Rasagiline improves polysomnographic sleep parameters in patients with Parkinson's disease: a double-blind, baseline-controlled trial.

BACKGROUND AND PURPOSE: The aim was to study the effects of rasagiline on sleep quality in patients with Parkinson's disease (PD) with sleep disturbances. Sleep disorders are common in PD. Rasagiline is widely used in patients with PD, but double-blind polysomnographic trials on its effects on sleep disturbances are missing. METHODS: This was a single-center, double-blind, baseline-controlled investigator-initiated clinical trial of rasagiline (1 mg/day) over 8 weeks in patients with PD with sleep disturbances. Blinding was achieved by running a strategic matched placebo parallel group. Co-primary outcome measures were the changes between baseline and end of the treatment period in sleep maintenance/efficiency as assessed by polysomnography and the Parkinson's Disease Sleep Scale Version 2 (PDSS-2) score. RESULTS: A total of 20 of 30 patients were randomized to rasagiline (mean ± SD age, 69.9 ± 6.9 years; 10 male; Hoehn-Yahr stage, 1.9 ± 0.8). Compared with baseline, sleep maintenance was significantly increased at the end of the treatment period (relative change normalized to baseline, +16.3 ± 27.9%; P = 0.024, paired two-sided t-test) and a positive trend for sleep efficiency was detected (+12.1 ± 28.6%; P = 0.097). Treatment with rasagiline led to significantly decreased wake time after sleep onset, number of arousals, percentage of light sleep and improved daytime sleepiness as measured by the Epworth Sleepiness Scale. We did not observe changes in the co-primary endpoint PDSS-2 score, and no correlations of polysomnographic sleep parameters or PDSS-2 score with motor function (Unified Parkinson's Disease Rating Scale motor score). Rasagiline was well tolerated with no unexpected adverse events. CONCLUSIONS: In patients with PD with sleep disturbances, rasagiline showed beneficial effects on sleep quality as measured by polysomnography. These effects were probably not related to motor improvement or translated into improved overall sleep quality perception by patients.

Young drivers' night-time mobility preferences and attitude toward alcohol consumption: A Hybrid Choice Model.

This paper proposes an analysis of mobility preferences of young people at nighttime. In OECD countries in the last decades, data show that road crashes are the single biggest cause of death of 15-24 years-old drivers. On average, over 8500 young drivers were killed each year and it is demonstrated that the accidents tend to occur on weekend nights and when young people drive under the influence of alcohol. Focusing on the demand for mobility, we approach the problem from several points of view, concentrating on the relationship between attitudes towards alcohol and some of the most common countermeasures implemented to address young-driver risk. In particular, we examine the potential demand of young drivers for new modes of public transport, understand their preferences for plans designed to reduce and/or prevent the number of risky situations. Our analysis covers different aspects of private modes of transport, including amounts of fines and police checkpoints. We also investigate the characteristics of existing and available public transport systems (e.g. fares and levels of services). Through a Stated Preferences experiment (SP), we collected young people's preferences about nighttime mobility within our application area (Lugano, Switzerland). Using the Hybrid Choice Models technique, we developed an approach and we estimated a model designed to incorporate simultaneously three dimensions of the problem: attributes of the alternatives, characteristics of young drivers, and alcohol-related psychological variables. Our estimates suggest that, first, there are young drivers who are willing to choose public alternatives; secondly, the countermeasures considered can increase their number; and, thirdly, people with a higher attitude to alcohol are more willing to switch to new public transport alternatives and more sensitive to "Drinking and Driving Do not Mix" policies. Action plans developed on the basis of these findings and on the relevance of the psychological component will have a better chance to succeed.