Journal of the neurological sciences
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A subtle cognitive impairment can be detected early in the course of Parkinson's disease (PD). Executive, memory and visuospatial functions are specifically affected, but the underlying pathophysiological basis is not well elucidated yet and may be heterogeneous. The recent identification of a PD-related cognitive metabolic pattern (PDCP), including hypometabolism in associative frontal, parietal and posterior limbic structures, has integrated the classical notion of a striato-frontal syndrome at the basis of cognitive dys-function. ⋯ Administration of AchE inhibitors to PDD patients increased brain metabolism in bilateral frontal and left parietal regions, and left posterior cingulate. Finally, the recent availability of radiopharmaceuticals able to disclose amyloid brain deposition has allowed to demonstrate amyloid load in a part of patients with PDD, possibly due to diffuse rather than neuritic plaques. Brain PET and SPECT have strongly contributed to the understanding of the pathophysiology of cognitive impairment in PD and may serve as probes to monitor the effects of therapeutic interventions.
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Sexual problems are common in Parkinson's disease and contribute to poor quality of life of patients and partners. Nonmotor and motor disease manifestations can affect sexual function. This article reviews the progressive and multidimensional sexual manifestations and provides practical suggestions for taking sexual history and treating sexual problems, which may enable clinicians to contribute to the sexual wellbeing of patients.
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The choice of a scale has important implications for the results of clinical research, including epidemiological and treatment studies. In addition to the requirements for any clinical scale, evaluation of rating scales for depression and apathy in Parkinson's disease (PD) faces additional challenges, reflecting the overlap of syndromes, controversies on the concept particularly of apathy, fluctuations related to medication, and difficulties in assessment. ⋯ Scales for screening need to have different properties than scales for rating severity. Overall, there is no perfect scale, but the choice of scale needs to take into account clinimetric properties, validity in the sample examined, content and purpose.