Movement Disorders Research Articles

Nonmotor symptoms (NMSs) in pediatric movement disorders, such as tics, dystonia, and cerebral palsy (CP), are important to consider but can be often overlooked, despite their substantial impact on daily functioning and quality of life. Understanding which NMSs are evaluated in these patient groups, and by which tools, can support the shaping of future research, including the potential development of future dedicated NMS assesment instruments. The aim of this scoping review was to identify the scales and tools used in routine practice and/or in research to assess NMSs in children with movement disorders. A comprehensive search of MEDLINE, Embase, and PsycINFO was conducted for studies published between 1990 and 2023. Eligible studies included those that evaluated NMSs using scales in children aged 0-18 years with tic disorders, dystonia, or CP. A total of 382 studies were included. Most of the articles identified were cross-sectional, cohort, and case-control studies. Cognitive impairment, mental health, behavioral difficulties, and pain were most frequently assessed using standardized scales. However, self-esteem and communication-critical components of social functioning-were rarely evaluated. The assessment of sleep disturbance, fatigue, and gastrointestinal and urinary symptoms was also less frequently addressed. Notably, our methodological approach may have led to an overrepresentation of NMS assessment in CP, given the larger body of literature available for this condition. Significant gaps exist in the evaluation of NMSs in pediatric movement disorders, particularly in areas such as pain, sleep, and gastrointestinal issues. While standardization of NMS assessment is needed, it is unclear whether disorder-specific tools are preferable to broader NMS-focused measures. Given the current lack of data, using general scales may be a pragmatic first step, with refinement into disorder-specific tools as our understanding of symptom patterns evolves. Cross-cultural validation is also essential to improve the applicability of NMS scales across diverse populations. Integrating NMS assessment into routine clinical practice and interdisciplinary care may facilitate early identification and better management of these symptoms.

Deep brain stimulation (DBS) is considered off-label and investigational in pediatric populations with some exceptions. There are limited data on the relative rates of complications after DBS across different indications and targets in children. This study aimed to evaluate the safety of DBS surgery for children with movement disorders (MDs; dystonia, chorea, or tic disorders), drug-resistant epilepsy (DRE), or neurodevelopmental disorders, namely, self-injurious behavior (SIB). Data were collected both prospectively and retrospectively from children implanted with DBS through the North American multicenter Child and Youth CompreHensIve Longitudinal Database for Deep Brain Stimulation and included demographic, clinical, operative, and postoperative variables. Complications included infection, noninfectious surgical site findings (dehiscence or seroma), hardware-related issues (disconnection or impedance change), intracranial injury, or other complications. The primary outcome was major complications, defined as any adverse event causing permanent neurologic injury or requiring surgical intervention. The secondary outcome was minor complications, defined as nonmajor complications. Generalized linear models were used to assess for any significant associations with complications. A total of 130 children and youth (mean age 12.2 ± 4.2; range 3-18) years and weighing 12.5-126.6 kg underwent DBS. The most common indication was MD (77, 59.2%), followed by DRE (47, 36.2%) and SIB (6, 4.6%). Major complications occurred in 11.5%, with a greater likelihood in MD (n = 12, 15.6%) compared with DRE (n = 2, 4.3%; odds ratio [OR] 3.55, 95% CI 2.66-4.73, p < 0.001) and significantly associated with lower weight at surgery (p < 0.001) and urgent intervention (p = 0.028). These included infection (6.2%), hardware malfunction (3.1%), and wound dehiscence (0.8%). Minor complications were also higher with MD compared with DRE (OR 1.83, 95% CI 1.16-2.89, p = 0.010) occurring in 22 participants (16.9%; 14 MD, 7 DRE, 1 SIB), including infection (6.2%), high impedance (1.5%), unrelated hydrocephalus (0.8%), perioperative worsening of symptoms (3.8%), incidental tract hemorrhage (2.3%), and noninfectious peri-electrode cystic changes (0.8%). DBS-associated complications were low across multiple pediatric indications and targets, with MD associated with higher risk of major complications. Limitations include a focus on surgical postoperative complications and not stimulation-related adverse outcomes. These findings demonstrate the safety profile of DBS in children in a large cohort.

Spinocerebellar ataxia (SCA) is a genetically heterogeneous neurodegenerative disorder with no effective treatments. Although noninvasive cerebellar neuromodulation has shown positive outcomes, invasive approaches such as deep brain stimulation (DBS) remain inadequately evaluated in SCA. This study assessed the treatment outcomes of DBS targeting the cerebellar dentate nucleus (DN) in SCA patients over a 6-month follow-up. Six patients with heterogeneous SCA underwent bilateral DN-DBS. The stimulation parameters were programmed iteratively, and ataxia symptoms were evaluated at predefined intervals using the Scale for the Assessment and Rating of Ataxia (SARA) and the International Cooperative Ataxia Rating Scale (ICARS). Individualized appropriate stimulation parameters (current, frequency, and pulse width) were established. At the 6-month follow-up, the SARA scores decreased by 43% (P = 0.014) and the ICARS scores by 51% (P = 0.013) compared with baseline. These findings provide evidence for the potential therapeutic efficacy of DN-DBS in SCA and offer preliminary insights for stimulation parameter programming. © 2025 International Parkinson and Movement Disorder Society.

DYT-VPS16, an early-onset isolated dystonia caused by variants in the VPS16 gene, has been reported in fewer than 70 patients. We explored the clinical and genotypic spectrum of DYT-VPS16 by investigating early-onset dystonia patients with VPS16 variants discovered in our large Biodatabank and through gene-matching initiatives. Patient samples were analyzed by exome/Sanger and RNA/cDNA sequencing. We identified 16 previously unreported DYT-VPS16 patients (7 male, median age at onset [AAO]: 12 years). Patients with initial leg involvement had an AAO more than 10 years earlier than those with involvement of the arms/craniocervical region. Dystonia progressed in 95%, generalized in 50%, and was accompanied by pyramidal, cerebellar, or psychiatric features in 25% of patients. Two young individuals benefited greatly from timely deep brain stimulation (DBS) surgery. Of the 11 identified VPS16 variants, 10 were novel. Utilizing RNA-Seq or cDNA sequencing, we discovered alternatively spliced transcripts, thereby elucidating the effects of splice-site, near-splice-site, and exonic variants. We expand the phenotypic and mutational spectrum of DYT-VPS16, emphasize the utility of RNA-Seq in clarifying VPS16 variant pathogenicity, and advocate for timely DBS as a promising therapeutic option for DYT-VPS16 patients. © 2025 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Laryngeal dystonia (LD) is a focal task-specific dystonia, affecting speaking but not whispering or emotional vocalizations. Therapeutic options for LD are limited. We developed and tested a non-invasive, closed-loop, neurofeedback, brain-computer interface (BCI) intervention for LD treatment. Ten patients with isolated focal LD participated in the study. The personalized BCI system included visual neurofeedback of individual real-time electroencephalographic (EEG) activity during symptomatic speaking compared toasymptomatic whispering, presented in the virtual reality (VR) environment of real-life scenarios. During five consecutive days of intervention, patients used the BCI to learn to modulate their abnormally increased brain activity during speaking and match it to near-normal activity of asymptomatic whispering. Changes in voice symptoms and EEG activity were quantified for the evaluation of BCI effects. Compared to baseline, LD patients had a statistically significant reduction of their voice symptoms on Days 1-5 of BCI intervention. Thiwas paralleled by improved controllability of the visual neurofeedback and a significant reduction of left frontal delta power, including superior and middle frontal gyri, on Day 1 and left central gamma power, including premotor, primary sensorimotor, and inferior parietal areas, on Days 3 and 5. The majority of patients (70%) reported sustained positive effects of the BCI intervention on their voice quality 1 week after the study participation. The closed-loop BCI neurofeedback intervention specifically targeting disorder pathophysiology shows significant potential as a novel treatment option for patients with LD and likely other forms of task-specific focal dystonia. © 2025 International Parkinson and Movement Disorder Society.

BackgroundPsychotic symptoms are common in patients with Parkinson's Disease Dementia and Dementia with Lewy Bodies, known collectively as the Lewy Body Dementias (LBD). It is important to identify these symptoms early and accurately. However, these symptoms are challenging to identify and quantify in clinical practice. The Psychosis and Hallucinations Questionnaire (PsycH-Q) was developed as a self-report tool using patient-friendly language to assess hallucinations and related phenomena and has been previously validated in Parkinson's Disease patients without dementia and their caregivers.ObjectivesThis study aimed to evaluate the utility of the PsycH-Q in patients diagnosed with a Lewy Body Dementia.MethodsA total of 33 LBD patients, assisted by their caregivers, completed the PsycH-Q, along with the Scales for Outcomes in Parkinson's Disease-Psychiatric Complications (SCOPA-PC) and the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS). Items relating to hallucinations and psychotic phenomena from the SCOPA-PC and MDS-UPDRS were then compared with analogous ratings on the PsycH-Q.ResultsScores on the PsycH-Q were significantly correlated with SCOPA-PC Questions 1 and 3, as well as the MDS-UPDRS question 1.2 (Spearman's rho of 0.65, 0.73, and 0.47, respectively; p < 0.01 for all three correlations).ConclusionsThese results support the PsycH-Q as a patient-friendly questionnaire that accurately identifies hallucinatory phenomena and their features in LBD patients via self-report completed by patients with their caregivers. Future use of the PsycH-Q in clinical practice and research could improve early detection of psychotic symptoms in LBD patients, leading to improved management.

We sought to characterize the sixth most common finding in our neuroimmunological laboratory practice (tissue assay-observed unclassified neural antibodies [UNAs]), combining protein microarray and phage immunoprecipitation sequencing (PhIP-Seq). Patient specimens (258; 133 serums; 125 CSF) meeting UNA criteria were profiled; October 2022-September 2023. Top-ranking candidate antigens were validated in silico, by dual-staining confocal microscopy, and ≥ 1 protein-specific assay. Clinical data were reviewed. Among 21 patients, 11 autoantibodies were characterized (serum, 19; CSF, all 9 available). Autoantigens were CACNA1I, 1; CAMK2B, 2; CLIP2, 1; FMN2, 2; MAP1A, 2; MAP2, 5; NECAB1, 1; SNAP91, 3; SRCIN1, 1; SYNJ1, 1; SYT3, 2. Analytical validation was by confocal TIIFA (all), western blot (10/10 available), and cell-based assay (5/5 performed). Clinical accompaniments were: encephalitis, 6; brainstem encephalitis, 2; encephalomyelitis, 2; cerebellar ataxia, 2; longitudinally extensive transverse myelitis (LETM), 2; sensory neuronopathy, 1; peripheral neuropathy, 4, and movement disorders, 2. Inflammatory MRI abnormalities were identified in 5/16 patients (31%) with CNS disorders: T2 signal change (2), LETM (2), leptomeningeal enhancement (1). Seven of 8 (88%) had inflammatory CSF (pleocytosis, 5 [median 25.5 cells, range 7-294]; elevated IgG index/synthesis rate, 4; CSF-exclusive oligoclonal bands, 4). Six had paraneoplastic causation (lung cancer, 2; other, 4); 3 were postinfectious (1 each of COVID-19, HSV-1, and post-Group A streptococcal infection). Of 9 immunotherapy-treated patients, 5 improved. UNAs are partly accounted for by a repertoire of diverse mostly intracellular synaptic antigens. Their characterization is expedited by protein arrays and PhIPSeq. Further individual studies are needed to assess them as disease biomarkers.

The brainstem plays a pivotal role in the generation and control of eye movements—including saccades, smooth pursuit, the vestibulo-ocular reflex (VOR), vergence, and gaze holding. Beyond its vital physiological functions, it is also essential for the coordination of balance and movement. Consequently, eye movement disorders of brainstem origin are often accompanied by vertigo, imbalance, unsteady gait, and diplopia, particularly during changes in head or body position. A sound understanding of the neural structures involved in oculomotor and vestibular control is therefore crucial for accurately identifying and localizing a wide variety of brainstem syndromes. However, oculomotor abnormalities resulting from brainstem disease represent a major diagnostic challenge for the neurotologist, owing to the wide spectrum of possible etiologies (vascular, traumatic, degenerative, neoplastic), their variable severity and clinical course (acute, fluctuating, or progressive), and the frequent concomitant involvement of other central structures, particularly the cerebellum. This mini review summarizes the pathophysiological mechanisms and clinical features of oculomotor disorders and nystagmus associated with brainstem disease.

Introduction Parkinson's disease (PD) is a neurodegenerative disorder for which deep brain stimulation (DBS) of the subthalamic nucleus (STN) is an established treatment. Despite standardized programming, some patients seem to respond very well to DBS (optimal responders), while others seem to react poorly (poor responders). The objective is to compare the area of tissue activated between optimal and poor responders and determine whether there is a potential optimal stimulation area. Methods For 338 PD patients with STN-DBS, four outcome categories on the Movement Disorders Society Unified Parkinson Disease Rating Scale (MDS-UPDRS) motor part were assessed: hemibody, rigidity, bradykinesia, and tremor score for left and right separately. For each outcome category, patients were divided into one of three responder groups, based on their percentage hemibody improvement (optimal responders, >70% improvement; responders, 30-70% improvement; poor responders, <30% improvement). For each of the resulting 12 groups, volumes of tissue activated (VTA) were modeled for every individual electrode based on the stimulation parameters during follow-up assessment. To enable the responder groups comparison, all VTAs were aggregated into a so-called heatmap in normalized space. As we were mainly interested in the difference in VTA location for the optimal and poor responders, only these group heatmaps were visually assessed in reference to the STN. For quantitative sub-analyses the amount of current applied and spread of electrode location was compared. Results Considerable overlap between heatmaps of optimal and poor responders within the dorsolateral region of the STN was seen. The amount of current applied and spread of electrode location did not differ. Conclusions This study comparing anatomical group-level studies of VTAs of optimal responders with poor responders for STN-DBS in PD did not find an area of optimal stimulation to reduce variability in DBS outcome. However, the heatmap of optimal responders can facilitate easier DBS targeting. To reduce variability in DBS outcome, focus could shift more towards patient-specific anatomy and connectivity levels in order to determine the individual optimal subthalamic area for programming.

Sleep bruxism has been investigated among sleep-related movement disorders, highly prevalent in children with Attention Deficit Hyperactivity Disorder (ADHD). Children and adolescents with ADHD tend to have more sleep disorders compared to those with neurotypical development. Although there are still no specific guidelines for the treatment of bruxism in this population, it is believed that exogenous melatonin may contribute to improving sleep quality and reducing bruxism episodes. Therefore, the present study aimed to report the case of a 13-year-old male adolescent diagnosed with ADHD and frequent episodes of sleep bruxism. The patient had a history of talking and agitation during sleep, in addition to daytime fatigue. He reported grinding his teeth at least three times a week, in addition to fatigue in the facial muscles and tooth sensitivity when consuming cold foods. To improve sleep quality, it was decided to administer 3 mg of melatonin for a period of 60 days, together with sleep hygiene recommendations. A significant improvement in sleep quality and a reduction in bruxism-related symptoms were observed. Although this is a single case, the findings suggest that melatonin may represent a promising therapeutic alternative, reinforcing the need for larger and more controlled clinical studies to investigate its efficacy and safety in this population

While ATPase Copper Transporting Beta (ATP7B), Dystonia-1 (DYT-1), Lysine (K) Methyl transferase 2B (KMT2B), and Adenylate Cyclase 5 (ADCY5) gene mutations are well-characterized causes of childhood-onset choreo-dystonic movement disorders, G protein subunit alpha O1 (GNAO1)-related disorders are not commonly suspected. The GNAO1 gene is crucial for neuronal transmission, and its mutation has been linked to neurodevelopmental delay, infantile-onset epilepsy, and movement disorders. To the best of our knowledge, only five Indian cases have been reported to date. We report a 9-year-old girl with predominant choreo-dystonic manifestations along with dyskinetic storm, i.e., episodes of significant worsening in involuntary movements following febrile episodes. Her brain magnetic resonance imaging (MRI) was unremarkable. She presented to us in a dyskinetic crisis, which responded to oral haloperidol. Thus, GNAO1-related disorder must be suspected in a child with developmental delay, infantile- to childhood-onset seizures with/without movement disorders, along with episodes of dyskinetic crisis related to stress or febrile episodes.

Functional movement disorders (FMDs) manifest as involuntary motor symptoms incongruent with known neuroanatomy. Once attributed to psychological factors, FMDs are now recognized as neurobiological conditions involving disrupted brain networks. They account for 2-20% of movement disorder referrals globally. While multidisciplinary rehabilitation benefits 60-70% of patients, 30-40% remain treatment-refractory, highlighting the need for biologically targeted therapies. This review synthesizes evidence on neuromodulation for FMDs, aiming to: (1) identify modifiable neural circuits, (2) evaluate clinical efficacy across phenotypes, (3) distinguish neurobiological from placebo-mediated effects, and (4) identify biomarkers for precision medicine. We conducted a narrative review (PubMed, Embase, 2000-2025), assessing risk-of-bias using RoB-2 and MINORS tools. FMD pathophysiology involves cortical hyperexcitability, limbic-motor decoupling, and predictive coding deficits. TMS reveals reduced intracortical inhibition and shortened cortical silent periods in M1; fMRI shows altered emotional-motor connectivity. rTMS demonstrates therapeutic potential, though placebo responses are prominent. Anodal tDCS over the left DLPFC shows promise in functional dystonia, especially with comorbid anxiety. FMDs reflect circuit-level dysfunction, supporting neuromodulation as a rational intervention. High-frequency rTMS over M1 and anodal tDCS over DLPFC yield modest clinical benefits, but placebo effects remain a confounder. Future progress requires addressing methodological gaps, validating biomarkers, and integrating neuromodulation within personalized, multidisciplinary frameworks that account for socioeconomic and psychosocial contexts to meaningfully reduce disability.

Variants in the GBA1 gene can increase the risk of Parkinson's disease (PD) by reducing glucocerebrosidase (GCase) activity, disrupting lysosomal and mitochondrial function, and increasing alpha-synuclein aggregation. The molecule GT-02287 prevents misfolding of GCase and ameliorates downstream pathway abnormalities. To assess the safety, tolerability, pharmacokinetics, and pharmacodynamics of GT-02287. The safety, tolerability, and plasma pharmacokinetics of single and multiple oral doses were evaluated in 73 healthy volunteers, and GT-02287 levels in cerebrospinal fluid (CSF) and GCase activity in blood were measured. All dose levels tested were safe and generally well-tolerated. No serious or severe adverse events occurred. The most common events were nausea and headache. Plasma and CSF exposures were within the projected therapeutic range, and GCase activity increased after GT-02287 administration. GT-02287 was safe and well-tolerated in healthy volunteers. Plasma and CSF levels were consistent with levels in rodents that modulate PD biology. © 2025 International Parkinson and Movement Disorder Society.

Neurologic examination is still the main source of data gathering for diagnosing and monitoring diseases. Items of neurologic examination need to be researched to assess their reliability, reproducibility, and correlation with various scales. To evaluate the competence of finger to crease (F-C) variation of the finger tapping test as opposed to the traditional method (F-T) in detecting bradykinesia in Parkinson's disease patients and to evaluate the interrater reliability of the test. We compared the two finger tapping variations in 42 Parkinson's disease patients. We examined our patients using the bradykinesia subscale of the Unified Parkinson's Disease Rating Scale (UPDRS) and the Hoehn and Yahr (H&Y) scales with the two methods of the finger-tapping test. To assess the interrater reliability of the test, a different pool of patients was used, in which four movement disorder specialists evaluated videos of 29 patients performing the finger-tapping test using the two methods with each hand. Both methods were positively correlated with Parkinson staging based on the H&Y scale and the bradykinesia subsection of the UPDRS. Mean H&Y scores and UPDRS bradykinesia subscale scores given to the patients using the F-C method were significantly higher than those when the F-T method was employed. Using F-C instead of F-T led to a higher H&Y stage placement in 12 subjects. Both methods showed good to excellent inter-rater reliability (Cronbach's alpha >0.80). Our findings show that this finger-tapping variation is reliable and may increase the sensitivity of the examination.

Background Parkinson’s disease (PD) is a neurodegenerative disorder characterized by progressive motor deficits and gait disturbances. While medication offers symptomatic relief, long-term complications and gradual functional decline remain significant challenges. Robot-assisted training provides intensive, task-specific motor rehabilitation and has shown promise in improving gait for PD patients. Soft wearable robot suits, designed with lightweight, flexible materials, offer enhanced comfort, adaptability, and biomechanical support compared to traditional robots. However, there is limited evidence regarding the effectiveness of hip extensor assistance with soft wearable robots for gait improvement in PD. Methods This is a prospective, single-center, single-blind, parallel-group study, and will recruit 34 PD patients. The participants will be assigned to either a robot or control group. Both groups will receive identical rehabilitation interventions, each session comprising 20-min of strength training, 5-min rest, and 20-min of treadmill walking. The rehabilitation program will be applied identically to all participants. The key difference between the groups will be whether participants wear the soft wearable robot suit during treadmill walking session. The intervention will be conducted 2 times per week, a total of 12 sessions for 6 weeks. The H-Medi (HUROTICS, Inc.), a cable-driven soft wearable robot suit will be utilized for the intervention and hip extensor assistance will be applied. For outcome measures, the following assessments will be performed at baseline (T0) and post-intervention (T1): Gait speed, Timed-Up and Go test, Short Physical Performance Battery, Berg Balance Scale, Movement Disorder Society-Unified Parkinson’s Disease Rating Scale, Freezing of Gait Questionnaire, gait parameters, muscle strength and endurance, quadriceps muscle thickness, body composition, cognition, and depression. The primary outcome will be the difference of gait speed from T0 to T1. The secondary outcomes will be the differences of other measures. Discussion This study will be the first to assess hip extensor assistance provided by a soft wearable robot suit as a targeted therapy for gait impairment in PD. Results are expected to clarify device usability, safety, and impact on gait. By focusing on hip extension, the findings may help advance personalized gait rehabilitation and inform the design and clinical adoption of future wearable robotic devices for PD. Clinical trial registration KCT0010793.

Essential tremor (ET) is a common movement disorder, characterized by bilateral postural or kinetic tremor and associated non-motor symptoms including anxiety and cognitive impairment. Current treatments offer limited efficacy and significant side effects, highlighting the need for novel therapeutic approaches. This study investigated the therapeutic potential of memantine and vitamin D3 (vitD3) combination therapy in a harmaline-induced mouse model of essential tremor. Adult male Swiss mice were divided into eight groups (n = 8/group): control, sham, harmaline-induced ET (10mg/kg, i.p. on days 1, 3, and 5), memantine (5mg/kg, i.p. for 7days), vitD3 (0.1µg/kg, i.p. for 7days), and combination treatment groups. Tremor severity, footprint analysis, rotarod, and wire grip tests were conducted to assess motor function. Moreover, anxiety-like behavior, depressive-like behavior, and cognitive function were examined. Expression of leucine-rich repeat and immunoglobulin domain-containing protein 1 (Lingo-1) and NMDA receptor expression in cerebellar tissue was evaluated using quantitative real-time PCR. Histological evaluation of Purkinje cell morphology was performed using hematoxylin-eosin staining. Harmaline administration induced significant tremor, motor coordination deficits, anxiety-like behaviors, and cognitive impairments. Treatment with memantine and/or vitD3 significantly reduced tremor scores on days 3 and 5 compared to harmaline alone. Combination therapy restored locomotor activity. Both individual and combination treatments demonstrated significant anxiolytic effects. VitD3 alleviated depressive-like behavior. Moreover, cognitive assessment revealed that combination therapy significantly improved passive avoidance learning and memory retention. Harmaline dramatically upregulated Lingo-1 and NMDA receptor expression, which was effectively normalized by memantine and/or vitD3 treatment. Histological examination demonstrated that vitD3 and combination therapy significantly reduced harmaline-induced Purkinje cell degeneration. Memantine and vitD3 combination therapy ameliorates both motor and non-motor symptoms in a mouse model of ET through modulation of Lingo-1 and NMDA receptor expression pathways. These findings suggest that this combination approach represents a therapeutic strategy that addresses the complex pathophysiology of ET while providing neuroprotective benefits.

BackgroundA higher prevalence of neurological conditions has been found in schizophrenia, bipolar disorder and other psychotic illnesses compared to the general population. We aimed to understand the cumulative prevalence of 15 neurological conditions in people with severe mental illness (SMI) from 5 years before to 5 years after their SMI diagnosis.MethodsWe identified patients with SMI, aged 18–100 years from 1 Jan 2000 to 31 Dec 2018, from the UK Clinical Practice Research Datalink. Each SMI patient was matched 1:4 to individuals without SMI. The cumulative prevalence of 15 neurological conditions was recorded at 5, 3 and 1 years prior to SMI diagnosis; at SMI diagnosis; and 1, 3 and 5 years after SMI diagnosis. Prevalences were compared with logistic regression.ResultsWe identified 68 789 patients with SMI and 274 827 comparators. Of 15 neurological conditions, 13 (multiple sclerosis, cerebrovascular disease, dementia, ataxic disorders, epilepsy, Parkinson’s disease, other parkinsonism, paralysis, other movement disorders, cerebrospinal fluid disorders, cerebral palsy, disorders of nerve root, plexus or peripheral nerves and autonomic disorders) were more prevalent in SMI compared with comparators at the time of SMI diagnosis. Dementia (OR: 4.22; 95% CI 3.88 to 4.58), epilepsy (OR: 3.01; 95% CI 2.83 to 3.19) and Parkinson’s disease (OR: 3.97; 95% CI 3.45 to 4.57) were particularly elevated at 5 years post-SMI diagnosis.ConclusionsMany neurological conditions have higher prevalence in the SMI cohort compared with those without SMI. The different prevalence patterns observed in our study highlight the need to establish the causal pathways between specific SMI and neurological disease diagnoses.

Prolonged hospitalization contributes to a decline in physical function and immobilization. This narrative review aims to explore physical rehabilitation approaches that address the specific characteristics of physical dysfunction in patients with schizophrenia. A literature review was conducted following an electronic search of PubMed for English-language articles published between January 2014 and January 2025. Based on the findings, a framework was constructed to categorize symptoms and physical challenges into three domains: (1) movement disorders and obesity induced by antipsychotic medications, which alter motor performance and lead to compensatory movements; (2) negative symptoms and cognitive impairments, which promote sedentary behavior and result in dysphagia, dynapenia, sarcopenia, and frailty; and (3) accelerated brain aging and disuse syndrome by schizophrenia, which impair neuromotor and cognitive function and increases the risk of physical dependency. These interconnected factors emphasize the need for targeted physical rehabilitation to maintain independence and reduce the risk of hospitalization. This review proposes a multidisciplinary approach involving psychiatrists, physical therapists, and occupational therapists, along with individualized nutritional support, as essential components of comprehensive rehabilitation strategies aimed at improving physical outcomes and reducing early mortality in this population.

IntroductionParkinson’s disease (PD) is a chronic neurodegenerative condition that affects approximately 10 million people worldwide. As the second most common neurodegenerative disease, its prevalence is expected to double in the next 30 years. PD is characterised by both motor and non-motor symptoms that significantly impact patients’ quality of life. The disease leads to physical disabilities and can strain the social and emotional well-being of patients and caregivers. While pharmacological and surgical treatments are essential, non-pharmacological approaches, including self-care strategies, play a critical role in managing the disease. This study protocol aims to describe methodological steps required to explore the self-care behaviours of patients with PD and their caregivers, with a particular focus on the dimensions of self-care maintenance, monitoring and management.Methods and analysisThis mixed-method study will involve dyads of patients with PD and their caregivers. Participants will be recruited from the PD and Movement Disorders Centre of the “Azienda Socio Sanitaria Territoriale (ASST) Gaetano Pini-Centro Traumatologico Ortopedico (CTO)”. Validated questionnaires, such as the WHOQOL-Bref, the version 2 Self-Care of Chronic Illness Inventory, and the Caregiver Self-Efficacy in Contributing to Self-Care Scale, will be administered. The study will also include semistructured interviews to collect qualitative data on patients’ and caregivers’ perceptions of self-care. A non-probabilistic convenience sampling method will be employed, encompassing both patients at any stage of disease and their primary caregivers. The estimated sample size is 311 dyads, calculated to provide a 5% margin of error.Ethics and disseminationThe study has been approved by the Lombardia 3 ethics committee (identification (ID) study 5732 12.03.2025 P bis). All participants will sign a written informed consent document. Ethical considerations include ensuring participant confidentiality, voluntary participation and the right to withdraw at any time without consequence. The study results will be disseminated through national and international conferences and published in clinical research journals to contribute to the broader understanding of self-care in the management of PD.Trial registration numberNCT06953050 (clinicaltrials.gov).

ABSTRACT We tested the hypothesis that Parkinson’s disease (PD) impairs verbs’ event structures and/or sensory-motor semantic features, as suggested by theories of grounded cognition. Nineteen participants with PD and 16 age-matched Controls produced verbs and used a Likert scale to rate verbs’ event-based association with instruments (e.g. fork – eating versus bathing) and locations (e.g. airport – waiting versus singing). When producing instrument-related verbs, PD participants responded slower and had a lower proportion of relevant responses than Controls. Yet PD participants showed a relatively intact ability to produce location-related verbs and to rate instrument- and location-related verbs. Greater motor disease primarily impacted instrument-related verb production. 4/19 PD participants had mild cognitive impairment (per Movement Disorders Society criteria), which affected both instrument- and location-related verb production and ratings. Overall, results were consistent with “weak” grounded cognition theories that propose that sensory-motor simulation may enrich action-semantic processing but is not strictly necessary for action-semantic processing.