Search

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.

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

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.

To investigate caregivers and patients characteristics related to different dimensions of burden in Parkinson’s disease (PD). 55 pairs of PD patients and caregivers were recruited. The burden was evaluated with the Caregiver Burden Inventory (CBI). Multivariate analysis was applied to evaluate the impact of caregivers’ and patients’ characteristics on the varying aspects of burden. ADL score was the dominant predictor for the total score and all dimensions of CBI, except for the social burden, which is strongly predicted by the motor severity of PD. As one can easily imagine, the Total CBI decreases as the ADL score increases. An increased appreciation for characteristics of caregiver burden is a fundamental aspect of the patient’s global evaluation. Clinicians may need to directly probe for these factors in the caregiver as they may not be elicited routinely.

Parkinson’s disease (PD) is a neurodegenerative pathology characterized by motor and non-motor symptoms that often lead to several impairments. Many studies show the efficacy of different rehabilitation protocols aimed to improve balance and gait functions in PD patients. However, multiple factors may influence rehabilitation outcome. Recently, it has been observed as the cognitive reserve (CR) may influence the rehabilitation outcome, helping to address the patient toward technological or conventional rehabilitation. Our study investigated how CR may affect motor rehabilitation outcomes in PD patients who undergo virtual reality (VR) rehabilitation, aimed at improving walking and balance. Thirty patients affected by idiopathic PD were enrolled. Patients underwent 12 sessions VR training, over 6 weeks (45 min). Six-Minute Walk Test (6MWT) and Berg Balance Scale (BBS) were used to assess walking and balance, respectively. CR was assessed by Cognitive Reserve Index questionnaire (CRIq). Significant correlations between CR and change from baseline in walking and balance measures were found, with a significant positive correlation between CRIq and 6MWT (r=0.50, p=0.01) and between CRIq and BBS (r=0.41, p=0.04). Our results showed that PD patients with higher CR treated with VR improved significantly more in their balance and walking distance than those with lower CR. The current study suggests that VR when aimed to improve balance and walking in PD patients is more effective in patients with higher CR.

Background The clinical picture of obsessive-compulsive disorder encompasses a broad range of symptoms that are related to multiple psychological domains, including perception, cognition, emotion, and social relatedness. As obsessive-compulsive symptoms (OCS) frequently have an early onset, there are limited data about OCS in older populations (≥65 years) and, in particular, in elderly subjects with Parkinson disease (PD). Objective This study aimed to estimate the prevalence of OCS using a self-report measure (Obsessive-Compulsive Inventory-Revised) and to identify associated sociodemographic and clinical factors in a sample of elderly PD patients compared to a comparison group of similarly aged healthy volunteers. Results The mean age was 74 ± 6 years in the PD patients and 73 ± 7 years in the comparison group. The mean disease duration was 9.6 ± 5.8 years. Among the PD patients, 30.7% reported at least one OCS or a related disorder compared to 21.1% in the comparison group. Hoarding was significantly more common in PD patients than in the comparison group. Conclusions Subclinical OCS were present at a high percentage in both PD patients and comparison group. The OCS phenotype in PD may present differently, as hoarding was more common in PD patients.

Objective To compare a 6-week virtual reality (VR) rehabilitation programme with a conventional rehabilitation programme in patients with Parkinson’s disease. Design Prospective, single-blinded, randomised controlled trial. Setting Outpatients. Participants Fifty-one patients with Parkinson’s disease were assigned at random to a VR rehabilitation programme or a conventional rehabilitation programme. Interventions Both programmes ran for 6 consecutive weeks, with a 40-minute session three times per week. Main outcome measures The Balance Berg Scale (BBS) was used to measure balance. Secondary outcome measures were: Dynamic Gait Index (DGI) to evaluate ability to adapt gait to complex walking tasks; Disabilities of the Arm, Shoulder and Hand (DASH) scale to measure performance of the upper limb; and Short Form 36 (SF-36) to evaluate quality of life. Results The VR rehabilitation programme led to an increase in BBS score {45.6 [standard deviation (SD) 7.9] vs 49.2 (SD 8.1), mean difference 3.6, 95% confidence interval (CI) 1.3 to 5.9; P = 0.003}, DGI score [18.7 (SD 4.7) vs 20.2 (SD 4.2), mean difference 1.6, 95% CI 0.6 to 2.5; P = 0.003] and SF-36 mental composite score [37.7 (SD 11.4) vs 43.5 (SD 9.2), mean difference 5.8, 95% CI 0.4 to 11.3; P = 0.037], and a decrease in DASH scale score [29.6 (SD 17.5) vs 21.6 (SD 15.1), mean difference −7.9, 95% CI −13.7 to −2.2; P = 0.009]. In contrast, the conventional rehabilitation programme only led to a decrease in DASH scale score [30.3 (SD 18.1) vs 25.1 (SD 15.8), mean difference −5.2, 95% CI −8.8 to −1.5; P = 0.007]. Conclusion These findings suggest that rehabilitation is useful in Parkinson’s disease, and the VR rehabilitation programme was more effective in determining overall improvement than the conventional rehabilitation programme. Clinical trial registration number : NCT02807740.

In Parkinson disease (PD), sarcopenia may represent the common downstream pathway that from motor and nonmotor symptoms leads to the progressive loss of resilience, frailty, and disability. Here we (1) assessed the prevalence of sarcopenia in older adults with PD using 3 different criteria, testing their agreement, and (2) evaluated the association between PD severity and sarcopenia.Cross-sectional, observation study.Geriatric day hospital.Older adults with idiopathic PD.Body composition was evaluated through dual energy x-ray absorptiometry. Handgrip strength and walking speed were measured. Sarcopenia was operationalized according to the Foundation for the National Institutes of Health, the European Working Group on Sarcopenia in Older Persons, and the International Working Group. Cohen k statistics was used to test the agreement among criteria.Among the 210 participants (mean age 73 years; 38% women), the prevalence of sarcopenia was 28.5%-40.7% in men and 17.5%-32.5% in women. The prevalence of severe sarcopenia was 16.8%-20.0% in men and 11.3%-18.8% in women. The agreement among criteria was poor. The highest agreement was obtained between the European Working Group on Sarcopenia in Older Persons (severe sarcopenia) and International Working Group criteria (k = 0.52 in men; k = 0.65 in women; P .01 for both). Finally, severe sarcopenia was associated with PD severity (odds ratio 2.30; 95% confidence interval 1.15-4.58).Sarcopenia is common in PD, with severe sarcopenia being diagnosed in 1 in every 5 patients with PD. We found a significant disagreement among the 3 criteria evaluated, in detecting sarcopenia more than in ruling it out. Finally, sarcopenia is associated with PD severity. Considering its massive prevalence, further studies should address the prognosis of sarcopenia in PD.

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.

Objective Gait impairment is a highly disabling symptom for Parkinson’s disease (PD) patients. Rhythmic auditory stimulation (RAS), has shown to improve spatio-temporal gait parameters in PD, but only a few studies have focused on their effects on gait kinematics, and the ideal stimulation frequency has still not been identified. Methods We enrolled 30 PD patients and 18 controls. Patients were evaluated under two conditions (with (ON), and without (OFF) medications) with three different RAS frequencies (90%, 100%, and 110% of the patient’s preferred walking cadence). Spatial-temporal parameters, joint angles and gait phases distribution were evaluated. A novel global index (GPQI) was used to quantify the difference in gait phase distribution. Results Along with benefits in spatial-temporal parameters, GPQI improved significantly with RAS at a frequency of 110% for both ON and OFF medication conditions. In the most severe patients, the same result was observed also with RAS at 100%. Conclusions RAS administration, at a frequency of 110% of the preferred walking frequency, can be beneficial in improving the gait pattern in PD patients. Significance When rhythmic auditory stimulation is provided to patients with PD, the selection of an adequate frequency of stimulation can optimize their effects on gait pattern.

Impulse-control disorders (ICDs) are frequently described in patients with Parkinson's disease (PD), particularly among those treated with dopaminergic medications, but data on the prevalence of ICDs in elderly populations are lacking.The aim of this study was to estimate the prevalence of ICDs by using an Italian validation of the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease (QUIP) and to identify associated sociodemographic and clinical factors in a sample of elderly PD patients and in a control group of similarly aged healthy volunteers.Using the United Kingdom Parkinson's Disease Society Brain Bank diagnostic criteria, we included 115 consecutive PD and 105 healthy controls. They were recruited from June 2014 to December 2015. All participants completed the self-administered QUIP-Anytime for assessment of ICDs occurring any time during the course of PD.Mean ± SD age was 75.7 ± 7.0 years in the PD patients and 76.1 ± 7.0 years in the control group. The mean disease duration was 6.8 years (range, 1-26 years). Among the PD patients, 44.7% (n = 51) had at least 1 ICD or related disorder compared to 25.2% (n = 26) in the control group (between-group difference: P = .003). Hypersexuality and compulsive shopping were significantly more common in the PD group than in the control group (P.05). The prevalence of other compulsive behaviors was 42.5% in the PD group and 38.9% in the control group (P = NS). The Italian version of the QUIP-Anytime showed high test-retest reliability (κ0.70 for all items).Our data confirm a high prevalence of ICD symptoms in elderly PD patients, approximately twice that seen in the general population.

Background and aims Impaired emotional facial expressiveness is an important feature in Parkinson's disease (PD). Although there is evidence of a possible relationship between reduced facial expressiveness and altered emotion recognition or imagery in PD, it is unknown whether other aspects of the emotional processing, such as subjective emotional experience (alexithymia), might influence hypomimia in this condition. In this study wee aimed to investigate possible relationship between reduced facial expressiveness and altered emotion processing (including facial recognition and alexithymia) in patients with PD. Methods Forty PD patients and seventeen healthy controls were evaluated. Facial expressiveness was rated on video recordings, according to the UPDRS-III item 19 and using an ad hoc scale assessing static and dynamic facial expression and posed emotions. Six blind raters evaluated the patients' videos. Emotion facial recognition was tested using the Ekman Test; alexithymia was assessed using Toronto Alexithymia Scale (TAS-20). Results PD patients had a significantly reduced static and dynamic facial expressiveness and a deficit in posing happiness and surprise. They performed significantly worse than healthy controls in recognizing surprise (p = 0.03). The Ekman total score positively correlated with the global expressiveness (R^2 = 0.39, p = 0.01) and with the expressiveness of disgust (R^2 = 0.32, p = 0.01). The occurrence of alexithymia was not different between PD patients and HC; however, a significant negative correlation between the expressiveness of disgust was found for a subscore of TAS (R^2 = − .447, p = 0.007). Conclusions Reduced facial expressiveness in PD may be in part related to difficulties with emotional recognition in a context of an unimpaired subjective emotional experience.

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.

Background Malnutrition has been found in up to 24% of patients with Parkinson's disease; dopaminergic drugs might impair nutritional status. We evaluated the association of nutritional status with the use of dopaminergic agents. Methods We analyzed data from 75 elderly patients with Parkinson's disease attending a geriatric day hospital. Nutritional status was assessed by the Mini Nutritional Assessment (MNA). Dopaminergic drugs were normalized for weight. Results In linear regression, total levodopa (l-dopa) equivalent daily dose (LEDD) was associated with worse MNA (B = −0.14, 95% CI = −0.26-−0.02; P = 0.019). This association remained significant only for l-dopa (B = −0.19, 95% CI = −0.32-−0.52; P = 0.007), but not dopaminergic agent dosages. Increasing l-dopa dosages were associated with increasing probability of risk of malnutrition (P for trend = 0.049). Conclusions In our population, LEDD was associated with worse nutritional status and risk of malnutrition; this association was limited to use of l-dopa. © 2014 International Parkinson and Movement Disorder Society

Patients benefit from the presence of empathic caregivers (CGs). In this regard, empathy toward the patient is one of the clinical targets for improving patient outcomes. However, relatively little is known about the impact of patients' empathic responses on the CGs' burden. Among people living with Parkinson's disease (PwP), care partners play a major role. This study involved 28 spouse-patient couples. Empathy, stress burden, and mood disorders (such as anxiety and depression) were assessed over a 6-month period, before and after the reported intervention. Our observation points out that the improvement of patient empathy is necessary for a significant burden reduction among spouses caring for PwP.

To assess whether among patients with Parkinson's disease (PD) depression, a common non-motor symptom associated with reduced survival, is associated with cardiovascular dysautonomia. We enrolled 125 subjects with PD consecutively admitted to a geriatric day hospital. All participants underwent comprehensive evaluation, fasting blood sampling, and 24-h ambulatory blood pressure monitoring. The percent reduction in nocturnal blood pressure (dipping) was calculated. Depressive symptoms were assessed through the 15-item Geriatric Depression Scale (GDS); a score ≥5 identified moderate to severe symptoms. Among participants (mean age 72.7 ± 7.8 years, 32 % women) 61 subjects (49 %) presented with a GDS score ≥ 5. When compared with other participants, subjects with a GDS score ≥ 5 had reduced adjusted levels of percent systolic (-2.6 ± 2.7 vs. 4.7 ± 2.5; p = 0.003), diastolic (0.6 ± 2.8 vs. 7.4 ± 2.6; p = 0.007), and mean blood pressure dipping (-0.7 ± 2.6 vs. 6.8 ± 2.5; p = 0.002). In separate logistic regression models, depressive symptoms were associated with reduced systolic (OR 0.94; 95 % CI 0.89; 0.98), diastolic (OR 0.94; 95 % CI 0.90; 0.99), and mean blood pressure dipping (OR 0.93; 95 % CI 0.89; 0.98), after adjusting for potential confounders. Depressive symptoms are prevalent, and independently associated with cardiovascular dysautonomia among patients with Parkinson's disease. This might explain the remarkable incidence of sudden death, as well as the association of depressive symptoms with reduced survival reported in these patients. The finding of depressive symptoms in subjects with Parkinson's disease should therefore prompt assessment of cardiovascular autonomic function.

Parkinson's disease (PD) patients frequently have an impairment of facial expression both in voluntary and spontaneous emotional expression. Aim of this study was to evaluate the feasibility of a rehabilitation program for hypomimia in patients with PD, comparing two different approaches. Thirty-six patients with PD were included: 20 patients received a rehabilitative intervention for hypomimia either with a DVD showing exercises focused on facial muscles (PD-group-A) or with a therapist-guided facial rehabilitation with a proprioceptive/recognition approach (PD-group-B). Sixteen patients (PD-Ctrl group) did not receive any treatment and served as control group. The feasibility of the proposed rehabilitation techniques was the main focus of this evaluation. We also evaluate the efficacy of the treatments by means of the sub-item 19 of the Unified Parkinson's disease Rating Scale motor score (UPDRS-III) and by a computerized analysis of facial expression (E-Motion), which was assessed prior to (T0) and after therapy (T1). The proposed rehabilitative program for the treatment of hypomimia was shown to be feasible. Our data show a significant improvement in UPDRS-III sub-item 19 in PD-group-B compared to PD-group-A, (p = 0.005) and to PD-Ctrl (p = 0.003) and in expressivity of fear in PD-group-B compared to PD-Ctrl (p = 0.01). The proposed rehabilitative program showed to be feasible. A larger multi-center trial is now warranted to establish its efficacy to improve facial expression over long time period.

Posture, gait and balance problems are very disabling symptoms in Parkinson's disease (PD). An increased stride-to-stri de variability, reduction of automaticity and asymmetry of lower limbs function characterize parkinsonian gait. These features predispose to freezing of gait (FOG), which often leads to falls. The aim of this study was to evaluate how the modulation of asymmetry through physiotherapy might improve gait and reduce FOG, thus preventing falls. Twenty-eight PD patients entered a double-blind pilot feasibility controlled study and were evaluated at baseline and after 3 months of a rehabilitative program (performed twice a week) by means of the motor part of the Unified Parkinson's Disease Rating Scale (UPDRS-III), Gait and Falls Questionnaire, Tinetti balance and gait scale, Short Physical Performance Battery (SPPB), European Quality of Life questionnaire. Patients were randomly assigned to three treatment arms: (1) worst side improvement; (2) best side improvement; (3) standard therapy. All study arms showed a significant improvement of the Tinetti and SPPB scores. BSI led to a greater improvement than ST in terms of UPDRS-III (p = 0.01); Tinetti total score (p = 0.05) and Tinetti gait subscore (p = 0.01). Our study confirms the efficacy of physical therapy in the treatment of PD and, more importantly, suggests that specific intervention tailored on individual feature (e.g., asymmetry of motor condition) might be even more effective than standard rehabilitative programs.

This study aimed to evaluate the relationship quality and satisfaction in couples, in which one partner had PD, obtaining the perspective of both patients and partner and to examine the impact of alexithymia, empathy, depression, and anxiety on ratings of relationship quality and satisfaction. Fifteen PD patients and partners completed the following scales: the Dyadic Adjustment Scale; Couple Satisfaction Index (CSI); the 20-item Toronto Alexithymia Scale; the Empathy Quotient; the Hamilton Depression and the Hamilton Anxiety Rating Scale (HAM-A). We evaluated patients' motor functions by means of Unified Parkinson's Disease Rating Scale and patients' quality of life by means of the PD Questionnaire. Patients were significantly less satisfied with the relationship than their partners as revealed by CSI (p = 0.031) and they were more depressed (p = 0.003) and anxious (p = 0.015). A negative correlation between measures of relationship quality and satisfaction and alexithymia was found in the patients group. No correlations were found between measures of relationship quality and satisfaction (both of patients and partners) and any other demographical and clinical variables. CSI and HAM-A were predictors of patient's social support evaluation. The presence of alexithymia in PD is an important factor affecting relationship quality and satisfaction.

Different and new approaches have been proposed to prevent the risk of falling of elderly people, particularly women. This study investigates the possibility that a new protocol based on the focal mechanical muscle vibration may reduce the risk of falling of elderly women. A pragmatic randomized controlled triple-blind trial with a 6-month follow-up after intervention randomized 350 women (mean age 73.4 years + 3.11), members of local senior citizen centers in Rome, into two groups: vibrated group (VG) and control group (CG). For VG participants a mechanical vibration (lasting 10 min) was focally applied on voluntary contracted quadriceps muscles, three times a day during three consecutive days. CG subjects received a placebo vibratory stimulation. Subjects were tested immediately before (T0) and 30 (T1) and 180 (T2) days after the intervention with the Performance-Oriented Mobility Assessment (POMA) test. All subjects were asked not to change their lifestyle during the study. CG underwent sham vibratory treatment. While CG did not show any statistically significant change of POMA at T1 and T2, VG revealed significant differences. At T2, ≈47 % of the subjects who completed the study obtained the full score on the POMA test and ≈59 % reached the full POMA score. The new protocol seems to be promising in reducing the risk of falling of elderly subjects.

Malnutrition has been found in up to 24% of patients with Parkinson's disease; dopaminergic drugs might impair nutritional status. We evaluated the association of nutritional status with the use of dopaminergic agents.We analyzed data from 75 elderly patients with Parkinson's disease attending a geriatric day hospital. Nutritional status was assessed by the Mini Nutritional Assessment (MNA). Dopaminergic drugs were normalized for weight.In linear regression, total levodopa (l-dopa) equivalent daily dose (LEDD) was associated with worse MNA (B = -0.14, 95% CI = -0.26--0.02; P = 0.019). This association remained significant only for l-dopa (B = -0.19, 95% CI = -0.32--0.52; P = 0.007), but not dopaminergic agent dosages. Increasing l-dopa dosages were associated with increasing probability of risk of malnutrition (P for trend = 0.049).In our population, LEDD was associated with worse nutritional status and risk of malnutrition; this association was limited to use of l-dopa.

Background Posture, gait and balance problems are very disabling symptoms in Parkinson’s disease (PD). Gait cycle in PD shows increased stride-to-stride variability because of the reduction of gait automaticity and asymmetry of lower limbs function. These feature predispose to freezing of gait (FOG) and recurrent falls. Aim of the study was to evaluate how the modulation of asymmetry through physiotherapy might improve gait and FOG preventing falls. Methods Twenty-eight PD patients entered the study and were evaluated at baseline and after three months of rehabilitative program (performed twice a week) by means of the motor part of the Unified Parkinson’s Disease Rating Scale (UPDRS-III), Gait and Falls Questionnaire (GFQ), Tinetti balance and gait scale, Short Physical Performance Battery (SPPB), European Quality of Life questionnaire (EQ-5D). Patients were randomly assigned to (1) physiotherapy for worst side improvement (WSI), (2) physiotherapy for best side improvement (BSI), and (3) standard physical therapy (SPT). Patients were unaware of study’s aim and evaluations were carried out by blinded physiotherapist and doctor. Results After three months, all three groups showed a significant improvement at the Tinetti and SPPB scores. The magnitude of change (end of treatment compared to baseline) was analyzed among groups: BSI led to a greater improvement than SPT in terms of UPDRS-III ( p = 0.01), Tinetti total score ( p = 0.05) and Tinetti gait subscore ( p = 0.01). No other significant differences arose. Conclusions Our study confirms the usefulness of physical therapy in the treatment of PD and, more importantly, suggests that specific intervention tailored on individual feature (e.g. asymmetry of motor condition) might be even more effective than standard rehabilitative programs. The impact of such approach on the benefit duration and rate of falls should be prospectively assessed by future trials.