Validation of the Italian version of the Parkinson's Disease- Cognitive Functional Rating Scale.

A key distinguishing factor between mild cognitive impairment (MCI) and dementia in Parkinson's disease (PD) lies in the notable decrease in functioning due to cognitive impairment. The Parkinson's Disease-Cognitive Functional Rating Scale (PD-CRFS) was developed to assess functional limitations caused by cognitive impairment, while reducing the influence of motor impairment. The aim of this multicenter study was to (i) validate the Italian version of the PD-CFRS in PD, (ii) determine optimal cut-off scores for detecting MCI and dementia in PD, (iii) compare its performances with the most established functional assessment tool (IADL). Six hundred and sixty nine PD participants were recruited from 4 Italian Movement Disorders centers (Venice, Milan, Gravedona, and Salerno). They underwent Level-II cognitive evaluation, which resulted in 282 PD-NC, 310 PD-MCI, and 77 PDD. The PD-CFRS's psychometric and clinimetric properties, applicability, and responsiveness were analyzed. The PD-CFRS showed high acceptability. Floor and ceiling effects were acceptable. It also displayed strong internal consistency (Cronbach's α = 0.738), and test-retest reliability (ICC = .854). The PD-CFRS demonstrated higher coefficient of variation to detect dysfunction in PD-MCI patients in comparison to the IADL scale (PD-CFRS 96% vs IADL 22.5%). Convergent validity with the IADL was r = - 0.638 and - 0.527 in males and females, respectively. PD-CFRS total score negatively correlated with global cognition (MoCA corrected score r = - 0.61; p < 0.001). A cut-off score > 6.5 identified PDD with a sensitivity of 90% and specificity of 88% (AUC = .959). A cut-off value of > 1 detected PD-MCI with a sensitivity of 68% and specificity of 69% (AUC = .695). The Italian version of the PD-CFRS demonstrated to be an easy, valid and reliable tool that properly captures functional impairment due to cognitive decline in PD. It also proved to be particularly effective in the advanced stages of PD, and would be a useful support for the diagnosis of PD-MCI and PDD.

Long-Term Impact of Deep Brain Stimulation in Parkinson's Disease: Does It Affect Rehabilitation Outcomes?

Background and Objectives: Although the growing literature is now focusing on the long-term effects of Deep Brain Stimulation (DBS) in Parkinson's disease (PD), there is still a large gap of knowledge about its long-term implications in rehabilitation. Therefore, this study aimed at investigating the effects of rehabilitation in PD patients years after DBS implantation. Materials and Methods: This retrospective case-control study analyzed records from Moriggia-Pelascini Hospital, Italy from September 2022 to January 2024. Data of PD patients (n = 47) with (DBS group, n = 22) and without (control group, n = 25) DBS were considered. All study participants underwent a daily rehabilitation program lasting four weeks, including warm-up, aerobic exercises, strength training, postural exercises, and proprioceptive activities. The outcomes assessed were the Unified Parkinson's Disease Rating Scale (UPDRS), Berg Balance Scale (BBS), Timed Up and Go (TUG), 6 Min Walk Test (6MWT), and Self-Assessment Parkinson Disease Scale (SPDDS). Results: DBS group showed significant improvements in terms of all outcome measures after the rehabilitation intervention (UPDRS III: -7.0 (-11.5 to -1.0); p = 0.001; UPDRS I II IV: -12.0 (-19.0 to -4.5); p = 0.001; BBS: 7.0 (3.8 to 10.3); p < 0.001; TUG (s): -2.8 (-5.7 to -1.1); p < 0.001; SPDDS: -8 (-13.0 to -4.0); p < 0.001; 6MWT (m): 81 (37.3 to 132.3); p < 0.001). No differences were reported in the between-group analysis (p: NS). Conclusions: This study emphasizes positive rehabilitation effects on PD patients irrespective of DBS status. Further research is essential to elucidate long-term effects of DBS on rehabilitation outcomes of PD patients.

Can we add whey protein supplementation in patients with Parkinson's disease without interfering with levodopa response?

OBJECTIVE: The main endpoint of the study was to evaluate if a daily intake of whey protein-based dietary supplement causes a worse response to levodopa in people with Parkinson's Disease (PWPD). BACKGROUND: In PWPD, the competition between large neutral aminoacids and levodopa at intestinal absorption level may interfere with dopaminergic therapy's (DRT) effect; therefore, protein redistribution dietary regimen has been suggested. Many dietary supplementations are available to help people in balancing the protein intake and overcoming muscle mass loss. However, most of the products contain protein and could potentially affect levodopa action in PWPD. METHODS: We performed a randomised single blind monocentric study on PWPD admitted in the rehabilitative unit for a 4-week multidisciplined intensive aerobic rehabilitation treatment. All patients received a standard protein redistribution dietary regimen plus a whey protein-based oral formula (N = 26) or Magnesium (N = 25) twice daily for 28 days. Neurological assessment and physical evaluation were conducted before (T0) and after (T1) rehabilitative treatment; DRT was recorded T0 and T1 as well. The delta of changes within groups in neurological (UPDRS III) and physical (TUG, 6 MW) evaluation scales was compared between groups. RESULTS: Groups were comparable at baseline in clinical and demographic data; at T1, both groups showed a decrease in UPDRS III, TUG and 6 MWT and no differences between deltas were found. DRT remained stable in both groups. CONCLUSIONS: Our results show that whey protein supplementation does not interfere with DRT's efficacy and can be used in PWPD who need a protein supplementation without restrictions in intake hours.

The Hopkins Symptom Checklist (SCL-90-R): A Patient-Reported Outcome Measure in Parkinson's Disease.

Objective: This is the first study applying Clinimetric Patient-Reported Outcome Measures (CLIPROM) criteria to evaluate the construct validity, sensitivity, and clinical utility of the SCL-90-R in patients with Parkinson's disease (PD). Methods: A Rasch analysis was conducted using a sample of 488 PD outpatients. Results: Testing for dimensionality revealed that less than 5% of t-tests were significant, indicating that the SCL-90-R subscales entailed the property of construct validity. As to the total score, a Person Separation Reliability Index of .96 was found. Conclusions: The SCL-90-R total score is a sensitive screening measure that can be used not only to differentiate healthy stress reactions from symptoms of psychological distress but also to detect PD patients with an increased risk for psychiatric complications. As to the subscales, the brief versions that did not include misfitting items should be used to assess the severity of specific symptoms of psychological distress affecting PD patients.

Pathological Gambling in Parkinson's disease: Autonomic measures supporting impaired decision-making.

According to the somatic marker hypothesis, autonomic measures and arousal modulation can reveal a difference in subgroups of patients developing impaired decision-making because of addictions. Previously, pathological gambling (PG) and Parkinson's disease (PD) have been associated with differential arousal levels during gambling behavior. However, no research considered the specific autonomic responses of Parkinson's disease patients with pathological gambling and with a previous history of gambling. Thus, this study investigated skin conductance responses (SCRs), skin conductance level (SCL) and heart rate (HR) during the Iowa Gambling Task (IGT) in two groups of PD patients with gambling disorder, active (PD Gamblers; n = 14) or remitted (PD Non-Gamblers; n = 13) and a control group of patients with Parkinson's disease only (n = 13). Anticipatory autonomic responses to disadvantageous decks and advantageous decks during the Iowa Gambling Task were measured for each participant. The PD Gamblers group performed worse than the PD Non-Gamblers and the control groups at the IGT task and exhibited lower SCRs, SCL, and HR during the decision-making processing of cards belonging to disadvantageous decks. The role of autonomic and behavioral measures was considered.

Survival and dementia in GBA-associated Parkinson's disease: The mutation matters.

OBJECTIVE: The objective of this work was to investigate survival, dementia, and genotype-phenotype correlations in patients with Parkinson's disease (PD) with and without mutations on the glucocerebrosidase gene (GBA). METHODS: We included 2,764 unrelated consecutive PD patients: 123 GBA carriers (67 mild-p.N370S and 56 severe mainly p.L444P) and 2,641 noncarriers. Brain perfusion and dopamine transporter imaging was analyzed, including dementia with Lewy Bodies (DLB) as an additional control group. RESULTS: Multivariable analysis adjusted by sex, age at onset, and disease duration attributed to GBA carriers a greater risk for dementia (hazard ratio [HR] = 3.16; p < 0.001) and death (HR = 1.85; p = 0.002) than noncarriers. When dementia was introduced in the model as a time-dependent covariate, the mortality risk remained greater in carriers (HR = 1.65; p = 0.016), suggesting that other clinical features are likely to contribute to reduced survival. At last examination, GBA carriers had worse motor symptoms, particularly nondopaminergic features. Carriers of severe mutations had greater risk for dementia compared to mild mutations (p < 0.001), but similar mortality risk. Consistent with clinical data, GBA carriers showed reduced posterior parietal and occipital cortical synaptic activity and nigrostriatal function than PD noncarriers. Neuroimaging features of carriers of mild mutations overlapped with PD noncarriers, whereas carriers of severe mutations were closer to DLB. INTERPRETATION: Survival is reduced in GBA carriers compared to noncarriers; this seems to be partially independent from the increased risk for early dementia. The risk for dementia is strongly modulated by type of mutation. In the clinical continuum between PD and DLB, patients with GBA mutations seem to localize midway, with carriers of severe mutations closer to DLB than to idiopathic PD. Ann Neurol 2016;80:662-673.

Penetrance estimate of LRRK2 p.G2019S mutation in individuals of non-Ashkenazi Jewish ancestry.

BACKGROUND: Penetrance estimates of the leucine-rich repeat kinase 2 (LRRK2) p.G2019S mutation for PD vary widely (24%-100%). The p.G2019S penetrance in individuals of Ashkenazi Jewish ancestry has been estimated as 25%, adjusted for multiple covariates. It is unknown whether penetrance varies among different ethnic groups. The objective of this study was to estimate the penetrance of p.G2019S in individuals of non-Ashkenazi Jewish ancestry and compare penetrance between Ashkenazi Jews and non-Ashkenazi Jews to age 80. METHODS: The kin-cohort method was used to estimate penetrance in 474 first-degree relatives of 69 non-Ashkenazi Jewish LRRK2 p.G2019S carrier probands at 8 sites from the Michael J. Fox LRRK2 Cohort Consortium. An identical validated family history interview was administered to assess age at onset of PD, current age, or age at death for relatives in different ethnic groups at each site. Neurological examination and LRRK2 genotype of relatives were included when available. RESULTS: Risk of PD in non-Ashkenazi Jewish relatives who carry a LRRK2 p.G2019S mutation was 42.5% (95% confidence interval [CI]: 26.3%-65.8%) to age 80, which is not significantly higher than the previously estimated 25% (95% CI: 16.7%-34.2%) in Ashkenazi Jewish carrier relatives. The penetrance of PD to age 80 in LRRK2 p.G2019S mutation carrier relatives was significantly higher than the noncarrier relatives, as seen in Ashkenazi Jewish relatives. CONCLUSIONS: The similar penetrance of LRRK2 p.G2019S estimated in Ashkenazi Jewish carriers and non-Ashkenazi Jewish carriers confirms that p.G2019S penetrance is 25% to 42.5% at age 80 in all populations analyzed. © 2017 International Parkinson and Movement Disorder Society.

Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) performance in progressive supranuclear palsy and multiple system atrophy.

To determine if Montreal Cognitive Assessment (MoCA) is more sensitive than the commonly used Mini-Mental State Examination (MMSE) in detecting cognitive abnormalities in patients with probable progressive supranuclear palsy (PSP) and multiple system atrophy (MSA) compared with Parkinson's disease (PD). In this multicenter observational study, MMSE and MoCA were administered in a random order to 130 patients: 35 MSA, 30 PSP and 65 age, and education and gender matched-PD. We assessed between-group differences for MMSE, MoCA, and their subitems. Receiver-operating characteristic (ROC) curves were calculated. The mean MMSE was higher than the mean MoCA score in each MSA (27.7 ± 2.4 vs. 22.9 ± 3.0, p < 0.0001), PSP (26.0 ± 2.9 vs. 18.2 ± 3.9, p < 0.0001), and PD (27.3 ± 2.0 vs. 22.3 ± 3.5, p < 0.0001). MoCA total score as well as its letter fluency subitem differentiated PSP from MSA and PD with high specificity and moderate sensitivity. More specifically, a cut-off score of 7 F-words or less per minute would support a diagnosis of PSP (PSP vs. PD: 86 % specificity, 70 % sensitivity; PSP vs. MSA: 71 % specificity, 70 % sensitivity). By contrast, MMSE presented an overall ceiling effect for most subitems, except for the pentagon scores, where PSP did less well than MSA or PD patients. These preliminary results suggest that PSP and MSA, similar to PD patients, may present normal MMSE and reduced MoCA performance. Overall, MoCA is more sensitive than MMSE in detecting cognitive impairment in atypical parkinsonism and together with verbal fluency would be a useful test to support PSP diagnosis.

Long-term cognitive follow-up of Parkinson's disease patients with impulse control disorders.

This study investigated cognitive functions in Parkinson's disease (PD) patients with impulse control disorders (ICDs) and aimed to identify possible predictors of behavioral outcome. In this longitudinal cohort study, 40 PD outpatients with ICDs and 40 without, were matched for sex, age at PD onset, age and disease duration at cognitive assessment. All patients had two neuropsychological assessments at least 2 years apart (mean, 3.5 years). Multivariate logistic regression analysis was performed to identify predictors of ICDs remission at follow-up. The PD patients with and without ICDs had overall comparable cognitive performance at baseline. When evaluating changes between baseline and follow-up, we found significant group × time interactions in several frontal lobe-related tests, with the ICDs group showing a less pronounced worsening over time. ICDs remission was associated with better performance at baseline in working memory-related tasks, such as digit span (odds ratio [OR] = 2.69 [95% confidence interval (CI), 1.09-6.66]) and attentive matrices (OR=1.19 [95%CI, 1.03-1.37]). ICDs remitters and non-remitters had no remarkable differences in baseline PD-related features and therapy management strategies (including the extent of dopamine agonist dose reduction). In conclusion, ICDs in PD patients are not related to greater cognitive impairment or executive dysfunction, but rather show relatively lower cognitive decline over time. The impaired top-down inhibitory control characterizing ICDs is likely attributable to a drug-induced overstimulation of relatively preserved prefrontal cognitive functions. Full behavioral remission in the long term was predicted by better working memory abilities. © 2015 International Parkinson and Movement Disorder Society.

Dopamine dysregulation syndrome in Parkinson's disease: from clinical and neuropsychological characterisation to management and long-term outcome.

OBJECTIVE: Dopamine dysregulation syndrome (DDS) refers to a compulsive pattern of dopaminergic drug misuse complicating Parkinson's disease (PD). To date, few data are available on DDS risk factors, cognitive profile and long-term outcome. METHODS: In this retrospective case-control study, consecutive PD outpatients fulfilling criteria for DDS were assessed over a 6-year period (2005-2011). They were compared with 70 PD cases matched for age at onset, gender and disease duration, and with 1281 subjects with motor fluctuations and dyskinesias. DDS patients and matched controls underwent extensive neuropsychological assessment. Strategies for DDS patients management and the outcome at the last follow-up visit were recorded. RESULTS: Thirty-five patients with DDS were identified, reporting history of depression, family history of PD and drug abuse, greater difference between 'Off' versus 'On' motor symptoms compared to age-matched controls. They had younger age at onset (but not any gender difference) compared to general PD population. Cognitive profile of DDS did not show major abnormalities, including executive functions. DDS patients have been followed up for 3.2±2.1 years and remission was recorded in 40% of cases. Negative DDS outcome was significantly associated with poor caregiver supervision. Sustained remission occurred more commonly on clozapine and on duodenal levodopa infusion and subthalamic nucleus deep brain stimulation (STN-DBS) than on apomorphine pump treatment. CONCLUSIONS: Clinicians should be aware of risk factors predisposing to DDS. Duodenal levodopa infusion and, less consistently, STN-DBS were more commonly associated with DDS remission. Effective caregiving plays a key role in long-term behavioural outcome.

Optimal MMSE and MoCA cutoffs for cognitive diagnoses in Parkinson's disease: A data-driven decision tree model.

BACKGROUND: Detecting cognitive impairment in Parkinson's disease (PD) is challenging due to diverse manifestations and outdated diagnostic criteria. Cognitive screening tools, as Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA), are adopted worldwide, but despite several cutoffs has been proposed for PD, no consensus has been reached, hindered by limited sample sizes, lack of validation, and inconsistent age- and education-adjustments. OBJECTIVES: Determine the optimal MMSE and MoCA cutoffs in a large PD cohort, spanning from normal cognition (PD-NC), mild cognitive impairment (PD-MCI) to dementia (PDD), and develop a decision tree model to assist physicians in cognitive workups. METHODS: Our retrospective Italian multicenter study involves 1780 PD, cognitively diagnosed with a level-II assessment: PD-NC(n = 700), PD-MCI(n = 706), and PDD(n = 374). Optimal cutoffs (for raw scores) were determined through ROC analysis. Then, a machine learning approach-decision trees-was adopted to validate and analyze the possible inclusion of other relevant clinical features. RESULTS: The decision tree model selected as primary feature a MMSE cutoff ≤24 to predict dementia, and a score ≤ 27 for PD-MCI. To enhance PD-MCIvs.PD-NC accuracy, it also recommends including a MoCA score ≤ 22 for PD-MCI, and > 22 for PD-NC. Age and education were not selected as relevant features for the cognitive workup. Both MoCA and MMSE cutoffs exhibited high sensitivity and specificity in detecting PD cognitive statues. CONCLUSIONS: For the first time, a clinical decision tree model based on robust MMSE and MoCA cutoffs has been developed, allowing to diagnose PD-MCI and/or PDD with a high accuracy and short administration time.

Dyskinesia and impulsive compulsive behaviour in Parkinson's disease are not related: Insights from a study with a wearable sensor.

INTRODUCTION: Previous studies have suggested an association between Impulsive Compulsive Behaviour (ICB) and dyskinesia in Parkinson's disease (PD). However, none of these studies have employed an objective home-based measure of dyskinesia. OBJECTIVES: To evaluate in advanced PD the relationship between ICB and dyskinesia, objectively measured with a wearable device. METHODS: In this cross-sectional study, ICB and other neuropsychiatric symptoms were assessed by means of structured clinical interview and specific screening instruments. Presence and severity of motor fluctuations and dyskinesia were rated with patient's and clinician's based rating instruments. Motor fluctuations and dyskinesia were also measured at home for 5-days using a validated wearable devise, the Parkinson's KinetiGraph™(PKG). RESULTS: We included 89 subjects with PD (29 females, 62 ± 7 years, disease duration 10.3 ± 4.5), of whom 36 (40%) had ICB. Patients with and without ICB did not differ by presence and severity of dyskinesia measured by clinical scales and PKG. There was no association between the presence of ICB and dyskinesia in the whole sample. CONCLUSION: Our data suggest that ICB and dyskinesia are common but unrelated disorders in advanced PD.

Cognitive and Neuropsychiatric Features of COVID-19 Patients After Hospital Dismission: An Italian Sample.

Background and Aims: Recent studies suggest cognitive, emotional, and behavioral impairments occur in patients after SARS-CoV-2 infection. However, studies are limited to case reports or case series and, to our knowledge, few of them have control groups. This study aims to assess the prevalence of neuropsychological and neuropsychiatric impairment in patients after hospitalization. Methods: We enrolled 29 COVID+ patients (M/F: 17/12; age 58.41 ± 10.00 years; education 11.07 ± 3.77 years, 2 left handers) who needed hospitalization but no IC, about 20 days post-dismission, and 29 COVID- healthy matched controls. Neuropsychological and neuropsychiatric assessments were conducted via teleneuropsychology using the following tests: MMSE, CPM47, RAVLT, CDT, Digit-Span Forward/Backward, Verbal fluencies; BDI-II, STAI. People with previous reported cognitive impairment and neurological or psychiatric conditions were excluded. Clinical and demographics were collected. Comparison between groups was conducted using parametric or non-parametric tests according to data distribution (T-test, Mann Withney-U test; Chi-square goodness of fit). Within COVID+ group, we also evaluated the correlation between the cognitive and behavioral assessment scores and clinical variables collected. Results: Among COVID+, 62% had at least one pathological test (vs. 13% in COVID-; p = 0.000) and significantly worst performances than COVID- in RAVLT learning (42.55 ± 10.44 vs. 47.9 ± 8.29, p = 0.035), RAVLT recall (8.79 ± 3.13 vs. 10.38 ± 2.19, p = 0.03), and recognition (13.69 ± 1.47 vs. 14.52 ± 0.63, p = 0.07). STAI II was higher in COVID- (32.69 ± 7.66 vs. 39.14 ± 7.7, p = 0.002). Chi-square on dichotomous values (normal/pathological) showed a significant difference between groups in Digit backward test (pathological 7/29 COVID+ vs. 0/29 COVID-; p = 0.005). Conclusions: Patients COVID+ assessed by teleneuropsychology showed a vulnerability in some memory and executive functions (working memory, learning, delayed recall, and recognition). Intriguingly, anxiety was higher in the control group. Our findings therefore confirm the impact of COVID-19 on cognition even in patients who did not need IC. Follow-up is needed to evaluate the evolution of COVID-19-related cognitive deficit. Clinical Trial Registration: [ClinicalTrials.gov], identifier [NCT05143320].

Pathological gambling in patients with Parkinson's disease is associated with fronto-striatal disconnection: a path modeling analysis.

BACKGROUND: Pathological gambling may occur in Parkinson's disease (PD) as a complication of dopaminergic therapy. Neuroimaging studies have suggested an abnormal dopamine transmission within the reward system, but the changes in the neural network characterizing PD patients with pathological gambling have never been investigated. METHODS: Thirty PD patients (15 with active gambling and 15 matched controls, on-medication) and 15 healthy subjects underwent brain perfusion single photon emission tomography at rest. The severity of gambling was assessed using the South Oaks Gambling Scale. Covariance analysis was applied to identify brain regions whose activity was associated with gambling severity. These regions were used as volume-of-interest to identify functionally interconnected areas using voxel-wise covariance analysis. A path model was defined by means of effective connectivity analysis within the Structural Equation Modeling framework. RESULTS: Gambling severity in PD was associated with a dysfunction of the brain network implicated in decision making, risk processing, and response inhibition, including the ventrolateral prefrontal cortex, anterior (ACC) and posterior cingulate cortex, medial prefrontal cortex, insula and striatum. PD gamblers showed a disconnection between the ACC and the striatum, while this interaction was very robust in both control groups. DISCUSSION: ACC-striatal disconnection may underlie a specific impairment of shifting behaviors after negative outcomes, possibly explaining why PD gamblers use to perseverate into risktaking behaviors despite self-destructive consequences.

Impulsivity and compulsivity in drug-naïve patients with Parkinson's disease.

BACKGROUND: Abnormal repetitive behaviors have been reported in Parkinson's disease (PD) during dopamine replacement therapy (DRT) and associated with individual predisposing features, including impulsivity. However, impulsivity and compulsive symptoms have never been explored in PD patients before initiation of DRT. We previously reported a 20% of impulse control disorders (ICD) in an Italian cohort. METHODS: 103 consecutive newly diagnosed drug-naïve PD patients (means: age = 60.5 ± 9.2 years; duration = 15.4 ± 15.3 months) were screened for compulsive sexual behavior, compulsive buying, intermittent explosive disorder (Minnesota Impulsive Disorders Interview, MIDI), and pathological gambling (South Oaks Gambling Screen, SOGS). Barratt Impulsiveness Scale (BIS-11) and Maudsley Obsessional-Compulsive Questionnaire (MOCQ/R) assessed impulsivity, obsessive-compulsive symptoms, respectively. Depression (GDS-15) and general cognitive status were additionally assessed. We also compared ICDs frequency with our healthy controls. RESULTS: 17.5% of PD patients screened positive for at least one ICD at MIDI (17/103) and SOGS (1/103), though none had a disorder based on DSM-IV criteria. These frequencies were similar to healthy controls. There was a trend toward higher scores in BIS-11 attentive-impulsivity subscale (15.2 ± 4.8 vs. 18.7 ± 4.9; P = 0.007) and in MOCQ/R-Doubting subscale (0.67 ± 1.1 vs. 1.5 ± 1.2; P = 0.007) in PD with ICD. We also observed a positive correlation between GDS-15 and BIS-11. CONCLUSIONS: Similar to our healthy control population, we found a significant proportion of early PD patients positive for ICDs before starting treatment. We also found a relationship between impulsivity and depression. A detailed behavioral assessment before starting dopaminergic therapy is recommended.

Cognitive bizarreness in the dream and waking mentation of nonpsychotic patients with Parkinson's disease.

Cognitive bizarreness is a shared feature of the dream and waking mentation of acutely psychotic patients. The authors investigated this measure of the structural architecture of thought in the dream and waking mentation of 20 nonpsychotic patients with Parkinson's disease after treatment with prodopaminergic drugs. Statistically overlapping levels of cognitive bizarreness were found in the waking fantasy and dream reports of the Parkinson's disease population, whereas almost no bizarreness was found in the waking cognition of the comparison group, suggesting it may be an inherent quality of cognition in Parkinson's disease patients, possibly related to the cholinergic/dopaminergic imbalance underlying this complex disorder.

Psychiatric symptoms in Parkinson's disease assessed with the SCL-90R self-reported questionnaire.

The frequency of psychopathological symptoms in patients with Parkinson's disease (PD) is often underestimated because of the lack of comprehensive evaluation tools. A total of 486 consecutive non-demented PD patients completed the Symptom Checklist 90 Revised (SCL-90R) self-reported questionnaire, a validated tool for the assessment of psychopathological symptoms on nine dimensions. Somatization, depression, anxiety and obsessive-compulsive behaviors were reported by nearly half of the PD patients. They were more likely to occur in females. Disease-related factors such as duration, severity and daily dosages, but not type of dopaminergic medications, were associated with the occurrence of these symptoms. Psychopathological features are frequent in PD and their occurrence is underlined by disease-related factors.

The prevalence of psychological distress in Parkinson's disease patients: The brief symptom inventory (BSI-18) versus the Hopkins symptom checklist (SCL-90-R).

The prevalence of psychological distress in Parkinson's disease (PD) patients has been evaluated by many different assessment instruments and with diverse control groups. The most frequently used distress symptom scale has been the Hopkins Symptom Checklist (SCL-90-R), although it contains many symptoms with problematic validity clinically. The 18-item subscale of the SCL-90-R, the Brief Symptom Inventory (BSI-18) has recently been shown to have a sufficient validity to screen for the prevalence of psychological distress (somatization) in PD patients. We have performed a clinimetric analysis by comparing the BSI-18 with SCL-90-R relevant subscales in PD patients. Our micro-analysis has focused on the Mokken model to test the scalability of the subscales. The macro-analysis has focused both on effect size statistics and the normative level of psychological distress with reference to the Italian general population data using T-score metric. The Mokken analysis indicated acceptable scalability for all the subscales of BSI-18. The effect size statistics identified somatization in both BSI-18 and SCL-90-R as the most prevalent and intense symptom of psychological distress. The T-score metric identified the phobic anxiety subscale of SCL-90-R to be clinically much more important than the BSI-18 anxiety subscale in the PD patients. We have found the SCL-90-R subscale of phobic anxiety and the BSI-18 somatization subscale most clinically valid when measuring psychological distress in PD patients.