Impulse control disorders in advanced Parkinson's disease with dyskinesia: The ALTHEA study.

BACKGROUND: Impulse control disorders and dyskinesia are common and disabling complications of dopaminergic treatment in Parkinson's disease. They may coexist and are possibly related. The objectives of this study were to assess the frequency and severity of impulse control disorders in Parkinson's disease patients with dyskinesia. METHODS: The ALTHEA study enrolled 251 Parkinson's disease patients with various degrees of dyskinesia severity from 11 movement disorders centers in Italy. Each patient underwent a comprehensive assessment including Unified Dyskinesia Rating Scale and the Questionnaire for Impulsive Compulsive Disorders in Parkinson Disease-Rating Scale. RESULTS: There was an overall 55% frequency of impulse control disorder and related behaviors (36% were clinically significant). The positive patients were younger at disease diagnosis and onset and had higher Unified Dyskinesia Rating Scale historical and total score (P = 0.001 and P = 0.02, respectively, vs negative). There was an increased frequency of clinically significant impulse control disorders in patients with severe dyskinesia (P = 0.013), a positive correlation between the questionnaire total score and dopamine agonist dose (P = 0.018), and a trend with levodopa dose. CONCLUSIONS: More than half of Parkinson's disease patients with dyskinesia have impulse control disorders and related behaviors, which are frequently clinically significant. Dopaminergic therapy total dose is associated with their severity. Clinicians should carefully assess patients with maladaptive behaviors and dyskinesia because they do not properly evaluate their motor and nonmotor status. © 2017 International Parkinson and Movement Disorder Society.

Parkinson's Disease Sleep Scale 2: application in an Italian population.

Sleep disturbances and nocturnal disabilities are common in Parkinson's Disease (PD). The PD sleep scale, second version (PDSS-2), has been proposed as a helpful tool for measuring sleep disorders in PD. We aimed to validate the Italian version of the PDSS-2. One hundred and twenty-three consecutive PD outpatients (76 males) were evaluated by means of PDSS-2, Epworth Sleepiness Scale, Hamilton Depression Rating Scale, Parkinson's Disease Quality of Life Questionnaire (self-administered scales), Unified Parkinson's Disease Rating (motor section) and Hoehn and Yahr Scales, and Mini Mental State Examination. PDSS-2 internal consistency was satisfactory (Cronbach's α: 0.77) with significant item to total score correlation and high intra-class correlation coefficient for test-retest reliability (0.943). Total PDSS-2 score was correlated with the scores on all other clinical scales. The factor analysis identified five factors, related to five areas of nocturnal disturbances, similarly as the original PDSS-2. The five factors mainly reflected: (1) nocturnal movement-related problems, (2) quality of sleep, (3) dreaming distress, (4) fragmentation of sleep and (5) insomnia symptoms. The PDSS-2 scale has confirmed its usefulness in evaluating sleep problems in Italian PD patients.

Linguistic, psychometric validation and diagnostic ability assessment of an Italian version of a 19-item wearing-off questionnaire for wearing-off detection in Parkinson's disease.

A patient self-rated 19-item wearing-off questionnaire (WOQ-19) was shown to be a potent screening tool for wearing-off (WO) in patients with Parkinson's disease. As part of the early detection of wearing-off in Parkinson's disease study, we preliminarily performed a linguistic and a psychometric validation of an Italian version of the WOQ-19. Moreover, we assessed the sensitivity and specificity of the WOQ-19 in the office-based settings. The psychometric validation study included assessment of discriminant ability, internal consistency and test-retest reliability. The intraclass correlation coefficient (ICC) and the Cronbach's Alpha were assessed. The WOQ-19 sensitivity and specificity were calculated in respect to the physician assessment of WO, taken as the gold standard. The Italian version of WOQ-19 was found easy to understand by ≥ 80% of the patients. The number of WO-related symptoms detected by WOQ-19 was 7.5 ± 3.2 in patients with WO and 1.6 ± 2.6 in patients without WO (p < 0.0001). Cronbach's alpha was equal to 0.868 for the total number of WO symptoms. The ICC value was equal to 0.858 for WO-related symptoms as a whole. The diagnostic ability study recruited 207 patients: for a WOQ-19 cut-off ≥ 2, the sensitivity was equal to 0.881 and the specificity was 0.674. This is the first validation of WOQ-19 in Italian, with excellent linguistic validity and psychometric properties. WOQ-19 was confirmed to be reliable in WO detection.

An objective measure combining physical and cognitive fatigability: Correlation with subjective fatigue in Parkinson's disease.

BACKGROUND: Objective measures of physical and cognitive fatigability do not correlate with subjective Parkinson's disease (PD)-related fatigue. The relationship of subjective PD-related fatigue to tasks combining cognitive and motor effort has never been explored. METHODS: Forty-four right-handed, non-demented PD patients, 22 with (PD-F) and 22 without (PD-NF) fatigue, were tested using a sensor-engineered glove on their more affected hand. Patients performed sequential opposition finger movements following a metronome at 2 Hz for 5 min (cued task), and for another minute following a 2-min rest. The same task was repeated without sustained auditory cueing. Movement time (inter-tapping interval, ITI) and rate, touch duration, percentage of correct sequences and clinical measures (motor and fatigue severity, depression, sleep impairment and apathy) were analysed. RESULTS: In the cued task, motor performance worsened over time (significantly increased ITI and decreased movement rate on the third to fifth minute) in PD-F patients only. In the uncued task, motor performance deteriorated similarly in the two groups. PD-F and PD-NF patients differed in ITI and movement rate deterioration over time only in the cued task, independently from motor severity, depression and sleep impairment. The severity of subjective fatigue complaints significantly correlated with motor performance deterioration in the cued task. CONCLUSIONS: PD-related fatigue is associated with performance on an externally cued, attention-controlled motor task, but not with an uncued version of the same task. The finding supports a link between PD-related fatigue and attention-demanding motor tasks, proposing a model of inducible fatigue applicable to future clinical and neuroimaging research.

Acute disseminated encephalomyelitis with severe neurological outcomes following virosomal seasonal influenza vaccine.

Acute disseminated encephalomyelitis (ADEM) is an inflammatory, usually monophasic, immune mediate, demyelinating disease of the central nervous system which involves the white matter. ADEM is more frequent in children and usually occurs after viral infections, but may follow vaccinations, bacterial infections, or may occur without previous events. Only 5% of cases of ADEM are preceded by vaccination within one month prior to symptoms onset. The diagnosis of ADEM requires both multifocal involvement and encephalopathy and specific demyelinating lesions of white matter. Overall prognosis of ADEM patients is often favorable, with full recovery reported in 23% to 100% of patients from pediatric cohorts, and more severe outcome in adult patients. We describe the first case of ADEM occurred few days after administration of virosomal seasonal influenza vaccine. The patient, a 59-year-old caucasic man with unremarkable past medical history presented at admission decreased alertness, 10 days after flu vaccination. During the 2 days following hospitalization, his clinical conditions deteriorated with drowsiness and fever until coma. The magnetic resonance imaging of the brain showed multiple and symmetrical white matter lesions in both cerebellar and cerebral hemispheres, suggesting demyelinating disease with inflammatory activity, compatible with ADEM. The patient was treated with high dose of steroids and intravenous immunoglobulin with relevant sequelae and severe neurological outcomes.