Effectiveness of a Family Support Intervention on Caregiving Burden in Family of Elderly Patients With Cognitive Decline After the COVID-19 Lockdown.

Background: The coronavirus disease 2019 (COVID-19) pandemic had a great impact on patients with cognitive decline or dementia. The lockdown period may exacerbate behavioral disorders and worsen distress of caregivers. The aim of this study is to evaluate the effectiveness of a family support intervention on the negative effects that the COVID-19 lockdown may have on patients and related caregivers. Methods: We recruited patients whose related caregivers had attended a family support course before the COVID-19 lockdown. The course was for family members of patients with cognitive decline or dementia and consisted in eight meetings during which the participants received information about the disease, the management of neuropsychiatric symptoms, and community resources and services available for patients with dementia. Data on cognitive decline, neuropsychiatric symptoms, and functional status had been collected before the course with the Mini-Mental State Examination (MMSE), the Neuropsychiatric Inventory (NPI), and the Instrumental (IADL) and Basic (BADL) Activities of Daily Living scales, respectively. The caregiving burden had been evaluated at the end of the course by means of the Zarit Burden Interview (ZBI). After the COVID-19 lockdown, a phone interview was made to compare neuropsychiatric symptoms, functional status, and caregiver's burden with the previous evaluation. Results: There were no significant changes before and after the COVID-19 lockdown in the mean NPI score. The IADL, BADL, and ZBI scores were significantly lower after lockdown than before. The BADL scores were inversely associated with ZBI scores. Thus, despite a worsening of patients' functional status, the caregivers' burden decreased significantly probably due to the positive effect of the family support intervention. Conclusions: Our study demonstrated that a complete family support intervention for caregivers of patients with cognitive decline or dementia can reduce the burden of care even in a particular negative period, such as the COVID-19 lockdown.

Cognitive and Neuropsychiatric Profiles in Idiopathic Rapid Eye Movement Sleep Behavior Disorder and Parkinson's Disease.

A bstract : Rapid eye movement (REM) sleep behavior disorder (RBD) is a risk factor for developing Parkinson's disease (PD) and may represent its prodromal state. We compared neuropsychological and neuropsychiatric phenotypes of idiopathic (i) RBD, PD and healthy comparators (HC) in order to identify iRBD specific characteristics. Thirty-eight patients with iRBD, 38 PD patients with RBD (PD + RBD), 38 PD patients without RBD (PD-RBD) and 38 HC underwent a comprehensive neurological, neuropsychological and neuropsychiatric evaluation. iRBD, PD + RBD and PD-RBD performed worse than HC in short-term verbal memory, praxia, language and executive functions. iRBD had higher levels of anxiety, depression, apathy and alexithymia than HC. iRBD had higher levels of apathy than PD + RBD. Both PD groups had higher levels of anxiety and depression than HC. Surprisingly, iRBD performed better than all groups in long-term verbal memory. Patients diagnosed with iRBD are characterized by poor global cognitive performance, but better long-term memory and higher levels of depression, anxiety, alexithymia and apathy. Alexithymia and apathy in patients diagnosed with iRBD may be the expression of precocious derangement of emotional regulation, subsequently observed also in PD. Cognitive and neuropsychiatric symptoms of iRBD are early clinical manifestations of widespread neurodegeneration.

Alexithymia and anhedonia in early Richardson's syndrome and progressive supranuclear palsy with predominant parkinsonism.

INTRODUCTION: Phenotypic variants of progressive supranuclear palsy (PSP) are all characterized by the combination of motor symptoms of parkinsonism with a number of neuropsychiatric and cognitive disorders. Despite the strong effort in characterizing these features in PSP, alexithymia and anhedonia have not been investigated at present. Here, we aimed at investigating the qualitative and quantitative differences of alexithymia and anhedonia in the two more frequent variants of PSP, Richardson's syndrome (PSP-RS) and PSP with predominant parkinsonism (PSP-P) compared to Parkinson's disease (PD) patients recruited within 24 months after the onset of motor symptoms. METHODS: One hundred fifty-five PD, 11 PSP-P, and 14 PSP-RS patients underwent clinical, neuropsychiatric, and neuropsychological evaluations. Alexithymia was assessed using the Toronto Alexithymia Scale-20 item (TAS-20), and hedonic tone was measured by the Snaith-Hamilton Pleasure Scale (SHAPS). RESULTS: In PSP-P and PSP-RS patients, the frequency of alexithymia diagnosis was higher than in PD. On the TAS-20 scores, PSP-RS performed worse in the total score and in F2 sub-scale when compared to PD. Among patients with diagnosis of depression, PSP-RS showed higher scores in TAS-20 total and TAS-20 F2 than PD. No significant differences in TAS-20 scores were found in nondepressed patients. Finally, we did not find significant differences among PD, PSP-P, and PSP-RS groups in the SHAPS scores. CONCLUSIONS: Alexithymia is identifiable very early in PSP-P and PSP-RS patients. Alexithymic symptoms differentiate PSP-RS group from PD group but not between the two subtypes of PSP. Further, alexithymia in PSP seems to be predicted by the presence of depression. Altered emotional capability could be related to specific neurophysiological dysfunction occurring precociously in PSP; therefore, its identification could orient the diagnosis toward PSP cases.

Neuropsychological disorders in non-central nervous system cancer: a review of objective cognitive impairment, depression, and related rehabilitation options.

AIM: The objective of the present review was to systematically characterize the types of cognitive impairment that are found in different non-brain types of cancer as measured by objective and validated tests, and also to further examine depression and cognitive function in cancer patients and explore their available rehabilitation treatments. RESULTS: A total of 29 articles were reviewed. Most of these studies suggest that chemotherapy as well as the combination of chemotherapy and hormonal therapy can influence cognition in different types of cancer patients. Breast cancer patients appear to be the most affected in neuropsychological function, specifically in terms of cognitive impairment and reduced quality of life, as compared to other non-brain solid tumours. Overall, the most impaired functions were verbal ability, memory, executive function, and motor speed. CONCLUSION: Chemotherapy-related cognitive dysfunction remains under-recognized and undertreated. The various studies reported differing and non-homogenous findings with mixed results, obtained by self-reporting and web-assisted assessment, with other confounding factors such as age and depression during both cancer diagnosis and treatment. An objective neuropsychological assessment is fundamental to avoid underestimation of the extent of chemobrain. Self-reported and web-assisted assessment may ultimately result in confusion between the neuropsychological signs of chemobrain versus those of depression.

Chronic Pain in the Elderly with Cognitive Decline: A Narrative Review.

The presence of pain in elderly persons with cognitive decline is often neglected, under-reported, underestimated, misdiagnosed and not adequately treated, with consequences that have a strong impact on health, independence in activities of daily living and quality of life. There is no empirical evidence that people with dementia experience less pain; therefore, in patients with severe cognitive impairment the progression of cognitive decline dramatically affects the ability to verbalize the presence of pain. Self-assessment scales are considered the "gold standard" for pain assessment, but the presence of cognitive impairment is likely to reduce the reliability of these measures. Treatment of pain in elderly with cognitive decline or dementia is based on non-pharmacological and pharmacological strategies. Pharmacological treatment should consider physiological changes, high comorbidity and drug interactions that occur frequently in the elderly. This narrative review aims to describe current knowledge, methods of detection and treatment approaches for chronic pain in elderly persons with cognitive deficits.

Psychiatric profile of motor subtypes of de novo drug-naïve Parkinson's disease patients.

BACKGROUND: Parkinson's disease (PD) is a heterogeneous neurodegenerative disorder. It is well established that different motor subtypes of PD evolve with different clinical courses and prognoses. The complete psychiatric profile underlying these different phenotypes since the very early stage of the disease is debated. AIMS OF THE STUDY: We aimed at investigating the psychiatric profile of the three motor subtypes of PD (akinetic-rigid, tremor-dominant, and mixed) in de novo drug-naïve patients with PD. METHODS: Sixty-eight patients with PD, divided into 39 akinetic-rigid (AR), seven mixed (MIX), and 22 tremor-dominant (TD) patients underwent a complete assessment of psychiatric, cognitive, and motor symptoms. RESULTS: No significant differences were found among groups. CONCLUSIONS: Our results suggest that a differentiation of the psychiatric symptoms associated with specific motor subtypes of PD is not detectable in de novo drug-naïve patients. Previous evidence that emerges later along the disease progression may be a consequence of the dopaminergic and nondopaminergic damage increase.

Alexithymia in Parkinson's disease: A systematic review of the literature.

INTRODUCTION: In this systematic review, we aimed to evaluate the role of alexithymia in Parkinson's disease (PD) and its relationship to neurological, neuropsychiatric, cognitive, and neuroimaging correlates. METHODS: The database was selected using PubMed Services, Cochrane, PsycNET and Scopus and a number of key words. Further studies were sought by manually searching for secondary sources, including relevant journals and references in primary articles. The search was restricted to articles written in English between January 1980 and August 2015. RESULTS: Ten studies reported that alexithymia prevalence was about double in PD patients compared to control subjects and that specific dimensions of alexithymia might be related to depression, anxiety, apathy and impulsivity. Some studies investigated the relationship between alexithymia and neuropsychological symptoms and found correlations with frontal and parietal lobe functions. Two studies on neurological features reported a link between alexithymia and disease stage or a specific motor subtype of PD; the remaining studies found that alexithymia was independent from neurological symptoms, dopaminergic therapy and laterality of motor symptom onset. Data on neuroimaging correlates and therapeutic intervention on alexithymia in PD patients are still lacking. CONCLUSION: Although results suggest that alexithymia is a primary characteristics of PD, further studies with larger patient samples are needed to definitively clarify the impact of alexithymia on the clinical features of PD patients.

Homotaurine Effects on Hippocampal Volume Loss and Episodic Memory in Amnestic Mild Cognitive Impairment.

Homotaurine supplementation may have a positive effect on early Alzheimer's disease. Here, we investigated its potential neuroprotective effect on the hippocampus structure and episodic memory performances in amnestic mild cognitive impairment (aMCI). Neuropsychological, clinical, and neuroimaging assessment in 11 treated and 22 untreated patients were performed at baseline and after 1 year. Magnetic resonance data were analyzed using voxel-based morphometry to explore significant differences (Family Wise Error corrected) between the two groups over time. Patients treated with homotaurine showed decreased volume loss in the left and right hippocampal tail, left and right fusiform gyrus, and right inferior temporal cortex which was associated with improved short-term episodic memory performance as measured by the recency effect of the Rey 15-word list learning test immediate recall. Thus, homotaurine supplementation in individuals with aMCI has a positive effect on hippocampus atrophy and episodic memory loss. Future studies should further clarify the mechanisms of its effects on brain morphometry.

Neuropsychiatric and cognitive symptoms and body side of onset of parkinsonism in unmedicated Parkinson's disease patients.

INTRODUCTION: The onset of motor symptoms is primarily unilateral in the majority of Parkinson's disease (PD) patients. Because of the lateralization of several cognitive and neuropsychiatric functions and the role of impaired dopaminergic transmission on non-motor symptoms in PD, the question raises whether body side of onset of parkinsonian motor symptoms might influence cognitive and/or neuropsychiatric domains in idiopathic PD. METHODS: Here we investigated the prevalence and severity of neuropsychiatric and cognitive alterations in a cohort of 84 drug naïve PD patients, divided into two groups according to the body side of onset of motor symptoms (42 left onset PD patients-LPD and 42 right onset PD patients-RPD). Eighty-four age-, sex- and educational level-matched healthy subjects (HC) served as controls. RESULTS: Both LPD and RPD patients had higher prevalence and severity of neuropsychiatric and cognitive symptoms with respect to HC. There were no difference between LPD and RPD as to the pattern or severity of neuropsychiatric and cognitive symptoms. However, significantly higher percentage of LPD patients than RPD deviated more than 1.5 SD from mean values of HC at scales for depression. CONCLUSIONS: Our results indicate that in early PD patients side of onset of parkinsonian motor symptoms does not influence non-motor accompanying signs, at least at neuropsychiatric and neuropsychological domains, and suggest that differences reported by previous reports may be secondary to disease progression and/or dopamine replacement therapy.

Unraveling predictors affecting compliance to MRI in Parkinson's disease.

INTRODUCTION: Magnetic resonance imaging (MRI) is a sensitive, noninvasive and widely available technique for studying Parkinson's disease (PD) from both research and clinical perspective. Several issues may physically impede execution of MRI. Moreover, the severity of motor or non-motor symptoms of PD might reduce compliance to MRI. Here we investigated predictors affecting compliance to MRI in PD patients. METHODS: Two-hundred-thirty-six PD patients underwent clinical, neuropsychological and neuropsychiatric investigations. Accordingly to their ability/inability to perform MRI scan, they were divided into 3 groups. Forty-two patients had physical incompatibility to MRI (PI); 51 patients refused to undergo scan during the MRI evaluation session (RR); 143 patients accepted to undergo and successfully completed MRI (SP). Multivariate/Univariate Analyses of Variance, followed by Bonferroni's post-hoc comparisons, were used to assess differences among groups. To identify predictors of compliance to MRI scan in the whole PD sample (SP vs. RR + PI) we carried out a logistic regression analysis. RESULTS: PI subjects were significantly older, had higher UPRDRS-III score, received lower daily dopamine agonist doses, and displayed worse cognitive performances than SP. RR subjects had significantly higher anxiety severity than SP. Lower daily dopamine agonist equivalents and higher anxiety scores were the significant whole predictors of not compliance to MRI in the logistic regression analysis. CONCLUSIONS: These results show that demographic, neuropsychological and neuropsychiatric features may limit compliance to MRI in PD, and provide valuable aid for setting and interpreting research and clinical MRI studies in PD.

The early course of affective and cognitive symptoms in de novo patients with Parkinson's disease.

Neuropsychiatric and cognitive symptoms are common in patients with Parkinson's disease (PD) from the early stage of the disease but their course is still unclear. In this study we investigated prospectively the progression of affective and cognitive symptoms and disorders in de novo idiopathic PD patients. Twenty-four de novo drug naïve PD patients underwent a comprehensive neurological, psychopathological and neuropsychological evaluation at the first diagnostic visit (OFF), after 4-6 months when the antiparkinsonian therapy regimen was stabilized (ON-1), and at one year following the ON-1 follow-up visit (ON-2). Generalized least squares analysis revealed a significant improvement over time in the depressive mood, short and long term episodic verbal memory, visual memory, and the motor symptoms. Pairwise comparisons showed a significant change from OFF to ON-1 for all the aforementioned variables, except for short term episodic verbal memory which approached significance. A significant improvement from ON-1 to ON-2, however, was shown for short term episodic verbal memory. An ancillary analysis indicated that overall level and change in a number of cognitive variables, but not depression, was conditional upon age of onset, education, and sometime gender. In conclusion, early stage PD is not associated with affective and cognitive deterioration. On the contrary, very specific neuropsychiatric and cognitive symptoms may improve. This study provides Class III evidence that antiparkinsonian treatment commonly used in the clinical practice improves memory performance and depression severity in de novo patients with PD.

Cognitive and affective changes in mild to moderate Alzheimer's disease patients undergoing switch of cholinesterase inhibitors: a 6-month observational study.

Patients with Alzheimer's disease after an initial response to cholinesterase inhibitors may complain a later lack of efficacy. This, in association with incident neuropsychiatric symptoms, may worsen patient quality of life. Thus, the switch to another cholinesterase inhibitor could represent a valid therapeutic strategy. The aim of this study was to investigate the effectiveness of the switch from one to another cholinesterase inhibitor on cognitive and affective symptoms in mild to moderate Alzheimer disease patients. Four hundred twenty-three subjects were included from the EVOLUTION study, an observational, longitudinal, multicentre study conducted on Alzheimer disease patients who switched to different cholinesterase inhibitor due either to lack/loss of efficacy or response, reduced tolerability or poor compliance. All patients underwent cognitive and neuropsychiatric assessments, carried out before the switch (baseline), and at 3 and 6-month follow-up. A significant effect of the different switch types was found on Mini-Mental State Examination score during time, with best effectiveness on mild Alzheimer's disease patients switching from oral cholinesterase inhibitors to rivastigmine patch. Depressive symptoms, when measured using continuous Neuropsychiatric Inventory values, decreased significantly, while apathy symptoms remained stable over the 6 months after the switch. However, frequency of both depression and apathy, when measured categorically using Neuropsychiatric Inventory cut-off scores, did not change significantly during time. In mild to moderate Alzheimer disease patients with loss of efficacy and tolerability during cholinesterase inhibitor treatment, the switch to another cholinesterase inhibitor may represent an important option for slowing cognitive deterioration. The evidence of apathy stabilization and the positive tendency of depressive symptom improvement should definitively be confirmed in double-blind controlled studies.

Can cardiac resynchronization therapy improve cognitive function? A systematic review.

INTRODUCTION: Cognitive impairment (CI) comprises a measurable deficit of different cognitive domains (memory, attention, problem solving, and motor speed), and has a high prevalence among congestive heart failure (CHF) patients. Only a few pilot studies have investigated the effects of cardiac resynchronization therapy (CRT) on cognitive performance. The purpose of this systematic review is to outline and evaluate results of published studies that assess the impact of CRT on neuropsychological function in CHF. METHODS: Electronic databases were searched for articles containing the following terms: CRT, cognition, cognitive, and neurocognitive. A data extraction was performed according to our objective from each study. Effect sizes were computed using Hedges' g. The within-group formula was used for cohort studies with a pre-post design, while the between-group formula was used for studies that compared independent groups. Multiple outcomes were combined in domain-specific synthetic scores as well as in a global score for each study, and a fixed-effect model was used to estimate the summary effects. RESULTS: Only three studies met criteria for inclusion in the analysis. The results of these studies were discordant and methodological limitations were identified. The meta-analysis of cognitive outcomes showed a nonsignificant overall effect (Hedges' g = 0.131, 95% confidence interval: -0.16 to 0.422), while the summary effects on executive functioning and attention reached statistical significance (Hedges' g = 0.374, 95% confidence interval: 0.085-0.662 and Hedges' g = 0.343, 95% confidence interval: 0.051-0.635, respectively). CONCLUSION: CI and related negative consequences have been largely documented in patients with heart failure but very few studies have assessed the plausible benefits of CRT on patients' cognitive function. Despite the statistical significance of the domain-specific pooled effects, their validity and clinical relevance is lacking due to methodological limitations.

Neuropsychiatric symptoms and interleukin-6 serum levels in acute stroke.

The role of interleukin-6 (IL-6) as a risk factor for developing depressive symptoms, neuropsychological impairment, and related functional and neurological symptom severity during the acute phase of ischemic stroke is still underexplored. Here, the authors assessed this issue, in 48 patients without significant clinical history for major medical illnesses or other factors that promote inflammation, 72 hours after a first-ever acute ischemic stroke. In the acute phase of ischemic stroke, increased IL-6 plays a key role in the onset of depressive disorders, apathy/amotivation, somatic symptoms of depression, and neurological/functional symptoms, resulting in higher disability and poor outcome of stroke patients.

Depressive symptoms in Parkinson's disease and in non-neurological medical illnesses.

BACKGROUND: Patients with neurological and non-neurological medical illnesses very often complain of depressive symptoms that are associated with cognitive and functional impairments. We compared the profile of depressive symptoms in Parkinson's disease (PD) patients with that of control subjects (CS) suffering from non-neurological medical illnesses. METHODS: One-hundred PD patients and 100 CS were submitted to a structured clinical interview for identification of major depressive disorder (MDD) and minor depressive disorder (MIND), according to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision (DSM-IV-TR), criteria. The Hamilton Depression Rating Scale (HDRS) and the Beck Depression Inventory (BDI) were also administered to measure depression severity. RESULTS: When considering the whole groups, there were no differences in depressive symptom frequency between PD and CS apart from worthlessness/guilt, and changes in appetite reduced rates in PD. Further, total scores and psychic and somatic subscores of HDRS and BDI did not differ between PD and CS. After we separated PD and CS in those with MDD, MIND, and no depression (NODEP), comparing total scores and psychic/somatic subscores of HDRS and BDI, we found increased total depression severity in NODEP PD and reduced severity of the psychic symptoms of depression in MDD PD, with no differences in MIND. However, the severity of individual symptom frequency of depression was not different between PD and CS in MDD, MIND, and NODEP groups. CONCLUSION: Although MDD and MIND phenomenology in PD may be very similar to that of CS with non-neurological medical illnesses, neurological symptoms of PD may worsen (or confound) depression severity in patients with no formal/structured DSM-IV-TR, diagnosis of depressive mood disorders. Thus, a thorough assessment of depression in PD should take into consideration the different impacts of neurological manifestations on MDD, MIND, and NODEP.

Stress cardiomyopathy (tako-tsubo) triggered by nervous system diseases: a systematic review of the reported cases.

BACKGROUND: It is not clarified whether the transient, regional left ventricular dysfunction (TRLVD) associated with several neurological disorders shares the same pathophysiology with the classical tako-tsubo cardiomyopathy occurring without overt neurological disease, and whether it is appropriate to include these patients in a single stress cardiomyopathy (SCM) condition. METHODS: In February 2012, we systematically explored major electronic medical information sources to identify cases of TRLVD triggered by neurological disorders. RESULTS: The 81 selected papers reported a total of 124 patients, suffering from neurological disorders, in whom TRLVD occurred: 117 with central nervous system diseases, 6 with peripheral nervous system diseases and 1 with both systems involved. Most patients were females (n=102), mean age was 63 ± 15 years, and the majority presented with an apex-involving pattern. The most common disease described was subarachnoid hemorrhage (n=52), followed by stroke/transient ischemic attack (n=24), and seizures (n=18). TRLVD in neurological patients was often associated with need of inotropic support, orotracheal intubation, cerebrovascular spasm and delayed surgery. CONCLUSIONS: TRLVD is a complication of neurological diseases, in particular in female patients in post-menopausal phase. The predilection for neurological damage at or close to the insular cortex highlights the pivotal role of sympathetic over-activation. Many other similarities with tako-tsubo support the inclusion in a single SCM category.

Rapid-onset apathy may be the only clinical manifestation after dorsal striatum hemorrhagic lesion: a case report.

Apathy is a common clinical feature of stroke patients and it is often correlated with cognitive deficits, functional impairment and depression. Here we report the case of a 70-year-old woman with no history of neuropsychiatric disorders who showed abrupt onset of pure apathy after the onset of a right brain vascular lesion located in the head of the caudate nucleus, the anterior part of the putamen, and the genu and the anterior limb of the internal capsule. A complete neuropsychological and neurological examination did not show deficits. A comprehensive neuropsychiatric assessment focusing on the post-stroke hospitalization period showed severe motor, cognitive and affective apathy with no depression or other neuropsychiatric symptoms. This case highlights the key role of the dorsal striatum in the development of pure apathy, possibly due to its function in regulating approach-attachment behavior, affect and initiative, which are the emotional, cognitive and motor dimensions of apathy.

Rivastigmine patch ameliorates depression in mild AD: preliminary evidence from a 6-month open-label observational study.

Here we investigated the effect of the rivastigmine patch alone on depression in 50 mild Alzheimer's disease (AD) patients with comorbid major depressive episode (MDE). First diagnosis acetyl-cholinesterase inhibitor and psychoactive drug-free outpatients (n=50) were recruited in memory clinics and reassessed after 3 and 6 months. Global cognitive functioning, depressive symptoms and MDE frequency were evaluated with the Mini Mental State Examination, the CERAD Dysphoria scale and the modified DSM-IV criteria for MDE in AD. MDE frequency reduced significantly from the first diagnostic visit (100%) to the 6-month follow-up (62%). We also found a significant reduction in CERAD Dysphoria scores that decreased from 6.2±3.9 mean±standard deviation to 4.9±4.5 at the 6-month follow-up. In AD patients with MDE rivastigmine alone can have a positive impact on depressive phenomena. Thus, future controlled study are justified to definitively verify if rivastigmine alone may improve depression in AD.

Anhedonia in Parkinson's disease: a systematic review of the literature.

Anhedonia, defined as lowered ability to experience physical or social pleasure, is a key symptom of several psychiatric illnesses. In this systematic review, we aimed to evaluate the role of anhedonia in Parkinson's Disease and its relationships with other clinical characteristics, dopamine dysfunction, and antiparkinsonian therapy. The database was selected using PubMed Services. Relevant journals were hand-searched, and the bibliographies of all the important articles were scrutinized to find additional publications. Fifteen studies assessed the topic of anhedonia in Parkinson's disease from 1984 to 2009 and mainly described it as a core symptom of depression in patients with Parkinson's disease. Some studies investigated the relationship between anhedonia and neuropsychological symptoms and found correlations with frontal lobe functions. Reports on the relationship between anhedonia and illness severity or motor symptoms are rather inconclusive. No definitive conclusions can be drawn because few studies have been published on this topic. Nevertheless, some evidence suggests that in Parkinson's disease anhedonia is a secondary phenomenon linked to depression, apathy severity, and frontal lobe dysregulation and that it could respond to antiparkinsonian treatment. Future studies of larger samples of patients are strongly required to definitively clarify the relationship between anhedonia and other clinical features, such as depression, anxiety, apathy, cognition, and motor status. Furthermore, more reliable tools and validated diagnostic criteria are necessary to assess anhedonia in patients with Parkinson's disease.