The effects of standard and modified LSVT BIG therapy protocols on balance and gait in Parkinson's disease: A randomized controlled trial.

BACKGROUND: Lee Silverman voice treatment (LSVT) BIG is an exercise program developed for patients with Parkinson's disease (PwPD), consisting of sets of exercises performed for 4 consecutive days a week for 4 weeks. However, the standard protocol suggests a treatment frequency difficult to follow for most patients who have difficulties reaching rehabilitation clinics. Our aim was to compare the standard LSVT BIG protocol with a modified LSVT (m-LSVT) BIG protocol (twice a week in the clinic for 4 weeks and twice a week at home for 4 weeks). METHODS: In this randomized controlled trial, 16 PwPD (aged 18-80 years, Hoehn and Yahr stages I-III) were recruited into two groups. The LSVT group received standard LSVT BIG training (four times per week for 4 weeks at the clinic). The other group was given m-LSVT BIG exercises, but unlike the LSVT group, the m-LSVT group exercised twice a week at the clinic and twice a week at home for 4 weeks. The Berg Balance Scale was used to assess functional balance. Biodex Balance System was used to assess laboratory balance measures. Timed Up and Go test and G-Walk sensor system were used to assess functional mobility and spatiotemporal gait analysis. RESULTS: Significant group-by-time interactions on the eyes open-firm surface score of the modified clinical test of sensory integration of balance (F = 10.138, p = .007) and gait cycle symmetry index (F = 10.470, p = .010) were found to be in favor of the LSVT group. Additionally, post hoc analyses revealed that both groups significantly improved postural stability, gait speed, motor symptoms, and functional mobility (p < .05). CONCLUSION: The results revealed the beneficial effects of the modified protocol on balance and gait in PwPD, as well as the superiority of the standard LSVT BIG protocol. The m-LSVT BIG protocol may be an effective intervention method, especially for PwPD who have difficulty adapting to the treatment frequency of the standard protocol.

The effect of task-oriented circuit training-based telerehabilitation on upper extremity motor functions in patients with Parkinson's disease: A randomized controlled trial.

INTRODUCTION: Upper extremity functions are impaired in patients with Parkinson's disease (PwPD), which leads to difficulties in activities of daily living (ADL), such as reaching or handwriting. The aim of this study was to investigate the effectiveness of task-oriented circuit training-based telerehabilitation (TOCT-TR) on the upper extremity motor function in PwPD. METHODS: In this randomized controlled trial (RCT) 30 PwPD (aged 45-70 years, Hoehn & Yahr stage I-III) were recruited and randomly allocated into two groups. The TOCT-TR group received home training through video sessions three days/week for six weeks. Additionally, both the TOCT-TR group and the control group (CG) underwent home exercises aimed at improving balance, gait, and mobility three days/week for six weeks. The primary outcome measure was upper extremity motor functions measured with the Nine Hole Peg test (9-HPT), the Jebsen Hand Function Test (JHFT), grip strengths, pinch strengths, and the Unified Parkinson's Disease Rating Scale-III (UPDRS-III). Secondary outcome measures included the UPDRS-II and the quality of life (QoL, PDQ-8). RESULTS: This study showed significant group-by-time interactions on the 9-HPT (p < 0.001), the JHFT (p < 0.001), grip strengths (p < 0.001), pinch strengths (p ≤ 0.015), and the UPDRS-III (p = 0.007) in favor of the TOCT-TR. Additionally, the UPDRS-II (p < 0.001), and the PDQ-8 (p = 0.005) improved in both groups. CONCLUSION: This is the first RCT showing that the TOCT-TR improved upper extremity motor functions, ADL, and QoL in PwPD. The TOCT-TR may help improve the upper extremities of PwPD who have difficulties reaching rehabilitation clinics.

The ability of patients with Parkinson's disease to recognize masked faces during the COVID-19 pandemic / A capacidade dos pacientes com doença de parkinson de reconhecer rostos mascarados durante a pandemia de covid-19

ABSTRACT. Patients with Parkinson's disease (PwP) have face recognition difficulties. Objective: This study aimed to evaluate the difficulties of PwP in recognizing masked faces during the COVID-19 pandemic. Methods: A total of 64 PwP, 58 age-matched older healthy controls (OHCs), and 61 younger healthy controls (YHCs) were included in the study. The Benton Face Recognition Test - short form (BFRT-sf) and the 13-item questionnaire on face recognition difficulties due to masks during the pandemic developed by the authors were applied to all three study groups. Results: Both the PwP and OHC groups scored worse in BFRT-sf when compared with the YHC group (p<0.001 and p<0.001, respectively). The number of those who had difficulty in recognizing people seen every day and the number of those who asked people to remove their masks because they did not recognize them were higher in the PWP group (p=0.026 and p=0.002, respectively). The number of individuals who looked at the posture and gait of people when they did not recognize their masked faces and those who stated that this difficulty affected their daily lives were higher in the OHC group (p=0.002 and p=0.009, respectively). The number of participants whose difficulty in recognizing masked faces decreased over time was higher in the YHC group (p=0.003). Conclusions: The PwP group demonstrated similar performance to their peers but differed from the YHC group in recognizing masked faces. Knowing difficulties experienced by elderly people in recognizing people who are masked can increase awareness on this issue and enhance their social interaction in pandemic conditions through measures to be taken.

RESUMO. Pacientes com doença de Parkinson (PcP) têm dificuldades de reconhecimento facial. Objetivo: Avaliamos as dificuldades de PcP em reconhecer rostos mascarados durante a pandemia de COVID-19. Métodos: Incluímos 64 PcP, 58 controles saudáveis ​​mais velhos (CSVs) pareados por idade, 61 controles saudáveis mais jovens (CSJs) no estudo. O Benton Face Recognition Test-short form (BFRT-sf) e o questionário de 13 itens sobre dificuldades de reconhecimento facial devido a máscaras durante a pandemia desenvolvido pelos autores foram aplicados a todos os três grupos de estudo. Resultados: Ambos os grupos PcP e CSV tiveram pior pontuação no BFRT-sf quando comparados com o grupo CSJ (p<0,001 e p<0,001, respectivamente). O número daqueles que tiveram dificuldade em reconhecer as pessoas atendidas todos os dias e o número daqueles que pediram para as pessoas retirarem suas máscaras por não as reconhecer foram maiores no grupo PcP (p=0,026 e p=0,002, respectivamente). O número de indivíduos que olharam para a postura e marcha das pessoas quando não reconheceram seus rostos mascarados e aqueles que afirmaram que essa dificuldade afetou seu cotidiano foi maior no grupo CSV (p=0,002 e p=0,009, respectivamente). O número de participantes cuja dificuldade em reconhecer rostos mascarados diminuiu ao longo do tempo foi maior no grupo CSJ (p=0,003). Conclusões: O grupo PcP demonstrou desempenho semelhante aos seus pares, mas diferiu do grupo CSJ no reconhecimento de rostos mascarados. Conhecer as dificuldades vivenciadas pelos idosos em reconhecer as pessoas mascaradas pode aumentar a conscientização sobre essa questão e potencializar sua interação social em condições de pandemia por meio de medidas a serem tomadas.

Botulinum toxin injections in jaw-opening dystonia. The lateral pterygoid - maxillary artery problem.

It has been suggested that the variations in the trajectory of the maxillary artery (MA) near the lateral pterygoid muscle (LPM) play a critical role in Botulinum neurotoxin (BoNT) injections in patients with jaw-opening/deviation dystonia (JOD). In the case of a lateral course to the LPM, an extraoral injection entails risks of MA injury, pain, and hematoma. Previous reports suggest geographical differences in variations of the MA-LPM relationship. We aimed to determine these variations in Turkish individuals and highlight the need to establish a consensus on approach to LPM injections. In 284 individuals, contrast-enhanced magnetic resonance angiography (MRA) images were evaluated by two radiologists on both sides for the variations in the course of the MA in the infratemporal fossa. Images of 44 were excluded due to trauma, arteriovenous malformation, mass, surgery, and imaging artifacts. Of the included, 62.1% were female. In 480 evaluations of 240 individuals, the MA passed lateral to the LPM in 65.6% (n = 315). No sex difference was noted. In 51 individuals (21.3%), the MA course differed on the right and left sides (medial-lateral asymmetry). These results confirm that the lateral course of the MA is more frequent. In patients with JOD, the trajectory of the MA should be determined with imaging prior to extraoral BoNT injections. In the case of a lateral course, an intraoral approach seems to be safer to avoid a potential MA injury.

The ability of patients with Parkinson's disease to recognize masked faces during the COVID-19 pandemic.

Patients with Parkinson's disease (PwP) have face recognition difficulties. Objective: This study aimed to evaluate the difficulties of PwP in recognizing masked faces during the COVID-19 pandemic. Methods: A total of 64 PwP, 58 age-matched older healthy controls (OHCs), and 61 younger healthy controls (YHCs) were included in the study. The Benton Face Recognition Test - short form (BFRT-sf) and the 13-item questionnaire on face recognition difficulties due to masks during the pandemic developed by the authors were applied to all three study groups. Results: Both the PwP and OHC groups scored worse in BFRT-sf when compared with the YHC group (p<0.001 and p<0.001, respectively). The number of those who had difficulty in recognizing people seen every day and the number of those who asked people to remove their masks because they did not recognize them were higher in the PWP group (p=0.026 and p=0.002, respectively). The number of individuals who looked at the posture and gait of people when they did not recognize their masked faces and those who stated that this difficulty affected their daily lives were higher in the OHC group (p=0.002 and p=0.009, respectively). The number of participants whose difficulty in recognizing masked faces decreased over time was higher in the YHC group (p=0.003). Conclusions: The PwP group demonstrated similar performance to their peers but differed from the YHC group in recognizing masked faces. Knowing difficulties experienced by elderly people in recognizing people who are masked can increase awareness on this issue and enhance their social interaction in pandemic conditions through measures to be taken.

Pacientes com doença de Parkinson (PcP) têm dificuldades de reconhecimento facial. Objetivo: Avaliamos as dificuldades de PcP em reconhecer rostos mascarados durante a pandemia de COVID-19. Métodos: Incluímos 64 PcP, 58 controles saudáveis ​​mais velhos (CSVs) pareados por idade, 61 controles saudáveis mais jovens (CSJs) no estudo. O Benton Face Recognition Test-short form (BFRT-sf) e o questionário de 13 itens sobre dificuldades de reconhecimento facial devido a máscaras durante a pandemia desenvolvido pelos autores foram aplicados a todos os três grupos de estudo. Resultados: Ambos os grupos PcP e CSV tiveram pior pontuação no BFRT-sf quando comparados com o grupo CSJ (p<0,001 e p<0,001, respectivamente). O número daqueles que tiveram dificuldade em reconhecer as pessoas atendidas todos os dias e o número daqueles que pediram para as pessoas retirarem suas máscaras por não as reconhecer foram maiores no grupo PcP (p=0,026 e p=0,002, respectivamente). O número de indivíduos que olharam para a postura e marcha das pessoas quando não reconheceram seus rostos mascarados e aqueles que afirmaram que essa dificuldade afetou seu cotidiano foi maior no grupo CSV (p=0,002 e p=0,009, respectivamente). O número de participantes cuja dificuldade em reconhecer rostos mascarados diminuiu ao longo do tempo foi maior no grupo CSJ (p=0,003). Conclusões: O grupo PcP demonstrou desempenho semelhante aos seus pares, mas diferiu do grupo CSJ no reconhecimento de rostos mascarados. Conhecer as dificuldades vivenciadas pelos idosos em reconhecer as pessoas mascaradas pode aumentar a conscientização sobre essa questão e potencializar sua interação social em condições de pandemia por meio de medidas a serem tomadas.

Dose conversion ratio, comparative efficacy, and adverse events after switching from onabotulinum toxin A to abobotulinum toxin A for neurological conditions.

OBJECTIVES: Onabotulinum toxin A (ONA, Botox®) and abobotulinum toxin A (ABO, Dysport®) are most frequently used in the treatment of movement disorders. The aim of this study was to identify the dose conversion ratio (ABO dose:ONA dose), comparative efficacy, and adverse events in patients who switched from ONA to ABO. METHODS: There were 64 patients with cervical dystonia (39), hemifacial spasm (16), oromandibular dystonia (5), blepharospasm (3), and extremity dystonia (1) who switched from ONA to ABO. The efficacy, adverse events, duration of action, and severity of the adverse events after the final dose of ONA, initial dose of ABO, and second dose of ABO were investigated in these patients. RESULTS: The mean dose conversion ratio was 4.70 (2.27-9.62). The mean efficacy of the final ONA injection was 70.62%; initial ABO injection, 72.27%; and second ABO injection, 73.52%, which showed improvement on a visual analog scale (p = 0.71, p = 0.5). Incidence of adverse events after the final ONA injection was 18.8%; this increased to 39.1% after the initial ABO injection (p < 0.001) and decreased to 14.1% after the second ABO injection (p = 0.77). After the initial ABO injection, 20% of the adverse events were trivial, 36% were mild, and 32% were severe. After the second ABO injection, 7.8% of the adverse events were mild and 6.3% were severe. CONCLUSION: Although the mean dose conversion ratio was 4.70, the range was very wide (approximately 2-9). Therefore, we conclude that after the switch from Botox to Dysport, the doses should be tailored to the patients' clinical situation at treatment initiation, without using a dose conversion ratio.

The effect of Subthalamic nucleus deep brain stimulation on verb and noun naming in Turkish-Speaking Parkinson's disease patients.

Parkinson's disease (PD) is associated with an action language deficit. Subthalamic nucleus deep brain stimulation (STN DBS) deteriorates verbal fluency, but may improve verb naming more than nouns in PD. We investigated effects of grammatical class (verb vs noun), action content (action vs non-action) of words and unilateral, bilateral or no stimulation on naming. Nouns were named more accurately and faster by controls and PD participants; however the noun-verb difference was higher for PD participants. Language, executive and visuospatial function deficits in PD accounted for this difference between PD group and controls. Noun-verb difference was accounted by differences in imageability, familiarity and complexity of the stimuli. Non-action words were named more accurately than action words in the overall sample. Stimulation conditions did not have an effect on naming. This study in Turkish-speaking participants show an action language deficit due to underlying cognitive deficits without an STN DBS effect in PD.

Assessment of hand functions in patients with idiopathic cervical dystonia.

Cervical dystonia (CD) is the most common form of focal dystonia characterized by involuntary contractions of the neck muscles, causing abnormal rotation of the head into specific directions. Studies report that idiopathic dystonia is a developmental disorder of the sensorimotor circuits, involving both the cortico-striatal and thalamo-cortical pathways. It is also suggested that enhanced cortical plasticity extends beyond the clinically affected region and may also be detected in the unaffected upper limbs of the patient with CD. In the present study, we aimed at exploring if patients with CD had hand motor dysfunctions. Forty patients with idiopathic CD and 40 healthy controls were included in this study. Dystonic symptoms were assessed by means of The Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS). Stanford Health Assessment Questionnaire (HAQ) was used to assess functional status. Quality of life (QoL) was assessed by using the Medical Outcomes Study Short Form 36-Item Health Survey (SF 36). Grip strength was assessed by using hand dynamometers. Tip pinch, lateral pinch and chuck pinch of the hand were assessed by using a pinchmeter. Fingertip dexterity and hand coordination was assessed using Purdue Pegboard. Duruoz Hand Index (DHI) was used for the assessment of hand functions. There were no significant differences between the groups in grip and pinch strengths of hands and fingers. As to the fingertip dexterity, patients with CD had a mean Pin 1 and Pin 2 test score of 10.6 ± 2.8 and 10.8 ± 3.2 respectively and a mean assembling test score of 5.2 ± 2.0. These results were significantly worse than those of the healthy controls. As to the SF 36 sub-scores, there were significant differences between the groups in all SF 36 sub-scores (p < .001). This study indicates that patients with CD suffer a deteriorated fine motor coordination of hands without dystonic involvement of upper extremities. Furthermore, lower SF 36 scores in patients with CD suggest poorer health-related quality of life.

Predictive Factors for Favorable Outcome from Subthalamic Nucleus Deep Brain Stimulation in Parkinson’s Disease.

AIM: To investigate predictive factors for a favorable outcome from subthalamic nucleus-deep brain stimulation (STN-DBS) in Parkinson’s disease (PD) and whether low serum vitamin B12 (vB12) levels can predict an unfavorable outcome. MATERIAL AND METHODS: Thirty-nine patients with PD who underwent bilateral STN-DBS were retrospectively analyzed. A difference of at least 30% between preoperative medication-off and postoperative medication-off stimulation-on Unified PD Rating Scale (UPDRS)-III scores was accepted to be a good outcome. Patients with good and bad outcomes were compared in terms of age, gender, levodopa responsiveness, vB12 levels, UPDRS subscores, presence of diabetes mellitus and hypertension, and presence of lacunes on cranial magnetic resonance imaging (MRI). RESULTS: Twenty-two of 39 patients (56.4%) had a good outcome postoperatively. No significant difference was observed in terms of age, gender, presence of abnormal MRI findings, and comorbid diseases between patients with good and bad outcomes. Mean preoperative bradykinesia score in patients with a good outcome was higher than those with a bad outcome. There was a positive correlation between the benefit of STN-DBS and preoperative levodopa responsiveness. In patients with low vB12 levels, 33.3% had a good outcome, whereas 55.2% of patients with normal vB12 levels had a good outcome (p = 0.589). CONCLUSION: Our results confirm that patients with better levodopa response have better outcomes. Interestingly, patients with worse bradykinesia had a better surgical outcome. A favorable surgical outcome was less frequent in patients with low vB12 levels and was not statistically significant.

Multicenter study of levodopa carbidopa intestinal gel in Parkinson's disease: the Turkish experience

Background/aim: Our purpose was to determine the efficacy of levodopa carbidopa intestinal gel (LCIG) in a series of Turkish patients with Parkinson's disease (PD). Materials and methods: We had telephone calls with 54 patients from 11 neurology centers who were on LCIG treatment, and 44 patients or their caregivers were included in an eight-item survey between September 2015 and June 2016. The reliability and validity of the survey were evaluated with intraclass correlation coefficients for every question separately. Results: Average age of the patients were 63.48 and the duration of PD was 12.79 years. Average LCIG treatment period was 15.63 months. Percentages of the patients who reported they were 'better' after LCIG treatment were as follows: 80% for time spent off, 55% for dyskinesia, 65% for tremor, 85% for gait disorder, 50% for pain, 50% for sleep disorders, 42.5% for depression, 32.5% for incontinence, and 70% for activities of daily living. Cronbach's alpha was 0.795 and the intraclass correlation coefficient was reliable for the items. Conclusion: As detected by a survey performed by telephone calls with good interrater reliability, patients with PD improve with LCIG treatment in many aspects of the disease.

Appendectomy History is not Related to Parkinson's Disease.

BACKGROUND: It has been suggested that appendectomy may modify the emergence of Parkinson's disease (PD) by affecting the retrograde transport of α-synuclein (α-syn) from the gastrointestinal system. OBJECTIVE: To explore the possible role of appendectomy on PD. METHODS: The retrospective data of the 1625 patients (839 PD, 633 non-α-syn parkinsonism and 153 controls) were compared. Disease specific measures between PD patients with (n = 69) and without (n = 770) appendectomy were also evaluated. RESULTS: The prevalence of appendectomy was not significantly lower in the PD group (8.2%) compared to the other groups (8.4% and 7.9%, p = 0.98), and the odds of having PD against other diagnoses (OR) were not significantly different in the appendectomy group (OR = 0.99, p = 0.96). No difference was determined between PD patients with and without appendectomy with respect to the age of disease onset, disease duration and severity. Appendectomy-first symptom interval was not determined to be related with PD diagnosis (hazard ratio = 1.12, p = 0.39) and did not predict disease severity in the PD group (OR = 0.99, p = 0.54). Age of appendectomy (lower or higher than 20) also did not affect future PD diagnosis (Relative Risk = 0.9, p = 0.54) or the disease severity. CONCLUSIONS: The results of the study suggest no effect of appendectomy on the emergence and clinical manifestations of PD. The removal of the appendix is possibly not sufficient to suppress the exposure of the brain stem to α-syn via vagal retrograde transport. Further studies are needed to elucidate the role of appendix in PD.

A Picture Database for Verbs and Nouns with Different Action Content in Turkish.

In this study we present a picture database of 160 nouns and 160 verbs. All verbs and nouns are divided into two groups as action and non-action words. Age of acquisition, familiarity, imageability, name agreement and complexity norms are reported alongside frequency, word length and morpheme count for each word. Data were collected from 600 native Turkish adults in total. The results show that although several measures have weak correlations with each other, only age of acquisition had moderate downhill relationships with familiarity and frequency with familiarity and frequency having a rather strong positive correlation with each other. The norms and the picture database are available as supplemental materials for use in psycholinguistic studies in Turkish.

Botulinum toxin injections for the treatment of hemifacial spasm over 16 years.

The aim of this study was to investigate the efficacy and side effects of botulinum toxin (BTX) in the treatment of hemifacial spasm (HFS). We also focused on the divergence between different injection techniques and commercial forms. We retrospectively evaluated 470 sessions of BTX injections administered to 68 patients with HFS. The initial time of improvement, duration and degree of improvement, and frequency and duration of adverse effects were analysed. Pretarsal and preseptal injections and Botox (Allergan, Irvine, CA, USA) and Dysport (Ipsen Biopharmaceuticals, Paris, France) brands were compared in terms of efficacy and side effects, accompanied by a review of papers which reported BTX treatment of HFS. An average of 34.5 units was used per patient. The first improvement was felt after 8 days and lasted for 14.8 weeks. Patients experienced a 73.7% improvement. In 79.7% of injections, no adverse effect was reported, in 4.9% erythema, ecchymosis, and swelling in the injection area, in 3.6% facial asymmetry, in 3.4% ptosis, in 3.2% diplopia, and in 2.3% difficulty of eye closure was detected. Patients reported 75% improvement on average after 314 sessions of pretarsal injections and 72.7% improvement after 156 sessions of preseptal injections (p=0.001). The efficacy and side effects of Botox and Dysport were similar. BTX is an effective and safe treatment option for HFS. No difference was determined between Botox and Dysport, and pretarsal injection is better than preseptal injection regarding the reported degree of improvement.

Sensorineural Hearing Loss in Non-depressed Essential Tremor Cases and Controls: A Clinical and Audiometric Study.

BACKGROUND: Patients with essential tremor (ET) have an increased prevalence of hearing loss, and depression is a confounding issue for both conditions. We assessed hearing loss in non-depressed ET patients and controls using a questionnaire and audiometric tests. METHODS: The study included 34 patients with ET and 45 volunteers were included. Both groups were asked if they had hearing loss, and pure tone audiometry, speech recognition threshold, tympanogram, short increment sensitivity index (SISI), tone decay, and otoacoustic emission audiological tests were conducted. RESULTS: Seventeen subjects (50.0%) in the patient group answered "yes" to the question "Do you have hearing loss?" compared to one (2.2%) subject in the control group (p<0.001). The tone decay values of the right ear at 4,000 Hz were higher in the patient group. The number of subjects in which the otoacoustic emissions could not be obtained in the right ear was higher in the ET patients (p = 0.005). DISCUSSION: The results support the presence of a cochlear pathology in ET and may indicate that ET and sensorineural hearing loss may be components of a common disease process.

Prevalence of restless legs syndrome in Ankara, Turkey: an analysis of diagnostic criteria and awareness.

The aim of this study was threefold: (1) to investigate the prevalence of restless legs syndrome (RLS), in Ankara, Turkey; (2) to determine the predictive values of diagnostic criteria; and (3) to determine the frequency of physician referrals and the frequency of getting the correct diagnosis. A total of 815 individuals, from randomly selected addresses, above the age of 15, were reached using the questionnaire composed of the four diagnostic criteria. Individuals who responded by answering 'yes' for at least one question were interviewed by neurologists for the diagnosis of RLS. Frequency of physician referrals and frequency of getting the correct diagnosis of RLS were also determined for patients getting the final diagnoses of RLS. Prevalence of RLS in Ankara was 5.52 %; 41.0 % of the individuals diagnosed with RLS had replied 'yes' to either one, two or three questions asked by interviewers. However, only 21.3 % of individuals who replied 'yes' to all four questions received the diagnosis of RLS. Among the patients who had the final diagnosis of RLS, 25.7 % had referred to a physician for the symptoms and 22.2 % got the correct diagnosis. The RLS prevalence in Ankara was somewhere between Western and Far East countries compatible with the geographical location. Diagnostic criteria may not be fully predictive when applied by non-physician pollsters. Physician's probability of correctly diagnosing RLS is still low.

Social anxiety in patients with Parkinson's disease.

Previous research highlights the presence of social anxiety disorder related to disfiguring diseases, although DSM-IV precludes the diagnosis of social anxiety disorder related to a medical condition. The present study investigated the frequency and severity of social anxiety disorder in patients with Parkinson's disease (n=50) and comparison subjects (n=50). Social anxiety was diagnosed in 16% of patients with Parkinson's disease and 2% of the comparison subjects. Regression analysis revealed younger age and depression as predictive factors of social anxiety. This study supported the likelihood of social anxiety disorder as a comorbid condition in Parkinson's disease. Revision of the criteria for social anxiety disorder in future diagnostic systems is necessary for the detection and management of these patients.