unadjusted (HR = 4.31, 95% CI: 2.59-7.18, p < 0.001) and adjusted (HR = 3.55, 95% CI: 2.10-6.01, p < 0.001) models. No significant difference in mortality risk was observed between patients treated with antipsychotics or SSRIs versus those who were not.ConclusionsPsychosis is a possible complication in EOPD and is associated with a significant increase in all-cause mortality. The use of antipsychotics and SSRIs did not significantly alter the mortality risk in these patients. Further research is needed to understand the mechanisms driving this association and to develop tailored interventions.
BackgroundParkinson's disease (PD) patients on dopaminergic drugs may experience non-motor fluctuations (NMFs) which are often heterogeneous and respond variably to treatments.ObjectiveWe evaluated if personality was ass...BackgroundParkinson's disease (PD) patients on dopaminergic drugs may experience non-motor fluctuations (NMFs) which are often heterogeneous and respond variably to treatments.ObjectiveWe evaluated if personality was associated to NMFs and could modulate the NMFs responsiveness to dopaminergic medication and deep brain stimulation of the sub-thalamic nucleus (STN-DBS).MethodsFrom the PREDISTIM cohort, personality dimensions of 235 PD patients were assessed by the Temperament and Character Inventory (TCI) before STN-DBS (V0). NMFs were evaluated using the NMFs Severity Scale at V0 and one year after STN-DBS (V1). Linear regression models were performed between TCI dimensions and NMFs at V0; and logistic regression models were done between TCI dimensions and 1) groups of dopa-sensitive patients (responders to ON medication at V0) versus non-dopa-sensitive ones, and 2) responders versus non-responders to STN-DBS at V1. Odds ratios (OR) were also calculated.ResultsSignificant associations were found between two TCI personality dimensions ("Harm Avoidance" and "Self-Directedness") and severity of NMFs in OFF medication at V0: PD patients with higher Harm Avoidance and lower Self-Directedness scores having more NMFs. TCI personality dimensions were not associated with the dopa-sensitivity while Novelty Seeking was significantly associated with the STN-DBS-responder group for the psychiatric (OR = 1.09 [1.02-1.17]) and for the dysautonomic NMFs (OR = 1.11 [1.04-1.18]).ConclusionsCertain personality dimensions (Harm Avoidance and Self-Directedness) are associated with NMFs severity at baseline, and PD patients with high Novelty Seeking seem to be better candidates for NMFs improvement after STN-DBS.
BackgroundCompensation strategies have been shown to improve functional mobility in people with Parkinson's disease (PD) who live independently. However, knowledge on its utilization in in long-term care (LTC) settings i...BackgroundCompensation strategies have been shown to improve functional mobility in people with Parkinson's disease (PD) who live independently. However, knowledge on its utilization in in long-term care (LTC) settings is unknown.ObjectiveThis study aimed to establish the knowledge and utilization of compensation strategies for functional mobility for individuals with PD among healthcare professionals working in LTC facilities in the Netherlands. Secondary aims included assessing subgroup differences among healthcare professionals and exploring perceived barriers to utilizing these strategies in LTC.MethodsA cross-sectional online survey design was conducted with (allied) healthcare professionals working in LTC facilities across the Netherlands.ResultsOverall knowledge and utilization of compensation strategies among 130 healthcare professionals was high, with a median of 5 out of 7 known categories, 4 out of 7 used for gait, and 3 out of 5 for transfers. Variations among professions existed, with physiotherapists and occupational therapists demonstrating higher scores than nurses and personal care assistants. Professionals specifically trained in PD care and those working in specialized PD departments demonstrated a higher level of knowledge. Main identified barriers for utilization were limited knowledge and time of the healthcare professionals, and concerns regarding limited feasibility in patients with severe cognitive impairments.ConclusionsWhile knowledge and utilization of compensation strategies for PD in LTC facilities was widespread, the findings highlight a need for tailored training programs for healthcare professionals to improve patient care. Future research should evaluate the feasibility and usefulness of such training programs.
BackgroundDepression can negatively influence an individual's perception of their disease. Although subthalamic nucleus deep brain stimulation (STN-DBS) is an effective treatment for Parkinson's disease (PD), some patien...BackgroundDepression can negatively influence an individual's perception of their disease. Although subthalamic nucleus deep brain stimulation (STN-DBS) is an effective treatment for Parkinson's disease (PD), some patients do not appreciate benefits despite showing objective improvements in motor function.ObjectiveWe explored the impact of depressive symptoms on self-reported outcomes of PD severity in patients who underwent STN-DBS.MethodsAssessments took place preoperatively and 2-years after surgery. Patients completed the Hospital Anxiety and Depression Scale (HADS), Unified Parkinson's Disease Rating Scale (UPDRS) Parts 2 and 4, Gait and Falls Questionnaire, Parkinson's Disease Questionnaire-39 (PDQ-39), and the Non-motor Symptoms Scale. The UPDRS Part 3 (motor examination) was also performed. Patients were dichotomized into two groups (normal or high) based on their postoperative follow-up HADS depression score.ResultsEighteen patients (33.3%) were assigned to the high group (hHADS-D), and 36 patients (66.7%) were assigned to the normal group (nHADS-D). The UPDRS Part 3 OFF-medication score improved to a similar extent in both groups, and participants experienced a similar reduction in their levodopa equivalent daily dose following STN-DBS. Unlike the nHADS-D group, however, hHADS-D patients did not self-report improvements on any clinical outcome measure at follow-up from baseline, and instead indicated a significant worsening on the UPDRS Part 2 ON-medication and PDQ-39 cognition domain. This was not explicable by their preoperative non-motor symptom burden, nor changes in dopaminergic medications. There were no differences between groups in terms of proportion using anti-depressants, surgical complications or postoperative side effects.ConclusionsDepressive symptoms may play a significant role in subjective self-reporting, and should be carefully considered when evaluating STN-DBS effectiveness and managing patients postoperatively.
Dobreva I, Kalam S, Roche M
… +3 more, Bayram E, Weil RS, Zarkali A
J Parkinsons Dis
· 2025 Aug · PMID 40538322
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People from Black backgrounds are underrepresented in Parkinson's research, despite evidence of higher disease burden and risk of dementia. Greater understanding of the factors influencing participation in Parkinson's re...People from Black backgrounds are underrepresented in Parkinson's research, despite evidence of higher disease burden and risk of dementia. Greater understanding of the factors influencing participation in Parkinson's research can improve recruitment, quality and generalizability of both observational research studies and clinical trials. Through focus groups with 17 people with Parkinson's and carers from Black communities, we identified distrust in the research process, stigma of Parkinson's diagnosis, and accessibility as key barriers to research participation. Participants made recommendations including: raising awareness of Parkinson's and related research, involving community ambassadors, improving communication throughout the research process, and providing practical support.
BackgroundFreezing of gait (FoG) is a debilitating symptom in Parkinson's disease (PD), yet its pathophysiological mechanisms remain poorly understood. Several studies have investigated the FoG neuroimaging correlates, w...BackgroundFreezing of gait (FoG) is a debilitating symptom in Parkinson's disease (PD), yet its pathophysiological mechanisms remain poorly understood. Several studies have investigated the FoG neuroimaging correlates, with heterogeneous results.ObjectiveThis study investigated in a large PD cohort whether the disparate neuroimaging findings may converge to a common brain network.MethodsT1-weighted MRI scans of 500 PD patients (90 with FoG [PD-FoG] and 410 without FoG [PD-nFoG]) were acquired from the Parkinson's Progression Markers Initiative. A voxel-based morphometry (VBM) analysis was conducted to identify clusters of decreased grey matter (GM) in PD-FoG patients. Subsequently, VBM coordinates of significant clusters were used as seed regions to generate connectivity network maps using a large functional normative connectome, and these maps were overlapped to identify regions connected with most VBM clusters.ResultsPD-FoG patients showed GM atrophy in cerebellar lobes, hippocampus, putamen, insula, inferior temporal gyrus and lateral orbitofrontal gyrus compared with PD-nFoG patients. Network analysis revealed that these regions colocalized within a specific brain network focused on midbrain, substantia nigra, subthalamic nucleus, globus pallidus, inferior putamen and dorsal medial cerebellum. These findings were confirmed by using coordinates from previous VBM studies for the network analysis, validating our results.ConclusionsThis study revealed a brain network underlying FoG in PD, reducing the heterogeneity of previous neuroimaging evidence on FoG. These results may represent a significant step forward in the understanding of FoG and may be relevant for optimized targeted neuro-modulatory treatments to reduce FoG in PD patients.
Electroretinography has emerged as a promising tool for identifying retinal functional anomalies in major psychiatric and neurodevelopmental disorders, such as schizophrenia, major depressive disorder, bipolar disorder,...Electroretinography has emerged as a promising tool for identifying retinal functional anomalies in major psychiatric and neurodevelopmental disorders, such as schizophrenia, major depressive disorder, bipolar disorder, and autism spectrum disorder, positioning it as a potential biomarker of monoaminergic dysfunction. However, despite its potential, electroretinography studies in Parkinson's disease (PD) over the past decades have been inconsistent, largely due to variations in research methodologies. These limitations diminish its potential and hinder the association between retinal electrophysiological responses and PD neuropathology. To address this challenge, this review examines the most relevant sources of data variability and reduced reproducibility in electroretinography studies aimed at detecting a retinal functional signature characteristic of PD. We propose the consolidation of four key protocol factors and five cohort criteria to enhance the diagnostic accuracy of electroretinography in PD biomarker research. As electroretinography protocols are adapted from their clinical origins for research purposes, we argue that careful attention must be given to electrode type and placement, as well as to factors like age, sex, disease duration and severity, medication intake, psychiatric conditions, and comorbidities in cohort selection to ensure reproducible results. Suggesting that past inconsistencies in these areas may explain the variability in reported results and contribute to the lack of consensus on which electroretinography parameters comprise a disease signature in PD, we ultimately offer recommendations to improve the utility of electroretinography techniques as early biomarkers for PD.
BackgroundParkinson's disease (PD) is a common neurodegenerative disorder characterized by the progressive loss of dopaminergic neurons. While abnormal protein aggregation has been classically implicated in PD, increasin...BackgroundParkinson's disease (PD) is a common neurodegenerative disorder characterized by the progressive loss of dopaminergic neurons. While abnormal protein aggregation has been classically implicated in PD, increasing evidence suggests that lipid dysregulation may also contribute to neuronal vulnerability. Recent studies have begun to link abnormal phosphatidylserine (PS) metabolism to mitochondrial impairment and dopaminergic neuron loss in PD, yet the underlying cellular mechanisms remain poorly defined.ObjectiveThis study aimed to determine how impaired PS synthesis in cortex glia affects mitochondrial function, oxidative stress, and dopaminergic neuron survival, using a model of glia-specific () knockdown.MethodsTo dissect the glial contribution to PS-related neurodegeneration, we employed a model in which the gene was selectively knocked down in cortex glia using the GAL4-UAS system. We evaluated PD-like phenotypes by assessing the number of dopaminergic neurons in the PPL1 and PPL2 clusters, as well as locomotor activity and lifespan, following glia-specific knockdown of gene.ResultsCortex glia-specific knockdown of impaired locomotion and reduced lifespan in flies, indicating a systemic decline in neuronal and mitochondrial function. knockdown reduced () expression, disrupted mitochondrial gene expression, and elevated ROS levels. Western blot analysis also revealed reduced AKT phosphorylation without changes in total AKT. These results ultimately lead to loss of dopaminergic neurons.ConclusionsThese findings establish a mechanistic link among abnormal PS metabolism, impaired AKT signaling, mitochondrial dysfunction, and dopaminergic neuron loss. Our study provides novel evidence that glia-driven abnormalities in PS metabolism may cause PD-like neurodegeneration, offering mechanistic insights and potential therapeutic targets.
BackgroundContinuous subcutaneous apomorphine infusion (CSAI) is a standard of care treatment in advanced Parkinson's disease (PD) to treat motor fluctuations. However, literature about its long-term data is scarce.Objec...BackgroundContinuous subcutaneous apomorphine infusion (CSAI) is a standard of care treatment in advanced Parkinson's disease (PD) to treat motor fluctuations. However, literature about its long-term data is scarce.ObjectiveThe aim of this study was to report about CSAI tolerance and discontinuation predictors in a large monocentric cohort.MethodsConsecutive PD patients who had CSAI were included. CSAI duration, discontinuation rates at 3, 12, 24, 36, 48, and 60 months, demographic data, MDS-UPDRS motor score, adverse events (AEs), discontinuation reasons and predictive factors were analyzed with logistic regression.ResultsA total of 208 patients were included from 1999 to 2023 (51% male; age: 67.4 ± 8.3 years; PD duration: 11.2 ± 5.0 years). In the overall group, CSAI duration was 25.0 ± 32.9 months (median: 13.0, range: 0.1-260.0). Ninety-five patients (45.7%) discontinued CSAI after 12.7 ± 15.3 months (median: 8.0). Main discontinuation causes were switching to deep brain stimulation (44.2%) and low efficacy (15.8%). Sixty% of discontinuations occurred within the first year. CSAI duration was the only significant difference between ongoing CSAI (116) and discontinued patients (35.4 ± 39.7 vs. 11.1 ± 18.4 months; < 0.001), after excluding 42 CSAI-to-DBS. About 79.8% patients had AEs, mainly hallucinations (41.3%) and nodules (24.0%). The best discontinuation predictors were CSAI duration and baseline medication MDS-UPDRS motor score.ConclusionsThese results may help clinicians better select patients, anticipate and manage AEs, and predict CSAI discontinuation.
Gender differences in progressive supranuclear palsy (PSP) may become relevant for clinical trials, treatment decisions and patient counseling. To study gender associated differences we conducted a retrospective data ana...Gender differences in progressive supranuclear palsy (PSP) may become relevant for clinical trials, treatment decisions and patient counseling. To study gender associated differences we conducted a retrospective data analysis of 191 male and 157 female PSP patients from a large multicenter observational cohort in Germany. While no differences in motor skills, disease severity, daily living abilities, global cognitive status and depressive symptoms were observed between genders, male patients showed significantly higher apathy scores, a finding also noted in other neurological diseases. In this study, apart from male patients exhibiting higher levels of apathy, no significant disease-specific gender differences were observed in PSP patients.
BackgroundCare for persons with Parkinson's disease (PD) is to a great extent carried out by care partners. It is important to understand their needs to ease their burden and help with their important role.ObjectiveTo pr...BackgroundCare for persons with Parkinson's disease (PD) is to a great extent carried out by care partners. It is important to understand their needs to ease their burden and help with their important role.ObjectiveTo present (1) what is known about needs in caregiving for someone with PD from both qualitative and quantitative papers; and (2) to identify research gaps in the existing literature to guide future research.MethodsA systematic search was conducted, searching PubMed, CINAHL, PsychINFO, and MEDLINE for both qualitative and quantitative studies examining care partner needs in Parkinson's disease published from the start of the databases up to 13 November 2024. The best-fit framework synthesis method was employed for qualitative data extraction and analysis. The Critical Appraisal Skills Programme (CASP) and the Newcastle-Ottawa Scale (NOS) were used for quality assessment of studies.ResultsForty-eight qualitative studies, ten quantitative studies, and three mixed methods studies met the eligibility criteria. All studies were of observational, cross-sectional design. A total of nine themes (the need for information, the need to be heard, PD healthcare, emotional support, daily living, financial support, skills, care partner physical well-being, and respite care) were identified from qualitative data and all quantitative data could fit this framework. Quantitative data on the frequency of needs and when they arise over the course of PD were scarce. Only one quantitative study made use of a validated measurement instrument to measure care partner needs, the Family Needs Questionnaire.ConclusionsCare partner needs in PD are wide-ranging. A significant gap identified is the absence of quantitative data to determine the prevalence, timing, and factor contributing to the needs revealed by the qualitative research.