Journal of Parkinson’s Disease

High intensity interval training (HIIT) involves vigorous intensity exercise bouts interspersed with low intensity bouts. Despite growing interest, the optimal dosage and clinical adaptability of HIIT in Parkinson's disease (PD) remain unclear. This scoping review synthesized the literature on systemic adaptations underlying HIIT in PD and developed a clinical framework while considering chronotropic incompetence, orthostatic hypotension, and disease progression.

Three databases were searched for studies that incorporated HIIT interventions in PD. The Template for Intervention Description and Replication checklist was used to characterize the quality of intervention reporting.

A total of 285 studies were screened, of which 10 studies were included. HIIT was administered 2–3 times/week for 30–60 min/session over 8–12 weeks. Seven studies used moderate-volume HIIT and three studies used high-volume HIIT protocols. The quality of intervention reporting was fair to good. HIIT improved cardiorespiratory fitness, motor severity, and functional mobility in PD, however, improvements were comparable to moderate intensity continuous training (MICT). HIIT may facilitate neuroplasticity by increasing brain-derived neurotrophic factor levels and dopamine transporter uptake. We recommend that HIIT programs for individuals with autonomic dysfunction use individualized heart rate targets, and perceived exertion for determining exercise intensity, and incorporate longer duration programs (>12 weeks).

HIIT is a well-tolerated intervention that may improve cardiorespiratory fitness, disease severity, and certain neurobiological markers in mild-moderate PD, with benefits similar to MICT. Larger trials comparing different HIIT volumes are needed to identify optimal exercise volume to inform individualized exercise prescription.

Alpha-synuclein can be detected in skin biopsies of individuals with synucleinopathies. However, quantitative data of total and phosphorylated Serine 129 (pS129) alpha-synuclein in skin biopsies are scarce.

We aimed to investigate the biomarker potential of quantitative total and pS129 alpha-synuclein measurements in skin biopsies from people with synucleinopathies and controls.

We developed and validated AlphaLISA™ immunoassays to determine total and pS129 alpha-synuclein concentrations. Postmortem skin biopsies of Parkinson's disease (PD: n = 18), Dementia with Lewy bodies (DLB: n = 3), Multiple System Atrophy (MSA: n = 5) and control (n = 5) subjects were collected at the cervical vertebra C7. Brain tissues (middle temporal gyrus and substantia nigra) were collected from these same cases. In addition, skin biopsies of controls (n = 20) and PD cases (n = 40) were obtained from the ProPark cohort.

Total and pSer129 alpha-synuclein could be robustly detected and quantified in all skin samples. We observed a trend towards increased total (+58%, p = 0.055) and pS129 (+131%, p = 0.060) alpha-synuclein skin concentrations in synucleinopathy cases compared to controls. We found no correlations between pS129 alpha-synuclein concentrations in paired brain and skin tissues from the same donors. pS129 alpha-synuclein concentrations were similar for clinical PD cases and controls and there was no correlation with motor symptom severity (UPDRS-III).

These findings highlight that total and pS129 alpha-synuclein can be biochemically quantified in skin biopsies, but warrant further validation and investigation to asses its potential as a diagnostic biomarker in clinical cohorts.

In people with Parkinson's disease (PD) or related disorders, together named synucleinopathies, alterations related to the protein alpha-synuclein can often be observed in skin tissue. To what extent this protein differs in skin tissues from people with synucleinopathies compared to people without, has yet to be evaluated. Therefore, we developed an assay to quantify concentrations of alpha-synuclein and a modified form (phosphorylated serine 129) in the skin tissue of people with synucleinopathies and controls after autopsy. Meanwhile, we also looked at alpha-synuclein levels in the brain tissues of these same people. And lastly, we studied alpha-synuclein levels in skin of individuals living with PD and healthy controls. With this assay, we showed that alpha-synuclein forms can be detected and quantified in skin tissue of all investigated cases. The concentration of phosphorylated alpha-synuclein in the skin did not correlate with the concentration observed in the studied brain regions . Skin phosphorylated alpha-synuclein concentrations were similar between subjects living with PD and healthy controls and no correlation was found with disease severity. Overall, this study highlights that alpha-synuclein can be detected and quantified in skin tissues of people suffering from synucleinopathies. More research is needed to determine whether these measures in skin biopsies can be used as a tool for the detection of synucleinopathies in a clinical setting.

Occupational pesticide (OcP) exposure and pathogenic GBA1 variants are established risk factors for Parkinson's disease (PD). However, whether they interact to influence disease onset or severity remains uncertain.

To determine the prevalence of OcP exposure and other lifestyle risks in relation to GBA1 status and their interactions on age of onset (AOO) and clinical scores in a well-characterized PD cohort.

We analyzed 505 people with PD (PwP) enrolled in the Ankara Parkinson's Disease Registry (ANPAR). GBA1 variants were identified using next-generation sequencing; benign or uncertain variants were excluded. Structured, face-to-face interviews collected data on history of OcP exposure, history of head trauma, smoking, coffee and tea consumption habits. PwP with and without GBA1 variants were compared using unadjusted and adjusted tests. General linear models assessed gene—environment interactions on AOO, non-motor, and motor scores.

Fifty-two PwP (10.3%) carried pathogenic GBA1 variants. OcP exposure was more common in carriers than non-carriers (36% vs. 22%; adjusted OR 1.98, 95%CI: 1.07–3.67, p = 0.031). No other risk factor differed between groups. Smoking independently delayed AOO, but there were no significant GBA1 × risk/lifestyle factor interactions for AOO or for motor/non-motor scores. Head trauma, coffee, tea, and OcP exposure showed neither main nor interaction effects on severity indices.

OcP exposure is reported more often by individuals carrying pathogenic GBA1 variants, supporting a gene—environment “dual-hit” model. However, OcPs did not modify AOO or disease severity once PD was manifest.

Parkinson's disease is a neurological disorder that mainly affects movement but also other functions. Genetic, environmental and lifestyle factors may contribute to this disease. One of the strongest genetic risk factors is carrying a harmful change (mutation) in the GBA1 gene. For environmental risks, exposure to pesticides also increases the likelihood of Parkinson's disease. However, not everybody having a GBA1 mutation develop disease. This suggests that additional risks may be necessary for the development of disease. In this study, we investigated the effects of several risk factors including pesticide exposure for their association with GBA1 mutations. We also investigated the impact of these factors on age of disease onset and disease severity. To do this, we examined 505 people with Parkinson's disease from the ANkara Parkinson's Disease Registry (ANPAR). All participants completed interviews about their lifestyle and exposures such as pesticide contact, head trauma, smoking, and coffee or tea consumption habits. We then compared people with and without GBA1 variants to see if there were any differences in these factors. We found that one every 10 patients carried a GBA1 mutation. Pesticide exposure was reported more often in patients carrying a GBA1 mutation. However, pesticide exposure did not have a significant effect on the age at which the disease started. Among the other lifestyle factors, only smoking delayed the onset of the disease. Other factors showed no effect on age of disease onset and severity. Our findings support the idea of a dual-hit model, meaning that having both a harmful GBA1 variant and pesticide exposure may increase the risk of Parkinson's disease. This highlights the complex interaction between genetic and environmental mechanisms for the development of Parkinson's disease.

Despite being the fastest-growing ethnic group in the United States, Asian Americans, encompassing all ethnic subgroups, remain notably underrepresented in Parkinson's Disease (PD) research and clinical trials. This qualitative study seeks to address this gap by exploring how Asian Americans experience PD diagnosis, treatment, care, and research participation.

In-depth interviews were conducted with ten Chinese and Vietnamese people with Parkinson's disease (PWP), nine family care partners, ten providers, and a focus group discussion was conducted with three community advocates in the Greater Boston area. Data were coded using a behavioral model that organizes health services utilization into three domains - predisposing, enabling, and need factors. Resulting themes were then mapped onto an access-to-care framework that conceptualizes access as influenced by both health system characteristics and individuals’ abilities to seek, reach, afford, and engage in care.

We identified individual- and systems-level barriers that present before and after the initial establishment of care, and additional barriers that inhibit research participation among Chinese and Vietnamese PWP. Barriers to delayed diagnosis and reduced quality of care included linguistic and physical inaccessibility to healthcare services, limited health literacy about PD symptoms, cultural beliefs, dissatisfaction with care, shame, and stigma. Outreach from researchers who share a similar ethnicity as PWP may help enhance research participation.

Our findings help fill important research gaps regarding the diagnosis and treatment of Asian American PWP. Recommendations for improvements include the need for linguistically- and culturally-tailored health education, outreach, and services to better support Asian American PWP.

Language and cultural barriers can affect how Parkinson's disease is diagnosed and managed, leading to delays in diagnosis, less effective treatment, and lower quality of life. Little research exists on this topic among Asian Americans, despite being the fastest-growing ethnic group in the United States. Asian Americans also participate in research studies and clinical trials less often than other groups.

We interviewed Chinese and Vietnamese people with Parkinson's disease, their family members caring for them, medical providers, and community leaders in the Greater Boston area. We found common problems affecting care for Parkinson's disease and research participation and added these to a model showing how both health system and individual factors affect access to care. Using what we learned, we created recommendations to improve the steps of the Parkinson's disease diagnosis and treatment journey, and to encourage more Asian Americans to take part in research opportunities.

Obstacles to Parkinson's disease care can exist both before and after someone first sees a doctor. These obstacles can come from personal issues or from aspects of their environment. Before seeing a doctor, problems include not being able to speak English well or feeling shame or stigma about their symptoms. After being diagnosed with Parkinson's disease, problems can include issues getting to doctor's appointments, dissatisfaction with the care they are getting, or not understanding the disease. Participation in research can also be improved when researchers share a similar ethnic background.

Our study helps add to research about Asian American people with Parkinson's disease. We suggest ways to improve care for Asian American people with Parkinson's disease and their family members, such as offering health information and services sensitive to their language and culture.

Osteoporosis and major osteoporotic fracture are more common in PD than controls, but evaluation of sociodemographic factors and preventive treatment is limited.

In a UK population-based nested case-control study, incidence rates of osteoporosis and major osteoporotic fracture were calculated, and risk factors and bone health treatments analyzed by multivariable regression.

Falls, osteoporosis and major osteoporotic fracture were more likely before a diagnosis of PD compared to controls (P < 0.0001). After diagnosis, incident osteoporosis, HR 1.96 (1.90, 2.02) and incident fractures, HR 2.16 (2.11, 2.21) were more likely in PD than controls, both P < 0.005. Risks of fracture were increased in PD cases during 3 consecutive time periods post-diagnosis: 0–7 years, HR 2.15 (2.09, 2.21), 7–14 years, HR 2.36 (2.24, 2.48), and 14–21 years, HR 1.88 (1.62, 2.17), all P < 0.0001. Risks of osteoporosis and fracture increased with older age, female sex, greater deprivation and White ethnicity. In PD, anti-osteoporosis treatment was underutilized in men, OR 0.25 (0.24, 0.26) versus women, being lower than the relative risks of osteoporosis in men, HR 0.35 (0.32, 0.37) and fracture in men, HR 0.60 (0.57, 0.63). There was also underutilization of anti-osteoporosis treatment in the most deprived quintile, HR 0.85 (0.80, 0.90), despite significantly higher rates of osteoporosis, HR 1.14 (1.01, 1.28) and fracture, HR 1.17 (1.06, 1.30).

The increased bone health risks at all stages including the prodrome, and across multiple risk categories, emphasizes the need for early bone health assessment and increased anti-osteoporosis treatment rates.

Handwriting changes are recognised as an early manifestation of Parkinson's disease. Whilst isolated rapid eye movement sleep behaviour disorder (iRBD) is strongly associated with future Parkinson's diagnosis, changes in handwriting remain under-explored.

To assess the handwriting of people with iRBD and develop a rating scale for detection of early disease clinical hallmarks.

Cross-sectional study involving 33 people with polysomnography-confirmed iRBD and 29 controls. Participants copied a standard sentence using pen and paper. A graphologist analysed each script blindly and designed a scale based on observed abnormal patterns which included: micrographia, sentence slope, hidden tremor, retracing, resting marks, irregular shape, excessive pen pressure, and inconsistent word spacing. Each item was scored 0/1 based on their absence/presence. Separately, three blinded movement disorders experts assessed the scripts based on their global clinical impression as well as using the rating scale.

People with iRBD were slower to complete the task than controls (76.70 s (SD = 30.39) vs 61 s (SD = 10.71); p = 0.004). Hidden tremor was the most common feature amongst the iRBD group (72.0% vs 34.5%; p = 0.005), followed by sentence slope (60% vs 24% p = 0.005) and pen pressure (48% vs 14%; p = 0.006). Micrographia was observed in both groups (iRBD 45.4%, controls 41.4% p = 0.801). Classification accuracy of the scale for iRBD was higher than expert global assessment (AUC 0.76 vs AUC 0.62; p = 0.029).

Writing speed, tremor, pen pressure and sentence slope are handwriting features that warrant further investigation to define early patterns in people with iRBD.

Background: Handwriting changes are a known early manifestation of Parkinson's disease. Whilst disturbances in rapid eye movement (REM) sleep are strongly associated with future Parkinson's diagnosis, changes in handwriting remain under-explored. Objective: To assess the handwriting of people with REM sleep disturbances and develop a rating scale for detection of early disease features. Methods: Cross-sectional study involving 33 people with sleep study confirmed REM sleep disturbances and 29 controls. Participants copied a standard sentence using pen and paper. A graphologist analysed each script blindly and designed a scale based on observed abnormal patterns. Each item of abnormal pattern on the scale was scored 0/1 (absence/presence). Separately, three movement disorders experts assessed the scripts based on their global clinical impression as well as using the rating scale. Results: People with REM sleep disturbances were slower to complete the task than controls (76.70s vs 61s). Hidden tremor was the most common feature amongst the iRBD group (72.0% vs 34.5%), followed by sentence slope (60% vs 24%) and pen pressure (48% vs 14%). Micrographia was observed in both groups (iRBD 45.4% vs controls 41.4%). Classification accuracy of the scale for REM sleep disturbances was higher than experts' assessment. Conclusions: Writing speed, tremor, pen pressure and sentence slope are handwriting features that warrant further investigation to define early changes in people with REM sleep disturbances.

Parkinson's disease (PD) frequently involves dysphagia, yet real-world longitudinal data capturing its progression and response to clinical care remain limited. Most prior studies exclude treated patients or rely solely on subjective or cross-sectional data. This study investigates long-term changes in swallowing physiology and diet in a pragmatic, treated PD population.

We retrospectively reviewed patients with PD who underwent at least two videofluoroscopic swallow studies (VFSS) ≥ 1 year apart at a tertiary laryngology center. Individuals with comorbid neurologic or structural disease were excluded. Standardized metrics included the Dynamic Imaging Grade of Swallowing Toxicity (DIGEST), Penetration Aspiration Scale (PAS), Functional Oral Intake Scale (FOIS), and International Dysphagia Diet Standardization Initiative (IDDSI), with kinematic analysis of Pharyngeal Constriction Ratio (PCR) and Maximum Pharyngoesophageal Segment Opening (PESmax). Ordinal outcomes were compared using Wilcoxon signed-rank tests; kinematic changes were analyzed with paired t-tests.

Nineteen patients (mean age 79.4 years, 73% male) completed 38 VFSS over a mean 2.6-year interval. Despite an average of 9.7 swallow therapy sessions per patient, significant declines were observed in PESmax (p < 0.001), DIGEST Overall (p = 0.024), Efficiency (p = 0.039), and IDDSI solids (p = 0.041). Subgroup analysis of mild-to-moderate PD (H&Y 1–3) showed similar trends.

Swallowing function deteriorates over time in PD, even with treatment. This study highlights the value of instrumental reassessment and supports proactive, longitudinal management in real-world care settings.

In anticipation of future clinical trials involving individuals with Parkinson's disease (PD), it is important to have fully validated, clinically-relevant, responsive, disease-specific patient-reported outcome measures that are capable of serially measuring how an individual with PD feels and functions.

To develop and validate a disease-specific patient-reported outcome measure for PD that is sensitive in detecting clinically meaningful changes in multifactorial disease burden during clinical trials.

We conducted qualitative interviews and a cross-sectional study to identify the most important symptoms to individuals with PD. Symptom questions with the highest frequency and relative importance to the cross-sectional study cohort were selected for potential inclusion in the Parkinson's Disease-Health Index (PD-HI). The PD-HI was evaluated and refined through: 1) Qualitative beta interviews; 2) Test-retest reliability assessments; 3) Internal consistency analysis; and 4) Cross-sectional subgroup analysis of PD-HI subscale scores.

Twenty individuals with PD participated in initial qualitative interviews and 404 individuals with PD participated in the cross-sectional study. Symptom questions representing 13 symptomatic themes of PD health were selected for inclusion in the PD-HI. Beta interview participants found the PD-HI to be comprehensive, relevant, and easy to use. The PD-HI demonstrated high test-retest reliability (ICC = 0.90) and internal consistency (α= 0.99). PD-HI total and subscale scores successfully distinguished between subgroups of participants with varying disease severity.

Initial evaluation of the PD-HI demonstrates its content validity, construct validity, usability, and test-retest reliability as a patient-reported outcome tool for potential use in PD clinical trials.

Family members of people with Parkinson's disease (PwP) often experience significant burden and poor quality of life (QoL). However, existing research predominantly centres on caregiver burden, with limited exploration of the broader impact of Parkinson's disease (PD) on family QoL.

To measure the impact of a person's PD on the QoL of their family members and partners using the validated generic Family Reported Outcome Measure-16 (FROM-16).

A cross-sectional study recruited online UK family members/partners of PwP through patient support groups to complete the FROM-16.

152 family members/partners (mean age=67 years, median=70, SD = 10.9; females=106) of patients (mean age=72.3, median=74, SD = 8.5; females=55) with PD completed the FROM-16. The FROM-16 mean total score was 15.3 (SD = 7.9), with 45% of family members/partners having a score ≥17, meaning “a very large effect” on QoL of family members. A significant predictor of family impact was if the patient was male. The most impacted areas were feeling worried, sad, and frustrated, and the impact on holiday, family activities, sleep and sex life.

A person's PD greatly impacts the QoL of their family members/partners. Their well-being has important implications for supporting PwP and nursing home placement, hence the need to measure this impact to provide tailored support to these family members/partners. FROM-16 could be used to measure the family impact of PD in the routine practice of different settings.

Misalignment between actual and perceived balance ability provides relevant information to understand functional deficits and fall risk. However, few studies have provided a continuous quantification of misalignment in neurological populations such as people with Parkinson's disease (PD).

Determine whether a continuous quantification of misalignment between actual and perceived balance ability, discordance, relates to functional outcomes such as quality of life and cognition.

Actual (gait velocity), and perceived (Activities of Balance Confidence) balance, cognition (measured via a computer-based cognitive assessment), and mobility-related quality of life were captured in a clinical sample of 95 people with PD. Primary outcomes were quality of life and cognitive domains frequently altered in people with PD (global cognition & executive function). Secondary cognitive domains assessed were attention, memory, visuo-spatial, verbal function, and information processing. Linear and non-linear models assessed the relationship between discordance, quality of life, and cognition.

Discordance related to mobility-related quality of life, such that under-confidence was related to poorer quality of life. Non-linear (quadratic) models were shown to fit the discordance-Global cognition (p = 0.02) data better than linear models such that over- and under-confidence related to poorer cognition. Secondary cognitive domains were not robustly related to discordance.

In a clinical sample of people with PD, discordance was related to mobility-related quality of life and global cognition. Global cognition further exhibited a possible non-linear relationship to discordance indicating that over- or under-confidence may relate to poorer cognition. This work underscores the functional relevance of misalignment of actual and balance abilities.

This study aimed to use data from the PD-MDCNC database to develop a risk prediction model using machine learning (ML) methods for the early identification of the risk of mild cognitive impairment in Parkinson's disease (PD-MCI) within a Parkinson's disease (PD) patients cohort.

This study used assessment scales and blood test results from 523 patients with Parkinson's disease (PD) in the PD-MDCNC database, collected from the Hubei Parkinson's Disease Clinical Research Center, to develop a predictive model for assessing the risk of mild cognitive impairment (MCI) in PD patients. Using simple assessment scales and blood test data, we developed ten machine learning algorithms to predict PD-MCI. The optimal model was determined through comparison, and its performance was evaluated using an external validation cohort of 139 PD patients from a Taihe state hospital in Shiyan City, Hubei Province.

The area under the receiver operating characteristic curve (AUC) for the ten models ranged from 0.57 to 0.72. The best predictive performance was achieved with RF (AUC=0.72). The variable importance ranking results indicated that the U3 score was the best important feature in predicting PD-MCI.

This study presents a robust machine learning model for the early detection of MCI in PD patients, which may help provide a simple method for early identification of PD-MCI patient.

Accessible screening tools are crucial for the early detection of cognitive impairment in Parkinson's disease (PD), especially in contexts where in-person assessments are not feasible.

To assess the clinical usability of telephone-based cognitive screening (TBCS) tools in PD patients.

Forty-two non-demented PD individuals and N = 103 healthy controls (HCs) underwent a TBCS battery including the Telephone Interview for Cognitive Status (TICS), the Telephone-based Frontal Assessment Battery (t-FAB) and sub-tests from the Telephone-based Verbal Fluency Battery (t-VFB) and Telephone Language Screener (TLS). PD individuals were also administered the Montreal Cognitive Assessment (MoCA) in person and assessed for behavior and cognitive-driven functional independence via caregiver-report questionnaires administered over the telephone (Neuropsychiatric Inventory, NPI and Amsterdam IADL Questionnaire – 30-item version, A-IADL-Q-30, respectively). Correlations were run to test the construct and ecological validity of TBCS tests in PD individuals; ROC analyses were run to test the capability of TBCS tests to discriminate PD individuals from HCs and PD individuals with a defective MoCA from those performing normally (PD-MCI vs. PD-CN).

The vast majority of TBCS measures were significantly associated with the MoCA and A-IADL-Q-30 scores, supporting convergent and ecological validity, respectively; TBCS measures also diverged from the NPI. TBCS measures of global cognition and executive-attentive measures discriminated PD individuals from HCs with acceptable accuracy (AUC = 0.71–0.75), showing, by contrast, a better performance in differentiating PD-MCI from PD-CN groups (AUC = 0.74–0.89).

TBCS tests are clinimetrically sound tools for identifying cognitive deficits in PD.

People with Parkinson's disease often face challenges with memory and attention, which can affect their daily lives. Finding these problems early is important, but traditional in-person tests can be hard to arrange, especially for people who live far away or have difficulty moving. This study looked at whether simple tests done over the telephone could help identify cognitive problems in people with Parkinson's disease. We tested 42 people with Parkinson's and 103 healthy individuals using phone-based tools that check memory, attention, language, and planning. We also compared the phone test results with in-person tests and questionnaires filled out by caregivers about how well patients manage daily activities. The results showed that phone tests gave information similar to in-person tests and caregiver reports. They were able to tell apart people with Parkinson's from healthy individuals, and especially to identify those with more severe cognitive difficulties. These findings suggest that telephone tests are a useful and reliable way to check cognitive problems in people with Parkinson's disease. This could make it easier for specialists to detect and monitor these problems, especially when in-person visits are not possible.

Levodopa is still the cornerstone of symptomatic treatment for people with Parkinson's disease (PwP). With disease progression and long-term use, PwP can develop motor complications such as wearing off and dyskinesia. There is limited practical guidance on the early identification of motor fluctuations and the optimal timing of adjunctive therapies in clinical practice.

To develop expert consensus on best practices for initiating and monitoring levodopa therapy, recognising early motor fluctuations, incorporating adjunctive therapies, and improving patient education in the management of Parkinson's disease (PD).

A modified Delphi methodology was used. A steering committee (SC) of nine clinicians with experience in managing PD drafted 59 consensus statements across four thematic domains. Statements were developed into an online survey and distributed to a panel of UK-based healthcare professionals (HCPs). Respondents rated their agreement using a four-point Likert scale. Consensus was defined as ≥75% agreement.

A total of 150 HCPs completed the survey, including neurologists, geriatricians, and PD nurse specialists. Consensus was achieved for all 59 statements (100%). Key areas of agreement included early alignment of treatment with individual patient goals, the need for routine monitoring using standardised tools, timely initiation of adjunctive therapies, and the importance of accessible, ongoing patient and caregiver education.

This Delphi consensus provides a set of expert-derived, clinically applicable recommendations to support proactive and individualised management of PD. Adoption of these practices may enhance the recognition and treatment of motor fluctuations, improve patient quality of life, and support better long-term outcomes.

Levodopa is a key medicine for treating Parkinson's disease, helping with symptoms like stiffness and slow movement. Over time, though, some people notice changes in how well their medication works during the day. This can mean the effects wear off too soon or cause involuntary movements called dyskinesia.

Healthcare professionals do not have much practical guidance on how to spot these problems early, when to add new treatments, or how to best support people with Parkinson's and their caregivers.

This study brought experts together to create useful recommendations for better care.

Nine UK experts who treat Parkinson's disease came up with 59 statements about different parts of care, like starting and monitoring levodopa, noticing early changes in movement, adding new medicines,and teaching patients and caregivers. They shared these statements with 150 healthcare professionals, including neurologists, geriatricians, and nurse specialists, who rated how much they agreed with each one. If 75% or more agreed, the statement was considered a consensus.

All 59 statements reached full agreement from the group. The main recommendations were to start treatment based on each person's goals and needs, check symptoms regularly with standard tools, add new therapies at the right time to prevent problems, and make sure people with Parkinson's and their caregivers get ongoing, easy-to-understand education and support.

The experts agreed on clear best practices to help healthcare professionals give more proactive and personalised care to people with Parkinson's disease. Using these recommendations may help spot movement problems sooner, improve symptom control, and boost patients' quality of life over time.

Exercise can improve outcomes for people with Parkinson's. Telerehabilitation (TR) may lower costs and maximise clinician time but its efficacy for gait and balance in early Parkinson's is uncertain. We conducted a randomized controlled feasibility trial of individualised real-time physiotherapy delivered via videoconference.

We recruited people with early (<4 years’ duration) Parkinson's from 2 English NHS hospitals. The TR group had 1 × 60 min, 4 × 30 min video calls and 2 × 10 min calls. These calls occurred within 12 weeks of randomization. Experienced physiotherapists prescribed individualized exercises. The usual care group received standard exercise advice from their physician. Physical activity was measured using Fitbit Inspire. A qualitative process evaluation was undertaken.

84 people were screened, 64 were eligible and 40 recruited. 21 and 19 were randomized to TR and usual care respectively. 90% of study instruments were completed per protocol.

Median [interquartile range; IQR] change in Unified Parkinson's Disease Rating Scale (UPDRS) at six months was −3.5 [−8 to 2.5] for the TR group and 7 [0 to 17] for usual care, effect size (Cohen's D = −0.537). Median [IQR] change in weekly step count was 4215 [−8769 to 19664] for the TR group versus −2185 [−10764 to 3143] for usual care (Cohen's D = 0.198). Participants found the intervention acceptable. Most participants were confident in using the videoconference systems.

A definitive trial of TR for early Parkinson's is feasible. UPDRS and step count are suitable outcomes.

The decision to undergo deep brain stimulation (DBS) surgery for patients with Parkinson's disease (PD) is often challenging and complex. Decisional outcomes may be improved by using decisional support tools that foster shared decision making.

The objective of this study was to develop a decision aid for PD patients considering DBS surgery and evaluate its acceptability.

The decision aid was developed using an evidence-based and systematic approach. The steps in development included a needs assessment, literature review, development of a decision aid prototype, and testing of the prototype with surveys for acceptability in a clinic setting.

A total of 136 participants with PD participated in this study. The needs assessment included 57 participants who completed the decisional conflict scale with a mean score of 35.3, indicating high decisional conflict. After development, initial testing of the decision aid was completed by 22 participants (16 on paper version and 6 on interactive website version). Subsequently, 46 PD participants evaluated the decision aid for acceptability. Eighty seven percent of participants agreed or strongly agreed that they were satisfied with the quality of the decision aid. Most participants found the language, amount of information, length, balance, and risk and benefits section acceptable.

We determined that PD patients undergoing DBS evaluation experience high decisional conflict. We subsequently created a DBS decision aid to increase knowledge, manage expectations, clarify values, and facilitate shared decision making. The decision aid was acceptable to PD patients with and without DBS.