Parkinson's Disease最新文献

{"title":"Speed-Variable Treadmill Training Improves Hand Motor Function in Individuals With Parkinson's Disease.","authors":"Lara Shigo, Brittany E Smith, Angela L Ridgel","doi":"10.1155/padi/6163541","DOIUrl":"10.1155/padi/6163541","url":null,"abstract":"<p><p>Aerobic exercise programs with proprioceptive sensory feedback elements such as split-belt treadmill training, perturbation treadmill training, and dynamic cycling improve function in people with Parkinson's disease (PwPD). However, these tools are expensive and not highly accessible. Speed-variable (SV) treadmill training utilizes small-amplitude treadmill belt speed fluctuations every 10-60 s, emulating aforementioned paradigms in a more-accessible design targeted toward home or gym settings. Fourteen PwPD (67.6 ± 6.5 years, 6 female) completed one 30-min session of SV training and one 30-min session of normal (N) non-speed-varied treadmill training in a counterbalanced design. Motor function was assessed pre- and postexercise with KinesiaONE inertial measurement unit validated for assessment of symptoms including tremor, bradykinesia, rhythm, and amplitude of movement. Heart rate (HR) did not differ significantly (<i>p</i> = 0.146, <i>t</i> = -1.102) across conditions, with average HR in 60%-65% age-predicted HRmax range. Rating of perceived exertion (RPE) was significantly (<i>p</i> = 0.020, <i>t</i> = 2.274, effect size 0.608) lower in SV condition than N condition by 0.8 points on the 6-20 Borg scale. Generalized linear mixed model analysis revealed significant interaction effects in sum hand motor function, bradykinesia and tremor sum, and resting and postural tremor items (<i>p</i> < 0.05), driven by improvements in symptoms post-SV exercise. No significant interactions were observed for hand amplitude, rhythm of movement, or lower body symptoms. Overall, data support SV treadmill training as an exercise paradigm for PwPD to acutely impact hand motor function utilizing a standard treadmill. Future work should evaluate multiple sessions of training and evaluate dose-response effect of speed variability.</p>","PeriodicalId":19907,"journal":{"name":"Parkinson's Disease","volume":"2026 ","pages":"6163541"},"PeriodicalIF":2.2,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13475450/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148765675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Air Pollution and Parkinson's Disease Pathology: Clinical Evidence and the Molecular Mechanisms Linking Airborne Toxicants to Neuroinflammation and Neurodegeneration.","authors":"Sina Pakkhesal, Seyedyashar Pourebrahimian Leilabadi, Sina Hamzehzadeh, Farshad Zare, Elnaz Gholipour-Khalili, Fatemeh Malekinejad, Shahrzad Fakhkhari, Mahnaz Talebi, Amirreza Naseri","doi":"10.1155/padi/6914112","DOIUrl":"10.1155/padi/6914112","url":null,"abstract":"<p><p>Parkinson's disease (PD) is a neurodegenerative condition, and its rising prevalence necessitates the urgent need to identify modifiable risk factors. Air pollution, a pervasive and also escalating public health problem, has emerged as a potential contributor to the incidence and progression of PD. As urbanization and industrialization continue to exacerbate global air pollution levels, understanding the relationship between airborne toxicants and PD is a pressing scientific and public health priority. In this review, we critically discuss the current epidemiological evidence and the cellular and molecular mechanisms underlying air pollution-induced neurodegeneration in PD. Clinical studies associate long-term interaction with pollutants such as nitrogen oxides, particulate matter, and ozone with increased PD risk. Evidence also suggests that air pollution worsens PD prognosis. Mechanistically, air pollution is hypothesized to contribute to PD pathogenesis through gut microbiome alternations, oxidative stress, and neuroinflammatory pathways, as well as promoting α-synuclein aggregation.</p>","PeriodicalId":19907,"journal":{"name":"Parkinson's Disease","volume":"2026 ","pages":"6914112"},"PeriodicalIF":2.2,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13454954/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148707223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Validity of Wrist- and Trunk-Worn Sensor-Derived Data Models in Parkinson's Disease.","authors":"Yanke Sun, Sally Day, Kate Walters, Anette Schrag","doi":"10.1155/padi/8598501","DOIUrl":"10.1155/padi/8598501","url":null,"abstract":"<p><strong>Background: </strong>Clinical rating scales for Parkinson's disease (PD) have limitations in the accurate assessment of disease severity, which may obscure treatment effects in clinical management and trials. Body-worn sensors can provide data for continuous and more precise monitoring of motor features of PD in patients' daily lives. However, little information exists on the clinical validity of sensor-derived data.</p><p><strong>Objectives: </strong>We assessed the clinical validity of outputs from three different machine learning models using trunk- or wrist-worn sensors in patients with PD, assessing their correlations with scores on clinical scales assessing motor severity and impact on function.</p><p><strong>Methods: </strong>Wrist- and/or trunk-worn sensors were worn by patients with PD, who had been assessed using the MDS-UPDRS and the EQ-5D-5L, for up to one week. Output data were analyzed using three different algorithms: One trained on a publicly available dataset using trunk sensor data and two previously derived from wrist sensor data. Clinical validity was examined by examining correlations of sensor-derived outputs with individual items of the MDS-UPDRS and EQ-5D-5L.</p><p><strong>Results: </strong>For the trunk-worn sensor-derived outputs, the strongest positive correlations were found between output data and axial features such as arising from a chair, posture, and body bradykinesia and aspects of daily functioning on the MDS-UPDRS Part II and health-related quality of life (EQ-5D-5L domain) scores. For the wrist-worn sensor-derived outputs, the strongest positive correlations were seen between output data and postural tremor, rest tremor amplitude, and ability to undertake hobbies. Outputs from both body locations were correlated with MDS-UPDRS II and EQ-5D-5L scores (<i>r</i> > 0.7). In participants who wore both trunk and wrist sensors, percentage of time spent in different activities was similar between trunk- and wrist-worn devices, except for time spent \"Lying down\" derived from the trunk-worn sensor compared to time spent \"Sleeping\" derived from the wrist-worn sensor algorithm.</p><p><strong>Conclusion: </strong>These data provide preliminary evidence for the clinical validity of single sensor assessments as measures of severity of motor features and motor functioning in patients with PD for use in clinical trials and practice. The results should be confirmed in large and more diverse populations and expanded to include other assessment methods such as laboratory-based motor measurements.</p>","PeriodicalId":19907,"journal":{"name":"Parkinson's Disease","volume":"2026 ","pages":"8598501"},"PeriodicalIF":2.2,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13449171/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148697546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Onset of Motor Complications and Medication Dose in Newly Diagnosed and Treated Parkinson's Disease.","authors":"Yasushi Osaki, Yukari Morita, Sho Ohtsuru, Tomohiro Shogase, Daiji Yoshimoto, Tatsuya Ikeda, Sayomi Kabeya, Yu Hashimoto, Takuya Matsushita","doi":"10.1155/padi/8827381","DOIUrl":"10.1155/padi/8827381","url":null,"abstract":"<p><strong>Background: </strong>Parkinson's disease (PD) patients under medical treatment experience motor complications (MCs), namely, ON/OFF fluctuations (ON/OFF) and dyskinesias.</p><p><strong>Methods: </strong>We assessed 120 newly diagnosed PD patients after the initiation of medical treatment who were followed up for at least 24 months. We reviewed the latency of ON/OFF or dyskinesias by months and calculated the levodopa dose (LD), levodopa dose divided by daily intake (LDdiv), and levodopa equivalent dose (LED). We estimated cumulative incidence and median latency by Kaplan-Meier survival analysis. We classified patients with MCs into four groups and patients with ON/OFF or dyskinesias into three groups, according to latency.</p><p><strong>Results: </strong>Seventy-six patients experienced MCs with a median latency of 28 months. Fifty-seven patients experienced ON/OFF and 19 experienced dyskinesias with a median latency of 28 and 50 months, respectively. The medication dose at which each patient experienced ON/OFF or dyskinesias varied widely. The median LD, LDdiv, and LED was 300 (237.5-350), 100 (79-111), and 300 (250-450) mg at the onset of MCs; 300 (200-300), 100 (83-125), and 300 (249-400) mg at the onset of ON/OFF; and 400 (375-500), 125 (105-133), and 600 (466-722.75) mg at the onset of dyskinesias, respectively. Consistently, the shortest latency group had the lowest medication dose, while the longest latency group had the highest. Five patients experienced dyskinesias before ON/OFF, with similar medication doses at the onset of ON/OFF and dyskinesias. Some patients experienced ON/OFF but have not yet developed dyskinesias under a comparable medication dose as patients who experienced dyskinesias; the latter had a significantly younger age at onset.</p><p><strong>Conclusions: </strong>The pathophysiological backgrounds and changes causing ON/OFF or dyskinesias are not the same for all patients. The presence of ON/OFF and higher medication doses does not always cause dyskinesias. A younger age at onset may be associated with the occurrence of dyskinesias.</p>","PeriodicalId":19907,"journal":{"name":"Parkinson's Disease","volume":"2026 ","pages":"8827381"},"PeriodicalIF":2.2,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13424818/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148654063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Efficacy and Safety of Monoclonal Antibodies That Target Alpha-Synuclein in Parkinson's Disease: A Systematic Review.","authors":"Daniel Coles, Anish Kalyana, Sameer Khalil, Dhyana Chauhan, Thiara Rupasinghe, Charlie Costello, Amit Batla, Tim Young","doi":"10.1155/padi/8540084","DOIUrl":"10.1155/padi/8540084","url":null,"abstract":"<p><strong>Background: </strong>Parkinson's disease is a progressive neurodegenerative disorder with no currently approved disease-modifying therapies. Alpha-synuclein targeting monoclonal antibodies provide a potential therapeutic strategy.</p><p><strong>Objectives: </strong>To evaluate published studies of the efficacy and/or safety of monoclonal antibodies that target alpha-synuclein in human subjects.</p><p><strong>Methods: </strong>A systematic review of peer-reviewed journal articles was conducted. PubMed, Embase and Scopus were searched up to March 2, 2025. Results were synthesised narratively. Risk of bias was assessed, and sensitivity analysis excluding studies with high risk was performed.</p><p><strong>Results: </strong>After screening 1509 papers, 10 publications incorporating a total of 13 studies were included. These assessed Prasinezumab, Cinpanemab, Exidavnemab and Lu-AF82422 with heterogeneity amongst studies. Tolerability was generally favourable across all studies. Cinpanemab showed almost no efficacy, whilst Prasinezumab demonstrated mixed motor symptom improvements. Safety profiles for all monoclonal antibodies reflected mostly consistent rates of adverse events. Six studies were removed in the sensitivity analysis due to high risks of bias, which reduced Prasinezumab's apparent efficacy findings.</p><p><strong>Conclusions: </strong>The efficacy of monoclonal antibodies in Parkinson's disease remains uncertain with most positive results coming from the studies with high risks of bias. Prasinezumab demonstrated an efficacy profile with the potential of significance, warranting further research. This lack of efficacy reported with Cinpanemab is consistent with the manufacturer's decision to discontinue it. Safety data on Exidavnemab and Lu-AF82422 in healthy volunteers support further investigation in Parkinson's disease patients. Future trials may benefit from the inclusion of subjects at earlier disease stages, diagnosed before clinical features have emerged. <b>Trial Registration:</b> ClinicalTrials.gov identifier: NCT03100149.</p>","PeriodicalId":19907,"journal":{"name":"Parkinson's Disease","volume":"2026 ","pages":"8540084"},"PeriodicalIF":2.2,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13392413/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148579994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Breaking the Freeze: The Role of Cognitive Function in Freezing of Gait in Parkinson's Disease.","authors":"Ondrej Papacek, Evzen Ruzicka","doi":"10.1155/padi/7199074","DOIUrl":"10.1155/padi/7199074","url":null,"abstract":"<p><p>Freezing of gait (FOG) is a highly disabling, poorly dopa-responsive symptom of Parkinson's disease (PD) that becomes increasingly prevalent with disease progression and is one of the main contributors to falls and loss of independence. Although FOG has long been viewed as a motor phenomenon, converging evidence shows that executive impairment-particularly deficits in attention, task-switching, inhibition, and visuospatial processing-is strongly implicated in its pathophysiology. Yet the field lacks a coherent framework explaining how these cognitive processes contribute to FOG and how they should be targeted in therapy. This narrative review synthesizes current evidence on the neural mechanisms linking cognitive dysfunction and FOG. Literature was identified through targeted searches of neuroimaging, behavioral, and rehabilitation studies in PD with and without FOG. Findings consistently demonstrate altered activity and connectivity within corticostriatal and corticolimbic circuits in freezers, including inefficient hyperactivation of the frontal, prefrontal, and posterior parietal cortices, and abnormal coupling between the ventral striatum, precuneus, and amygdala. These patterns suggest that cognitive networks become overrecruited yet insufficient to compensate for impaired motor automaticity, especially under dual-task demands or emotional load. Robust cognitive reserve can serve as compensation, whereas cognitive impairment can contribute to FOG in situations with high cognitive load. Freezers show disproportionate deficits in inhibitory control, visuospatial processing, and task-switching, which correlate with gait initiation failures and FOG severity. Cognitive training, particularly dual-task and other motor-cognitive interventions, shows promising yet variable effects on gait, executive performance, and FOG; however, the field lacks clarity about which cognitive and executive domains are causally involved and which merely reflect compensatory strain. FOG-specific mechanistic models integrating motor, executive, and limbic dysfunction are needed to guide individualized cognitive training and optimize therapeutic outcomes for people with PD.</p>","PeriodicalId":19907,"journal":{"name":"Parkinson's Disease","volume":"2026 ","pages":"7199074"},"PeriodicalIF":2.2,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13386393/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148550179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Walking Speed Explains Apparent Ground Reaction Force Differences in Parkinson's Disease: A Waveform-Level SPM Analysis During Normal and Virtual Reality Walking.","authors":"Elaheh Azadian, Mahdi Majlesi, Alireza Ardalany Moghadam, Makwan Jabar Ali, Rezvan Bakhtiarian","doi":"10.1155/padi/5474367","DOIUrl":"10.1155/padi/5474367","url":null,"abstract":"<p><strong>Background: </strong>Ground reaction force (GRF) alterations are reported in Parkinson's disease (PD), but most kinetic measures depend on walking speed. Since individuals with PD walk more slowly, apparent differences may reflect speed rather than disease-specific biomechanics. Virtual reality (VR) may further modify gait kinetics beyond speed effects.</p><p><strong>Objective: </strong>To determine whether between-group differences in GRF waveforms during overground walking persist after accounting for walking speed and whether VR induces speed-independent kinetic modulation in individuals with PD.</p><p><strong>Methods: </strong>14 adults with mild-to-moderate PD (Hoehn and Yahr stage II-III) and seventeen age-matched controls performed overground walking under normal and immersive VR conditions. Three-dimensional kinematics (100 Hz) and GRFs (1000 Hz) were recorded. Discrete spatiotemporal and kinetic variables were analyzed using mixed-design repeated-measures ANOVA. Time-continuous GRF waveforms were examined using mixed-model statistical parametric mapping (SPM) ANCOVA with walking speed entered as a covariate.</p><p><strong>Results: </strong>Individuals with PD walked significantly slower than controls in both conditions. VR increased stride length and modulated several discrete GRF variables, including anterior-posterior and mediolateral components. However, waveform-level SPM analyses revealed no persistent group or group × task effects once walking speed was included as a covariate. In contrast, walking speed demonstrated widespread and robust associations with vertical and mediolateral GRF trajectories across multiple stance-phase intervals.</p><p><strong>Conclusion: </strong>During comfortable overground walking in mild-to-moderate PD, many apparent kinetic differences are largely speed-coupled rather than clearly speed-independent. These findings underscore the necessity of speed-aware modeling when interpreting gait kinetics and evaluating VR-based paradigms in Parkinson's disease.</p>","PeriodicalId":19907,"journal":{"name":"Parkinson's Disease","volume":"2026 ","pages":"5474367"},"PeriodicalIF":2.2,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13373526/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148472224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Knowledge and Misconceptions About Parkinson's Disease in Lebanon: A Cross-Sectional Survey.","authors":"Noura El-Loubani, Hanan Hijazi, Sarah Mawed, Layal El Bayda, Rabih Roufayel, Hervé Kovacic, Ziad Fajloun, Jeanne d'arc Bacha","doi":"10.1155/padi/1010419","DOIUrl":"10.1155/padi/1010419","url":null,"abstract":"<p><strong>Background: </strong>Parkinson's disease (PD) is a neurodegenerative disorder affecting brain structure and function. It is manifested by unintended movements, characterized by tremors, stiffness, and difficulty with balance and coordination. According to the statistics reported by the World Health Organization (WHO), the prevalence of PD has doubled over the past 25 years. Nowadays, PD has become a major global health burden, including in the Middle East, particularly in Lebanon. Since 2000, the number of people living with PD has increased by 81%, whereas mortality associated with the disease has risen by more than 100%.</p><p><strong>Objectives: </strong>Our goal in this study is to assess the level of knowledge and awareness of PD among community-dwelling Lebanese individuals across different age groups and from various segments of society.</p><p><strong>Methods: </strong>We conducted a cross-sectional survey of the Lebanese population, encompassing individuals from various regions of the country. A questionnaire covering participants' sociodemographic characteristics, as well as the etiology, symptoms, management, and other aspects of PD, was distributed via Google Form to individuals from diverse professional, educational, and socioeconomic backgrounds. Using a systematic sampling method, we gathered data from 582 participants.</p><p><strong>Results: </strong>Among the 582 participants, we observed significantly lower levels of knowledge regarding the symptoms, causes, and treatments of PD, particularly among individuals employed outside the healthcare sector and those with lower levels of education.</p><p><strong>Conclusion: </strong>The outcomes showed us that there is an extensive knowledge gap in neurological disorders, especially in PD, concerning the etiologies of its occurrence and how to deal with patients having the disorder. Our community in Lebanon needs more awareness about PD, which will play an important role in the acceptance and understanding of the disorder.</p>","PeriodicalId":19907,"journal":{"name":"Parkinson's Disease","volume":"2026 ","pages":"1010419"},"PeriodicalIF":2.2,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13343311/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148412600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rehabilitation Utilization for Parkinson's Disease in Southern Ghana: A Descriptive Cross-Sectional Survey.","authors":"Mary Wetani Agoriwo, Marianne Unger, Conran Joseph, Erika Franzén","doi":"10.1155/padi/1443255","DOIUrl":"10.1155/padi/1443255","url":null,"abstract":"<p><strong>Background: </strong>There is limited literature describing rehabilitation utilization among the Parkinson's disease (PD) population across the world and especially in Africa, despite ample evidence and clinical guidelines in support of rehabilitation for persons with PD (PwPD).</p><p><strong>Objectives: </strong>To describe the characteristics of PwPD, the types of rehabilitation services and treatment parameters used, and the factors associated with rehabilitation utilization in southern Ghana.</p><p><strong>Methods: </strong>A descriptive cross-sectional survey was conducted among PwPD receiving care at one primary and two tertiary hospitals selected from southern Ghana. The MDS-UPDRS Part III, PDQ-8, and modified ICF Checklist Clinician Form were used to assess motor function, health-related quality of life, and rehabilitation use. Descriptive and inferential statistics were conducted with significance set at <i>p</i> < 0.05.</p><p><strong>Results: </strong>Seventy-five PwPD were included, with 61.3% being males. Engagement in physiotherapy and/or gymnasium activities was reported by 40.0% of participants. The most common indication for physiotherapy was gait difficulties. No participant had used occupational therapy or speech therapy. Nonreferral by neurologists and participants' poor knowledge of rehabilitation benefits and needs were the main reasons for nonuse of rehabilitation. Gait retraining and strengthening exercises were the most common physiotherapy interventions received by 73.7% of the participants. Longer PD duration was associated with physiotherapy utilization. A total of 42.4% of participants discontinued physiotherapy services, primarily due to transportation challenges and high treatment cost.</p><p><strong>Conclusion: </strong>Rehabilitation services are underutilized by PwPD in southern Ghana due to limited referrals, poor awareness of benefits, and related barriers. This highlights the need for more accessible and integrated services.</p>","PeriodicalId":19907,"journal":{"name":"Parkinson's Disease","volume":"2026 ","pages":"1443255"},"PeriodicalIF":2.2,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13318674/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148369487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dynamic Changes in Midbrain-Striatal Association and Their Relationship With Levodopa-Induced Dyskinesia in Parkinson's Disease.","authors":"Eun Hye Jeong, Jae Yong Lee, Hyun Soo Park, Yoo Sung Song","doi":"10.1155/padi/8235933","DOIUrl":"10.1155/padi/8235933","url":null,"abstract":"<p><strong>Background: </strong>The neurobiological pathology of levodopa-induced dyskinesia (LID) remains unclear despite its prevalence. Emerging evidence suggests a critical interplay between dopaminergic and serotonergic systems in the development of LID.</p><p><strong>Objective: </strong>This study aimed to investigate longitudinal changes in striatal and midbrain SBRs and their association with LID development, with exploratory evaluation of midbrain-striatal monoaminergic coupling.</p><p><strong>Methods: </strong>A total of 169 drug-naïve PD patients from the PPMI database were followed over four years. I-123 FP-CIT SPECT imaging was used to measure specific binding ratios (SBRs) in the caudate, putamen, and midbrain. Patients were categorized into LID and non-LID groups at follow-up. Interregional correlation analysis assessed the correlation between midbrain and striatal subregions. The impact of levodopa-equivalent daily dose (LEDD) on correlation was also evaluated.</p><p><strong>Results: </strong>The LID group exhibited significantly lower striatal SBRs at baseline and follow-up compared to the non-LID group. Midbrain SBRs declined more steeply in the LID group over time. In multivariable regression models adjusting for baseline clinical differences, the interaction between midbrain SBR and LID status for the 4-year putamen SBR showed a trend-level association (<i>p</i> = 0.09, <i>q</i> = 0.15). The regression slope for the midbrain-putamen association was numerically higher in the LID group (<i>β</i> = 1.1571) compared to the non-LID group (<i>β</i> = 0.5201) at 4 years. The midbrain-to-putamen ratio was higher in the LID group at baseline, indicating relatively preserved nonstriatal monoaminergic signal early in the disease course. After adjustment, LEDD and the midbrain × LEDD interaction were not independently associated with midbrain-putamen coupling.</p><p><strong>Conclusion: </strong>Our findings suggest a dynamic pattern in which early relative preservation of nonstriatal monoaminergic signals, reflected by midbrain SBR changes, may accompany dopaminergic loss in patients who develop LID. Midbrain SBR should be interpreted as a proxy of monoaminergic integrity rather than a direct serotonergic biomarker. LID appears to mark a phenotype of accelerated nigrostriatal degeneration characterized by lower baseline and faster longitudinal decline of putaminal SBR. Midbrain-striatal coupling patterns may reflect secondary monoaminergic network changes associated with disease progression rather than a causal serotonergic mechanism.</p>","PeriodicalId":19907,"journal":{"name":"Parkinson's Disease","volume":"2026 ","pages":"8235933"},"PeriodicalIF":2.2,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13277766/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148296032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}