Jennifer A. Foley

Background: Depression can negatively influence an individual's perception of their disease. Although subthalamic nucleus deep brain stimulation (STN-DBS) is an effective treatment for Parkinson's disease (PD), some patients do not appreciate benefits despite showing objective improvements in motor function. Objective: We explored the impact of depressive symptoms on self-reported outcomes of PD severity in patients who underwent STN-DBS. Methods: Assessments took place preoperatively and 2-years after surgery. Patients completed the Hospital Anxiety and Depression Scale (HADS), Unified Parkinson's Disease Rating Scale (UPDRS) Parts 2 and 4, Gait and Falls Questionnaire, Parkinson's Disease Questionnaire-39 (PDQ-39), and the Non-motor Symptoms Scale. The UPDRS Part 3 (motor examination) was also performed. Patients were dichotomized into two groups (normal or high) based on their postoperative follow-up HADS depression score. Results: Eighteen patients (33.3%) were assigned to the high group (hHADS-D), and 36 patients (66.7%) were assigned to the normal group (nHADS-D). The UPDRS Part 3 OFF-medication score improved to a similar extent in both groups, and participants experienced a similar reduction in their levodopa equivalent daily dose following STN-DBS. Unlike the nHADS-D group, however, hHADS-D patients did not self-report improvements on any clinical outcome measure at follow-up from baseline, and instead indicated a significant worsening on the UPDRS Part 2 ON-medication and PDQ-39 cognition domain. This was not explicable by their preoperative non-motor symptom burden, nor changes in dopaminergic medications. There were no differences between groups in terms of proportion using anti-depressants, surgical complications or postoperative side effects. Conclusions: Depressive symptoms may play a significant role in subjective self-reporting, and should be carefully considered when evaluating STN-DBS effectiveness and managing patients postoperatively.

Objectives Hypersexuality involves an inability to control intense, recurring sexual impulses, resulting in repetitive sexual behaviours. It frequently manifests in patients with neurodegenerative disorders such as Parkinson’s disease (PD) and dementia. Using a qualitative approach, this study aims to explore the impact of hypersexuality on spousal carers of patients with PD and dementia. Design Qualitative study using semistructured interviews and thematic analysis. Setting This study was conducted in secondary care settings, including movement disorder and dementia clinics, as well as through patient support organisations. Participants were recruited from multiple centres across the UK. Interviews were conducted in a clinical research setting. Participants Eight spousal carers (five caring for patients with PD, three for patients with dementia) participated in the study. Participants were selected based on their role as primary carers and their experience managing hypersexuality in their partners. Results The thematic analysis identified 12 themes: manifestations, sexual practices, impact, control, emotional formulations, beliefs in causes of hypersexuality and attributions, relationship with the partner, dealing with hypersexuality, coping with hypersexuality, self-image, stigma and professional help-seeking. Hypersexuality altered patients’ sexual cognitions and behaviours, causing distress and strain on carers’ mental health and marital life. Carers struggled to cope with their partners’ hypersexuality, facing emotional burden and barriers to seeking professional help. Conclusions Hypersexuality significantly impacts spousal carers of patients with PD and dementia, affecting their emotional well-being and relationships. Healthcare professionals should recognise and address hypersexuality’s psychological and relational consequences. Psychoeducation, support groups and tailored interventions for patients and carers are recommended to alleviate emotional distress. Future research should explore the broader familial impact of hypersexuality and develop effective management strategies.

Surveys repeatedly suggest inadequate psychological support for people with Parkinson’s disease (PD). However, absence of official service or workforce statistics obscures our understanding of current service provision. The aims of this study were to provide the first formal evaluation of UK PD psychological services and identify any development needs. An online survey was distributed to clinical psychologists who were members of relevant professional groups and/or working in neurology centres. A total of 45 clinical psychologists responded to the survey. Respondents saw a mean of 19 PD patients in a year with marked variation in numbers seen and services offered, particularly between the different nations. There was limited integration with the multidisciplinary team and inclusion of carers. This may reflect inadequacies in professional training and supervision, as well as a lack of funding. Improved clinical guidelines, enhanced professional training and a better network for clinical supervision are now critical.

Background: People with Parkinson's disease (PD) have an increased risk of dementia, yet patients and clinicians frequently avoid talking about it due to associated stigma, and the perception that “nothing can be done about it”. However, open conversations about PD dementia may allow people with the condition to access treatment and support, and may increase participation in research aimed at understanding PD dementia.Objectives: To co‐produce information resources for patients and healthcare professionals to improve conversations about PD dementia.Methods: We worked with people with PD, engagement experts, artists, and a PD charity to open up these conversations. 34 participants (16 PD; 6 PD dementia; 1 Parkinsonism, 11 caregivers) attended creative workshops to examine fears about PD dementia and develop information resources. 25 PD experts contributed to the resources.Results: While most people with PD (70%) and caregivers (81%) shared worries about cognitive changes prior to the workshops, only 38% and 30%, respectively, had raised these concerns with a healthcare professional. 91% of people with PD and 73% of caregivers agreed that PD clinicians should ask about cognitive changes routinely through direct questions and perform cognitive tests at clinic appointments. We used insights from the creative workshops, and input from a network of PD experts to co‐develop two open‐access resources: one for people with PD and their families, and one for healthcare professionals.Conclusion: Using artistic and creative workshops, co‐learning and striving for diverse voices, we co‐produced relevant resources for a wider audience to improve conversations about PD dementia.

Introduction: Although delusions in Parkinson's disease (PD) are rare, when they occur they frequently take the form of "Othello syndrome": the irrational belief that a spouse or partner is being unfaithful. Hitherto dismissed as either a by-product of dopamine therapy or cognitive impairment, there are still no convincing theoretical accounts to explain why only some patients fall prey to this delusion, or why it persists despite clear disconfirmatory evidence.Methods: We discuss the limitations of existing explanations of this delusion, namely hyperdopaminergia-induced anomalous perceptual experiences and cognitive impairment, before describing how Bayesian predictive processing accounts can provide a more comprehensive explanation by foregrounding the importance of prior experience and its impact upon computation of probability. We illustrate this new conceptualisation with three case vignettes.Results: We suggest that in those with prior experience of romantic betrayal, hyperdominergic-induced aberrant prediction errors enable anomalous perceptual experiences to accrue greater prominence, which is then maintained through Bayes-optimal inferencing to confirm cognitive distortions, eliciting and shaping this dangerous delusion.Conclusions: We propose the first comprehensive mechanistic account of Othello syndrome in PD and discuss implications for clinical interventions.

Objectives: Visual hallucinations (VH) ranging from minor to complex, are the most common psychiatric feature of Lewy Body Disease (LBD). Despite their high prevalence and poor prognostic implications instigating extensive research, the precise mechanisms underlying VH remain unclear. Cognitive impairment (CI) is a risk factor and a consistent correlate of VH in LBD. To help shed light on their underlying mechanisms, this study investigates the pattern of CI across the spectrum of VH in LBD.Methods: 30 LBD patients with minor VH (MVH), 13 with complex VH (CVH) and 32 without VH were retrospectively compared on the domains of higher‐order visual processing, memory, language and executive functioning. The VH groups were further stratified to investigate whether phenomenological subtypes have distinct cognitive correlates.Results: LBD patients with CVH were impaired on the visuo‐spatial and executive functioning domains relative to controls. LBD patients with MVH were also impaired on the visuo‐spatial domain. No differences emerged in cognitive domains affected between patient groups endorsing specific hallucinatory phenomena.Conclusion: A pattern of CI indicating fronto‐subcortical dysfunction in combination with posterior cortical involvement is implicated in the genesis of CVH. Moreover, this posterior cortical dysfunction may precede the occurrence of CVH as indicated by selective visuo‐spatial deficits in LBD patients with MVH.

Raven's Advanced Progressive Matrices (APM) Set I is a validated and brief test of fluid intelligence, ideal for use in busy clinical settings. However, there is a dearth of normative data allowing an accurate interpretation of APM scores. To address this, we present normative data from across the adult lifespan (18–89 years) for the APM Set I. Data are presented in five age cohorts (total N = 352), including two older adult cohorts (65–79 years and 80–89 years), which allows age‐standardized assessment. We also present data from a validated measure of premorbid intellectual ability, which was absent from previous standardizations of longer forms of the APM. In line with previous findings, a striking age‐related decline was noted, beginning relatively early in adulthood and most marked amongst lower‐scoring individuals. Older adults did not demonstrate difficulty with specific test items or make an increased proportion of specific errors. Sex was not a significant predictor of performance. The data set is of particular use in the neuropsychological assessment of older adults, given the known susceptibility of fluid intelligence to both the effects of normal ageing and acquired brain injury in older age. The results are discussed in light of theories of neurological ageing.