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• The Barthel Index and modified Ranking Scale are valid and reliable outcome measures that can be used to assess level of disability in Parkinson disease (PD). • Along with PD specific assessments, the Barthel Index and modified Rankin Scale are accurate tools for patients in clinical settings. • The Barthel Index and modified Ranking Scale can be used in future research to measure level of disability in the ON and OFF medication phase, particularly. Independence in activities of daily living (ADL) is one of the most important aspects in planning treatment for people with Parkinson disease (PD). The Barthel Index (BI) and modified Rankin Scale (mRS) are commonly used in neurological diseases. This study was conducted to confirm the validity and reliability of the BI and mRS in PD during ON and OFF medication phases. We included 260 individuals with a diagnosis of idiopathic PD. The disability in ADL was measured by the BI, mRS, Parkinson's Disease Questionnaire-39 (PDQ-39), Unified Parkinson Disease Rating Scale-Activities of Daily Living (UPDRS-ADL), and Schwab and England ADL scale (SE). Test–retest, inter-rater reliability, and internal consistency were assessed by the intra-class correlation (ICC) and Cronbach α coefficients. Dimensionality was evaluated by factor analysis. Convergent validity was assessed by the SE, Berg Balance Scale (BBS), PDQ-39 and UPDRS-ADL. For the 260 participants (187 [71.9%] males; mean [SD] age 60.3 [12.3] years), both the BI and mRS achieved an acceptable level of test–retest and inter-rater reliability (ICC = 0.77 to 0.91) in ON and OFF medication phases. The Cronbach α for BI was 0.85 and 0.88, respectively. We found 1 and 2 factors for BI in ON and OFF phases, respectively. Investigation of convergent validity showed moderate to high correlation for the BI with the UPDRS-ADL, SE, PDQ-39 (ADL), BBS and mRS scores in ON and OFF phases (ρ = 0.51–0.74) and mRS with SE, UPDRS-ADL, PDQ-39 (ADL) and BBS scores (ρ = 0.48–0.82). The BI and mRS showed acceptable validity and reliability to measure the degree of disability in patients with PD in daily activities in both ON and OFF medication phases. [ABSTRACT FROM AUTHOR]

Subthalamic (STN) and pallidal (GPi) deep brain stimulation (DBS) improve quality of life, motor, and nonmotor symptoms (NMS) in advanced Parkinson's disease (PD). However, few studies have compared their nonmotor effects. To compare nonmotor effects of STN-DBS and GPi-DBS. In this prospective, observational, multicenter study including 60 PD patients undergoing bilateral STN-DBS (n = 40) or GPi-DBS (n = 20), we examined PDQuestionnaire (PDQ), NMSScale (NMSS), Unified PD Rating Scale-activities of daily living, -motor impairment, -complications (UPDRS-II, –III, -IV), Hoehn&Yahr, Schwab&England Scale, and levodopa-equivalent daily dose (LEDD) preoperatively and at 6-month follow-up. Intra-group changes at follow-up were analyzed with Wilcoxon signed-rank or paired t -test, if parametric tests were applicable, and corrected for multiple comparisons. Inter-group differences were explored with Mann-Whitney-U/unpaired t-tests. Analyses were performed before and after propensity score matching which balanced out demographic and preoperative clinical characteristics. Strength of clinical changes was assessed with effect size. In both groups, PDQ, UPDRS-II, -IV, Schwab&England Scale, and NMSS improved significantly at follow-up. STN-DBS was significantly better for LEDD reduction, GPi-DBS for UPDRS-IV. While NMSS total score outcomes were similar, explorative NMSS domain analyses revealed distinct profiles: Both targets improved sleep/fatigue and mood/cognition, but only STN-DBS the miscellaneous (pain/olfaction) and attention/memory and only GPi-DBS cardiovascular and sexual function domains. To our knowledge, this is the first study to report distinct patterns of beneficial nonmotor effects of STN-DBS and GPi-DBS in PD. This study highlights the importance of NMS assessments to tailor DBS target choices to patients' individual motor and nonmotor profiles. • Specific nonmotor effect profiles identified for STN- and GPi-DBS in PD. • Both targets improve sleep/fatigue and mood/cognition. • Only STN improves pain/attention/memory, only GPi cardiovascular/sexual functions. • Aligning patient and target profiles may provide precisely personalized treatment. [ABSTRACT FROM AUTHOR]

The underlying genetic defect in most cases of dilated cardiomyopathy (DCM), a common inherited heart disease, remains unknown. Intriguingly, many patients carry single missense variants of uncertain pathogenicity targeting the giant protein titin, a fundamental sarcomere component. To explore the deleterious potential of these variants, we first solved the wild-type and mutant crystal structures of I21, the titin domain targeted by pathogenic variant p.C3575S. Although both structures are remarkably similar, the reduced hydrophobicity of deeply buried position 3575 strongly destabilizes the mutant domain, a scenario supported by molecular dynamics simulations and by biochemical assays that show no disulfide involving C3575. Prompted by these observations, we have found that thousands of similar hydrophobicity-reducing variants associate specifically with DCM. Hence, our results imply that titin domain destabilization causes DCM, a conceptual framework that not only informs pathogenicity assessment of gene variants but also points to therapeutic strategies counterbalancing protein destabilization. [Display omitted] • DCM mutation C3575S destabilizes titin domain I21 without affecting its crystal structure • Destabilization of I21 C3575S domain is not linked to loss of a disulfide bond • C3575S severely compromises the stability of the hydrophobic core of the I21 domain • Variants that reduce core hydrophobicity of titin domains are linked to DCM Distinguishing pathogenic missense variants from benign polymorphisms is extremely challenging for genes the size of titin. Martinez-Martin et al. have characterized the deleterious physical-chemical features of titin DCM-causing mutation C3575S and used this information to develop a method able to pinpoint pathogenic variants in immunoglobulin domains. [ABSTRACT FROM AUTHOR]

Background: The relationship between Health-Related Quality of Life (HRQoL) and MDS-UPDRS has not been fully studied so far. The aim of this study was to evaluate the relationship between all MDS-UPDRS components and HRQoL in a representative international cohort of PD patients.Methods: We collected demographic and disease-related data as well as MDS-UPDRS and PDQ8 scales. Data were analyzed using correlations between PDQ8 and all MDS-UPDRS items, subsequently two hierarchical multiple regressions were performed, first between the scores of the MDS-UPDRS Parts and PDQ8 and second between individual items from those Parts demonstrating significant relationship to PDQ8 scores in the first regression. LASSO regression analyses were performed to evaluate the relationship between PDQ8 and all individual MDS-UPDRS items.Results: A total of 3206 PD patients were included in the study. In the first regression analysis, PDQ8 was significantly related to MDS-UPDRS parts I and II, but not to III and IV. In the second regression model, significant contributions to PDQ8 were found for Part I items Fatigue, Pain, Depressed mood, Apathy; and Part II items Dressing, Doing hobbies, Freezing, Speech and Tremor. In the LASSO analysis, six Part I, seven Part II, three Part III and one Part IV items contributed to PDQ8 scores. The five items most significantly related to the model were Depressed mood, Dressing, Apathy, Pain and Fatigue.Conclusions: This is so far the largest study related to HRQoL issues in PD. Restrictions in activities of daily living and non-motor symptoms significantly contribute to HRQoL in PD. [ABSTRACT FROM AUTHOR]

Background Subthalamic nucleus (STN) deep brain stimulation (DBS) improves quality of life (QoL), motor, and non-motor symptoms (NMS) in Parkinson's disease (PD). Few studies have investigated the influence of the location of neurostimulation on NMS. Objective To investigate the impact of active contact location on NMS in STN-DBS in PD. Methods In this prospective, open-label, multicenter study including 50 PD patients undergoing bilateral STN-DBS, we collected NMSScale (NMSS), NMSQuestionnaire (NMSQ), Hospital Anxiety and Depression Scale (anxiety/depression, HADS-A/-D), PDQuestionnaire-8 (PDQ-8), Scales for Outcomes in PD-motor examination, motor complications, activities of daily living (ADL), and levodopa equivalent daily dose (LEDD) preoperatively and at 6 months follow-up. Changes were analyzed with Wilcoxon signed-rank/ t -test and Bonferroni-correction for multiple comparisons. Although the STN was targeted visually, we employed an atlas-based approach to explore the relationship between active contact locations and DBS outcomes. Based on fused MRI/CT-images, we identified Cartesian coordinates of active contacts with patient-specific Mai-atlas standardization. We computed linear mixed-effects models with x-/y-/z-coordinates as independent, hemispheres as within-subject, and test change scores as dependent variables. Results NMSS, NMSQ, PDQ-8, motor examination, complications, and LEDD significantly improved at follow-up. Linear mixed-effect models showed that NMS and QoL improvement significantly depended on more medial (HADS-D, NMSS), anterior (HADS-D, NMSQ, PDQ-8), and ventral (HADS-A/-D, NMSS, PDQ-8) neurostimulation. ADL improved more in posterior, LEDD in lateral neurostimulation locations. No relationship was observed for motor examination and complications scores. Conclusions Our study provides evidence that more anterior, medial, and ventral STN-DBS is significantly related to more beneficial non-motor outcomes. [ABSTRACT FROM AUTHOR]

Background Subthalamic nucleus (STN) deep brain stimulation (DBS) improves quality of life (QoL), motor, and non-motor symptoms (NMS) in advanced Parkinson's disease (PD). However, considerable inter-individual variability has been observed for QoL outcome. Hypothesis We hypothesized that demographic and preoperative NMS characteristics can predict postoperative QoL outcome. Methods In this ongoing, prospective, multicenter study (Cologne, Manchester, London) including 88 patients, we collected the following scales preoperatively and on follow-up 6 months postoperatively: PDQuestionnaire-8 (PDQ-8), NMSScale (NMSS), NMSQuestionnaire (NMSQ), Scales for Outcomes in PD (SCOPA)-motor examination, -complications, and –activities of daily living, levodopa equivalent daily dose. We dichotomized patients into “QoL responders”/“non-responders” and screened for factors associated with QoL improvement with (1) Spearman-correlations between baseline test scores and QoL improvement, (2) step-wise linear regressions with baseline test scores as independent and QoL improvement as dependent variables, (3) logistic regressions using aforementioned “responders/non-responders” as dependent variable. Results All outcomes improved significantly on follow-up. However, approximately 44% of patients were categorized as “QoL non-responders”. Spearman-correlations, linear and logistic regression analyses were significant for NMSS and NMSQ but not for SCOPA-motor examination. Post-hoc, we identified specific NMS (flat moods, difficulties experiencing pleasure, pain, bladder voiding) as significant contributors to QoL outcome. Conclusions Our results provide evidence that QoL improvement after STN-DBS depends on preoperative NMS characteristics. These findings are important in the advising and selection of individuals for DBS therapy. Future studies investigating motor and non-motor PD clusters may enable stratifying QoL outcomes and help predict patients' individual prospects of benefiting from DBS. [ABSTRACT FROM AUTHOR]

Parkinson's disease is a complex neurodegenerative disorder characterized by motor and non-motor symptoms, with neuropsychiatric manifestations among the most frequent non-motor symptoms. Health-related quality of life is a patient-reported outcome that reflects the impact of the disease on physical, mental, and social wellbeing, and on other aspects of patient’ life. Although older studies on health-related quality of life in Parkinson's disease mainly investigated the role of the motor impairment, recent research focused on non-motor symptoms has highlighted the critical role that behavioural disturbances due to neuropsychiatric symptoms play in determining health related quality of life. A considerable number of studies have demonstrated the importance of depression as a determinant of health-related quality of life in this population, but less evidence is available regarding the role of other neuropsychiatric symptoms such as anxiety, apathy, psychosis, and impulse control disorders. This narrative review analyses recent literature on this topic, focusing on studies in which neuropsychiatric symptoms were investigated as potential determinants of quality of life using regression techniques, including discussion of the assessment tools used. [ABSTRACT FROM AUTHOR]

Parkinson's disease is a complex neurodegenerative disorder characterized by motor and non-motor symptoms, with neuropsychiatric manifestations among the most frequent non-motor symptoms. Health-related quality of life is a patient-reported outcome that reflects the impact of the disease on physical, mental, and social wellbeing, and on other aspects of patient’ life. Although older studies on health-related quality of life in Parkinson's disease mainly investigated the role of the motor impairment, recent research focused on non-motor symptoms has highlighted the critical role that behavioural disturbances due to neuropsychiatric symptoms play in determining health related quality of life. A considerable number of studies have demonstrated the importance of depression as a determinant of health-related quality of life in this population, but less evidence is available regarding the role of other neuropsychiatric symptoms such as anxiety, apathy, psychosis, and impulse control disorders. This narrative review analyses recent literature on this topic, focusing on studies in which neuropsychiatric symptoms were investigated as potential determinants of quality of life using regression techniques, including discussion of the assessment tools used. [ABSTRACT FROM AUTHOR]

Background Parkinson's disease (PD) is one of the factors which are associated with a higher risk of mortality during heat waves. The use of certain neuroleptic medications to control some of this disease's complications would appear to be related to an increase in heat-related mortality. Objective To analyse the relationship and quantify the short-term effect of high temperatures during heat wave episodes in Madrid on daily mortality and PD-related hospital admissions. Methods We used an ecological time-series study and fit Poisson regression models. We analysed the daily number of deaths due to PD and the number of daily PD-related emergency hospital admissions in the city of Madrid, using maximum daily temperature (°C) as the main environmental variable and chemical air pollution as covariates. We controlled for trend, seasonalities, and the autoregressive nature of the series. Results There was a maximum daily temperature of 30 °C at which PD-related admissions were at a minimum. Similarly, a temperature of 34 °C coincides with an increase in the number of admissions. For PD-related admissions, the Relative Risk (RR) for every increase of 1 °C above the threshold temperature was 1.13 IC95%:(1.03–1.23) at lags 1 and 5; and for daily PD-related mortality, the RR was 1.14 IC95%:(1.01–1.28) at lag 3. Conclusion Our results indicate that suffering from PD is a risk factor that contributes to the excess morbidity and mortality associated with high temperatures, and is relevant from the standpoint of public health prevention plans. [ABSTRACT FROM AUTHOR]

Background STN-DBS is well established to improve motor symptoms and quality of life in patients with PD. While non-motor symptoms are crucial for quality of life in these patients, only neuropsychiatric and neuropsychological symptoms have been systematically studied in a longitudinal design so far. However, these are only a part of the non-motor symptoms spectrum. Hypothesis We hypothesized that STN-DBS is associated with a beneficial effect on a range of non-motor symptoms. Methods In this multicenter, open, prospective, international study (EuroInf-study, UKCRN10084/DRKS00006735) we investigated non-motor effects of STN-DBS in “real-life” use. We evaluated Non-motor Symptom Scale, and Questionnaire, PD Questionnaire-8, Scales for Outcomes of PD motor examination and complications, and activities of daily living preoperatively and at 6 months follow-up in 60 consecutive patients (35 male, mean age: 61.6 ± 7.8 years, mean disease duration: 10.4 ± 4.2 years). Results All outcomes improved significantly at 6 months follow-up (PD Questionaire-8, p = 0.006; activities of daily living, p = 0.012; all others, p < 0.001; Wilcoxon signed-rank, respectively paired t-test; Bonferroni-correction). Post-hoc analyses of Non-motor Symptom Scale domains showed a significant reduction of sleep/fatigue and miscellaneous domains (p ≤ 0.001), perceptual problems/hallucinations (p = 0.036), and urinary (p = 0.018) scores. Effect sizes were “moderate” for Non-motor Symptom Scale, and motor complications, “large” for motor examination, and “small” for other outcomes. Conclusions This study provides evidence that bilateral STN-DBS improves non-motor burden in patients with PD and opens the door to a more balanced evaluation of DBS outcomes. Further randomized studies are needed to confirm these findings and compare DBS non-motor effects to other invasive therapies of advanced PD. [ABSTRACT FROM AUTHOR]

Introduction In Parkinson's disease (PD), neuropsychiatric symptoms (NPS) can be particularly burdensome for caregivers. The main goal of this study was to assess the impact of NPS, assessed by means of a new specific scale, on caregiver burden. Methods A sample of 584 pairs of PD patients and their primary caregivers was studied. Patients' NPS were measured with the Scale for Evaluation of Neuropsychiatric Disorders in PD (SEND-PD), and the Zarit Caregiver Burden Inventory was used to quantify caregiver burden. Three linear regression models were built to check factors associated with caregiver burden, one for the total sample and two for subgroups stratified by the presence of dementia. Results The most frequent NPS were depression (in 66% of the sample), anxiety (65%) and mental fatigue (57%). Patients with dementia (n = 94; 16% of sample) consistently presented more NPS than patients without dementia (p < 0.001). On linear regression models, the main determinants of caregiver burden (for the total sample and the sample of patients without dementia) were SEND-PD dimensions mood/apathy and psychosis, PD-related disability and disease duration. For patients with dementia, the only significant caregiver burden determinants were SEND-PD psychosis and mood/apathy subscale scores. Conclusions NPS in PD are highly associated with and are determinants of caregiver burden, and are more prevalent and burdensome in patients with dementia. Detailed assessment and specific interventions aimed at NPS could alleviate caregiver burden. [ABSTRACT FROM AUTHOR]

Introduction Evidence is emerging that nonmotor symptoms (NMS) such as neuropsychiatric, sensory and sleep disturbances play an important role in dystonia. Methods In this observation, 102 patients with cervical dystonia (CD) were included. We evaluated the complaints about NMS with an adapted NMS Questionnaire and motor severity measured with Unified Dystonia Rating Scale. Results 95% of CD patients experienced NMS with 36% presenting with at least seven NMS. Mean UDRS score was 5.09 points (standard deviation (SD) ± 2.64 points, range 0.5–14.0). 42% patients had additional head tremor. The total number of experienced NMS was not significantly correlated with the age of the patients and disease duration of dystonia. There was also no significant association between number of NMS and sex. The correlation between number of NMS and motor severity assessed with UDRS was weak ( r S = 0.23; p = 0.02). Conclusion The number of NMS as a whole has been shown to be a key determinant of health related quality of live in patients with Parkinson's disease and we would assume that can influence this construct in patients with dystonia, too. As 95% of our patients with focal CD present with NMS, especially loss of self-confidence, insomnia, fatigue and pain, higher awareness for NMS needs to be raised in the context of routine clinical consultations in patients with focal dystonia. [ABSTRACT FROM AUTHOR]

The article discusses research examining the syndromal pattern of the anxiety spectrum in patients with Parkinson disease (PD). The severity of anxiety, depression, cognition, and parkinsonism were assessed and structured psychiatric interview were conducted. The authors found that PD patients showed different syndromic profiles of anxiety that did not correspond to the "Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition's (DSM-IV's)" classification of anxiety disorders.

Scientific study of genetic contributions to chronic antisocial behavior has stemmed from many lines of research in recent years. Genetic research involving twin, family, and adoption studies has traditionally been used to compare the health and behavior outcomes of individuals who share the same environment or hereditary lineage; several of these studies have concluded that heredity plays some role in the formation of chronic antisocial behavior, including various forms of aggression and chronic norm-defiance. However, the ethical, social, and legal environment surrounding research on the biological contributions to antisocial behavior in the United States is contentious. Although there has been some discussion in the last few decades regarding the ethical, social, and legal concerns around this type of research within academic and policy circles, analysis and discussion of these concerns rarely appear together. This paper explores the main themes that interact to form the basis of much of the resistance to positing biological contributions to antisocial behavior. [Copyright &y& Elsevier]

Abstract: Kelvin probe force microscopy images show that the surface potential of graphite changes with time as the contamination covers its surface. Using mass spectrometry we identify the molecular mass of the contaminants to be compatible with that of tetracene, a polycyclic aromatic hydrocarbon (PAH), and its isomers. A combination of desorption and Kelvin probe force microscopy experiments plus theoretical calculations confirms that these molecules are the main contaminant for graphitic surfaces in air ambient conditions. Interestingly, when the sample temperature is increased above ∼50°C the molecules are desorbed and the surface potential becomes fairly homogeneous, suggesting that graphitic surfaces should be almost atomically clean above this temperature. PAHs are potent atmospheric pollutants, potentially carcinogenic, that consist of fused aromatic rings. Incomplete combustion of organic materials can increase the concentration of PAHs in the atmosphere, which in urban regions is enough to totally cover the surface of graphite in a time period that varies from minutes to a few hours. One of the consequences of the adsorption of molecules on graphene is the doping of its surface and the variation of the charge neutrality point originated by the charge transfer between graphene and the contamination layer. [Copyright &y& Elsevier]

Abstract: Background: Non-motor symptoms of Parkinson's disease (PD) represent major causes of morbidity. RECOVER, a randomized controlled trial of rotigotine transdermal system, was the first prospective controlled trial to use the Non-Motor Symptoms Scale (NMSS) as an exploratory outcome for assessment of treatment effects on non-motor symptoms in PD. Rotigotine improved NMSS total score compared with placebo, and the “Sleep/fatigue” and “Mood/apathy” domains. This post hoc analysis further characterizes the effects of rotigotine on sleep/fatigue and mood/apathy. Methods: Patients with PD and unsatisfactory early-morning motor impairment were randomized to transdermal patches of rotigotine (2–16 mg/24 h) or placebo. Treatment was titrated to optimal dose over 1–8 weeks, maintained for 4 weeks. The NMSS was assessed at baseline and end of treatment. Post hoc analyses are presented for individual items of the “Sleep/fatigue” and “Mood/apathy” domains. The interpretation of p-values is considered exploratory in nature. Results: Of 287 patients randomized, NMSS data were available for 267 patients (178 rotigotine, 89 placebo). Within the “Sleep/fatigue” domain there was a significant difference, in favor of rotigotine, in change from baseline score in 1 of 5 items: “fatigue (tiredness) or lack of energy” (ANCOVA, p < 0.0001). Within the “Mood/apathy” domain, there were significant differences in favor of rotigotine in 4 of 7 items: “lost interest in surroundings” (p < 0.0001), “lost interest in doing things” (p < 0.0001), “seems sad or depressed” (p < 0.01), and “difficulty experiencing pleasure” (p < 0.05). Conclusions: Rotigotine transdermal system may improve non-motor symptoms such as fatigue, symptoms of depression, anhedonia, and apathy in patients with PD; further prospective controlled studies are required to confirm this post hoc analysis. [Copyright &y& Elsevier]

Abstract: Background: Twenty-four-hour treatment options are increasingly used in Parkinson's disease (PD) as part of continuous drug delivery strategy to aid concordance and reduce motor complications. However, 24h apomorphine therapy in advanced PD is beneficial but often not attempted because of nodule formation and tolerability issues as well as cost implications. Objective: To extend the beneficial effect of 12–14h waking day apomorphine infusion to 24h therapy by combining with Rotigotine transdermal patch therapy and assess motor and non-motor effects over a follow up period of 2 years. Methods: 15 PD patients (mean age 60.3±11.3 years; disease duration 15.3±4.8 years) on 14h apomorphine infusion were additionally treated with transdermal Rotigotine patch (mean dose 9.3±4.3mg) used overnight and continue to use this at 2 years follow up. Motor (Unified Parkinson's Disease Rating Scale part 3), non-motor (NMSS), sleep (sleep domain of NMSS) and quality of life (PDQ-8) measures were assessed as part of routine clinical practice. Results: There was a significant improvement in all outcome measures at 2 years with good tolerability. In particular significant improvements were noted and sustained at 2 years in relation to sleep/fatigue and mood/apathy domains of NMSS. Conclusions: Combining apomorphine infusion with Rotigotine patch appears to be a useful of way of extending the beneficial effects of infusion with good tolerability and improved aspects of sleep and mood sustained at 2 years in advanced PD. Larger randomized study would be of use. [Copyright &y& Elsevier]

Abstract: Objective: Anxiety is a common non-motor symptom in Parkinson's disease (PD). This study analyzed the measurement properties of three frequently used anxiety scales in PD: the Beck Anxiety Inventory (BAI), the Hamilton Anxiety Rating Scale (HARS), and the Hospital Anxiety and Depression Scale—Anxiety subscale (HADS-A). Method: The Rasch model was applied to a multicenter international cohort of 342 patients and assessed the following aspects: fit to the Rasch model, unidimensionality, reliability, response category ordering, item local independence, differential item functioning, and scale targeting. Results: In their original form, the BAI, HARS, and HADS-A, did not fit the Rasch model. A good fit to the Rasch model was only found after significant modifications, including rescoring some items and deleting those failing to fit the model. For the BAI and HADS-A, these adjustments resulted in unidimensionality. The HARS was not unidimensional and separate analyses were performed for its psychic and somatic subscales. Whereas the somatic anxiety subscale fit the Rasch model, this was achieved for the psychic anxiety subscale after modifications. Conclusion: None of the currently used anxiety scales display satisfactory measurement properties for assessing anxiety in PD. The results suggest the need to develop a new disease-specific scale for measuring anxiety in PD. [Copyright &y& Elsevier]

Abstract: Objective: Independent validation of the Non motor Symptoms Scale in Parkinson''s disease (NMSS) based on a cross-culturally adapted Brazilian version. Methods: Parkinson''s disease (PD) patients were evaluated by means of the Scales for Outcomes in Parkinson''s disease-Motor (SCOPA-M), Autonomic, Cognition, and Psychosis; Hoehn and Yahr staging (H&Y); Berg Balance Scale; PD Sleep Scale; Clinical Impression of Severity Index for PD (CISI-PD); PDQ-39; and EQ-5D. The following clinimetric attributes were explored for the NMSS: acceptability, scaling assumptions, reliability, construct validity, and precision. Results: 150 patients were assessed (mean age 63.1 years; 56.7% males; mean duration of illness 8.7 years; HY median: 2). Mean NMSS was 48.9 (SD 36.3; median 42; skewness 1.3). Neither floor nor ceiling effect was observed on the NMSS total score. For domains, the Cronbach''s alpha coefficient ranged from 0.40 to 0.82. The NMSS total score correlated significantly with SCOPA-AUT (r S  = 0.65) and with those scales measuring related constructs (r S  = 0.46–0.57). NMSS significantly increased as the H&Y stage increased (Kruskal–Wallis, p < 0.0001). These values were quite close to those from the original validation studies. Conclusions: The NMSS is a reliable and valid measure to evaluate non motor symptoms in Brazilian PD patients. [Copyright &y& Elsevier]