Functional Movement Disorders during COVID-19: Psychological Distress, Affective Temperament and Emotional Dysregulation.

Background and objective: Functional movement disorders (FMD) represent a spectrum of psychosomatic symptoms particularly sensitive to stress. The COVID-19 pandemic has increased psychological distress worldwide and may have worsened FMD. The study aimed to confirm this hypothesis and to test whether in FMD there is a relationship between affective temperament, emotional dysregulation and psychological distress due to the pandemic. Methods: We recruited individuals with FMD, diagnosed them according to validated criteria and matched them with healthy controls (HC). Psychological distress and temperament were obtained using the Kessler-10 and the Temperament Evaluation of Memphis, Pisa and San Diego Autoquestionnaire, respectively. We used bootstrapped mediation analysis to test the mediator role of emotional dysregulation on the effect of temperament on psychological distress. Results: The sample consisted of 96 individuals. During the pandemic, 31.3% of the patients reported the need for urgent neurological care, and 40.6% reported a subjective worsening neurological condition. Patients with FMD presented with more psychological distress during the COVID-19 pandemic (F = 30.15, df = 1, p ≤ 0.001) than HC. They also reported more emotional dysregulation (F = 15.80, df = 1, p ≤ 0.001) and more cyclothymic traits (F = 14.84, df = 1, p ≤ 0.001). Cyclothymic temperament showed an indirect effect on COVID-19-related psychological distress, mediated by deficits in emotion regulation mechanisms (Bootstrapped LLCI = 0.41, ULCI = 2.41). Conclusion: Our results suggest that emotional dysregulation may represent a dimension mediating cyclotimic temperament response to the stressful effect of the pandemic and provide insight for developing intervention policies.

Role of Sport Activity on Quality of Life in Charcot-Marie-Tooth 1A Patients.

The present study aims to investigate the benefits induced by physical activity/practiced sport in Charcot-Marie-Tooth 1A (CMT1A). Patients were divided into sport and no-sport groups according to their sports performance habit. Thirty-one patients were enrolled, of which 14 practiced sports and 17 did not. Clinical assessments were administered to evaluate disability, self-esteem, depression, quality of life, and pain. Statistical analysis revealed significant differences in terms of gender in the no-sport group compared to the sport group (p = 0.04). Regarding the quality of life, physical function (p = 0.001), general health (p = 0.03), social function (p = 0.04), and mental health (p = 0.006) showed better patterns in the sport group than no-sport group. Moreover, neuropathic pain was reduced in the sport group according to the Neuropathic Pain Symptom Inventory (p = 0.001) and ID-PAIN (p = 0.03). The other administered questionnaires showed no significant differences. Our study confirms that CMT1A patients, who practice sports, with a similar severity of disability, may have a better physical quality of life while suffering less neuropathic pain than their peers who do not practice sports. Results recommend the prescription of sport in CMT1A patients.

Subjective Response Measurement to Prosthesis or Device Use: Validation of the Prosthetic-Bionic Paradigm Questionnaire (PBP-Q).

Many subjects with somatic pathologies or traumas in their recent anamnesis tend to experience symptoms and changes to their daily life parameters after technically successful treatment. Hence, this study aims to validate an investigation tool inspired by the prosthetic-bionic paradigm-namely, the PBP-Q-which allows for the evaluation of variation in questions relating to identity, psychosociality, and psychopathology in relation to the use of a prosthesis or device. We gathered 118 participants (68 females and 50 males) aged between 27 and 94 years (Mean = 58.42 ± 15.17). We performed both exploratory (EFA) and confirmatory (CFA) factor analyses on this sample. Moreover, we calculated the internal consistency for the PBP-Q scales and the total score for the questionnaire's final 26-item and 5-factor versions. The five scales are psychological well-being; interpersonal relationships; professional relationships; autonomy and safety; addictions, compulsions, and obsessions. The internal consistency is good for both the total score and the subscales. In conclusion, overall, the PBP-Q has satisfactory psychometric properties, especially considering the measure's complexity. It provides a quick and effective way to evaluate the changes that might arise after the use of a prosthesis or device and, subsequently, has implications for clinical practice.

Parkinson's disease and virtual reality rehabilitation: cognitive reserve influences the walking and balance outcome.

INTRODUCTION: Parkinson's disease (PD) is a neurodegenerative pathology characterized by motor and non-motor symptoms that often lead to several impairments. Many studies show the efficacy of different rehabilitation protocols aimed to improve balance and gait functions in PD patients. However, multiple factors may influence rehabilitation outcome. Recently, it has been observed as the cognitive reserve (CR) may influence the rehabilitation outcome, helping to address the patient toward technological or conventional rehabilitation. Our study investigated how CR may affect motor rehabilitation outcomes in PD patients who undergo virtual reality (VR) rehabilitation, aimed at improving walking and balance. MATERIALS AND METHODS: Thirty patients affected by idiopathic PD were enrolled. Patients underwent 12 sessions VR training, over 6 weeks (45 min). Six-Minute Walk Test (6MWT) and Berg Balance Scale (BBS) were used to assess walking and balance, respectively. CR was assessed by Cognitive Reserve Index questionnaire (CRIq). RESULTS: Significant correlations between CR and change from baseline in walking and balance measures were found, with a significant positive correlation between CRIq and 6MWT (r=0.50, p=0.01) and between CRIq and BBS (r=0.41, p=0.04). DISCUSSION: Our results showed that PD patients with higher CR treated with VR improved significantly more in their balance and walking distance than those with lower CR. The current study suggests that VR when aimed to improve balance and walking in PD patients is more effective in patients with higher CR.

COVID-19 Pandemic and Psychiatric Symptoms: The Impact on Parkinson's Disease in the Elderly.

Background: The coronavirus disease 2019 (COVID-19) pandemic represents a condition of increased vulnerability and frailty for elderly patients with Parkinson's disease (PD). Social isolation may worsen the burden of the disease and specifically exacerbate psychiatric symptoms, often comorbid with PD. This study aimed at identifying risk/protective factors associated with subjective worsening of psychiatric symptomatology during the COVID-19 outbreak in a sample of individuals with PD aged 65 years or older. Methods: Patients with PD routinely followed at the outpatient clinic of Gemelli University Hospital, Rome, were assessed for subjective worsening of psychiatric symptoms through a dedicated telephone survey, after Italy COVID-19 lockdown. Patients' medical records were reviewed to collect sociodemographic and clinical data, including lifetime psychiatric symptoms and pharmacological treatment. Results: Overall, 134 individuals were assessed and 101 (75.4%) reported lifetime psychiatric symptoms. Among those, 23 (22.8%) presented with subjective worsening of psychiatric symptomatology during the COVID-19 outbreak. In this group, the most frequent symptom was depression (82.6%), followed by insomnia (52.2%). Subjective worsening of neurological symptoms (Wald = 24.03, df = 1, p = 0.001) and lifetime irritability (Wald = 6.35, df = 1, p = 0.020), together with younger age (Wald = 5.06, df = 1, p = 0.038) and female sex (Wald = 9.07 df = 1, p = 0.007), resulted as specific risk factors for ingravescence of psychiatric presentation. Lifetime pre-existing delusions, having received antipsychotics, and not having received mood stabilizer were also associated with subjective worsening of psychiatric symptomatology due to the COVID-19 pandemic. Conclusions: Individuals with PD and lifetime history of psychiatric symptoms may be exposed to increased vulnerability to the stressful effect of COVID-19 outbreak. Interventions aimed at reducing irritability and mood instability might have an indirect effect on the health of patients with PD during the COVID-19 pandemic.

Metabolic syndrome is associated with better quality of sleep in the oldest old: results from the "Mugello Study".

BACKGROUND AND AIMS: Reduced sleep quality is common in advanced age. Poor sleep quality is associated with adverse outcomes, chiefly cardiovascular, in young and middle-aged subjects, possibly because of its association with metabolic syndrome (MetS). However, the correlates of sleep quality in oldest populations are unknown. We evaluated the association of sleep quality with MetS in a cohort of subjects aged 90+. METHODS AND RESULTS: We analysed data of 343 subjects aged 90+ living in the Mugello area (Tuscany, Italy). Quality of sleep was assessed using the Pittsburgh Sleep Quality Assessment Index (PSQI). Good quality of sleep was defined by a PSQI score < 5. MetS was diagnosed according to the National Cholesterol Education Program's ATP-III criteria; 83 (24%) participants reported good quality of sleep. MetS was diagnosed in 110 (24%) participants. In linear and logistic models, MetS was inversely associated with PSQI score ((B = - 1.04; 95% CI - 2.06 to - .03; P = .044), with increased probability of good sleep quality (OR = 2.52; 95% CI 1.26-5.02; P = .009), and with a PSQI below the median (OR = 2.11; 95% CI 1.11-3.40, P = .022), after adjusting. None of the single components of MetS were associated with PSQI (all P values > .050). However, an increasing number of MetS components was associated with increasing probability of good quality of sleep (P for trend = .002), and of PSQI below the median (P for trend = .007). Generalized Additive Model analysis documented no smoothing function suggestive of nonlinear association between PSQI and MetS. CONCLUSION: Our results confirm a high prevalence of poor sleep quality in oldest age; however, in these subjects, MetS seems to be associated with better sleep quality. Additional larger, dedicated studies are required to confirm our results, and, if so, to identify the subsystems involved and the potential therapeutic implications of such an association.

Effects of COVID-19 Lockdown on Movement Disorders Patients With Deep Brain Stimulation: A Multicenter Survey.

Background: The containment measures taken by Italian government authorities during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic caused the interruption of neurological activities of outpatient clinics. Vulnerable patients, as Parkinson's disease (PD) and dystonic patients with deep brain stimulation (DBS), may have an increased risk of chronic stress related to social restriction measures and may show a potential worsening of motor and psychiatric symptoms. Methods: This cross-sectional multicenter study was carried out during the SARS-CoV-2 pandemic and was based on a structured survey administered during a telephone call. The questionnaire was designed to gather motor and/or psychiatric effects of the lockdown and coronavirus disease 2019 (COVID-19) epidemiologic information in PD and dystonic patients with a functioning DBS implant. Results: One hundred four patients were included in the study, 90 affected by PD and 14 by dystonia. Forty-nine patients reported a subjective perception of worsening of global neurological symptoms (motor and/or psychiatric) related to the containment measures. In the multivariate analysis, having problems with the DBS device was the only independent predictor of motor worsening [odds ratio (OR) = 3.10 (1.22-7.91), p = 0.018]. Independent predictors of psychiatric worsening were instrumental activities of daily living (IADL) score [OR = 0.78 (0.64-0.95), p = 0.012] and problems with DBS [OR = 5.69 (1.95-16.62), p = 0.001]. Only one patient underwent nasopharyngeal swabs, both negative, and no patient received a diagnosis of COVID-19. Conclusions: Lockdown restriction measures were associated with subjective worsening of motor and psychiatric symptoms in PD and dystonic patients treated with DBS, and they may have exacerbated the burden of neurological disease and increased the chronic stress related to the DBS management.

Mobility Disorders in Stroke, Parkinson Disease, and Multiple Sclerosis: A Multicenter Cross-Sectional Study.

OBJECTIVE: The aims of the study were to compare mobility in multiple sclerosis, Parkinson disease, and stroke, and to quantify the relationship between mobility and participation restrictions. DESIGN: This is a multicenter cross-sectional study. Included were compliant subjects with Parkinson disease, multiple sclerosis, and stroke seen for rehabilitation, with no comorbidities interfering with mobility. Functional scales were applied to each subject to investigate gait speed (10-meter walking test), balance while maintaining body position (Berg Balance Scale), dynamic balance and mobility (Timed Up and Go and Dynamic Gait Index), and participation (Community Integration Questionnaire). RESULTS: Two hundred ninety-nine patients (111 multiple sclerosis, 94 Parkinson disease, and 94 stroke) were enrolled. Stroke had the slowest gait speed (mean gait speed = 0.9 m/sec) compared with Parkinson disease (1.1 m/sec), and multiple sclerosis (1.2 m/sec) (P < 0.001). Multiple sclerosis was more limited than Parkinson disease and stroke in dynamic balance both in the Timed Up and Go Test (multiple sclerosis = 16.7 secs, Parkinson disease = 11.4 secs, stroke = 14.0 secs; P < 0.001) and Dynamic Gait Index (multiple sclerosis = 11.6 points, Parkinson disease = 12.9 points, stroke = 13.6 points; P = 0.03); ability to maintain balance and body position (Berg Balance Scale) was more affected in stroke and Parkinson disease than multiple sclerosis (multiple sclerosis = 42.6 points, Parkinson disease = 39.4 points, stroke = 39.7 points; P = 0.03). Balance disorders were associated with participation restrictions but not gait speed. CONCLUSIONS: Neurological conditions have differing impacts on gait and balance, leading to different levels of participation restriction.

Educational and Exercise Intervention to Prevent Falls and Improve Participation in Subjects With Neurological Conditions: The NEUROFALL Randomized Controlled Trial.

Background: Falls, mobility impairments and lack of social support lead to participation restrictions in people with neurological conditions. The aim of this multicenter, single blinded randomized controlled trial was to test whether an educational program focusing on fall prevention and safe mobility reduces falls and increases social participation among people with neurological conditions. Methods: Ninety people with Stroke (n = 25), multiple sclerosis (n = 33) and Parkinson disease (n = 32), median age 63 (31-89), were randomized. A permuted block algorithm stratified by field center was used to allocate participants to an education group (EG, n = 42) consisting of an educational program focused on fall prevention and tailored balance exercises and a control group (CG, n = 48) receiving usual treatments. After baseline assessment, each participants was followed for 6 months with telephone contacts by blinded interviewers. Being fallers (>1 fall) and time to become a faller were used as primary outcomes. Community Integration Questionnaire (CIQ) and Instrumental Activities of Daily Living (IADL) scales assessed treatment effects on social integration and daily living activities. Results: Over a median (Interquartile Range) follow-up of 189 (182-205) days, [EG = 188 (182-202), CG = 189 (182-209)] fallers were 10 in the CG and 11 in the EG (hazard ratio 0.95, 95% confidence interval (CI) 0.45 to 2.5; P = 0.94). At follow-up the EG scored significantly better than CG on the CIQ (+1.7 points, CI: 0.1 to 3.3) and IADL (+2.2 points, CI: 0.4 to 4.0). Conclusions: This educational program did not reduce the risk of falls but it improved the ability to carry out activities of daily living and decreased participation restrictions in people with neurological conditions.

Immediate effects of rhythmic auditory stimulation on gait kinematics in Parkinson's disease ON/OFF medication.

OBJECTIVE: Gait impairment is a highly disabling symptom for Parkinson's disease (PD) patients. Rhythmic auditory stimulation (RAS), has shown to improve spatio-temporal gait parameters in PD, but only a few studies have focused on their effects on gait kinematics, and the ideal stimulation frequency has still not been identified. METHODS: We enrolled 30 PD patients and 18 controls. Patients were evaluated under two conditions (with (ON), and without (OFF) medications) with three different RAS frequencies (90%, 100%, and 110% of the patient's preferred walking cadence). Spatial-temporal parameters, joint angles and gait phases distribution were evaluated. A novel global index (GPQI) was used to quantify the difference in gait phase distribution. RESULTS: Along with benefits in spatial-temporal parameters, GPQI improved significantly with RAS at a frequency of 110% for both ON and OFF medication conditions. In the most severe patients, the same result was observed also with RAS at 100%. CONCLUSIONS: RAS administration, at a frequency of 110% of the preferred walking frequency, can be beneficial in improving the gait pattern in PD patients. SIGNIFICANCE: When rhythmic auditory stimulation is provided to patients with PD, the selection of an adequate frequency of stimulation can optimize their effects on gait pattern.

Prevalence of Impulsive-Compulsive Symptoms in Elderly Parkinson's Disease Patients: A Case-Control Study.

BACKGROUND: Impulse-control disorders (ICDs) are frequently described in patients with Parkinson's disease (PD), particularly among those treated with dopaminergic medications, but data on the prevalence of ICDs in elderly populations are lacking. OBJECTIVE: The aim of this study was to estimate the prevalence of ICDs by using an Italian validation of the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease (QUIP) and to identify associated sociodemographic and clinical factors in a sample of elderly PD patients and in a control group of similarly aged healthy volunteers. METHODS: Using the United Kingdom Parkinson's Disease Society Brain Bank diagnostic criteria, we included 115 consecutive PD and 105 healthy controls. They were recruited from June 2014 to December 2015. All participants completed the self-administered QUIP-Anytime for assessment of ICDs occurring any time during the course of PD. RESULTS: Mean ± SD age was 75.7 ± 7.0 years in the PD patients and 76.1 ± 7.0 years in the control group. The mean disease duration was 6.8 years (range, 1-26 years). Among the PD patients, 44.7% (n = 51) had at least 1 ICD or related disorder compared to 25.2% (n = 26) in the control group (between-group difference: P = .003). Hypersexuality and compulsive shopping were significantly more common in the PD group than in the control group (P < .05). The prevalence of other compulsive behaviors was 42.5% in the PD group and 38.9% in the control group (P = NS). The Italian version of the QUIP-Anytime showed high test-retest reliability (κ > 0.70 for all items). CONCLUSIONS: Our data confirm a high prevalence of ICD symptoms in elderly PD patients, approximately twice that seen in the general population.

Measuring Gait Quality in Parkinson's Disease through Real-Time Gait Phase Recognition.

Monitoring gait quality in daily activities through wearable sensors has the potential to improve medical assessment in Parkinson's Disease (PD). In this study, four gait partitioning methods, two based on thresholds and two based on a machine learning approach, considering the four-phase model, were compared. The methods were tested on 26 PD patients, both in OFF and ON levodopa conditions, and 11 healthy subjects, during walking tasks. All subjects were equipped with inertial sensors placed on feet. Force resistive sensors were used to assess reference time sequence of gait phases. Goodness Index (G) was evaluated to assess accuracy in gait phases estimation. A novel synthetic index called Gait Phase Quality Index (GPQI) was proposed for gait quality assessment. Results revealed optimum performance (G < 0.25) for three tested methods and good performance (0.25 < G < 0.70) for one threshold method. The GPQI resulted significantly higher in PD patients than in healthy subjects, showing a moderate correlation with clinical scales score. Furthermore, in patients with severe gait impairment, GPQI was found higher in OFF than in ON state. Our results unveil the possibility of monitoring gait quality in PD through real-time gait partitioning based on wearable sensors.

Gender effect on well-being of the oldest old: a survey of nonagenarians living in Tuscany: the Mugello study.

The population of industrialized nations is progressively aging, with Italy having one of the most elderly populations in the world. Natural aging may be associated with physical and cognitive impairments, often straining public resources. The present study aims to investigate the influence of gender on wellness of the nonagenarians. We evaluated quality of life among nonagenarians living in the Mugello area, an Italian location with a large population of individuals > 90 years, using the Health Survey Scoring SF-12. The 15-item Geriatric Depression Scale and Basic and Instrumental Activity of Daily Living scales were also assessed. The Mini-Mental State Examination was used to evaluate the cognitive status. In the current survey, women outnumbered men 2.7:1 confirming their higher longevity. However, on the basis of SF-12 scores, nonagenarian women felt worse than men, both physically (mean: women = 41.8 vs men = 44.4, p = 0.004) and mentally (mean: women = 46.7 vs men =48.5, p = 0.034), and their depression rates were higher: considering a General Depression Scale score ≥ 5 as a possible depression status; 37.5% of men reported depression vs. 48.5% of women (p = 0.021). Significant differences were observed also in daily activities, both basic (median: woman = 3 vs men = 5, p < 0.001) and instrumental (median woman = 1 vs me = 3, p < 0.001). Despite prior reports showing that women perform better than men in aging, our study confirms data reported in most national and European surveys: women live longer than men, but with poorer quality of life. The current study confirms the phenomenon known as the "male-female health-survival paradox."

The impact of cognitive reserve on the effectiveness of balance rehabilitation in Parkinson's disease.

BACKGROUND: Cognitive reserve (CR) can be considered an active expression of brain resilience in response to a damage. Several studies have shown the influence of CR on cognitive impairment and its relationship with cognitive function in Parkinson's disease (PD). AIM: The aim of the present study was to show if CR influences the effectiveness of balance rehabilitation in PD patients who performed a conventional rehabilitative treatment. DESIGN: Observational longitudinal study. SETTING: Neurology Outpatient Unit, University Hospital. POPULATION: Fifty-three patients affected by idiopathic PD, stage 2-3 at the Hoehn and Yahr Scale. METHODS: Each patient underwent 32 group sessions of conventional rehabilitative treatment. At baseline, patients' CR was assessed by the Cognitive Reserve Index questionnaire (CRIq). The primary outcome was the evaluation of static and dynamic balance modifications, induced by the treatment, through the Berg Balance Scale (BBS), assessed at T0 and T1. Mini Mental State Examination, Unified Parkinson's Disease Rating Scale Part III (clinician-scored monitored motor evaluation) and Brief Intelligence Test were assessed only at T0 and used as descriptive variables. RESULTS: Considering the clinically meaningful change, BBS improved in 26% of patients, worsened in 2% and was unchanged in 72%. BBS score significantly improved in older patients, and in those with lower CRI total score. A significant inverse correlation was observed between changes in BBS and work and education related CR. Patients with lower baseline BBS score showed better improvement in balance. CONCLUSIONS: We found an inverse correlation between CR level and balance improvement in PD patients who underwent conventional rehabilitation: higher improvement in BBS was observed in those with a lower CRI score. This may suggest that patients with higher CRI could benefit from more stimulating types of non-conventional rehabilitation (e.g. robotic, virtual reality). CLINICAL REHABILITATION IMPACT: Rehabilitation should be individually tailored considering CR as a significant variable.

An exploratory study of BDNF and oxidative stress marker alterations in subacute and chronic stroke patients affected by neuropathic pain.

Patients affected by stroke, particularly subacute stroke patients, often complain of neuropathic pain (NP), which may severely impair their quality of life. The aim of this exploratory study was to characterize NP and to investigate whether there is a correlation between NP and serum brain-derived neurotrophic factor (BDNF) and serum markers of oxidative stress. We enrolled 50 patients divided in subacute (< 90 days from stroke onset) and chronic (> 90 and 180 < days from stroke onset). The Barthel Index, Deambulation Index, and Short Form 36 were used to assess the patients' degree of disability and quality of life. Pain-specific tools, namely the Numeric Rating Scale (NRS), Neuropathic Pain Diagnostic questionnaire (DN4), and Neuropathic Pain Symptom Inventory (NPSI), were also used. Serum levels of BDNF and markers of oxidative stress and of metal status were evaluated: copper, iron, transferrin, ferritin, ceruloplasmin concentration (iCp) and activity (eCp), Total Antioxidant status (TAS), Cp/Tf ratio, eCp/iCp ratio, and non-ceruloplasmin bound copper (Non-Cp Cu). We found the highest value of BDNF in subacute with NP (DN4 score ≥ 4). The TAS, Cp/Tf ratio, and eCp/iCp not only fell outside the normal reference range in a high percentage of subacute and chronic patients, but were also found to be related to specific NP symptoms. These preliminary results reveal altered BDNF and oxidative stress indices in subacute stroke patients who complain of NP. These investigative findings may shed more light on the mechanisms underlying NP and consequently lead to a more tailored therapeutic and/or rehabilitation procedure of subacute stroke patients.

Use of a Virtual-Technological Sailing Program to Prepare Children With Disabilities for a Real Sailing Course: Effects on Balance and Quality of Life.

Sailing might produce a positive effect on a patient's general health and become an integrated part of rehabilitation. Our hypothesis was that a specific technological rehabilitation program might be used to prepare a group of disabled subjects for sailing. Seventeen patients (age range: 9-20) with impairments in motor coordination and balance and 15 healthy subjects participated in the study. The study was divided into the virtual-technological sailing phase, theory-practice phase, and sports phase. Proprioceptive platforms were used to evaluate balance, and the Child Health Questionnaire-PF50 was used to evaluate quality of life. Trunk displacement and the center of pressure velocity improved significantly after the virtual-technological sailing program. As regards quality of life, the physical and psychosocial score significantly improved at the end of the program. A technological rehabilitation training improved balance in disabled subjects and may be used to prepare them for a real sailing course. Sailing improves the quality of life of disabled subjects and could be used in the rehabilitation.