Advanced Parkinson disease (APD) is often under-recognized, which may delay treatment optimization and referral for device-aided therapy assessment. Machine learning-enabled remote monitoring systems (ML-RMS) may support earlier recognition of progression, but their value depends on whether alerts lead to clinical action and patient benefit.

We developed a Markov model comparing standard care with ML-RMS-supported care from the Finnish health care perspective. The model simulated persons with Parkinson disease at risk of APD over 16 years. The base case assumed ML-RMS sensitivity and specificity of 88 percent and 62 percent. Costs, quality-adjusted life years (QALYs), incremental cost-effectiveness ratios, and incremental net monetary benefit were estimated. Scenario and probabilistic sensitivity analyses explored diagnostic accuracy, monitoring costs, direct quality-of-life effects, deep brain stimulation (DBS) costs, pathway timing, and delayed nursing home admission.

In the base case, ML-RMS generated 0.0044 additional QALYs at an additional cost of €761 per patient, resulting in an incremental cost-effectiveness ratio of €172,023 per QALY gained. At a willingness-to-pay threshold of €35,000 per QALY, the incremental net monetary benefit was negative. Scenario analyses indicated that ML-RMS could become cost-effective if active monitoring produced direct quality-of-life gains or delayed nursing home admission.

ML-RMS is unlikely to be economically favorable if limited to earlier APD recognition and timely DBS treatment in a small eligible subgroup. Its value depends on whether monitoring changes care pathways, improves patient outcomes, or reduces long-term care needs. Future studies should prioritize clinical utility, quality-of-life effects, treatment decisions, and institutional care.

Virtual care services increased during the COVID-19 pandemic, enabling access to physician consultations. Most studies on virtual care in Parkinson’s disease (PD) have focused on tertiary centers, limiting generalizability.

To describe trends in virtual care use over time in people living with PD in Ontario, Canada, by rural and urban region of residence using health administrative data.

We conducted a population-based repeated cross-sectional study between March 2020 and August 2023, among community-dwelling people living with PD aged ≥66 years in Ontario, Canada. We used Poisson regression models with generalized estimating equations to estimate rate ratios (RR) with 95% confidence intervals (CIs) comparing virtual visit rates in urban versus rural areas across physician specialties (family physicians, neurologists and psychiatrists/geriatricians).

Among 24,736 people living with PD in March 2020, 58.6% were male (mean age 77.6 [SD = 7.0] years), and most resided in urban areas (89.9%). Compared to urban residents, rural residents had significantly lower rates of virtual visits to neurologists (adjusted RR = 0.93; 95% CI: 0.90–0.96), family physicians (aRR = 0.73; 95% CI: 0.70–0.77) and geriatricians/psychiatrists (aRR = 0.67; 95% CI: 0.65–0.77). Over 3.5 years, virtual visits declined compared to the first 6 months for neurologists (aRR = 0.23; 95% CI: 0.22–0.25), family physicians (aRR = 0.39; 95% CI: 0.38–0.41) and geriatricians/psychiatrists (aRR = 0.45; 95% CI: 0.40–0.51).

People living with PD in urban centers accessed virtual care more frequently than those living rurally. Virtual care utilization decreased over time. The sustainability of virtual care and its impact on health equity among people living with PD requires further study.

In Parkinson’s disease (PD) and dementia with Lewy bodies (DLB), the cholinergic system has been implicated in cognitive and gait decline. The nucleus basalis of Meynert (NBM), within the substantia innominata (SI), is the main cholinergic nucleus projecting to the cortex. In this study, the relationship between atrophy of the SI on cognitive phenotypes and quantitative gait performance was evaluated in relation to gray matter (GM) volume.

Ninety-nine participants – 20 control, 42 PD with normal cognition (PD-NC), 19 PD with mild cognitive impairment (PD-MCI) and 18 PD dementia or DLB patients (PDD/DLB) – were examined. Measures included Montreal Cognitive Assessment (MoCA) score, motor symptom severity, quantitative gait analysis measures and dual-task cost (DTC) to gait speed. Manual measurement of SI volume was performed on T1 MRI scans; automated methods were used for GM volumes. The relationships between gait changes, volumetric imaging and clinical measures were assessed.

Smaller SI volumes were seen in PD-MCI and PDD/DLB subjects adjusting for age. SI and GM atrophy were both associated with greater step length variability, and GM was associated with increased DTC to gait speed. These were not significant after adjusting for the false discovery rate. Lower MoCA score was associated with impairments in gait speed, DTC to gait speed and gait variability.

The SI was associated with cognitive impairment in participants with Lewy body diseases. However, more widespread cortical atrophy may be better related to selected cognitive aspects of gait (DTC to gait speed with animal fluency).

Orthostatic hypotension (OH) is common in Parkinson disease and contributes to injury, fatigue and reduced quality of life. More efficient approaches to identify higher-risk patients are needed.

A cross-sectional, single-center study of consecutive people with Parkinson disease was conducted over three months. Linear models adjusted for age, sex and disease duration assessed associations of OH to patient-reported outcomes (autonomic symptoms, quality of life), medications and other clinical features. Receiver operating characteristic curves evaluated patient-reported outcomes as predictors of clinic-measured orthostatic hypotension.

Fifty-seven participants (mean age 69; 60% male) completed assessments. OH was present in 29 (50.9%), but only 3 were symptomatic. The Orthostatic Hypotension Questionnaire showed strong discrimination for OH (sensitivity 81%; specificity 73%). Supine-to-3-minute standing systolic blood pressure dropped most when measured within 1 hour of dopaminergic medication (−17.4 mmHg; 95% CI −30.4 to −4.4) or 1–2 hours (−17.2 mm Hg;−26.8 to −7.6) compared with 2–3 hours (+1.6 mm Hg; −10.0 to + 13.2) or more (−2.9 mmHg; −14.9 to + 9.1). Older age was associated with a greater diastolic blood pressure drop. Delayed OH was associated with worse patient-reported mobility.

Orthostatic hypotension was common and usually asymptomatic in this sample. Patient-reported outcomes showed good sensitivity for identifying those likely to have OH. Time since dopaminergic medication impacted the blood pressure drop, and the delayed onset of hypotension was associated with worse mobility-related quality of life. Brief questionnaires may help risk-stratify patients for assessment, counseling and treatment of orthostatic hypotension.

Parkinson’s disease (PD) is a neurodegenerative disorder whose diagnostic motor symptoms appear only after significant progression of neurodegeneration. Identification of preclinical markers is essential. Idiopathic rapid eye movement sleep behavior disorder (iRBD) has a high risk of conversion to PD. Olfactory impairment (hyposmia) is present in both PD and iRBD; hyposmia in iRBD may be an additional clue indicating the development of PD. The processes underlying hyposmia in iRBD are unknown. Using resting-state functional connectivity (rsFC), a “sensory olfactory subnetwork” (SOS) has been identified that is thought to represent the processing of basic sensory olfactory information. We investigated whether changes in the SOS are seen in both PD and iRBD and whether changes are associated with hyposmia in both conditions.

The University of Pennsylvania Smell Identification Test (UPSIT) and a seed-based approach to analyze SOS region rsFC in early PD, iRBD and healthy controls (HC) were employed. Our SOS regions included (right hemisphere) anterior piriform cortex, dorsal insula (INSd), ventral insula (INSv), posterior insula (INSp) and ventral posterior thalamus (THLvp).

Compared to HC, idiopathic iRBD and PD participants performed significantly worse on UPSIT and exhibited lower FC between INSd and INSv and higher FC between INSd and THLvp and INSv and THLvp. UPSIT scores were negatively correlated with FC between INSv and THLvp and INSp and THLvp.

Idiopathic iRBD may be associated with similar functional and perceptual olfactory alterations and potential compensatory changes as early PD, which may show promise as additional preclinical biomarkers of PD.

Levodopa-induced dyskinesia (LID) is a disabling symptom of Parkinson’s disease (PD). There have been prior attempts to find risk factors contributing to this symptom, but risk factors for the severity of LID have not been comprehensively studied. We aimed to evaluate factors that correlate with LID severity in patients with PD based on the Unified Dyskinesia Rating Scale (UDysRS).

A cross-sectional study was designed on 52 idiopathic PD patients who were referred for LID between 2023 and 2024. Their demographic and clinical records were studied. Furthermore, cognitive decline (MoCA), PD severity (Hoehn and Yahr) and the severity of dyskinesia (UDysRS) were examined. The association between factors and LID severity was evaluated by carrying out univariate regression and multivariate regression backward elimination analysis.

The mean age of patients with LID was 59.9 ± 11.4 years. Results of univariate regression analysis indicated that male sex (β = −0.24, P = 0.04), BMI (β = −0.3, P = 0.005), H&Y (β = 0.4, P = 0.002), diabetes mellitus (β = 0.3, P = 0.018) and levodopa dosage per kilogram (β = 0.37, P = 0.01) were significant factors involved in the severity of dyskinesia. The univariate regression model results showed that lack of constipation (P = 0.04), hyperlipidemia (P = 0.04) and total daily levodopa dosage per kilogram (P = 0.01) were associated with the severity of end-dose dystonia.

This study revealed that female sex, more advanced PD, diabetes mellitus, daily levodopa dosage per kilogram body weight and BMI are associated with the severity of LID. Also, it suggests that hyperlipidemia and lack of constipation are associated with the severity of end-dose dystonia.

Movement disorders (Parkinson’s disease, essential tremor, dystonia) are debilitating, progressive conditions that profoundly impact patients’ quality of life. Surgical therapies, such as deep brain stimulation (DBS) can provide tremendous relief to patients but remain costly and, therefore, limited in availability. It is critical to understand regional barriers to accessing this service to improve access for all patients who may benefit from it.

This is a mixed methods survey of stakeholders (patients/family members, advocacy groups, family physicians, neurologists, neurosurgeons) assessing perceived barriers to DBS for movement disorders. Closed and open-ended questions were used. Descriptive statistics were used to highlight regions of Canada where perceived access is poor and to identify barriers to access.

A total of 220 responses were recorded (12 neurosurgeons, 22 neurologists, 30 family physicians, 153 patients and caregivers and 3 advocacy group personnel). Themes included limited resources/centralization of resources, education, burdensome referral patterns and personal patient factors. Barriers included costs associated with travel, waitlists, lack of specific resources and poor understanding of movement disorders, DBS indications and referral pathways.

A number of barriers to access to DBS have been identified, related to geography and centralization of services, referrals and need for further education of indications and safety. The use of virtual care, centralized referral pathways and further research to determine the true prevalence of candidates for this therapy are required to improve access to DBS for movement disorders in Canada.

Parkinson disease (PD) is a neurological disorder that affects more than 10 million people worldwide, impacting both quality of life and marital relationships. Divorce rates are higher in Western compared to Eastern countries. However, it is unclear if there are differences in marital status after PD onset between the two regions.

We searched MEDLINE and Embase from inception to March 31, 2024. Original studies discussing marital status in participants with PD were included. An unmarried status includes single, widowed, divorced or separated. Outcomes included the prevalence of being unmarried, measured as proportions, and the risk ratio (RR) of being unmarried in participants with PD relative to controls.

Out of 567 studies screened initially, 55 studies involving 3,723,966 participants were included. The prevalence of being unmarried was evaluated in 55 studies (25.16%; 95% CI: 21.52–29.18). The prevalence of being unmarried was significantly higher in countries in the West compared to the East (28.83%; 95% CI: 25.09–32.89 vs 17.47%; 95% CI: 12.10–24.57, p < 0.01). Compared to controls, the risk of being unmarried in PD participants after the onset of PD was significantly higher in the East (RR: 1.21, 95% CI: 0.91–1.60) compared to the West (RR: 0.87, 95% CI: 0.65–1.15).

Our meta-analysis showed significantly higher rates of being unmarried in Western compared to Eastern countries. After PD onset, participants in the East were at significantly higher risk of being unmarried compared to participants in the West, suggesting that differences in cultural practices, societal norms and healthcare systems may affect marital status outcomes in PD participants.

Parkinson’s disease (PD) is a progressive neurological disorder that associates multiple psychiatric symptoms and disorders, like depression, neurocognitive impairment, sleeping disorders, etc. Insomnia is frequently detected in this population, with a prevalence of over 50% according to several studies.

To present a case series dedicated to the treatment of insomnia in patients diagnosed with PD, who did not meet diagnostic criteria for any other psychiatric disorder.

A number of three patients (2 male, one female, mean age 65.2 years) diagnosed with PD, were evaluated for insomnia. They were all initiated on quetiapine XR 50 mg QD, and up-titrated according to the individual response. All these patients were undergoing treatment for their neurological disease, which remained stable for the next 3 months. A structured clinical evaluation was performed monthly, and safety measurements were also performed. All patients self-evaluated their insomnia severity on a 10-point visual analogic scale (VAS).

After 3 months, patients reported a favorable evolution of their insomnia- VAS score improved significantly to baseline (from 7.3 to 3.3), without significant adverse events (metabolic parameters and QTc values did not change significantly during the treatment period). Daytime sleepiness was not reported as being significant by any of these patients. The mean dose of quetiapine XR used was 75 mg QD (50-150 mg QD), and the mean duration of the needed treatment for insomnia was 8.3 weeks (4-11 weeks).

Quetiapine XR could be useful in patients with PD-related insomnia, and the mean dose is usually below 100 mg QD.

No significant relationships.

We present the case of a 65-year-old woman who was prescribed levodopa by the Neurology department due to motor symptoms that were not clearly suggestive of a diagnosis of Parkinson’s Disease (PD). Before that, the patient had never showed any hallucinations or delusions. After years of increasing doses of levodopa, the diagnosis of PD was withdrawn. However, during the treatment the patient developed severe psychosis with severe impairment of social functioning. Levodopa is the most effective treatment for motor symptoms in PD. However, it might involve difficulties in dose-control and may present with deletereous complications and adverse effects.

To analyse the incidence of pharmacological psychotic symptoms after levodopa treatment.

A case report is presented alongside a review of the available literature regarding psychotic symptoms in patients treated with levodopa.

Hallucinations and delusions are prevalent symptoms of PD. Nonetheless, they could also be potential side-effects of levodopa treatment. When psychotic symptoms occur, they are commonly attributed to the natural course of the disease. Available evidence does not provide with clear guidelines to distinguish the iatrogenic syndrome from the one caused by the disease itself. Our patient, whose PD diagnosis was dismissed, presented extreme psychotic symptoms which disappeared after the discontinuation of levodopa treatment.

Levodopa is an effective treatment with important risks which must not be overlooked. Adverse effects of the drug could have been minimized by making an accurate differential diagnosis of PD. Individualized benefit-risk balance previous to prescription and a close follow-up should be standardized.

No significant relationships.

Older persons with parkinsonism (PWP) are at high risk for hospitalization and adverse outcomes. Few effective strategies exist to prevent Emergency Department (ED) visits and hospitalization. The interdisciplinary Geriatrics Clinic for Parkinson’s (“our clinic”) was founded to address the complexity of parkinsonism in older patients, supported by a pharmacist-led telephone intervention (TI) service. Our primary objective was to study whether TI could avert ED visits in older PWP.

Using a prospective, observational cohort, we collected data from all calls in 2016, including who initiated and reasons for the calls, patient demographics, number of comorbidities and medications, diagnoses, duration of disease, and intervention provided. Calls with intention to visit ED were classified as “crisis calls”. Outcome of whether patients visited ED was collected within 1 week, and user satisfaction by anonymous survey within 3 weeks.

We received 337 calls concerning 114 patients, of which 82 (24%) were “crisis calls”. Eighty-one percent of calls were initiated by caregivers. Ninety-three percent of “crisis calls” resolved without ED visit after TI. The main reasons for “crisis calls” were non-motor symptoms (NMS) (39%), adverse drug effects (ADE) (29%), and motor symptoms (18%). Ninety-seven percent of callers were satisfied with the TI.

Pharmacist-led TI in a Geriatrics Clinic for Parkinson’s was effective in preventing ED visits in a population of older PWP, with high user satisfaction. Most calls were initiated by caregivers. Main reasons for crisis calls were NMS and ADE. These factors should be considered in care planning for older PWP.

Burden of care might be highly dependent of specific characteristics of the disease (Lee et al., 2019). Uncertainties remain about factors that influence burden of care in Parkinson Disease (PD).

To identify a list of ICF-related domains identified by caregivers of older patients with PD.

Caregivers of people with PD were recruited in Portugal Parkinson Foundation, if they take care of someone with PD older than 65 yrs, and for more than 6 hours/day. A focus group was video recorded, based on the following questions: Can you please tell us how did you spent your day before you're a caregiver; there are any differences in your daily routine now? How do you feel or think when you're caring for a relative? Can you tell us if there is any kind of daily activity more pleasant or more embarrassing? Verbal interactions during focus group were transcribed and codified using International Classification of Functioning and Disability (ICF) domains.

Seven caregivers (5 females; 40-73 yrs; 5 were spousal) were enrolled. Thirty-six caregivers’ references were about body functions and structures (91.67% - mental functions: “I feel tired…it is a constant monotony”); fifty-seven references were about activities and participation (“I need to assist him with bathing”; “when he wants to standing from his favourite chair, he always need help…and his body is very stiff”);eleven references were about environmental factors, mostly about medication and family/health professionals assistance.

Our results demonstrated that caregivers are worried about their mental health and routine preservation, which is in accordance with previous studies in this topic (Tessitore et al.,2018). However, new caregivers’ perceptions were found in our study, which are very specific domains in PD: body motion rigidity and medication for patients’ psychomotor agitation. A previous study stated that control of mental symptoms in PD are the most powerful predictors of caregivers' burden (Hooker et al., 2000), but do not consider the importance of Parkinson’s motor symptoms.

Burden of care in PD is mostly associated with the need of preservation in daily routines, but also with management of mental and motor symptoms in PD.

To examine whether sociodemographic characteristics and health care utilization are associated with receiving deep brain stimulation (DBS) surgery for Parkinson’s disease (PD) in Ontario, Canada.

Using health administrative data, we identified a cohort of individuals aged 40 years or older diagnosed with incident PD between 1995 and 2009. A case-control study was used to examine whether select factors were associated with DBS for PD. Patients were classified as cases if they underwent DBS surgery at any point 1-year after cohort entry until December 31, 2016. Conditional logistic regression modeling was used to estimate the adjusted odds of DBS surgery for sociodemographic and health care utilization indicators.

A total of 46,237 individuals with PD were identified, with 543 (1.2%) receiving DBS surgery. Individuals residing in northern Ontario were more likely than southern patients to receive DBS surgery [adjusted odds ratio (AOR) = 2.23, 95% confidence interval (CI) = 1.15–4.34]; however, regional variations were not observed after accounting for medication use among older adults (AOR = 1.04, 95% CI = 0.26–4.21). Patients living in neighborhoods with the highest concentration of visible minorities were less likely to receive DBS surgery compared to patients living in predominantly white neighborhoods (AOR = 0.27, 95% CI = 0.16–0.46). Regular neurologist care and use of multiple PD medications were positively associated with DBS surgery.

Variations in use of DBS may reflect differences in access to care, specialist referral pathways, health-seeking behavior, or need for DBS. Future studies are needed to understand drivers of potential disparities in DBS use.