An evaluation of istradefylline treatment on Parkinsonian motor and cognitive deficits in 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-treated macaque models.

Istradefylline (KW-6002), an adenosine A2A receptor antagonist, is used adjunct with optimal doses of L-3,4-dihydroxyphenylalanine (l-DOPA) to extend on-time in Parkinson's disease (PD) patients experiencing motor fluctuations. Clinical application of istradefylline for the management of other l-DOPA-induced complications, both motor and non-motor related (i.e. dyskinesia and cognitive impairments), remains to be determined. In this study, acute effects of istradefylline (60-100 mg/kg) alone, or with optimal and sub-optimal doses of l-DOPA, were evaluated in two monkey models of PD (i) the gold-standard 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-treated macaque model of parkinsonian and dyskinetic motor symptoms and (ii) the chronic low dose (CLD) MPTP-treated macaque model of cognitive (working memory and attentional) deficits. Behavioural analyses in l-DOPA-primed MPTP-treated macaques showed that istradefylline alone specifically alleviated postural deficits. When combined with an optimal l-DOPA treatment dose, istradefylline increased on-time, enhanced therapeutic effects on bradykinesia and locomotion, but exacerbated dyskinesia. Istradefylline treatment at specific doses with sub-optimal l-DOPA specifically alleviated bradykinesia. Cognitive assessments in CLD MPTP-treated macaques showed that the attentional and working memory deficits caused by l-DOPA were lowered after istradefylline administration. Taken together, these data support a broader clinical use of istradefylline as an adjunct treatment in PD, where specific treatment combinations can be utilised to manage various l-DOPA-induced complications, which importantly, maintain a desired anti-parkinsonian response.

Transcranial Direct Current Stimulation to Enhance Dual-Task Gait Training in Parkinson's Disease: A Pilot RCT.

OBJECTIVE: To investigate the feasibility and safety of a combined anodal transcranial direct current stimulation (tDCS) and dual task gait training intervention in people with Parkinson's Disease (PD) and to provide data to support a sample size calculation for a fully powered trial should trends of effectiveness be present. DESIGN: A pilot, randomized, double-blind, sham-controlled parallel group trial with 12 week follow-up. SETTING: A university physiotherapy department. INTERVENTIONS: Sixteen participants diagnosed with PD received nine dual task gait training sessions over 3 weeks. Participants were randomized to receive either active or sham tDCS applied for the first 20 minutes of each session. MAIN MEASURES: The primary outcome was gait speed while undertaking concurrent cognitive tasks (word lists, counting, conversation). Secondary measures included step length, cadence, Timed Up and Go, bradykinesia and motor speed. RESULTS: Gait speed, step length and cadence improved in both groups, under all dual task conditions. This effect was maintained at follow-up. There was no difference between the active and sham tDCS groups. Time taken to perform the TUGwords also improved, with no difference between groups. The active tDCS group did however increase their correct cognitive response rate during the TUGwords and TUGcount. Bradykinesia improved after training in both groups. CONCLUSION: Three weeks of dual task gait training resulted in improved gait under dual task conditions, and bradykinesia, immediately following training and at 12 weeks follow-up. The only parameter enhanced by tDCS was the number of correct responses while performing the dual task TUG. tDCS applied to M1 may not be an effective adjunct to dual task gait training in PD. TRIAL REGISTRATION: Australia-New Zealand Clinical Trials Registry ACTRN12613001093774.

Behavioural and neuroimaging correlates of impaired self-awareness of hypo- and hyperkinesia in Parkinson's disease.

INTRODUCTION: Anosognosia or impaired self-awareness of motor symptoms (ISAm) has been rarely investigated in Parkinson's disease (PD). We here studied the relationship between ISAm during periods with and without dopaminergic medication (ON- and OFF-state), and clinical, neuropsychological, and neuroimaging data to further elucidate behavioural aspects and the neurobiological underpinnings of ISAm. METHODS: Thirty-one right-handed, non-demented, non-depressed PD patients were included. ISAm was evaluated using a recently developed scale that assesses awareness of dyskinesia, resting tremor, and bradykinesia. The test was applied during both ON- and OFF-states. Multiple correlation analyses between ISAm and behavioural data were conducted. In addition, imaging of glucose metabolism using 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) was performed to investigate the neural basis of ISAm. A multiple regression approach was applied to investigate metabolism alterations related to ISAm. RESULTS: In the OFF-state, higher ISAm was associated with left-sided disease onset, older age, and shorter disease duration. Concerning FDG-PET data, there was a significant negative correlation between higher OFF-state ISAm and decreased glucose metabolism in the right inferior frontal gyrus (IFG). In the ON-state, ISAm was not significantly correlated with clinical or behavioural data. However, there was a significant correlation between higher ISAm and an increased metabolism in the bilateral medial frontal gyrus, left IFG, right superior frontal gyrus and right precentral gyrus. CONCLUSION: The results support the role of the right hemisphere in awareness of motor symptoms in the OFF-state. In the ON-state, dopaminergic medication and dyskinesia influence ISAm and relate to metabolism changes in bilateral frontal regions.

Comparison of self and proxy ratings for motor performance of individuals with Parkinson disease.

The impact of Parkinson disease (PD) has been examined in recent years by comparing self-ratings by individuals with PD and proxy ratings by caregivers, communication partners, and/or health care providers. However, the existing evidence is mixed with some researchers suggesting perfect agreement between rater groups while others suggesting differences among rater groups for motor performance of individuals with PD. The current study examined self and proxy perception of performance of individuals with PD for six motor characteristics (gait, rigidity, right and left bradykinesia, rest tremors, and perception of physical effort) based on Unified Parkinson Disease Rating Scale (UPDRS) motor tasks. Participants included 20 individuals with PD, 20 communication partners, and a trained rater. The study compared perceptual ratings and corresponding UPDRS scores as well as rater group differences for perceptual motor ratings. A series of Pearson Product Moment Correlations indicated significant relationship only between self-ratings for gait and rest tremors by individuals with PD and corresponding UPDRS scores (p<.05). Further, a multivariate analysis of variance was completed to compare rater group differences. Results indicated significant overestimation of rest tremors by both individuals with PD and communication partners when compared to corresponding ratings by the trained rater. Overall, the study provided evidence for perception deficits among individuals with PD and communication partners regarding motor performance of individuals with PD. Additional studies are needed to further explore the changes in perception abilities of individuals with PD and communication partners with respect to disease duration, disease severity, and other co-morbid factors.

Motivational modulation of bradykinesia in Parkinson's disease off and on dopaminergic medication.

Motivational influence on bradykinesia in Parkinson's disease may be observed in situations of emotional and physical stress, a phenomenon known as paradoxical kinesis. However, little is known about motivational modulation of movement speed beyond these extreme circumstances. In particular, it is not known if motivational factors affect movement speed by improving movement preparation/initiation or execution (or both) and how this effect relates to the patients' medication state. In the present study, we tested if provision of motivational incentive through monetary reward would speed-up movement initiation and/or execution in Parkinson's disease patients and if this effect depended on dopaminergic medication. We studied the effect of monetary incentive on simple reaction time in 11 Parkinson's disease patients both "off" and "on" dopaminergic medication and in 11 healthy participants. The simple reaction time task was performed across unrewarded and rewarded blocks. The initiation time and movement time were quantified separately. Anticipation errors and long responses were also recorded. The prospect of reward improved initiation times in Parkinson's disease patients both "off" and "on" dopaminergic medication, to a similar extent as in healthy participants. However, for "off" medication, this improvement was associated with increased frequency of anticipation errors, which were eliminated by dopamine replacement. Dopamine replacement had an additional, albeit small effect, on reward-related improvement of movement execution. Motivational strategies are helpful in overcoming bradykinesia in Parkinson's disease. Motivational factors may have a greater effect on bradykinesia when patients are "on" medication, as dopamine appears to be required for overcoming speed-accuracy trade-off and for improvement of movement execution. Thus, medication status should be an important consideration in movement rehabilitation programmes for patients with Parkinson's disease.

[Movement disorders is psychiatric diseases]. / Mozgászavarok pszichiátriai betegségekben.

Movement disorders are common in psychiatry. The movement disorder can either be the symptom of a psychiatric disorder, can share a common aetiological factor with it, or can be the consequence of psychopharmacological therapy. Most common features include tic, stereotypy, compulsion, akathisia, dyskinesias, tremor, hypokinesia and disturbances of posture and gait. We discuss characteristics and clinical importance of these features. Movement disorders are frequently present in mood disorders, anxiety disorders, schizophrenia, catatonia, Tourette-disorder and psychogenic movement disorder, leading to differential-diagnostic and therapeutical difficulties in everyday practice. Movement disorders due to psychopharmacotherapy can be classified as early-onset, late-onset and tardive. Frequent psychiatric comorbidity is found in primary movement disorders, such as Parkinson's disease, Wilson's disease, Huntington's disease, diffuse Lewy-body disorder. Complex neuropsychiatric approach is effective concerning overlapping clinical features and spectrums of disorders in terms of movement disorders and psychiatric diseases.

Comparison of symptoms of delirium across various motoric subtypes.

AIM: The aim of this study was to determine the correlation between delirium motor subtypes and other symptoms of delirium. METHODS: Three hundred and twenty-one (n = 321) consecutive patients referred to consultation-liaison psychiatry services were evaluated on Delirium Rating scale-Revised-98 version and amended Delirium Motor Symptom Scale. RESULTS: Half of the patients had hyperactive subtype (n = 161; 50.15%) delirium. One-quarter of the study sample met the criteria for mixed subtype (n = 79; 24.61%), about one-fifth of the study sample met the criteria for hypoactive delirium subtype (n = 64; 19.93%), and only very few patients (n = 17; 5.29%) did not meet the required criteria for any of these three subtypes and were categorized as 'no subtype'. When the hyperactive and hypoactive subtypes were compared, significant differences were seen in the prevalence of perceptual disturbances, delusions, lability of affect, thought process abnormality, motor agitation and motor retardation. All the symptoms were more common in the hyperactive subtype except for thought process abnormality and motor retardation. Compared to hyperactive subtype, the mixed subtype had significantly higher prevalence of thought process abnormality and motor retardation. Significant differences emerged with regard to perceptual disturbances, delusions, lability of affect and motor agitation when comparing the patients with mixed subtype with those with hypoactive subtype. All these symptoms were found to be more common in the mixed subtype. No significant differences emerged for the cognitive symptoms as assessed on Delirium Rating scale-Revised-98 across the different motoric subtypes. CONCLUSION: Different motoric subtypes of delirium differ on non-cognitive symptoms.

Properties of 3-methyl-TIQ and 3-methyl-N-propargyl-TIQ for preventing MPTP-induced parkinsonism-like symptoms in mice.

BACKGROUND: Selegiline, a therapeutic drug for Parkinson's disease (PD), structurally resembles the endogenous parkinsonism-related compound 1,2,3,4-tetrahydroisoquinoline (TIQ). In the present study, we evaluated the effects of 3-methyl-TIQ (3-MeTIQ) and 3-methyl-N-propargyl-TIQ (3-Me-N-proTIQ), selegiline mimetic TIQ derivatives, for preventing 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced parkinsonism-like symptoms in mice. METHODS: We evaluated the preventative effects of 3-MeTIQ and 3-Me-N-proTIQ on MPTP-induced bradykinesia and depletion of striatal dopamine (DA) and nigral tyrosine hydroxylase (TH)-positive cells. RESULTS: MPTP-induced bradykinesia was not different when mice were pretreated with 3-MeTIQ, except for the high-dose group. However, pretreatment with 3-Me-N-proTIQ significantly prevented the appearance of this akinesic status. MPTP-induced striatal DA and 3,4-dehydroxyphenylacetic acid reduction were significantly prevented by pretreatment with 3-Me-N-proTIQ, but not 3-MeTIQ, in a dose-dependent manner. On the other hand, levels of serotonin and its metabolite, 5-hydroxyindole acetic acid, in the striatum were increased following treatment with 3-MeTIQ. In addition, the MPTP-induced decrease in TH-positive cells in the substantia nigra was significantly reduced by pretreatment with 3-Me-N-proTIQ, but not 3-MeTIQ. CONCLUSIONS: These results suggest that not only does 3-Me-N-proTIQ have potential as a candidate compound for disease-modifying therapy for PD, but also the N-propargyl functional group plays an important role in neuroprotection.

The effect of motivation on movement: a study of bradykinesia in Parkinson's disease.

BACKGROUND: Bradykinesia is a cardinal feature of Parkinson's disease (PD). Despite its disabling impact, the precise cause of this symptom remains elusive. Recent thinking suggests that bradykinesia may be more than simply a manifestation of motor slowness, and may in part reflect a specific deficit in the operation of motivational vigour in the striatum. In this paper we test the hypothesis that movement time in PD can be modulated by the specific nature of the motivational salience of possible action-outcomes. METHODOLOGY/PRINCIPAL FINDINGS: We developed a novel movement time paradigm involving winnable rewards and avoidable painful electrical stimuli. The faster the subjects performed an action the more likely they were to win money (in appetitive blocks) or to avoid a painful shock (in aversive blocks). We compared PD patients when OFF dopaminergic medication with controls. Our key finding is that PD patients OFF dopaminergic medication move faster to avoid aversive outcomes (painful electric shocks) than to reap rewarding outcomes (winning money) and, unlike controls, do not speed up in the current trial having failed to win money in the previous one. We also demonstrate that sensitivity to distracting stimuli is valence specific. CONCLUSIONS/SIGNIFICANCE: We suggest this pattern of results can be explained in terms of low dopamine levels in the Parkinsonian state leading to an insensitivity to appetitive outcomes, and thus an inability to modulate movement speed in the face of rewards. By comparison, sensitivity to aversive stimuli is relatively spared. Our findings point to a rarely described property of bradykinesia in PD, namely its selective regulation by everyday outcomes.

Estudios neurofisiológicos en los parkinsonismos / Neurophysiological studies in parkinsonism

Introducción. El estudio del sistema motor y de sus trastornos ha sido un tema importante para la neurofisiología, siendo uno de sus objetivos intentar comprender los mecanismos fisiopatológicos que subyacen a las disfunciones del mismo. Desarrollo: Se revisa lo más relevante acerca de: (1) Técnicas neurofisiológicas utilizadas en el diagnóstico de la EP y otros parkinsonismos; (2) Utilidad de la estimulación magnética transcraneal (EMT); (3) Estudios neurofisiológicos de los trastornos del sueño en la EP; (4) Aspectos neurofisiológicos de la estimulación cerebral profunda (ECP). Conclusiones: Las pruebas neurofisiológicas puede ayudar en el diagnóstico diferencial del parkinsonismo además de profundizar en la fisiopatología de los síntomas y signos parkinsonianos. Diferentes técnicas pueden emplearse en el estudio de los trastornos del sueño en la EP. La EMT resulta útil tanto desde el punto de vista diagnóstico como probablemente también terapéutico en la EP. Actualmente, los registros con microelectrodos constituyen la forma más precisa de poder identificar la diana seleccionada en la cirugía de la EP (AU)

Introduction. The study of motor system and its diseases has been an interesting topic for neurophysiology, being one of the objectives of this to know the physiopathology mechanisms. Development. We review the most relevant about: (1) Neurophysiological techniques used in the diagnosis of Parkinson's disease (PD) and other parkinsonisms; (2) Utility of transcranial magnetic stimulation (TMS); (3) Neurophysiological techniques used in the diagnosis of sleep disorders in PD patients; (4) Neurophysiological aspects of deep brain stimulation (DBS). Conclusions. Different neurophysiological techniques can be used for differential diagnosis of PD and others parkinsonisms besides to investigate in the physiopathology mechanisms. We can use different techniques for study sleep disorders in PD patients. TMS results to be utility for diagnosis and probably such as therapy in PD patients. Actually, microelectrode recording could be the best method for target identification in DBS surgery (AU)

Mild cognitive impairment and cognitive-motor relationships in newly diagnosed drug-naive patients with Parkinson's disease.

BACKGROUND AND AIMS: (1) To establish the prevalence of mild cognitive impairment (MCI) in newly diagnosed drug-naive patients with Parkinson's disease adopting recently proposed and more conservative preliminary research criteria. (2) To investigate the relation between cognitive performances, MCI and motor dysfunction. METHODS: 132 consecutive newly diagnosed drug-naive PD patients and 100 healthy controls (HCs) underwent a neuropsychological evaluation covering different cognitive domains. Moreover, on the basis of the Unified Parkinson's Disease Rating Scale II/III, different motor scores were calculated and patients were classified in motor subtypes. 11 patients were excluded from the analysis during clinical follow-up which was continued at least 3 years from the diagnosis; therefore, the final sample included 121 patients. RESULTS: MCI prevalence was higher in PD (14.8%) patients than in HCs (7.0%). PD patients reported lower cognitive performances than HCs in several cognitive domains; HCs also outperformed cognitively preserved PD patients in tasks of episodic verbal memory and in a screening task of executive functions. MCI-PD patients presented a more severe bradykinesia score than non-MCI PD patients and patients mainly characterised by tremor had better performances in some cognitive domains, and specific cognitive-motor relationships emerged. CONCLUSIONS: Although the adoption of more conservative diagnostic criteria identified a lower MCI prevalence, we found evidence that newly diagnosed drug-naive PD patients present a higher risk of MCI in comparison with HCs. Axial symptoms and bradykinesia represent risk factors for MCI in PD patients and a classification of PD patients that highlights the presence/absence of tremor, as proposed in this study, is probably better tailored for the early stages of PD than classifications proposed for more advanced PD stages.

A longitudinal study of motor subtypes in delirium: frequency and stability during episodes.

OBJECTIVE: Motor-defined subtypes are a promising means of identifying clinically relevant patient subgroups but little is known about their course and stability during a delirium episode. METHODS: We assessed 100 consecutive adult palliative care patients with DSM-IV delirium twice weekly during their episodes using the Delirium Motor Subtype Scale (DMSS), Delirium Rating Scale-Revised-98 (DRS-R98) and Cognitive Test for Delirium (CTD). DMSS subtypes were assigned for each assessment and analysed for stability within patients during episodes. RESULTS: Across all assessments (n=303; mean 3 per patient, range 2-9), subtype occurrence was hypoactive (35%), mixed (26%), hyperactive (15%) and no subtype (24%). "No subtype" was associated with significantly lower DRS-R98 severity scores, of which 80% were subsyndromal, whereas mixed subtype assessments were the most impaired on the DRS-R98 and CTD. Subtypes were stable within delirium episodes in 62% of patients: 29% hypoactive, 18% mixed, 10% hyperactive and 6% no-subtype. The DRS-R98 noncognitive subscale scores differed across groups whereas cognitive subscale scores did not (p<0.001). CONCLUSIONS: We conclude that motor subtypes occur in nearly all patients with full syndromal delirium and are often stable during an episode. Subtypes exhibited comparable levels of cognitive impairment but differed in non-cognitive symptoms, supporting the importance of cognitive testing to detect delirium in less overt cases.

Maladaptive behavior in survivors: dysexecutive survivor syndrome.

This paper attempts to answer the question: why does normal, goal-directed, purposeful, and coordinated behavior fragment in a survival situation? Events accompanying the initial impact phase of a survival incident are characterized by speed, danger, violence, and uncontrollability. The following recoil phase is known to produce behavioral and cognitive impairment that leads to a reduced ability to produce a response that is meaningful and may result in tonic immobility. The author argues that the commonly witnessed responses among survivors comprise a subset of known behaviors, including loss of initiative, stereotypy, perseveration of thought and action, hyperkinesia, hypokinesia, and, in extreme cases, akinesia or cognitive paralysis. These behaviors are characteristic of executive dysfunction and a model is given suggesting how this condition may arise under survival conditions. The case is presented that during the initial phase of a survival incident, victims show a transient, nonclinical dysexecutive syndrome. This model should aid survival training and provide a context for conducting behavioral autopsies by accident investigators.

Retrospective chart review of catatonia in child and adolescent psychiatric patients.

OBJECTIVE: Identify the frequency of catatonia among at-risk children and adolescents receiving psychiatric treatment. METHOD: Subjects were children and adolescents (<18 years), who had received psychiatric treatment at a University Hospital during 2004-2009, and were diagnosed with disorders with known risk for catatonia or displayed symptoms suggestive of catatonia. Approval was obtained from the Investigational Review Board (IRB). The first 101 (n = 101) subjects were selected among 570 subjects identified by psychiatric diagnoses: any pervasive developmental disorder, psychosis-NOS (Not Otherwise Specified), intermittent explosive disorder, mental retardation, catatonia and neuroleptic malignant syndrome. Subjects met study-defined criteria for catatonia, if they had three or more of the following symptoms: unexplained agitation/excitement, disturbed or unusual movements, reduced movements, repetitive or stereotyped movements, or reduced or loss of speech. RESULTS: Eighteen (17.8%) subjects, among a group suspected to be at a higher risk for catatonia, met the study-defined criteria for this syndrome. However, only two subjects had been diagnosed by their treatment providers. Higher rates of intellectual disability and aggression were found among the group that met study-criteria. CONCLUSION: We concluded that catatonia is under recognized and undertreated among children and adolescents receiving psychiatric treatment.

[Structural and functional features of the rats' prefrontal cortex following 14-day suspension].

Effects of 14-d suspension on the processes of rats' nervous cells conjugation in the brain cognitive cortex were studied. Signs of cognitive functions degradation and decrease of the number of conjugated nervous cells were found in the experimental group after suspension. This evidence are qualified as a negative effect of suspension on memory and physiological regeneration of neurons.

The influence and the mechanism of docosahexaenoic acid on a mouse model of Parkinson's disease.

This study aimed to investigate the effects of docosahexaenoic acid (DHA) on the oxidative stress that occurs in an experimental mouse model of Parkinson's disease (PD). An experimental model of PD was created by four intraperitoneal injections of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) (4 × 20 mg/kg, at 12h intervals). Docosahexaenoic acid was given daily by gavage for 4 weeks (36 mg/kg/day). The motor activity of the mice was evaluated via the pole test, and the dopaminergic lesion was determined by immunohistochemical analysis for tyrosine hydroxylase (TH)-immunopositive cells. The activity of antioxidant enzymes in the brain were determined by spectrophotometric assays and the concentration of thiobarbituric acid-reactive substances (TBARS) were measured as an index of oxidative damage. The number of apoptotic dopaminergic cells significantly increased in MPTP-treated mice compared to controls. Although DHA significantly diminished the number of cell deaths in MPTP-treated mice, it did not improve the decreased motor activity observed in the experimental PD model. Docosahexaenoic acid significantly diminished the amount of cell death in the MPTP+DHA group as compared to the MPTP group. TBARS levels in the brain were significantly increased following MPTP treatment. Glutathione peroxidase (GPx) and catalase (CAT) activities of brain were unaltered in all groups. The activity of brain superoxide dismutase (SOD) was decreased in the MPTP-treated group compared to the control group, but DHA treatment did not have an effect on SOD activity in the MPTP+DHA group. Our current data show that DHA treatment exerts neuroprotective actions on an experimental mouse model of PD. There was a decrease tendency in brain lipid oxidation of MPTP mice but it did not significantly.

Teacher reports of hypoactivity symptoms reflect slow cognitive processing speed in primary school children.

The mediating effect of cognitive processing speed on the ability of a primary school child to achieve his/her full potential of intellectual functioning emphasizes the importance of methods to detect "slow" children. Primary school teachers may be the first to have concerns about inattentive pupils who show symptoms of hypoactivity, but may find the symptoms difficult to interpret. In the present study we ask if a primary school teacher's report of hypoactivity symptoms can be explained by the child's performance on tests of processing speed. The 255 children included in the present study were part of the first wave of the Bergen Child Study, in which teachers completed a questionnaire including two hypoactivity items from the Five to Fifteen (FTF) questionnaire. Processing speed was measured by the Processing Speed Index (PSI) from the WISC-III, 1-2 years after the teacher rating. Teachers reported "certainly true" on at least one FTF item of hypoactivity for 11.8% of the children. These children obtained lower scores on the PSI than the remaining children in the sample. The PSI accounted for a considerable proportion of the variance of teacher reports on the FTF item "difficulty getting started on a task/activity". The risk of a PSI score below 85 was increased in children with teacher-reported hypoactivity symptoms. The results indicate that teacher reports of hypoactivity symptoms reflect slow cognitive processing speed and should be followed up by a psychometric examination. Still, future studies are needed to improve detection and treatment of children with slow processing speed.

Protracted benefit from paradoxical kinesia in typical and atypical parkinsonisms.

Paradoxical kinesia (PK) is the sudden resolution of a previously stabilized akinesia in an advanced idiopathic Parkinson's disease (IPD) patient facing an immediate threat. We are reporting the effect of PK, as a consequence of a life threatening event (earthquake), in a group of 14 patients with parkinsonism and dementia in Hoehn/Yahr (H/Y) stage 3-5. All the patients presented an extraordinary motor response during the earthquake that has recently stricken the Italian city of L'Aquila. All of them were able to safely escape unaided and, in some cases, to assist their families, despite they suffered before from severe night time akinesia and gait difficulties with postural instability requiring assistance. In five patients, the improvement of motor disabilities, particularly of freezing, lasted for 2-5 months.

Bradykinesia in patients with obsessive-compulsive disorder.

OBJECTIVE: To investigate the frequency of bradykinesia in patients with obsessive-compulsive disorder (OCD) and to see whether patients with OCD who also have bradykinesia display distinctive neuropsychological and neuropsychiatric features. METHODS: We studied 23 antipsychotic-free patients with OCD and 13 healthy controls. Bradykinesia was assessed with section III of the Unified Parkinson Disease Rating Scale. The Wechsler Adult Intelligent Scales-Revised (WAIS-R) was used to assess the Full Scale IQ and to measure visuospatial, visuoconstructional ability and psychomotor speed/mental slowness. RESULTS: Of the 23 patients with OCD studied, 8 (34%) had mild symptoms of bradykinesia. No relationship was found between bradykinesia and the sociodemographic variables assessed but this motor symptom was significantly associated with the severity of compulsions. Patients with bradykinesia differed from those without: they had a higher frequency of repeating compulsions, and lower IQ scores, performance scores, and WAIS-R subtest scores for similarities and picture completion. No significant differences were found between patients without bradykinesia and healthy controls in any test. CONCLUSIONS: Clinical assessment of motor symptoms in adult patients with OCD often discloses mild bradykinesia sometimes associated with repeating compulsions and poor WAIS-R performance scores.