Fabiana Giada Radicati

Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele

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Fabrizio Stocchi

IRCCS Ospedale San Raffaele

Laura Vacca

Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele

КR

К. Ray Chaudhuri

King's College Hospital

Margherita Torti

Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele

Marco Onofrj

University of Chieti-Pescara

Pablo Martínez‐Martín

Biomedical Research Networking Center on Neurodegenerative Diseases

Cristian Falup‐Pecurariu

Clinical Emergency Hospital Bucharest

Stefano Bonassi

IRCCS Ospedale San Raffaele

Massimiliano Casali

University of Modena and Reggio Emilia

C Fossati

University of Milan

Cooperative Institutions

Istituti di Ricovero e Cura a Carattere Scientifico

Sapienza University of Rome

Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele

John Wiley & Sons (United States)

IRCCS Ospedale San Raffaele

Vita-Salute San Raffaele University

University of Rome Tor Vergata

Parkinson's UK

Biomedical Research Networking Center on Neurodegenerative Diseases

University College London

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Effectiveness of an herbaceous derivatives, PHGG, plus sodium hyaluronate in the treatment of chronic constipation in patients with Parkinson’s disease: a pilot study

Neurological Sciences (2021)

Laura Vacca Stefania Proietti Daniele Bravi Fabiana Giada Radicati Fabrizio Stocchi

10.1007/s10072-021-05342-8

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Citations (3)

Applications of the European Parkinson’s Disease Association sponsored Parkinson’s Disease Composite Scale (PDCS)

npj Parkinson s Disease (2019)

Roberta Balestrino Carlos Alberto Hurtado González Fabrizio Stocchi Fabiana Giada Radicati К. Ray Chaudhuri

Abstract This study was addressed to determine the presence of Parkinson disease (PD) manifestations, their distribution according to motor subtypes, and the relationships with health-related quality of life (QoL) using the recently validated European Parkinson’s Disease Association sponsored Parkinson’s Disease Composite Scale (PDCS). Frequency of symptoms was determined by the scores of items (present if >0). Using ROC analysis and Youden method, MDS-UPDRS motor subtypes were projected on the PDCS to achieve a comparable classification based on the PDCS scores. The same method was used to estimate severity levels from other measures in the study. The association between the PDCS and QoL (PDQ-39) was analyzed by correlation and multiple linear regression. The sample consisted of 776 PD patients. We found that the frequency of PD manifestations with PDCS and MDS-UPDRS were overlapping, the average difference between scales being 5.5% only. Using the MDS-UPDRS subtyping, 215 patients (27.7%) were assigned as Tremor Dominant (TD), 60 (7.7%) Indeterminate, and 501 (64.6%) Postural Instability and Gait Difficulty (PIGD) in this cohort. With this classification as criterion, the analogous PDCS-based ratio provided these cut-off values: TD subtype, ≥1.06; Indeterminate, <1.06 but >0.65; and PIGD, <0.65. The agreement between the two scales on this classification was substantial (87.6%; kappa = 0.69). PDCS total score cut-offs for PD severity were: 23/24 for mild/moderate and 41/42 for moderate/severe. Moderate to high correlations ( r = 0.35–0.80) between PDCS and PDQ-39 were obtained, and the four PDCS domains showed a significant independent influence on QoL. The conclusions are: (1) the PDCS assessed the frequency of PD symptoms analogous to the MDS-UPDRS; (2) motor subtypes and severity levels can be determined with the PDCS; (3) a significant association between PDCS and QoL scores exists.

Association (psychology)

10.1038/s41531-019-0097-1

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Poor Reactivity of Posterior Electroencephalographic Alpha Rhythms During the Eyes Open Condition in Patients with Dementia Due to Parkinson’s Disease

SSRN Electronic Journal (2022)

Claudio Babiloni Giuseppe Noce Federico Tucci Raffaele Ferri Simonetta Panerai

Patients with Parkinson’s disease dementia (PDD) suffer from vigilance dysregulation reflected by hypersomnolence, cognitive fluctuations, hallucinations, and sleep disorders. Therefore, we hypothesized that such dysregulation may be reflected by altered reactivity of posterior resting-state electroencephalographic (rsEEG) alpha rhythms during the vigilance transition from eyes-closed to -open condition. A Eurasian database provided clinical, demographic, and rsEEG datasets in 73 PDD patients, 35 ADD patients, and 25 matched cognitively unimpaired (Healthy) persons. The eLORETA freeware was used to estimate cortical rsEEG sources at delta, theta, alpha, beta, and gamma frequency bands during eyes-closed and-open conditions. Results showed substantial (> -10%) reduction (reactivity) in the posterior alpha source activities from the eyes-closed to the eyes-open condition in 88% of the Healthy seniors, 57% of the ADD patients, and only 35% of the PDD patients. In these alpha-reactive participants, there was lower reactivity in the parietal alpha source activities in the PDD group than in the healthy control subjects and the ADD patients. These results suggest that PDD is characterized by poor reactivity of mechanisms desynchronizing posterior rsEEG alpha rhythms in response to visual inputs. This finding could be an interesting biomarker of impaired vigilance regulation in the quiet wakefulness in PDD patients. Such biomarkers may provide endpoints targets for pharmacological intervention and brain electromagnetic stimulations to improve the PDD patients’ general ability to regulate vigilance and visual primary consciousness in the activities of daily living.

Alpha (finance)

Eyes open

10.2139/ssrn.4163963

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Non motor symptoms in progressive supranuclear palsy: prevalence and severity

npj Parkinson s Disease (2017)

Fabiana Giada Radicati Pablo Martínez Martín C Fossati К. Ray Chaudhuri Margherita Torti

NMSs have been extensively studied in PD patients but not in other forms of parkinsonism such as Progressive Supranuclear Palsy (PSP). The primary objective of this study was to analyze the frequency, severity and the type of non-motor symptoms (NMS) in PSP patients using the non-motor symptoms scale (NMSS). The secondary objective was to differentiate NMS between PSP and Parkinson's disease (PD). We enrolled in this cross-sectional study 50 consecutive PSP and 100 matched Parkinson's disease (PD) patients, in the proportion PSP/PD = 1/2, matched in age, sex, and disease duration. Motor and Non Motor symptoms (different scales for each disease) were evaluated at baseline using PSP scale, SCOPA Motor, Montreal Cognitive Assessment (MOCA), HADS, Hamilton, and Non Motor Symptom scale (NMSS). Comparative analysis was done using chi-squared test, Mann-Whitney test and Fisher's exact test. Fifty PSP (56% female) and 100 PD (59% female) patients completed the study protocol and were included for statistical analysis. The NMSS total domains score in the PSP group was 77.58 ± 42.95 (range 14-163) with NMS burden grade: 4, very severe, and the in the PD group was 41.97 ± 35.45 (range: 0-215) with NMS burden grade: 3, severe. The comparative analysis showed that NMS total score (p < 0.0001), Sleep/Fatigue (p = 0.0007), Mood/Apathy (p = 0.0001), Gastrointestinal (p < 0.0001), and Urinary dysfunction (p = 0.0001) domains were significantly more severe in PSP patients than in PD. This observational study reports that NMSs are very frequent in PSP patients hence the higher burden of NMS in PSP specifically related to mood/apathy, attention/memory, gastrointestinal, urinary disturbances compared to PD.

Apathy

10.1038/s41531-017-0037-x

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Citations (35)

Parkinson's Disease Composite Scale

PsycTESTS Dataset (2018)

Fabrizio Stocchi Fabiana Giada Radicati К. Ray Chaudhuri Ann‐Cathrine Johansson C. Padmakumar

10.1037/t74207-000

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Extensive validation study of the Parkinson's Disease Composite Scale

European Journal of Neurology (2019)

Pablo Martínez‐Martín Fabiana Giada Radicati Carmen Rodríguez‐Blázquez John B. Wetmore Norbert Kovács

A composite instrument able to rapidly and reliably assess the most relevant motor and non-motor afflictions suffered by Parkinson's disease (PD) patients in a real world clinic setting is an unmet need. The recently validated PD Composite Scale (PDCS) was designed to fulfil this gap as a quick, comprehensive PD assessment. The objective of this study was extensive evaluation of the PDCS's clinimetric properties using a large international sample.This was a cross-sectional study in which the PDCS, the Movement Disorder Society Unified Parkinson's Disease Rating Scale and the Clinical Impression of Severity Index for PD were applied. Basic clinimetric attributes of the PDCS were analysed.In total, 776 PD patients were included. The PDCS total score showed negligible floor and ceiling effects. Three factors (54.5% of the variance) were identified: factor 1 included motor impairment, fluctuations and disability; factor 2, non-motor symptoms; and factor 3, tremor and complications of therapy. Cronbach's alpha was from 0.66 to 0.79. Inter-rater reliability showed weighted kappa values from 0.79 to 0.98 for items and intraclass correlation coefficient values from 0.95 (Disability) to 0.99 (Motor and total score). The Bland-Altmann method, however, showed irregular concordance. PDCS standard error of measurement and convergent validity with equivalent constructs of other measures were satisfactory (≥0.70). PDCS scores significantly differed by Hoehn and Yahr stage.Overall, in line with previous findings, the PDCS is a feasible, acceptable, valid, reliable and precise instrument for quickly and comprehensively assessing PD patients.

Concordance

Kappa

10.1111/ene.13976

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Citations (14)

The Parkinson's Disease Composite Scale: results of the first validation study

European Journal of Neurology (2017)

Fabrizio Stocchi Fabiana Giada Radicati К. Ray Chaudhuri Anders Johansson Chandrasekhara Padmakumar

Background and purpose The aim was to validate the Parkinson's Disease Composite Scale ( PDCS ). Methods The study included 194 Parkinson's disease ( PD ) patients in five countries. Investigators completed the following scales: PDCS , the Movement Disorder Society Unified Parkinson's Disease Rating Scale ( MDS ‐ UPDRS ), Parkinson's Disease Sleep Scale Version 2, Montreal Cognitive Assessment, the Scale for Evaluation of Neuropsychiatric Disorders in Parkinson's Disease and the Clinical Impression of Severity Index for PD ( CISI ‐ PD ). For test−retest analysis, a second administration of the PDCS was carried out in 61 stable patients (as per the CISI ‐ PD ) in 7–14 days after the first evaluation. The PDCS is a novel scale for PD with a total of 17 items divided into four domains: motor, non‐motor, treatment complications and disability. Results Parkinson's Disease Composite Scale mean and median values were close. Skewness values were into the criterion limits (−1 to +1). The complete range of scores was covered for 14 of the 17 items (83.4%). A floor effect of 25.26% and 28.25% was observed in the complications and disability level dimensions due to the proportion of patients free of these difficulties. No relevant floor or ceiling effect was observed for the PDCS total score (1.03% and 0.52%, respectively). The stability of the scale appeared excellent with most items meeting weighted kappa and intraclass correlation coefficient values >0.80. The convergent validity of the PDCS with corresponding scores of the MDS ‐ UPDRS showed high correlation values ( r S ≥ 0.60). The internal validity was into acceptable limits, with the majority of values higher than the minimal 0.30 threshold. The standard error of measurement suggested a satisfactory precision (SEM 3.81, <30% of the PDCS total score standard deviation). Conclusion The PDCS appears to be a feasible, acceptable, reproducible and valid scale.

Movement Disorders

Ceiling effect

Montreal Cognitive Assessment

Convergent validity

Cohen's kappa

10.1111/ene.13529

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Citations (27)

How to optimize the treatment of early stage Parkinson’s disease

Translational Neurodegeneration (2015)

Fabrizio Stocchi Laura Vacca Fabiana Giada Radicati

The approach to early Parkinson's disease denotes the communication of the diagnosis and important decisions, such as when and how to start treatment. Evidence based medicine and guidelines indicate which drugs have robust evidence of efficacy and tolerability in this specific population. However, de-novo patients may show different characteristics and they may be in a different phase of their disease. In this review, we will give an insight into the appropriate time therapy should be started and the actual knowledge about disease modification therapies. Moreover, the drugs indicated for early treatment will be considered and an indication for the use of these drugs will be given with the support of the actual knowledge.

Tolerability

10.1186/2047-9158-4-4

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Effect of family history, occupation and diet on the risk of Parkinson disease: A case-control study

PLoS ONE (2020)

Margherita Torti C Fossati Massimiliano Casali Maria Francesca De Pandis Paola Grassini

Background The aetiology of Parkinson’s disease (PD) is still very controversial, with a peculiar lack of established risk factors or protective behavior. Methods We carried out a case–control study of 634 idiopathic PD patients admitted from 2011 to 2015 to two hospitals located in central Italy and 532 controls matched by hospital, gender and age (± 5 years). The study questionnaire included questions on host factors, family history, residence, occupation and lifestyle. Odds ratios (ORs) for PD and 95% confidence intervals (CIs) were estimated with logistic regression, adjusting for actual and potential confounders. Results A lower OR was observed in females (0.74; 95%CI:0.58–0.96), while older age classes showed a constantly increased risk for PD (p<0.005) starting from the class 65–69 years. Subjects who reported a first degree relative affected by PD showed a borderline increase which was more evident in those enrolled in the urban center of Rome (OR = 1.65; 95%CI: 1.09–2.50). Significant reduction of the risk was associated to current smoking (OR = 0.48; 95%CI: 0.24–0.54), and to vegetables consumption (p<0.03), while borderline increases were associated to meat and cold cut consumption. Occupational activities classified according to ISCO-08 categories did not show increased risk, while higher ORs’ were found for pilots and physicians. Conclusions The results from this study confirmed the higher risk of PD in males and in elderly, and the inverse association with smoking habit. The possible etiological role of familial clustering, dietary habit, and some job tasks is suggested.

Etiology

10.1371/journal.pone.0243612

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Clinical and pharmacokinetics equivalence of multiple doses of levodopa benserazide generic formulation vs the originator (Madopar)

British Journal of Clinical Pharmacology (2019)

Margherita Torti Jhessica Alessandroni Daniele Bravi Massimiliano Casali Paola Grassini

While several generic preparations of levodopa/carbidopa and levodopa/benserazide (LBD) are currently available, pharmacokinetic (PK) equivalence and therapeutic equivalence studies with levodopa generics are not available in Italy. Lack of data on generic formulations is a critical factor for their limited use in this country and often lead patients to refuse the generic version of the branded drug.

Benserazide

10.1111/bcp.14086

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Citations (2)