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\n The ability to identify individuals in the prodromal phase of Parkinson’s disease has improved in recent years, raising the question of whether and how those affected should be informed about the risk of future disease. Several studies investigated prognostic counselling for individuals with isolated REM sleep behavior disorder and have shown that most patients want to receive information about prognosis, but autonomy and individual preferences must be respected. However, there are still many unanswered questions about risk disclosure or early diagnosis of PD, including the impact on personal circumstances, cultural preferences and specific challenges associated with different profiles of prodromal symptoms, genetic testing or biomarker assessments. This narrative review aims to summarize the current literature on prognostic counselling and risk disclosure in PD, as well as highlight future perspectives that may emerge with the development of new biomarkers and their anticipated impact on the definition of PD.An important goal of Parkinson’s disease research is to diagnose the disease at an earlier stage, even before the typical motor symptoms appear, in the so-called ‘prodromal phase’. Currently, there are no treatments available that can slow down or prevent disease progression in this early phase, even though many of the early symptoms are treatable. This raises ethical questions about whether people want to know their future risk of Parkinson’s and, if so, how this information should be given. This article summarizes the current state of knowledge, but also open questions about risk disclosure in the prodromal phase of Parkinson’s. Previous studies have shown that many people with early symptoms of Parkinson’s would like to know their risk, but that the individual’s wish to know (or not to know) must first be ascertained and respected. Future studies need to find out whether very early diagnosis of Parkinson’s might have an impact on people affected, for example in terms of psychological stress or anxiety, and whether cultural background might influence attitudes to risk disclosure. Furthermore, it is expected that in the future it will be possible to make an early diagnosis of Parkinson’s using specific new techniques, e.g., by testing spinal fluid. It is of utmost importance to find out if and how test results of these new techniques should be communicated to patients, even if they do not lead to direct medical treatment. [ABSTRACT FROM AUTHOR]

The intermittent subcutaneous injection of apomorphine is highly effective in the management of motor and non-motor symptoms of Parkinson's disease. Although it has been shown that apomorphine injection can be safely used in selected cases at all stages of the disease, there is no consensus regarding intermittent administration strategies. This review aimed to discuss the indications for intermittent subcutaneous apomorphine use in clinical practice, possible side effects and their management, and contraindicated cases in light of the literature and to present practical recommendations for clinical practice. [ABSTRACT FROM AUTHOR]

Introduction: Previous studies have reported an association between low 25-hydroxyvitamin D (25(OH)D) levels and cognitive impairment. However, this association has not been reported in Turkish patients with cognitive impairment. We investigated this relationship in Turkish patients diagnosed with Alzheimer's disease (AD). Materials and Method: Seventy-two patients with a diagnosis of "Probable AD" were included in the study. Demographic and disease specific characteristics were recorded. Cognitive performance was assessed using the Mini-mental State Examination (MMSE). Patients were categorized into two groups with regard to their 25(OH)D levels based on the recommended cut-off value (30 ng/ml) for 25(OH)D insufficiency. Association between 25(OH) D levels and MMSE scores was assessed using a regression model taking probable confounding factors into account. Results: Sixty-nine patients were included in the final analysis. Patients with 25(OH)D levels higher than 30 ng/ml performed (n=18) significantly better in MMSE than the group with lower values (n=51) (p=0.027). Subsequently, the multiple linear regression analysis showed a significant association between 25(OH)D levels and MMSE scores; this association was independent of the confounding effects of age, gender, education, disease duration, antidementia medication and depressive state (B= 2.81, p=0.04). Conclusion: Our results support that low 25(OH)D levels are associated with worse cognitive performance in Turkish patients with AD. Larger population-based studies are required to clarify this relationship in Turkish population not only in patients with AD, but also in individuals with mild cognitive impairment and healthy elderly. [ABSTRACT FROM AUTHOR]

Objectives: During the last two decades transcranial sonography (TCS) of the brain parenchyma evolved from a pure research tool to a clinical relevant neuroimaging method especially in Parkinson's disease and related movement disorders. The aim of this systematic review is to update and summarise the published TCS findings in psychiatric disorders and critically address the question whether TCS may be a valuable tool for the diagnosis or differential diagnosis of psychiatric disorders similarly to the field of movement disorders. Methods: This paper provides detailed information about the perspectives and limitations of TCS, including guidelines for the scanning procedures, assessment of midbrain structures and discusses the potential causes of the ultrasound abnormalities in psychiatric disorders. Results: Changes in the echogenicity of subcortical brain structures were detected in different disorders, such as obsessive-compulsive disorder, autism spectrum disorder, schizophrenia, panic disorder, attention-deficit/hyperactivity (ADHD), bipolar disorder and depressive disorder. Although the physical properties of brain tissue underlying the echogenic features in TCS are largely unknown, no alternative technique provides the same insight into the specific central nervous structural characteristics. Conclusions: Urgent research questions to further clarify the underlying pathophysiological and structural alterations are further outlined to bring this promising technique to the clinic. [ABSTRACT FROM AUTHOR]

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