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Background and purpose: The clinical differentiation between parkinsonism in idiopathic normal pressure hydrocephalus (iNPH) and Parkinson's disease (PD) remains challenging in the initial phase. Whether an early cognitive profiling might support the differential diagnosis of early iNPH and PD was addressed. Methods: Neuropsychological tests of 40 iNPH subjects with early symptoms resembling parkinsonism were retrospectively evaluated together with 47 de novoPD patients (dnPD). Only neuropsychological tests performed within 1 year from the first motor symptom were included. The cognitive spectrum of iNPH and dnPD was also compared with a sample of 70 normal controls. Results: A clear difference in the cognitive profile of iNPH, dnPD patients and normal controls was shown. 65% of iNPH subjects showed a diffuse cognitive impairment, including memory, visuospatial abilities, fronto‐executive functioning and attention, whereas only 25.5% of the dnPD patients presented an executive dysfunction. 35% of iNPH and 74.5% of PD patients performed within the normal range (P < 0.05). Conclusion: Subjects with iNPH showed an early and diffuse alteration of cognition with respect to dnPD patients. Performing a prompt and accurate neuropsychological evaluation might support the differential diagnosis of these two conditions of parkinsonism. [ABSTRACT FROM AUTHOR]

Background: Modern management of Parkinson's disease (PD) aims to obtain symptom control, to reduce clinical disability, and to improve quality of life. Music acts as a specific stimulus to obtain motor and emotional responses by combining movement and stimulation of different sensory pathways. We explored the efficacy of active music therapy (MT) on motor and emotional functions in patients with PD.Methods: This prospective, randomized, controlled, single-blinded study lasted 3 months. It consisted of weekly sessions of MT and physical therapy (PT). Thirty-two patients with PD, all stable responders to levodopa and in Hoehn and Yahr stage 2 or 3, were randomly assigned to two groups of 16 patients each. We assessed severity of PD with the Unified Parkinson's Disease Rating Scale, emotional functions with the Happiness Measure, and quality of life using the Parkinson's Disease Quality of Life Questionnaire. MT sessions consisted of choral singing, voice exercise, rhythmic and free body movements, and active music involving collective invention. PT sessions included a series of passive stretching exercises, specific motor tasks, and strategies to improve balance and gait.Results: MT had a significant overall effect on bradykinesia as measured by the Unified Parkinson's Disease Rating Scale (p < .034). Post-MT session findings were consistent with motor improvement, especially in bradykinesia items (p < .0001). Over time, changes on the Happiness Measure confirmed a beneficial effect of MT on emotional functions (p < .0001). Improvements in activities of daily living and in quality of life were also documented in the MT group (p < .0001). PT improved rigidity (p < .0001).Conclusions: MT is effective on motor, affective, and behavioral functions. We propose active MT as a new method for inclusion in PD rehabilitation programs. [ABSTRACT FROM AUTHOR]

Background: A significant percentage of patients with Parkinson’s disease (PD) continue to experience motor fluctuations and dyskinesias despite the association of dopamine agonists and levodopa with COMT or MAO-B inhibitors. The use of apomorphine infusion is limited by compliance while deep brain stimulation is feasible only for a small number of patients mostly because of age constraints. Objective: To assess prospectively the effectiveness of duodenal levodopa infusion on quality of life as well as motor features in patients with advanced PD. In all but 1 case levodopa infusion was stopped at nighttime. Methods: We report the outcome of 22 PD patients, followed for up to 2 years, who were on continuous duodenal levodopa/carbidopa infusion through percutaneous endoscopic gastrostomy. Results: We found a significant reduction in ‘off’ period duration as well as dyskinesia severity (Unified Parkinson’s Disease Rating Scale part IV, items 33 and 39). There was significant improvement in the 39-item Parkinson’s Disease Quality of Life Questionnaire as well as in the Unified Parkinson’s Disease Rating Scale part II up to the 2-year follow-up. Five patients withdrew: 2 for poor compliance and 3 for adverse events (1 was related to percutaneous endoscopic gastrostomy). Conclusions: These results demonstrate significant clinical improvements in quality of life and activities of daily living consistent with the occurrence of a satisfactory therapeutic response and a reduction in dyskinesia severity. Copyright © 2008 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Deep Brain Stimulation (DBS) is the surgical procedure of choice in advanced patients with Parkinson’s disease (PD) complicated by motor fluctuations. The subthalamic nucleus (STN) and the globus pallidus internal (GPi) are the two most common targets used to treat PD. Anyway the most source of information about the efficacy of this procedure came from STN DBS. Only recently the comparison between GPi and STN DBS in advanced PD had shown in 24months follow-up study similar improvement in motor score; GPi DBS also improved depression while in STN patients it worsened, finally the reduction of dopaminergic therapy was higher in STN DBS patients [1]. Experiences of simultaneous stimulation of both STN and GPi are inconclusive and limited in literature [2,3]. The long term follow-up at 4, 8 and recently at 9years after STN DBS shows that while the improvement of levodopa induced motor complications are maintained, freezing, postural instability, falling, speech difficulties and cognitive impairment emerge as the major source of disability [4–6]. Nevertheless the information emerging from latter studies, some patients manifest a motor disease progression need increasing dopaminergic doses after many years of STN DBS. In some of these cases continuous infusion of Duodopa is reported as possible therapeutic strategy [7]. We describe three patients (Table) with severe functional impairment after 8year with STN DBS in whom GPi implant has been done as “rescue therapy”. [Copyright &y& Elsevier]

Two patients with recurrent painful ophthalmoplegia due to granulomatous involvement of the intracavernous sinus (Tolosa-Hunt syndrome) had circulating anti-neutrophil cytoplasmic antibodies with a granular cytoplasmic immunofluorescence pattern during a flare-up of the disease. The presence of these antibodies suggests that Tolosa-Hunt syndrome might be regarded as a localized form of Wegener's granulomatosis. [ABSTRACT FROM PUBLISHER]

Mild Cognitive Impairment (MCI), is an intermediate stage between normal cognitive function and dementia, is common in Parkinson disease (PD) and its presence might be a risk factor for progression to dementia. The prevalence and profiles of PD-MCI are variable. The aim of this study is to evaluate the relationship between types of PD-MCI and clinical variables of disease in PD patients. Methods: We enrolled 300 PD patients consecutively referring to the surgery of Parkinson’s disease and movement disorders of IRCCS “National Institute of Neurology C. Mondino” Foundation of Pavia, Italy from March 2009 to December 2010 and underwent neuropsychological assessment. Of these 100 are PD without cognitive impairment, 145 PD-MCI and 55 PD whit dementia. Patients without cognitive impairment and patients with dementia are excluded. PD-MCI are included. Subjects were classified as having MCI if their age and education corrected z score on one or more cognitive domains was at least 1.5 standard deviations below the mean of normative data. Results: In our population the most frequent is MCI non amnesic single domain (naMCI-SD): with logical-executive deficit (43% ), and with visuo-spatial deficit (25 %). The second most frequent MCI is non amnesic multiple domain (naMCI-MD19%). The MCI amnesic single domain (aMCI-SD) in 6% and multiple domain (aMCI-MD) in 7% of patients. The five groups are the same age, education, age of onset and disease severity (UPDRS and HY). The significant differences are a longer disease’s duration in aMCI-MD respect to naMCI-SD, meaning the parallelism between motor and cognitive worsening. Besides in this group hallucinations, anamnestic RBD and confusional episodes are most frequent. Conclusions: Our study naMCI-SD is most frequent (LE>VSP) while memory impairment may emerge later. The aMCI-MD in fact, is most frequent associated whit hallucinations, RBD, confusional episodes; could be a prelude to dementia. [Copyright &y& Elsevier]