Fabrizio Stocchi’s research while affiliated with Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Pisana and other places

Here, we investigated whether educational attainment influences the neurophysiological mechanisms underlying vigilance regulation, as reflected in resting-state eyes-closed electroencephalographic (rsEEG) rhythms, in patients with dementia due to Parkinson’s (PDD) and Lewy body disease (DLB). Clinical, demographic, and rsEEG data were obtained from an international database, including PDD patients ( N = 75), DLB patients ( N = 50), and cognitively unimpaired older controls (Healthy; N = 54). Each group was partitioned into low (Edu-) and high (Edu+) educational attainment subgroups, matched for age, sex, and cognitive-motor status. We analyzed rsEEG rhythms across the individual delta, theta, and alpha frequency bands. Cortical rsEEG source topography was estimated using eLORETA freeware. In the Healthy group, Edu+ participants exhibited significantly greater widespread rsEEG alpha source activities compared to Edu- participants, possibly reflecting neuroprotective neurophysiological mechanisms. Conversely, in the PDD group, Edu+ patients showed lower widespread rsEEG alpha source activities than Edu- patients, possibly indicating compensatory mechanisms. No significant differences in rsEEG source activities were observed between DLB-Edu+ and DLB-Edu- patients. Educational attainment may be associated with compensatory mechanisms that counteract the abnormal neurophysiological processes underlying rsEEG alpha rhythms and vigilance regulation in PDD patients, but not in DLB patients. Future studies combining rsEEG and neuroimaging techniques should investigate the metabolic and functional connectivity correlates of these putative compensatory mechanisms in the PDD brain. Early education may be a key investment for national governments, especially in low-income countries, to prevent the cognitive deficits of Parkinson’s disease along aging, thereby reducing the unbearable social and economic burden.

Background Evidence suggests that female gender represents a risk factor for the development of motor/nonmotor fluctuations and dyskinesia in Parkinson's disease (PD). So far, no prospective study has analyzed this aspect in relation to the introduction of levodopa treatment. Objective This prospective multicenter study aims to assess the development of motor/nonmotor fluctuations and dyskinesia based on gender over a 2‐year observation period in PD patients starting levodopa. Methods Two hundred and eighty‐nine PD patients requiring levodopa at baseline were enrolled at 17 Movement Disorders Centers and followed for 2 years. Gender differences in the development of fluctuations, defined as a score ≥2 in the 19‐item Wearing‐Off Questionnaire, and dyskinesia, defined by Movement Disorders Society Unified Parkinson's Disease Rating Scale Part IV (MDS‐UPDRS‐IV) score >0 on item 4.1 were assessed. Baseline predictors of such complications were evaluated by stepwise multivariate logistic regression analysis. Results Two hundred and sixteen patients (139 men, 77 women) completed the follow‐up (M24). By M24, 53,2% of men and 64.9% of women had fluctuations (P = 0.048), whereas 5% of men and 14.3% of women developed dyskinesia (P = 0.0185). Multivariate analysis showed that female gender significantly predicted wearing‐off (Odds ratio [OR] = 1.930; P = 0.0333), whereas older age was a significant protective factor (for 5‐year increase: OR = 0.712; P < 0.0001). Multivariate analysis showed that gender (OR = 3.405; P = 0.0228) and MDS‐UPDRS Part III score (for a 5‐unit increase: OR = 1.281; P = 0.0239) were significant predictors of dyskinesia at M24. Conclusions Female gender was the strongest predictor of fluctuations and dyskinesia after 2‐year intake of levodopa. This finding could have important implications for the development of gender‐oriented therapeutic recommendations in early PD.

Background Abnormal posture occurs in about 30% of Parkinson's disease (PD) patients. The neuromuscular taping (NMT) is a new treatment that induces micromovements that stimulate skin receptors. Application of NMT with a decompression and eccentric technique expands the interstitial spaces and therefore improves circulation and absorption of liquids by reducing the pressure under the skin favoring the muscular relaxation. Objectives We conducted a 4‐week, randomized, observer‐blind, trial of NMT on pharmacologically treated PD patients with postural abnormality according to the item 3.13 of Movement Disorder Society‐Unified Parkinson's Disease Rating Scale (MDS‐UPDRS). Methods The primary endpoint of the study was the change in kinetic evaluation using movement analysis technique. Main secondary endpoint was change in scale UPDRS part III score from baseline to week 4, comparing NMT+Pharmacological therapy (NMT+PT) or only Pharmacological therapy (PT). 46 PD patients were enrolled and randomly assigned to two groups. Both groups remained on stable pharmacological treatment throughout the entire duration of the study. The NMT‐PT group received 8 sessions of specific decompression with neuromuscular taping. Results At the end of the study, the kinematic data showed statistically significant change in α1 (the parameter related to the sagittal trunk inclination), close to 12% of improvement in the NMT‐PT group. Conclusions Results showed a significant improvement in some kinematic parameters along with an improvement in motor and nonmotor symptoms in NMT + PT group compared to PT. NMT can represent a valid therapeutic option in combination with neurorehabilitation to treat abnormal posture in PD patients.

Objectives: Evaluate the efficacy of istradefylline in people with Parkinson's disease with motor fluctuations, with and without dyskinesia, and characterize potential predictors for treatment-emergent dyskinesia with istradefylline. Methods: Pooled analysis of 8 phase 2b/3 trials of istradefylline (20 or 40mg/day) versus placebo. Results: Data from 2719 patients, including 56% with baseline dyskinesia, were analyzed post-hoc. The presence of baseline dyskinesia did not affect mean reductions in OFF-time, increases in ON-time without troublesome dyskinesia, or improvements in Unified Parkinson's Disease Rating Scale motor scores associated with istradefylline treatment. Dyskinesia was reported by 17% of istradefylline-treated patients, with higher rates for women (21%), patients with BMI <18.5 kg/m2 (22%), and patients treated with COMT inhibitors plus dopamine agonists (22%) and MAO-B inhibitors (25%). Conclusion: Istradefylline treatment resulted in greater reductions in total OFF hours/day and increases in ON-time without troublesome dyskinesia versus placebo regardless of the presence or absence of pre-existing dyskinesia.

Background Pharmacological, surgical and physical therapies ameliorate motor and non-motor symptoms in Parkinson’s disease (PD). Unfortunately, the progression of the disease induces deterioration in daily activities, especially in gait and balance. Invasive and non invasive medical devices have been developed to alleviate drug-resistant symptoms in patients with advanced PD, and automated mechanical peripheral stimulation (AMPS) has been proposed as a new rehabilitative approach. Methods This multicentre, double-blind, crossover randomized controlled trial included 83 participants with PD assigned to two groups: AMPS treatment (Gondola® group, n = 40) and placebo treatment (SHAM group, n = 43). The intervention consisted of 6 sessions of stimulation over 3 weeks (AMPS or SHAM), interspersed with a wash-out period of 6 weeks, before switching groups. The aim of this study was to evaluate the effects of AMPS treatment on gait speed and gait-related disorders in subjects with PD. Results The Gondola® device resulted in a moderate clinical impact on gait speed in people with PD since the improvement in walking speed exceeded the cut-off of 0.14 m/s in both treatments. The improvement in walking velocity was accompanied by a significantly longer stride length and a prominent increase in % stride length without altering gait cadence in the Gondola® group compared with the SHAM group. Conclusions AMPS stimulation improved gait speed in people with PD. Trial registration ClinicalTrials.gov identifier: NCT03843268. Date of registration: 12 Feb 2019, retrospectively registered.