Journal of Movement Disorders

Original Articles

Conceptualizing a Personalized Care Pathway for Parkinson’s Disease Using Wearable Sensors in Muslim Patients: The Ramadan Regime: Vinod Metta, Huzaifa Ibrahim, Haidar Dafsari, Rajinder K. Dhamija, Hani T. S. Benamer, Tom Loney, Mishal Abu Al-Melh, Hasna Hussain, Afsal Nalarekttil, Guy Chung-Faye, Gloria Tanjung, Bushra Alblooshi, Shaikha Almazrouei, Bassam Darwish, Mohamed Al Mheiri, Mohamed Elmahdy, Rukmini Mridula, Sai Sampath Kumar, Vinay Goyal, Karolina Popławska-Domaszewicz, Cristian Falup Pecurariu, Prashanth Kukle, Jacob Chacko, Rupam Borgohain, Kallol Ray Chaudhuri; J Mov Disord. 2026;19(1):39-48. Published online September 30, 2025; DOI: https://doi.org/10.14802/jmd.25198

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Abstract PDF: Objective
Parkinson’s disease (PD) affects approximately 2% of individuals over the age of 60. With more than two billion Muslims observing Ramadan, individuals with PD encounter specific challenges, such as deteriorating motor skills, sleep disturbances, and an increased risk of falls during fasting.
Methods
Our study focused on 75 patients with idiopathic PD divided into two groups: the Ramadan Regime group, which consisted of 50 patients whose medication was adjusted to twice daily at Suhoor and Iftar, and the Nontreatment group, which included 25 patients who abstained from medication for religious reasons. Both groups were instructed to wear a Parkinson’s KinetiGraph (PKG) wrist device.
Results
The study findings revealed that motor function worsened in the Nontreatment group (p<0.001) but improved in the Ramadan Regime group (p=0.007). Daytime sleepiness also significantly increased in the Nontreatment group (p<0.001).
Conclusion
Overall, the findings suggest that the Ramadan regime significantly enhances patient health and quality of life.

Subtyping of Parkinson’s Disease by Longitudinal Trajectories of Levodopa Equivalent Daily Dose: Young-gun Lee, Kyoungwon Baik, Mincheol Park, Sung Woo Kang, So Hoon Yoon; J Mov Disord. 2025;18(4):317-326. Published online July 18, 2025; DOI: https://doi.org/10.14802/jmd.25099

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Abstract PDF Supplementary Material: Objective
Clinical heterogeneity exists in the optimal timing and dosage of symptomatic treatments for Parkinson’s disease (PD). This study aimed to cluster PD patients on the basis of longitudinal trajectories of levodopa equivalent daily dose (LEDD) and evaluate the clinical features and progression associated with these clusters.
Methods
From the Parkinson’s Progression Markers Initiative database, we enrolled 301 PD patients who were followed up for at least 3 years after the initiation of antiparkinsonian medications. On the basis of the longitudinal trajectories of the LEDD increment, the participants were classified into three clusters: slow-increment, initial-increment, and rapid-increment. The outcomes were initial and longitudinal changes in motor phenotype, on-time motor symptoms, and the efficacy of antiparkinsonian medications.
Results
The initial-increment cluster exhibited the greatest symptomatic improvements following the administration of higher doses of LEDD, although the motor improvement per unit of LEDD was comparable across clusters. Longitudinally, motor phenotypes changed rapidly in the initial-increment cluster. The initial-increment cluster showed continuous worsening of on-time motor symptoms, with limited LEDD efficacy. In contrast, the rapid-increment cluster exhibited stable on-time motor symptoms, whereas the efficacy of antiparkinsonian medications declined over time. The risk of disability related to walking and balance milestones and motor complications was twice as high in the initial-increment and rapid-increment clusters than in the slow-increment cluster.
Conclusion
Heterogeneity is noted in the increase in the use of antiparkinsonian medications, which is driven by changes in motor phenotype, medication efficacy, and the occurrence of PD-relevant milestones. Subtyping patients on the basis of LEDD trajectories may provide insight into clinical heterogeneity for future research on individualized treatment strategies for patients with PD.

Brief communication

The Effects of Biofeedback Therapy on Anxiety and Depression in Parkinson’s Disease: A Pilot Study: Justus Chun-Yu Chen, Tzu-Yun Tseng, Jong-Ling Fuh, Yu-Hsiang Cheng, Dai-Wei Lin, Han-Lin Chiang; J Mov Disord. 2025;18(4):360-364. Published online July 14, 2025; DOI: https://doi.org/10.14802/jmd.25097

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Abstract PDF Supplementary Material: Objective
This pilot study aimed to evaluate the feasibility and potential effects of biofeedback therapy (BT) on anxiety and depression among patients with Parkinson’s disease (PD).
Methods
A randomized waitlist-controlled trial was conducted involving 19 patients with PD and comorbid anxiety and/or depression. Anxiety and depression were assessed at baseline, posttreatment, and 1-month follow-up.
Results
All 19 patients completed the study. Compared with those of the control group, significant improvements in the Hamilton Depression Rating Scale and the anxiety subscale (but not the depression subscale) of the Hospital Anxiety and Depression Scale were observed immediately after BT. In the pooled analysis, the anxiolytic effect persisted at the 1-month follow-up, with greater improvements observed in those with more severe baseline anxiety.
Conclusion
These preliminary findings suggest that BT may help reduce anxiety symptoms among PD patients. Future studies with larger, more severely affected cohorts are needed to confirm these findings.

Review Article

Longitudinal Multimodal Functional Imaging: An Essential Tool for Visualizing Pathologic Progression in Parkinson’s Disease: Antonio Martín-Bastida, María Cruz Rodríguez-Oroz; J Mov Disord. 2025;18(3):197-207. Published online June 8, 2025; DOI: https://doi.org/10.14802/jmd.24257

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Abstract PDF: Research on the pathophysiology of Parkinson’s disease (PD) has traditionally been performed with functional magnetic resonance imaging (fMRI); however, only a few studies have been conducted in longitudinal cohorts. In the present literature review, we aim to summarize the most recent progress in functional fMRI studies in prospective cohorts and, more specifically, in combination with other biomarkers to track the disease progression of PD. This review focuses on the potential application of multimodal longitudinal functional approaches based on the current evidence for the purpose of understanding disease progression and monitoring future therapeutic interventions.

Brief communication

Modified Ratio of Tremor/Postural Instability Gait Difficulty Score as an Indicator of Short-Term Outcomes of Subthalamic Nucleus Deep Brain Stimulation in Parkinson’s Disease: Chakradhar Reddy, Kanchana Pillai, Shejoy Joshua, Anup Nair, Harshad Chavotiya, Manas Chacko, Asha Kishore; J Mov Disord. 2025;18(2):165-169. Published online January 2, 2025; DOI: https://doi.org/10.14802/jmd.24175

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Abstract PDF Supplementary Material: Objective
The outcomes of motor and nonmotor features of Parkinson’s disease (PD) following deep brain stimulation (DBS) vary among its subtypes. We tested whether preoperative motor subtyping using the modified tremor/postural instability and gait difficulty ratio (T/P ratio) could indicate the short-term motor, nonmotor and quality of life (QOL) outcomes of subthalamic nucleus (STN) DBS.
Methods
In this prospective study, 39 consecutive STN DBS patients were assessed in the drug-OFF state before surgery and subtyped according to the T/P ratio. Patients were reassessed 6 months after surgery in the stimulation ON-drug-OFF state, and the percentage changes in motor, nonmotor and QOL scores (Parkinson’s Disease Quality of Life Questionnaire [PDQ-39]) were calculated.
Results
The modified T/P ratio was moderately and positively correlated with the percentage change in the Unified Parkinson’s Disease Rating Scale III score in the OFF state, the sum of cardinal motor signs, the Non-Motor Symptom Scale score, and QOL (PDQ-39).
Conclusion
Preoperative PD motor subtyping can be used as an indicator of the short-term outcomes of STN DBS in PD patients.

Review Article

Non-Motor Fluctuations in Parkinson’s Disease: Underdiagnosed Yet Important: Iro Boura, Karolina Poplawska-Domaszewicz, Cleanthe Spanaki, Rosabel Chen, Daniele Urso, Riaan van Coller, Alexander Storch, Kallol Ray Chaudhuri; J Mov Disord. 2025;18(1):1-16. Published online December 20, 2024; DOI: https://doi.org/10.14802/jmd.24227

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Abstract PDF

Non-motor fluctuations (NMFs) in Parkinson’s disease (PD) significantly affect patients’ well-being. Despite being identified over two decades ago, NMFs remain largely underrecognized, undertreated, and poorly understood. While they are often temporally associated with motor fluctuations (MFs) and can share common risk factors and pathophysiologic mechanisms, NMFs and MFs are currently considered distinct entities. The prevalence and severity of NMFs, often categorized into neuropsychiatric, sensory, and autonomic subtypes, vary significantly across studies due to the heterogeneous PD populations screened and the diverse evaluation tools applied. The consistent negative impact of NMFs on PD patients’ quality of life underscores the importance of further investigations via focused and controlled studies, validated assessment instruments and novel digital technologies. High-quality research is essential to illuminate the complex pathophysiology and clinical nuances of NMFs, ultimately enhancing clinicians’ diagnostic and treatment options in routine clinical practice.

Citations

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Motor and non-motor fluctuations in Parkinson’s disease: the knowns and unknowns of current therapeutic approaches
Martin Regensburger, Ilona Csoti, Wolfgang H. Jost, Zacharias Kohl, Stefan Lorenzl, David J. Pedrosa, Paul Lingor
Journal of Neural Transmission.2026; 133(2): 309. CrossRef
The challenges with the identification of Parkinson’s disease subtypes
Leonardo Rigon, Karolina Poplawska-Domaszewicz, Vinod Metta, Carmelo Fogliano, Maria Laura Nasi, Anna Sauerbier, Haider Dafsari, Valentina Leta, Cristian Falup-Pecurariu, Per Odin, Angelo Antonini, Kallol Ray Chaudhuri
Expert Review of Neurotherapeutics.2026; 26(2): 135. CrossRef
Low-frequency activity in the subthalamic nucleus informs about the acute neuropsychiatric state in Parkinson’s disease
Elena Bernasconi, Alberto Averna, Valentina D’Onofrio, Deborah Amstutz, Damian M. Herz, Laura Alva, Andreia D. Magalhães, Katrin Petermann, Ines Debove, M. Lenard Lachenmayer, Andreas Nowacki, Claudio Pollo, Paul Krack, Mario Sousa, Gerd Tinkhauser
npj Parkinson's Disease.2026;[Epub] CrossRef
Persistent Tremor in Bipolar Disorder: A Case Report of Idiopathic Parkinson’s Disease Superimposed on Lithium and Antipsychotic Effects
Ethan Jetter, Daisy Valle, Diego Nolasco, Brent Carr, Edo S. Jaya
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Managing non-motor symptoms of Parkinson disease in China: clinical perspectives
Jing Chen, Xiaotong Feng, Danhua Zhao, Baoyu Chen, Chaobo Bai, Qi Wang, Yuan Li, Junyi Chen, Xintong Guo, Jinjin Wang, Lin Zhang, Junliang Yuan
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Post hoc exploratory analysis of the effect of foslevodopa/foscarbidopa continuous subcutaneous infusion on nocturia in patients with Parkinson’s disease
K. Ray Chaudhuri, Manon Bouchard, Eric Freire-Alvarez, Rajesh Pahwa, Lars Bergmann, Resmi Gupta, Pavnit Kukreja, Megha B. Shah, Stuart H. Isaacson
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Neuropsychiatric disorders in Parkinson’s disease
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Distinction and mutual Influences between Parkinson's Disease‐related and unrelated Chronic Pain
Jonathan Hunger, Florian Brugger, Georg Kägi, Jens Carsten Möller, Nathalie Hollenstein, David H. Benninger, Michele Tinazzi, Julien F. Bally, Roman Gonzenbach, Daniel Ciampi de Andrade, Santiago Perez Lloret, Veit Mylius
Movement Disorders Clinical Practice.2025;[Epub] CrossRef
Effects of levodopa–entacapone–carbidopa intrajejunal infusion on non-motor symptoms of advanced Parkinson’s disease—interim analysis of the ELEGANCE study
Tobias Warnecke, Per Odin, Rocío García-Ramos, Lydia Lopez, Delia Tulbă, Traian Flavius Dan, Dragos Catalin Jianu, Petra Bago Rožanković, Teus van Laar
Journal of Neural Transmission.2025;[Epub] CrossRef
Treatment strategies for motor fluctuations in Parkinson’s disease: a systematic review of efficacy, functionality, and drug accessibility with a focus on Latin America
Oscar Arias-Carrión, Emmanuel Ortega-Robles
Frontiers in Pharmacology.2025;[Epub] CrossRef
Non-motor symptoms in Parkinson’s disease: a practical approach
Ann Subota, Veronica Bruno
Practical Neurology.2025; : pn-2025-004696. CrossRef

Original Articles

Pain Characteristics of Parkinson’s Disease Using Validated Arabic Versions of the King’s Parkinson’s Disease Pain Scale and Questionnaire: A Multicenter Egyptian Study: Ali Shalash, Salma R. Mohamed, Marwa Y. Badr, Shimaa Elgamal, Shaimaa A. Elaidy, Eman A. Elhamrawy, Hayam Abdel-Tawab, Haidy Elshebawy, Heba Samir Abdelraheem, Tamer Roushdy, Wafik S. Bahnasy, Haitham H. Salem, Ehab A. El-Seidy, Hatem S. Shehata, Hazem Marouf, K. Ray Chaudhuri, Eman Hamid; J Mov Disord. 2024;17(4):387-397. Published online June 25, 2024; DOI: https://doi.org/10.14802/jmd.24088

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Abstract PDF Supplementary Material

Objective
Pain is one of the most common nonmotor symptoms in Parkinson’s disease (PD), with variable characteristics among populations. This multicenter Egyptian study aimed to translate and validate the King’s Parkinson’s Disease Pain Scale (KPPS) and Questionnaire (KPPQ) into Arabic versions and to investigate the pain characteristics in Egyptian people with PD (PWP).
Methods
A total of 192 PWP and 100 sex- and age-matched controls were evaluated by the KPPS-Arabic and KPPQ-Arabic. Both tools were assessed for test–retest reliability, floor or ceiling effects, construct validity and convert validity. PWP were also assessed by the Movement Disorders Society-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS), Hoehn and Yahr scale (H&Y), Non-Motor Symptom Scale (NMSS), PD Questionnaire-39, and Non-Motor Fluctuation Assessment (NoMoFA).
Results
The KPPS-Arabic and KPPQ-Arabic showed inter- and intrarater consistency and high validity, with an acceptable ceiling effect. A total of 188 PWP (97.9%) reported at least 1 type of pain (p < 0.001). The severity and prevalence of all pain domains in the KPPS-Arabic were significantly higher among PWP than among controls (p < 0.001). Fluctuation-related and musculoskeletal pains were the most common (81.3% and 80.7%, respectively). In the PD group, the total and domains of KPPS-Arabic were significantly correlated to the MDS-UPDRS total score and the scores of Parts I, II, III, postural instability gait disorder, axial, and H&Y but not with age or age of onset. The predictors of KPPS-Arabic scores included the total MDS-UPDRS, the part III-OFF, disease duration, the total NMSS, and the NoMoFA scores.
Conclusion
The current multicenter study provided validated Arabic versions of the KPPS and KPPQ, which exhibited high reliability and validity, and demonstrated a high prevalence and severity of pain within Egyptian PWP and characterized its determinants.

Citations

Citations to this article as recorded by

Test-retest reliability and construct validity of the King's Parkinson's Disease Pain Scale – Brazilian version
Rafaela Moura Santos Rocha, Iza de Faria-Fortini, Paula Luciana Scalzo
Clinical Neurology and Neurosurgery.2025; 251: 108814. CrossRef
Redefining Non-Motor Symptoms in Parkinson’s Disease
Laura Peña-Zelayeta, Karen M. Delgado-Minjares, Marcos M. Villegas-Rojas, Karen León-Arcia, Alberto Santiago-Balmaseda, Jesús Andrade-Guerrero, Isaac Pérez-Segura, Emmanuel Ortega-Robles, Luis O. Soto-Rojas, Oscar Arias-Carrión
Journal of Personalized Medicine.2025; 15(5): 172. CrossRef
Clinical Outcome Assessments in Parkinson's Disease: A Scoping Review of Current Rating Scales and Future Needs
Evita Papathoma, Panagiota Tsitsi, Nirosen Vijiaratnam, Camila Aquino, Stephen R. Duma, Norbert Kovacs, Kigocha Lameck Okeng'o, Aparna Wagle Shukla, Roongroj Bhidayasiri, Tiago A. Mestre, Alvaro Sanchez Ferro, Alberto J. Espay, Michelle H.S. Tosin, Matej
Movement Disorders Clinical Practice.2025;[Epub] CrossRef

Fasting Plasma Glucose Levels and Longitudinal Motor and Cognitive Outcomes in Parkinson’s Disease Patients: Ko-Eun Choi, Dong-Woo Ryu, Yoon-Sang Oh, Joong-Seok Kim; J Mov Disord. 2024;17(2):198-207. Published online March 6, 2024; DOI: https://doi.org/10.14802/jmd.23264

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Abstract PDF Supplementary Material

Objective
Hyperglycemia and diabetes mellitus have been identified as poor prognostic factors for motor and nonmotor outcomes in patients with Parkinson’s disease (PD), although there is some controversy with this finding. In the present study, we investigated the effects of fasting plasma glucose (FPG) levels on longitudinal motor and cognitive outcomes in PD patients.
Methods
We included a total of 201 patients who were diagnosed with PD between January 2015 and January 2020. The patients were categorized based on FPG level into euglycemia (70 mg/dL < FPG < 100 mg/dL), intermediate glycemia (100 mg/dL ≤ FPG < 126 mg/dL), and hyperglycemia (FPG ≥ 126 mg/dL), and longitudinal FPG trajectories were analyzed using group-based trajectory modeling. Survival analysis was conducted to determine the time until motor outcome (Hoehn and Yahr stage ≥ 2) and the conversion from normal cognition to mild cognitive impairment.
Results
Among the patient cohort, 82 had euglycemia, 93 had intermediate glycemia, and 26 had hyperglycemia. Intermediate glycemia (hazard ratio 1.747, 95% confidence interval [CI] 1.083–2.816, p = 0.0221) and hyperglycemia (hazard ratio 3.864, 95% CI 1.996–7.481, p < 0.0001) were found to be significant predictors of worsening motor symptoms. However, neither intermediate glycemia (hazard ratio 1.183, 95% CI 0.697–2.009, p = 0.5339) nor hyperglycemia (hazard ratio 1.297, 95% CI 0.601–2.800, p = 0.5078) demonstrated associations with the longitudinal progression of cognitive impairment. Diabetes mellitus, defined by self-reported medical history, was not related to poor motor or cognitive impairment outcomes.
Conclusion
Our results suggest that both impaired glucose tolerance and hyperglycemia could be associated with motor progression in PD patients.

Citations

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Type 2 Diabetes Mellitus and Parkinson's Disease: An Emerging Link
Shubham Teli, Mallappa Shalavadi, Chandrashekhar V.M., Lingaraj Anawal
Current Signal Transduction Therapy.2025;[Epub] CrossRef
Early diagnosis of Parkinson's disease by highly sensitive monitoring of glucose using an atomic-level defect-enriched MoS2/Au SERS sensor enabled by LSPR-PICT synergy
Yingjiao Zhai, Yu Zhang, Fujun Liu, Kaixi Shi, Wenhui Fang, Zhiying Wang, Jinhua Li
Applied Physics Letters.2025;[Epub] CrossRef
Association of triglyceride glucose-waist to height ratio index with Parkinson’s disease and the mediating role of systemic inflammatory response index: A cross-sectional study
Keyu Shi, Zikai Pei, Sijie Quan, Yue Shi, Yi Zhou
Medicine.2025; 104(52): e46737. CrossRef
Peripheral inflammatory markers and clinical phenotypes reflecting the impact of diabetes on Parkinson's disease
In Hee Kwak, Hyeo-il Ma, Yun Joong Kim, Hye-Mi Noh, Jeongjae Lee, Je Kook Yu, Young Eun Kim
Journal of Parkinson’s Disease.2025; 15(8): 1431. CrossRef

Effectiveness of Live-Streaming Tele-Exercise Intervention in Patients With Parkinson’s Disease: A Pilot Study: Jongmok Ha, Jung Hyun Park, Jun Seok Lee, Hye Young Kim, Ji One Song, Jiwon Yoo, Jong Hyeon Ahn, Jinyoung Youn, Jin Whan Cho; J Mov Disord. 2024;17(2):189-197. Published online February 29, 2024; DOI: https://doi.org/10.14802/jmd.23251

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Abstract PDF Supplementary Material

Objective
Exercise can improve both motor and nonmotor symptoms in people with Parkinson’s disease (PwP), but there is an unmet need for accessible and sustainable exercise options. This study aimed to evaluate the effect, feasibility, and safety of a regularly performed live-streaming tele-exercise intervention for PwP.
Methods
A live-streaming exercise intervention for PwP was implemented twice a week for 12 weeks. We measured the motor and nonmotor symptom scores of the included patients before and after the intervention. Changes in clinical scores from baseline to postintervention were analyzed using paired t-tests. Factors associated with improvements in clinical scores and compliance were analyzed using Pearson’s correlation analysis.
Results
Fifty-six participants were enrolled in the study. There were significant improvements in Hospital Anxiety and Depression Scale (HADS)-anxiety (p = 0.007), HADS-depression (p < 0.001), Unified Parkinson’s Disease Rating Scale (UPDRS) part III (p < 0.001), UPDRS total (p = 0.015), Hoehn and Yahr stage (p = 0.027), and Parkinson’s Disease Fatigue Scale-16 (p = 0.026) scores after the intervention. Improvements in motor symptoms were associated with improvements in mood symptoms and fatigue. Higher motor impairment at baseline was associated with a greater compliance rate and better postintervention composite motor and nonmotor outcomes (ΔUPDRS total score). Overall, the 12-week tele-exercise program was feasible and safe for PwP. No adverse events were reported. The overall adherence rate was 60.0% in our cohort, and 83.4% of the participants were able to participate in more than half of the exercise routines.
Conclusion
The live-streaming tele-exercise intervention is a safe, feasible, and effective nonpharmacological treatment option that can alleviate fatigue and improve mood and motor symptoms in PwP.

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Feasibility and preliminary efficacy of an online home-based functional exercise program for Parkinson's disease: a pilot study
Hyungwoo Lee, Hunyoung Ha, Heehyun Shin, Byungjun Park, Nyeonju Kang, Kiwon Park, Ryul Kim, Kyeongho Byun
Frontiers in Neurology.2025;[Epub] CrossRef
Effectiveness of telerehabilitation in reducing motor disability and enhancing quality of life in parkinson’s disease: a systematic review and meta-analysis
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Acta Neurologica Belgica.2025;[Epub] CrossRef
Effects of Whole-Body, Local, and Modality-Specific Vibration Therapy on Gait in Parkinson’s Disease: A Systematic Review and Meta-Analysis
Ji-Woo Seok, Se-Ra Park
Biomedicines.2025; 13(10): 2505. CrossRef
Factors Associated With the Response to Exercise in Patients With Parkinson’s Disease
Myung Jun Lee, Jinse Park, Dong-Woo Ryu, Dallah Yoo, Sang-Myung Cheon
Journal of Movement Disorders.2025; 18(4): 308. CrossRef

Review Article

Gastrointestinal Dysfunction in Parkinson’s Disease: Neuro-Gastroenterology Perspectives on a Multifaceted Problem: Ai Huey Tan, Kee Huat Chuah, Yuan Ye Beh, Jie Ping Schee, Sanjiv Mahadeva, Shen-Yang Lim; J Mov Disord. 2023;16(2):138-151. Published online May 24, 2023; DOI: https://doi.org/10.14802/jmd.22220

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Abstract PDF

Patients with Parkinson’s disease (PD) face a multitude of gastrointestinal (GI) symptoms, including nausea, bloating, reduced bowel movements, and difficulties with defecation. These symptoms are common and may accumulate during the course of PD but are often under-recognized and challenging to manage. Objective testing can be burdensome to patients and does not correlate well with symptoms. Effective treatment options are limited. Evidence is often based on studies in the general population, and specific evidence in PD is scarce. Upper GI dysfunction may also interfere with the pharmacological treatment of PD motor symptoms, which poses significant management challenges. Several new less invasive assessment tools and novel treatment options have emerged in recent years. The current review provides an overview and a practical approach to recognizing and diagnosing common upper and lower GI problems in PD, e.g., dyspepsia, gastroparesis, small bowel dysfunction, chronic constipation, and defecatory dysfunction. Management aspects are discussed based on the latest evidence from the PD and general populations, with insights for future research pertaining to GI dysfunction in PD.

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Coriander (Coriandrum sativum L. leaves) improves brain and gut pathology in mouse models of brain-first and gut-first Parkinson's disease
Hanbyeol Lee, Jin Hee Kim, Yujin Choi, Minji Lee, Hi-Joon Park, Myung Sook Oh
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Yeonsoo Kim, Eunsol Seo, Anna Kang, Min-Geun Kang, Ki Beom Jang, Sangnam Oh, Younghoon Kim
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Lactiplantibacillus plantarum SG5 inhibits neuroinflammation in MPTP-induced PD mice through GLP-1/PGC-1α pathway
Yueyan Qi, Yuxuan Dong, Jinhu Chen, Siyou Xie, Xin Ma, Xueping Yu, Yang Yu, Yanqin Wang
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Gastrointestinal Dysfunction Bears on the Clinical‐Biological Profile of Parkinson's Disease
Jacopo Bissacco, Roberta Bovenzi, Matteo Conti, Clara Simonetta, Davide Mascioli, Rocco Cerroni, Giulia Maria Sancesario, Piergiorgio Grillo, Mariangela Pierantozzi, Alessandro Stefani, Nicola Biagio Mercuri, Marta Camacho, Tommaso Schirinzi
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The interrelationship between intestinal immune cells and enteric α-synuclein in the progression of Parkinson’s disease
Yuan-Kai Cheng, Hao-Sen Chiang
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Gastrointestinal Manifestations in Parkinson's Disease Using a Validated Arabic Version of Gastrointestinal Dysfunction Scale: A Multicenter Study
Ali Soliman Shalash, Marwa Yassien Badr, Yara Salah, Shimaa Elgamal, Shaimaa Ahmed Elaidy, Eman Abdel‐Mageed Elhamrawy, Hayam Abdel‐Tawab, Eman Hamid, Ehab Ahmed El‐Seidy, Noha Lotfy Dawood
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Original Articles

Safinamide as an Adjunct to Levodopa in Asian and Caucasian Patients With Parkinson’s Disease and Motor Fluctuations: A Post Hoc Analysis of the SETTLE Study: Roongroj Bhidayasiri, Takayuki Ishida, Takanori Kamei, Ryan Edbert Husni, Ippei Suzuki, Shey Lin Wu, Jin Whan Cho; J Mov Disord. 2023;16(2):180-190. Published online April 26, 2023; DOI: https://doi.org/10.14802/jmd.22196

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Abstract PDF Supplementary Material

Objective
Safinamide is a selective, reversible monoamine oxidase B inhibitor with demonstrated efficacy and tolerability in placebo-controlled studies and is clinically useful for patients with motor fluctuations. This study evaluated the efficacy and safety of safinamide as a levodopa adjunct therapy in Asian patients with Parkinson’s disease.
Methods
Data from 173 Asian and 371 Caucasian patients from the international Phase III SETTLE study were included in this post hoc analysis. The safinamide dose was increased from 50 mg/day to 100 mg/day if no tolerability issues occurred at week 2. The primary outcome was the change from baseline to week 24 in daily ON-time without troublesome dyskinesia (i.e., ON-time). Key secondary outcomes included changes in Unified Parkinson’s Disease Rating Scale (UPDRS) scores.
Results
Safinamide significantly increased daily ON-time relative to placebo in both groups (least-squares mean: 0.83 hours, p = 0.011 [Asians]; 1.05 hours, p < 0.0001 [Caucasians]). Motor function relative to placebo (UPDRS Part III) improved significantly in Asians (-2.65 points, p = 0.012) but not Caucasians (-1.44 points, p = 0.0576). Safinamide did not worsen Dyskinesia Rating Scale scores in either subgroup, regardless of the presence or absence of dyskinesia at baseline. Dyskinesia was largely mild for Asians and moderate for Caucasians. None of the Asian patients experienced adverse events leading to treatment discontinuation.
Conclusion
Safinamide as a levodopa adjunct is well tolerated and effective in reducing motor fluctuations in both Asian and Caucasian patients. Further studies to investigate the real-world effectiveness and safety of safinamide in Asia are warranted.

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Comparing the efficacy and safety of safinamide with rasagiline in China Parkinson’s disease patients with a matching adjusted indirect comparison
Yuyan Tan, Qianqian Wei, Pingyi Xu, Enxiang Tao, Lijiao Wang, Carlo Cattaneo, Huifang Shang, Shengdi Chen
Scientific Reports.2025;[Epub] CrossRef
Optimized use of safinamide as an add-on therapy in Asian patients with Parkinson’s disease: a narrative review and expert opinion
Jong Sam Baik, Young Hee Sung, Ruey-Meei Wu, Chin-Song Lu, Roongroj Bhidayasiri
Therapeutic Advances in Neurological Disorders.2025;[Epub] CrossRef
Safinamide as an adjunct to levodopa monotherapy in Asian patients with Parkinson’s disease experiencing early wearing-off: a pooled analysis of the J-SILVER and KEEP studies
Noriko Nishikawa, Do-Young Kwon, Yuki Kogo, Taku Hatano, Jin Whan Cho, Chizuru Kobayashi, Hiroyuki Shiiba, JiEun Kim, Takayuki Ishida, Jong Sam Baik, Nobutaka Hattori
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The Effects of Safinamide in Chinese and Non-Chinese Patients with Parkinson’s Disease
Carlo Cattaneo, Jaime Kulisevsky
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Safinamide as adjunctive therapy to levodopa monotherapy for patients with Parkinson's disease with wearing-off: The Japanese observational J-SILVER study
Noriko Nishikawa, Taku Hatano, Kenya Nishioka, Shin-Ichi Ueno, Shinji Saiki, Ryota Nakamura, Asako Yoritaka, Takashi Ogawa, Yasushi Shimo, Wataru Sako, Hideki Shimura, Yoshiaki Furukawa, Takanori Kamei, Takayuki Ishida, Nobutaka Hattori
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Potential Link Between Cognition and Motor Reserve in Patients With Parkinson’s Disease: Seok Jong Chung, Yae Ji Kim, Yun Joong Kim, Hye Sun Lee, Mijin Yun, Phil Hyu Lee, Yong Jeong, Young H. Sohn; J Mov Disord. 2022;15(3):249-257. Published online September 7, 2022; DOI: https://doi.org/10.14802/jmd.22063

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Objective
To investigate whether there is a link between cognitive function and motor reserve (i.e., individual capacity to cope with nigrostriatal dopamine depletion) in patients with newly diagnosed Parkinson’s disease (PD).
Methods
A total of 163 patients with drug-naïve PD who underwent ¹⁸F-FP-CIT PET, brain MRI, and a detailed neuropsychological test were enrolled. We estimated individual motor reserve based on initial motor deficits and striatal dopamine depletion using a residual model. We performed correlation analyses between motor reserve estimates and cognitive composite scores. Diffusion connectometry analysis was performed to map the white matter fiber tracts, of which fractional anisotropy (FA) values were well correlated with motor reserve estimates. Additionally, Cox regression analysis was used to assess the effect of initial motor reserve on the risk of dementia conversion.
Results
The motor reserve estimate was positively correlated with the composite score of the verbal memory function domain (γ = 0.246) and with the years of education (γ = 0.251). Connectometry analysis showed that FA values in the left fornix were positively correlated with the motor reserve estimate, while no fiber tracts were negatively correlated with the motor reserve estimate. Cox regression analysis demonstrated that higher motor reserve estimates tended to be associated with a lower risk of dementia conversion (hazard ratio, 0.781; 95% confidence interval, 0.576–1.058).
Conclusion
The present study demonstrated that the motor reserve estimate was well correlated with verbal memory function and with white matter integrity in the left fornix, suggesting a possible link between cognition and motor reserve in patients with PD.

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Considering the response in addition to the challenge – a narrative review in appraisal of a motor reserve framework
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Jinyoung Youn, Ji Hye Won, Mansu Kim, Junmo Kwon, Seung Hwan Moon, Minkyeong Kim, Jong Hyun Ahn, Jun Kyu Mun, Hyunjin Park, Jin Whan Cho
Journal of Parkinson’s Disease.2022; 13(1): 39. CrossRef

Review Article

The Supplementary Motor Complex in Parkinson’s Disease: Shervin Rahimpour, Shashank Rajkumar, Mark Hallett; J Mov Disord. 2022;15(1):21-32. Published online November 25, 2021; DOI: https://doi.org/10.14802/jmd.21075

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Abstract PDF

Parkinson’s disease (PD) is a neurodegenerative disorder characterized by both motor and nonmotor symptoms. Although the basal ganglia is traditionally the primary brain region implicated in this disease process, this limited view ignores the roles of the cortex and cerebellum that are networked with the basal ganglia to support motor and cognitive functions. In particular, recent research has highlighted dysfunction in the supplementary motor complex (SMC) in patients with PD. Using the PubMed and Google Scholar search engines, we identified research articles using keywords pertaining to the involvement of the SMC in action sequencing impairments, temporal processing disturbances, and gait impairment in patients with PD. A review of abstracts and full-text articles was used to identify relevant articles. In this review of 63 articles, we focus on the role of the SMC in PD, highlighting anatomical and functional data to create new perspectives in understanding clinical symptoms and, potentially, new therapeutic targets. The SMC has a nuanced role in the pathophysiology of PD, with both hypo- and hyperactivation associated with various symptoms. Further studies using more standardized patient populations and functional tasks are needed to more clearly elucidate the role of this region in the pathophysiology and treatment of PD.

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Brief communication

Dance Intervention Using the Feldenkrais Method Improves Motor, and Non-Motor Symptoms and Gait in Parkinson’s Disease: A 12-Month Study: Sung Hoon Kang, Jinhee Kim, Ilsoo Kim, Young Ae Moon, Sojung Park, Seong-Beom Koh; J Mov Disord. 2022;15(1):53-57. Published online November 3, 2021; DOI: https://doi.org/10.14802/jmd.21086

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Objective
The aim of this study was to assess the effects of dancing (using the Feldenkrais method) on motor and non-motor symptoms, quality of life (QoL), and objective parameters of gait at the time of intervention and at the end of the 1-year study period.
Methods
This was a single-arm study in which 12 subjects with Parkinson’s disease (PD) received dance intervention during a 6-month period. Objective motor scales, gait analysis, and questionnaires on non-motor symptoms were evaluated at baseline and at 3, 6, and 12 months.
Results
Dance intervention decreased motor scale (Unified Parkinson’s Disease Rating Scale and Tinetti scale) scores and improved gait disturbance (gait velocity and step length) without increasing levodopa equivalent dose. Furthermore, dancing decreased non-motor scale (Non-Motor Symptoms Scale and Montgomery-Asberg Depression Rating Scale) scores and improved QoL.
Conclusion
Our findings suggest that dance intervention can be a complementary management method for PD patients.

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Original Article

Factors Associated with Medication Beliefs in Patients with Parkinson’s Disease: A Cross-Sectional Study: Sung Reul Kim, Ji Young Kim, Hye Young Kim, Hui Young So, Sun Ju Chung; J Mov Disord. 2021;14(2):133-143. Published online May 3, 2021; DOI: https://doi.org/10.14802/jmd.20147

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Abstract PDF Supplementary Material

Objective
Medication beliefs are a significant determinant of medication adherence in chronic illness. This study aimed to identify demographic, clinical, and medication-related factors associated with medication beliefs in patients with Parkinson’s disease (PD).
Methods
We used a descriptive cross-sectional design with a convenience sample of 173 PD patients who had been taking antiparkinson drugs for more than one year.
Results
The subjects who believed PD medication was more necessary had more severe illness, younger age of onset, longer illness duration, and longer duration of levodopa therapy. They had higher levels of non-motor symptoms and depression, number of medication uses, number of drugs, and levodopa equivalent dose, and they reported fluctuation of motor symptoms and dyskinesia. The subjects who used catechol-O-methyltransferase (COMT) inhibitors, dopamine agonists, amantadine, and monoamine oxidase-B (MAO-B) inhibitors had significantly higher necessity scores than those who did not use them. The subjects who had higher concerns about PD medications had higher levels of non-motor symptoms and depression. The subjects using amantadine and anticholinergics had significantly higher concern scores than those who did not use them. Positive necessity-concerns differentials were associated with severe illness, the presence of motor fluctuation and dyskinesia, and the use of COMT inhibitors. Based on stepwise multiple regression, the most significant factors influencing necessity beliefs were severe illness, followed by depression and motor fluctuation.
Conclusion
Severe illness, higher levels of depression, and motor fluctuation are independent factors influencing patients’ beliefs regarding medication necessity. Therefore, these characteristics should be considered in medication belief assessment and interventions for PD patients.

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Brief communication

Effectiveness of Exercise on the Sequence Effect in Parkinson’s Disease: Suk Yun Kang, Young Ho Sohn; J Mov Disord. 2020;13(3):213-217. Published online August 31, 2020; DOI: https://doi.org/10.14802/jmd.20045

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Abstract PDF Supplementary Material

Objective
To determine the benefits of motor training on the sequence effect (SE), an essential component of bradykinesia in Parkinson’s disease (PD).
Methods
Seven patients with de novo PD participated in this study. The patients performed regular pentagon drawing tests and exercises during four visits. The first two visits occurred before the start of medication, and the last two visits occurred at least six months after the start of medication. We assessed the severity of bradykinesia and SE at each visit and compared the results before and after exercise in both the de novo and treatment conditions.
Results
In the de novo condition, the severity of bradykinesia significantly improved after motor training (p = 0.018), but it did not resolve and only showed a trend of improvement after treatment (p = 0.068). The severity of the SE decreased significantly in the drug-naïve condition (p = 0.028) but not after medication (p = 0.273).
Conclusion
Our study suggests that regular motor training may be beneficial for the SE in PD.

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Review Article

Emerging Concepts of Motor Reserve in Parkinson’s Disease: Seok Jong Chung, Jae Jung Lee, Phil Hyu Lee, Young H. Sohn; J Mov Disord. 2020;13(3):171-184. Published online August 31, 2020; DOI: https://doi.org/10.14802/jmd.20029

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Abstract PDF

The concept of cognitive reserve (CR) in Alzheimer’s disease (AD) explains the differences between individuals in their susceptibility to AD-related pathologies. An enhanced CR may lead to less cognitive deficits despite severe pathological lesions. Parkinson’s disease (PD) is also a common neurodegenerative disease and is mainly characterized by motor dysfunction related to striatal dopaminergic depletion. The degree of motor deficits in PD is closely correlated to the degree of dopamine depletion; however, significant individual variations still exist. Therefore, we hypothesized that the presence of motor reserve (MR) in PD explains the individual differences in motor deficits despite similar levels of striatal dopamine depletion. Since 2015, we have performed a series of studies investigating MR in de novo patients with PD using the data of initial clinical presentation and dopamine transporter PET scan. In this review, we summarized the results of these published studies. In particular, some premorbid experiences (i.e., physical activity and education) and modifiable factors (i.e., body mass index and white matter hyperintensity on brain image studies) could modulate an individual’s capacity to tolerate PD pathology, which can be maintained throughout disease progression.

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Brief communication

Risk Factors for Falls in Patients with de novo Parkinson’s Disease: A Focus on Motor and Non-Motor Symptoms: Kyum-Yil Kwon, Mina Lee, Hyunjin Ju, Kayeong Im; J Mov Disord. 2020;13(2):142-145. Published online May 29, 2020; DOI: https://doi.org/10.14802/jmd.20009

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Objective
We aimed to identify risk factors for falls in patients with de novo Parkinson’s disease (PD). Methods Forty-six patients with de novo PD were retrospectively included in the study. We assessed details on the patients’ motor symptoms as well as non-motor symptoms using several representative scales for global cognition, depression, fatigue, and dysautonomia. Fallers and non-fallers were identified according to their history of falls during the preceding year. Results Twenty-two patients (45.8%) with de novo PD had a history of falls. Compared with the non-faller group, the faller group exhibited higher scores for postural instability/gait difficulty (PIGD), anxiety, fatigue, total dysautonomia, gastrointestinal dysfunction, and thermoregulatory dysfunction. Moreover, logistic regression analysis showed that falling was positively correlated with anxiety and gastrointestinal symptoms but negatively associated with the tremor scores. Conclusion Our findings suggest that falling in patients with de novo PD is significantly associated with PIGD/non-tremor symptoms, anxiety, and gastrointestinal dysfunction.

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Viewpoint

Future of Tanscranial Magnetic Stimulation in Movement Disorders: Introduction of Novel Methods: Yoshikazu Ugawa, Yasushi Shimo, Yasuo Terao; J Mov Disord. 2020;13(2):115-117. Published online April 6, 2020; DOI: https://doi.org/10.14802/jmd.19083

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Review Article

Principles of Electrophysiological Assessments for Movement Disorders: Kai-Hsiang Stanley Chen, Robert Chen; J Mov Disord. 2020;13(1):27-38. Published online January 31, 2020; DOI: https://doi.org/10.14802/jmd.19064

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Electrophysiological studies can provide objective and quantifiable assessments of movement disorders. They are useful in the diagnosis of hyperkinetic movement disorders, particularly tremors and myoclonus. The most commonly used measures are surface electromyography (sEMG), electroencephalography (EEG) and accelerometry. Frequency and coherence analyses of sEMG signals may reveal the nature of tremors and the source of the tremors. The effects of voluntary tapping, ballistic movements and weighting of the limbs can help to distinguish between organic and functional tremors. The presence of Bereitschafts-potentials and beta-band desynchronization recorded by EEG before movement onset provide strong evidence for functional movement disorders. EMG burst durations, distributions and muscle recruitment orders may identify and classify myoclonus to cortical, subcortical or spinal origins and help in the diagnosis of functional myoclonus. Organic and functional cervical dystonia can potentially be distinguished by EMG power spectral analysis. Several reflex circuits, such as the long latency reflex, blink reflex and startle reflex, can be elicited with different types of external stimuli and are useful in the assessment of myoclonus, excessive startle and stiff person syndrome. However, limitations of the tests should be recognized, and the results should be interpreted together with clinical observations.

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Original Articles

Comparison of Spontaneous Motor Tempo during Finger Tapping, Toe Tapping and Stepping on the Spot in People with and without Parkinson’s Disease: Dawn Rose, Daniel J. Cameron, Peter J. Lovatt, Jessica A. Grahn, Lucy E. Annett; J Mov Disord. 2020;13(1):47-56. Published online January 31, 2020; DOI: https://doi.org/10.14802/jmd.19043

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Abstract PDF Supplementary Material

Objective
Spontaneous motor tempo (SMT), observed in walking, tapping and clapping, tends to occur around 2 Hz. Initiating and controlling movement can be difficult for people with Parkinson’s (PWP), but studies have not identified whether PWP differ from controls in SMT. For community-based interventions, e.g. dancing, it would be helpful to know a baseline SMT to optimize the tempi of cued activities. Therefore, this study compared finger tapping (FT), toe tapping (TT) and stepping ‘on the spot’ (SS) in PWP and two groups of healthy controls [age-matched controls (AMC) and young healthy controls (YHC)], as SMT is known to change with age.
Methods
Participants (PWP; n = 30, AMC; n = 23, YHC; n = 35) were asked to tap or step on the spot at a natural pace for two trials lasting 40 seconds. The central 30 seconds were averaged for analyses using mean inter-onset intervals (IOI) and coefficient of variation (CoV) to measure rate and variability respectively.
Results
PWP had faster SMT than both control groups, depending on the movement modality: FT, F(2, 87) = 7.92, p < 0.01 (PWP faster than YHC); TT, F(2, 87) = 4.89, p = 0.01 (PWP faster than AMC); and SS, F(2, 77) = 3.26, p = 0.04 (PWP faster than AMC). PWP had higher CoV (more variable tapping) than AMC in FT only, F(2, 87) = 4.10, p = 0.02.
Conclusion
This study provides the first direct comparison of SMT between PWP and two control groups for different types of movements. Results suggest SMT is generally faster in PWP than control groups, and more variable when measured with finger tapping compared to stepping on the spot.

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Asymptomatic Hearing Impairment Frequently Occurs in Early-Onset Parkinson’s Disease: Kuldeep Shetty, Syam Krishnan, Jissa Vinoda Thulaseedharan, Manju Mohan, Asha Kishore; J Mov Disord. 2019;12(2):84-90. Published online April 5, 2019; DOI: https://doi.org/10.14802/jmd.18048

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Abstract PDF

Objective
Recent reports of hearing impairment in Parkinson’s disease (PD) have suggested that auditory dysfunction could be a non-motor manifestation of PD. These reports were based on observations of elderly patients for whom presbycusis may, to some extent, have contributed to hearing dysfunction. Therefore, we aimed to explore the auditory functions in younger patients with PD. Methods We conducted a case-control study in a relatively younger (< 55 years of age at study time) population of PD patients and healthy volunteers to test whether auditory dysfunction is a significant non-motor dysfunction in PD. Pure tone audiometry (PTA) and brainstem evoked response audiometry (BERA) were performed in all participants. Results None of the patients or controls reported hearing deficits. Fifty-one patients with PD and 50 healthy volunteers who were age- and gender-matched to the patients participated. PTA-detected hearing impairment was found in 64.7% of patients and 28% of controls (p < 0.001) for both low-mid and/or high frequencies. Hearing impairment was more frequent in the younger subgroups of patients than age-matched controls, while the frequency of hearing impairment was similar in older groups of subjects. BERA was not different between patients and controls. Conclusion Asymptomatic auditory dysfunction is a common non-motor manifestation of early-onset PD and more frequent in younger patients, indicating that it may be independent of aging. The mechanism underlying this dysfunction appears to be peripheral, although a central dysfunction cannot be ruled out based on the findings of this study.

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Review Article

Functional Neuroanatomy for Posture and Gait Control: Kaoru Takakusaki; J Mov Disord. 2017;10(1):1-17. Published online January 18, 2017; DOI: https://doi.org/10.14802/jmd.16062

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Abstract PDF

Here we argue functional neuroanatomy for posture- gait control. Multi-sensory information such as somatosensory, visual and vestibular sensation act on various areas of the brain so that adaptable posture- gait control can be achieved. Automatic process of gait, which is steady-state stepping movements associating with postural reflexes including headeye coordination accompanied by appropriate alignment of body segments and optimal level of postural muscle tone, is mediated by the descending pathways from the brainstem to the spinal cord. Particularly, reticulospinal pathways arising from the lateral part of the mesopontine tegmentum and spinal locomotor network contribute to this process. On the other hand, walking in unfamiliar circumstance requires cognitive process of postural control, which depends on knowledges of self-body, such as body schema and body motion in space. The cognitive information is produced at the temporoparietal association cortex, and is fundamental to sustention of vertical posture and construction of motor programs. The programs in the motor cortical areas run to execute anticipatory postural adjustment that is optimal for achievement of goal-directed movements. The basal ganglia and cerebellum may affect both the automatic and cognitive processes of posturegait control through reciprocal connections with the brainstem and cerebral cortex, respectively. Consequently, impairments in cognitive function by damages in the cerebral cortex, basal ganglia and cerebellum may disturb posture-gait control, resulting in falling.

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Original Article

N30 Somatosensory Evoked Potential Is Negatively Correlated with Motor Function in Parkinson’s Disease: Suk Yun Kang, Hyeo-Il Ma; J Mov Disord. 2016;9(1):35-39. Published online January 25, 2016; DOI: https://doi.org/10.14802/jmd.15038

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Abstract PDF

Objective
aaThe aim of this study was to investigate frontal N30 status in Parkinson’s disease (PD) and to examine the correlation between the amplitude of frontal N30 and the severity of motor deficits.
Methods
aaThe frontal N30 was compared between 17 PD patients and 18 healthy volunteers. Correlations between the amplitude of frontal N30 and the Unified Parkinson’s Disease Rating Scale (UPDRS) motor score of the more severely affected side was examined.
Results
aaThe mean latency of the N30 was not significantly different between patients and healthy volunteers (p = 0.981), but the mean amplitude was lower in PD patients (p < 0.025). There was a significant negative correlation between the amplitude of N30 and the UPDRS motor score (r = -0.715, p = 0.013).
Conclusions
The frontal N30 status indicates the motor severity of PD. It can be a useful biomarker reflecting dopaminergic deficits and an objective measurement for monitoring the clinical severity of PD.

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Review Articles

Nonmotor Symptoms and Subthalamic Deep Brain Stimulation in Parkinson’s Disease: Han-Joon Kim, Beom S. Jeon, Sun Ha Paek; J Mov Disord. 2015;8(2):83-91. Published online May 31, 2015; DOI: https://doi.org/10.14802/jmd.15010

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Abstract PDF

Subthalamic deep brain stimulation (STN DBS) is an established treatment for the motor symptoms in patients with advanced Parkinson’s disease (PD). In addition to improvements in motor symptoms, many studies have reported changes in various nonmotor symptoms (NMSs) after STN DBS in patients with PD. Psychiatric symptoms, including depression, apathy, anxiety, and impulsivity, can worsen or improve depending on the electrical stimulation parameters, the locations of the stimulating contacts within the STN, and changes in medications after surgery. Global cognitive function is not affected by STN DBS, and there is no increase in the incidence of dementia after STN DBS compared to that after medical treatment, although clinically insignificant declines in verbal fluency have been consistently reported. Pain, especially PD-related pain, improves with STN DBS. Evidence regarding the effects of STN DBS on autonomic symptoms and sleep-related problems is limited and remains conflicting. Many symptoms of nonmotor fluctuations, which are occasionally more troublesome than motor fluctuations, improve with STN DBS. Although it is clear that NMSs are not target symptoms for STN DBS, NMSs have a strong influence on the quality of life of patients with PD, and clinicians should thus be aware of these NMSs when deciding whether to perform surgery and should pay attention to changes in these symptoms after STN DBS to ensure the optimal care for patients.

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Many Faces of Parkinson’s Disease: Non-Motor Symptoms of Parkinson’s Disease: Hye Mi Lee, Seong-Beom Koh; J Mov Disord. 2015;8(2):92-97. Published online May 31, 2015; DOI: https://doi.org/10.14802/jmd.15003

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Abstract PDF

Parkinson’s disease (PD) is a multi-systemic disorder that is characterized by a combination of motor and non-motor symptoms (NMS). The dopaminergic neurodegeneration of PD is involved in the genesis of NMS, but other conditions and side effects of levodopa are also associated with NMS. NMS can develop at all stage of PD and rapid eyeball movement sleep behavior disorder (RBD), constipation, depression, and olfactory dysfunction are considered prodromal signs of PD. Many NMS related with motor deficits and cognitive dysfunction. Some NMS including olfactory dysfunction, RBD and abnormal stereopsis are associated with presence of other NMS of PD. In addition, several NMS can be helpful to differentiate between idiopathic PD and other parkinsonian disorders. Early recognition and management of NMS in PD patients is important for preserving quality of life.

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Original Article

Neuropsychiatric Symptoms in Parkinson’s Disease Dementia Are Associated with Increased Caregiver Burden: Yoon-Sang Oh, Ji E. Lee, Phil Hyu Lee, Joong-Seok Kim; J Mov Disord. 2015;8(1):26-32. Published online January 31, 2015; DOI: https://doi.org/10.14802/jmd.14019

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Abstract PDF

Objective Neuropsychiatric symptoms are common in Parkinson’s disease dementia (PDD). Frequent and severe neuropsychiatric symptoms create high levels of distress for patients and caregivers, decreasing their quality of life. The aim of this study was to investigate neuropsychiatric symptoms that may contribute to increased caregiver burden in PDD patients.
Methods Forty-eight PDD patients were assessed using the 12-item Neuropsychiatric Inventory (NPI) to determine the frequency and severity of mental and behavioral problems. The Burden Interview and Caregiver Burden Inventory were used to evaluate caregiver burden.
Results All but one patient showed one or more neuropsychiatric symptoms. The three most frequent neuropsychiatric symptoms were apathy (70.8%) and anxiety (70.8%), followed by depression (68.7%). More severe neuropsychiatric symptoms were significantly correlated with increased caregiver burden. The domains of delusion, hallucination, agitation and aggression, anxiety, irritability and lability, and aberrant motor behavior were associated with caregiver stress. After controlling for age and other potential confounding variables, total NPI score was significantly associated with caregiver burden.
Conclusions The results of this study confirm that neuropsychiatric symptoms are frequent and severe in patients with PDD and are associated with increased caregiver distress. A detailed evaluation and management of neuropsychiatric symptoms in PDD patients appears necessary to improve patient quality of life and reduce caregiver burden.

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Trait Impulsivity Is Independent of Mild Cognitive Impairment in a Parkinson’s Disease Cohort
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Cognitive impairment in Parkinson's disease: impact on quality of life of carers
RA Lawson, AJ Yarnall, F Johnston, GW Duncan, TK Khoo, D Collerton, JP Taylor, DJ Burn
International Journal of Geriatric Psychiatry.2017; 32(12): 1362. CrossRef
Rivastigmine as a Symptomatic Treatment for Apathy in Parkinson’s Dementia Complex: New Aspects for This Riddle
Rita Moretti, Paola Caruso, Matteo Dal Ben
Parkinson's Disease.2017; 2017: 1. CrossRef
The relationship of specific items on the Neuropsychiatric Inventory to caregiver burden in dementia: a systematic review
Toril Marie Terum, John Roger Andersen, Arvid Rongve, Dag Aarsland, Ellen J. Svendsboe, Ingelin Testad
International Journal of Geriatric Psychiatry.2017; 32(7): 703. CrossRef
Neuropsychiatric symptoms in Alzheimer’s disease: associations with caregiver burden and treatment outcomes
C.T. Chen, C.-C. Chang, W.-N. Chang, N.-W. Tsai, C.-C. Huang, Y.-T. Chang, H.-C. Wang, C.-T. Kung, Y.-J. Su, W.-C. Lin, B.-C. Cheng, C.-M. Su, S.-Y. Hsiao, C.-W. Hsu, C.-H. Lu
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Johanna C. Badcock, Hedwige Dehon, Frank Larøi
Frontiers in Psychology.2017;[Epub] CrossRef
Dementia Caregiver Burden: a Research Update and Critical Analysis
Sheung-Tak Cheng
Current Psychiatry Reports.2017;[Epub] CrossRef
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Jong Sam Baik, Joong-Seok Kim, Seong-Beom Koh, Jin Whan Cho, Phil Hyu Lee, Hyeo-Il Ma, Yun Joong Kim, Tae-Beom Ahn, Sang Jin Kim, Yong Duk Kim, Seong-min Choi, Ho-Won Lee, Hee Tae Kim
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Case Report

Hypomania Induced by Subthalamic Nucleus Stimulation in a Parkinson’s Disease Patient: Does It Suggest a Dysfunction of the Limbic Circuit?: Ji Seon Kim, Hee Jin Kim, Ji-Young Lee, Jong Min Kim, Ji Young Yun, Beom S. Jeon; J Mov Disord. 2012;5(1):14-17.; DOI: https://doi.org/10.14802/jmd.12004

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Abstract PDF

The aim of this report was to describe a case of hypomania after deep brain stimulation of the subthalamic nucleus (STN DBS) in a Parkinson’s disease (PD) patient. 59-year-old man with a 15-year history of PD underwent bilateral implantation of electrodes to the STN. Immediately after surgery, his motor function was markedly improved and his mood was elevated to hypomania. Fusion images of the preoperative MRI and postoperative CT scan showed that the electrodes were located in the medial portion of the STN. In this case, behavioral mood change was related to the deep brain stimulation. Moreover, the anatomical location and the functional alteration of the STN after the DBS surgery might be related to the regulatory system of the associative and limbic cortico-subcortical circuits.

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Is the Medial Subthalamic Region in Humans Homologous to That in Rodents? Relevance to Neuropsychiatric Disorders and Their Treatment With Deep Brain Stimulation
Marie Barbier, Yvan Peterschmitt, Matthieu Béreau, Pierre-Yves Risold
Biological Psychiatry.2026; 99(3): 200. CrossRef
Architecture of the subthalamic nucleus
Asheeta A. Prasad, Åsa Wallén-Mackenzie
Communications Biology.2024;[Epub] CrossRef
Treating addiction with deep brain stimulation: Ethical and legal considerations
Clara Lo, Mansee Mane, Jee Hyun Kim, Michael Berk, Richard R. Sharp, Kendall H. Lee, Jason Yuen
International Journal of Drug Policy.2023; 113: 103964. CrossRef
The anatomo-functional organization of the hyperdirect cortical pathway to the subthalamic area using in vivo structural connectivity imaging in humans
Gizem Temiz, Sophie B. Sébille, Chantal Francois, Eric Bardinet, Carine Karachi
Brain Structure and Function.2020; 225(2): 551. CrossRef
Hypomania and saccadic changes in Parkinson’s disease: influence of D2 and D3 dopaminergic signalling
Esther A. Pelzer, Barbara Dillenburger, Sophie Grundmann, Vladimir Iliaev, Sophie Aschenberg, Corina Melzer, Martin Hess, Gereon R. Fink, Carsten Eggers, Marc Tittgemeyer, Lars Timmermann
npj Parkinson's Disease.2020;[Epub] CrossRef
Overlapping and distinct neural metabolic patterns related to impulsivity and hypomania in Parkinson’s disease
Frank Schwartz, Masoud Tahmasian, Franziska Maier, Luisa Rochhausen, Kim L. Schnorrenberg, Fateme Samea, Joseph Seemiller, Mojtaba Zarei, Christian Sorg, Alexander Drzezga, Lars Timmermann, Thomas D. Meyer, Thilo van Eimeren, Carsten Eggers
Brain Imaging and Behavior.2019; 13(1): 241. CrossRef
Affective modulation of the associative-limbic subthalamic nucleus: deep brain stimulation in obsessive–compulsive disorder
Mircea Polosan, Fabien Droux, Astrid Kibleur, Stephan Chabardes, Thierry Bougerol, Olivier David, Paul Krack, Valerie Voon
Translational Psychiatry.2019;[Epub] CrossRef
Beyond Emotions: Oscillations of the Amygdala and Their Implications for Electrical Neuromodulation
Lisa-Maria Schönfeld, Lars Wojtecki
Frontiers in Neuroscience.2019;[Epub] CrossRef

Review Article

Electrophysiological Evidences of Organization of Cortical Motor Information in the Basal Ganglia: Hirokazu Iwamuro; J Mov Disord. 2011;4(1):8-12.; DOI: https://doi.org/10.14802/jmd.11002

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Abstract PDF

During the last two decades, the many developments in the treatment of movement disorders such as Parkinson disease and dystonia have enhanced our understanding on organization of the basal ganglia, and this knowledge has led to other advances in the field. According to many electrophysiological and anatomical findings, it is considered that motor information from different cortical areas is processed through several cortico-basal ganglia loops principally in a parallel fashion and somatotopy from each cortical area is also well preserved in each loop. Moreover, recent studies suggest that not only the parallel processing but also some convergence of information occur through the basal ganglia. Information from cortical areas whose functions are close to each other tends to converge in the basal ganglia. The cortico-basal ganglia loops should be comprehended more as a network rather than as separated subdivisions. However, the functions of this convergence still remain unknown. It is important even for clinical doctors to be well informed about this kind of current knowledge because some symptoms of movement disorders may be explained by disorganization of the information network in the basal ganglia.

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Striatal stimulation causing movements mimicking faciobrachial dystonic seizures
Kia Gilani, Madeline Fields, Dina Bolden, Matthew Davitz, Richard Wennberg
Epileptic Disorders.2025;[Epub] CrossRef
Parvalbumin+and Npas1+Pallidal Neurons Have Distinct Circuit Topology and Function
Arin Pamukcu, Qiaoling Cui, Harry S. Xenias, Brianna L. Berceau, Elizabeth C. Augustine, Isabel Fan, Saivasudha Chalasani, Adam W. Hantman, Talia N. Lerner, Simina M. Boca, C. Savio Chan
The Journal of Neuroscience.2020; 40(41): 7855. CrossRef

Case Report

Compulsive Shopping in Parkinson’s Disease - A Case Report: Hyun Cho, Ji-hyun Kwan, Hyun-jin Seo; J Mov Disord. 2008;1(2):97-100.; DOI: https://doi.org/10.14802/jmd.08019

45,061 View
137 Download
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Abstract PDF

Patients with Parkinson’s disease (PD) are at risk of a number of compulsive behaviors associated with dopaminergic drugs. We report one case of unusual compulsive shopping in idiopathic Parkinson disease (IPD) in relation to dopaminergic therapy. The mechanism explaining the behavior in this case is likely related to increased dopaminergic stimulation of non-motor basal ganglia loops. It suggests that perhaps many dopaminergic medications can be associated with compulsive behaviors.

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Kompulsif Satın Alma Davranışının Y ve Z Kuşaklarında Cinsiyetler Arası Analizi
Asena Gizem YİĞİT, Mehmet YİĞİT
OPUS Uluslararası Toplum Araştırmaları Dergisi.2020; 16(28): 1. CrossRef

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