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Background and aims: The need for intimacy and sexual expression is an essential dimension of quality of life. As patients with Parkinson's disease (PD) have to cope with essential changes in their global and sexual functioning, achieving a satisfying intimate and sexual relationship can be challenging. Sexual experience is a complex process that involves a dyadic relationship. In this study, we aimed to characterize the sexual experience of patients with Parkinson's disease and patients' vs caregivers' perceptions. Methods Twenty-seven PD patients and their caregivers were asked to complete the Arizona Sexual Experience Scale (ASEX) anonymously. They were instructed to refer to their sexual behavior over the past year and to consider behavioral changes that lasted for at least four consecutive weeks. Results Our data suggest that when considering sexual perceptions in PD, there is often agreement of judgment between patients and their partners. Overall, they have a rather good sex life, especially in the early stage of the disease, with similar behavior shown by men and women. Conclusions The effect of PD on the sexual and couple relationship challenges healthcare professionals to focus on the needs of both partners and to plan specific interventions in such a way as to prevent the deterioration of the couples' sexual wellbeing.

Rhythmic auditory stimuli (RAS) improve the disabling motor symptom of Parkinson’s disease patients. In the large majority of studies, the effect of RAS has been assessed during common activities such as walking and turning. However, how RAS modulates parkinsonian behaviors in more challenging settings of daily living and whether a machine learning algorithm could classify them remains unclear. Eleven patients with idiopathic PD (age 72±7 years) were asked to walk under four conditions: straight walking, walking over an irregular surface, walking within a narrow pathway, and walking along a curving path (eight-shaped), with and without external stimulation. RAS pace was set at 110% of the normal cadence and spatio-temporal gait parameters were measured through two inertial measurement units placed on feet. k-Nearest Neighbor (k-NN) algorithm, with and without principal component analysis (PCA) as feature selector, was used for the classification of walking conditions. Cadence, gait speed, and gait time improved during RAS walking, regardless of challenging walking conditions. On the contrary, stride length increased only in straight walking, while gait speed showed improvement also in walking over an irregular surface and walking within narrow pathway conditions. k-NN algorithm reported higher accuracy (72.4%) in the classification of eight- shaped curving path both considering the overall feature set and a reduced one. These results open to the possibility of measuring RAS-induced effects on PD mobility in an ecological scenario and improving their administration based on the actual motor activity.

Background Parkinson’s disease (PD) is responsible for significant changes in body composition. Aims We aimed to test the association between PD severity and fat distribution patterns, and to investigate the potential modifier effect of nutritional status in this association. Methods We enrolled 195 PD subjects consecutively admitted to a university geriatric day hospital. All participants underwent comprehensive clinical evaluation, including assessment of total and regional body composition (dual-energy X-ray absorptiometry, DXA), body mass index, nutritional status (Mini-Nutritional Assessment, MNA), motor disease severity (UPDRS III), comorbidities, and pharmacotherapy. Results The fully adjusted linear regression model showed a negative association between UPDRS III and total body fat in kg and percentage (respectively, B − 0.79; 95% CI − 1.54 to − 0.05 and B − 0.55; 95% CI − 1.04 to − 0.05), percentage android fat (B − 1.07; 95% CI − 1.75 to − 0.39), trunk–leg fat ratio (B − 0.02; 95% CI − 0.04 to − 0.01), trunk–limb fat ratio (B − 0.01; 95% CI − 0.06 to − 0.01) and android–gynoid fat ratio (B − 0.01; 95% CI − 0.03 to − 0.01). After stratification by MNA score, all the parameters of android-like fat distribution resulted negatively associated (p

Safinamide, as a levodopa adjunct, is effective in reducing motor fluctuations in Parkinson’s disease (PD) patients; however, scarce evidence is available regarding its use in older PD patients. To evaluate the safety and tolerability of safinamide as an adjunct therapy in patients aged ≥ 60 years with advanced PD. A retrospective study including 203 PD patients admitted to a geriatric day hospital, who were evaluated following an extensive clinical protocol. Safinamide use was categorized as never used, ongoing, and withdrawn. Potential correlations of Safinamide withdrawal were investigated in stepwise backward logistic regression models. A total of 44 out of 203 participants were current or former users of Safinamide. Overall, 14 (32%) patients discontinued due to treatment-emergent adverse events (TEAEs). Withdrawal was not associated with older age. Safinamide as an adjunct therapy in patients aged ≥ 60 years with advanced PD was found to be safe and well-tolerated in older patients. There were no specific demographic or clinical characteristics associated with suspension.

Background Cognitive reserve (CR) can be considered an active expression of brain resilience in response to a damage. Several studies have shown the influence of CR on cognitive impairment and its relationship with cognitive function in Parkinson's disease (PD). Aim The aim of the present study was to show if CR influences the effectiveness of balance rehabilitation in PD patients who performed a conventional rehabilitative treatment. Design Observational longitudinal study. Setting Neurology Outpatient Unit, University Hospital. Population Fifty-three patients affected by idiopathic PD, stage 2-3 at the Hoehn and Yahr Scale. Methods Each patient underwent 32 group sessions of conventional rehabilitative treatment. At baseline, patients' CR was assessed by the Cognitive Reserve Index questionnaire (CRIq). The primary outcome was the evaluation of static and dynamic balance modifications, induced by the treatment, through the Berg Balance Scale (BBS), assessed at T0 and T1. Mini Mental State Examination, Unified Parkinson's Disease Rating Scale Part III (clinician-scored monitored motor evaluation) and Brief Intelligence Test were assessed only at T0 and used as descriptive variables. Results Considering the clinically meaningful change, BBS improved in 26% of patients, worsened in 2% and was unchanged in 72%. BBS score significantly improved in older patients, and in those with lower CRI total score. A significant inverse correlation was observed between changes in BBS and work and education related CR. Patients with lower baseline BBS score showed better improvement in balance. Conclusions We found an inverse correlation between CR level and balance improvement in PD patients who underwent conventional rehabilitation: higher improvement in BBS was observed in those with a lower CRI score. This may suggest that patients with higher CRI could benefit from more stimulating types of non-conventional rehabilitation (e.g. robotic, virtual reality). Clinical rehabilitation impact Rehabilitation should be individually tailored considering CR as a significant variable.