Roberta Biundo

Background/Objectives: Depression, anxiety and apathy are often associated with subjective cognitive complaints (SCCs) in people with Parkinson’s disease (PwPD) without cognitive impairment. Cognitive reserve (CR) enhances emotional resilience, allowing people to better cope with stress and emotional challenges, factors affecting quality of life. We aimed to explore the relationship between CR and mood/anxiety in cognitively intact PwPD with and without SCCs. Methods: In this cross-sectional study we enrolled 133 PwPD and normal cognitive function (age 59.8 ± 6.7 years; disease duration 9.0 ± 5.5 years; male/female 84/49). We assessed cognitive reserve (CR scale), subjective cognitive complaints (with PD-CFRS), QoL (PDQ8), mood, anxiety and apathy (BDI-II; STAI, PAS, Apathy scales). We used a t-test to compare groups (with/without SCC; M/F); correlations and moderation analysis to evaluate the relation between CR and behavioral features and the interplay between CR, behavioral discomfort and QoL. Results: The group with SCCs had significantly (p < 0.05) higher scores in PDQ8, Apathy, STAI, PAS-C and BDI-II scales than those with no SCCs. Males with SCCs had higher scores in PDQ8, Apathy scale and BDI-II while females differed in PDQ8 and Apathy scale scores. In the SCC group, late-life CR was negatively correlated with PAS-C (avoidance behavior) and BDI-II; correlations were confirmed in the male group where CR also correlated with PDQ-8 and PAS persistent anxiety. Conclusions: PwPD and SCCs are more depressed and anxious compared to people without SCCs. Furthermore, we found a relationship between depressive symptoms, anxiety and CR: PwPD with SCCs may rely on cognitive reserve to better cope with the feeling of anxiety and depression, especially in male gender.

Background: Cognitive impairment in Parkinson's disease (PD) is a well‐established non‐motor complication that significantly affects the quality of life and well‐being of both patients and care partners. To optimally detect mild cognitive impairment or dementia, extensive neuropsychological assessment is essential. A wide range of cognitive tests and clinical outcome assessments have been used in clinical settings, often without regard to their clinimetric quality.Methods: We performed a literature review of tests assessing attention/working memory and executive domains in PD (tests on other domains are included in an accompanying review). The selected tests were evaluated for their clinimetric properties and categorized by a panel of experts as “recommended,” “recommended with caveats,” “suggested,” or “listed” according to the International Parkinson and Movement Disorder Society Clinical Outcome Assessment Scientific Evaluation Committee guidelines.Results: A total of 30 tests were reviewed. Eight tests were “recommended,” including four tests assessing attention/working memory abilities (WAIS‐IV Digit Span, Coding and Symbol Search subtests, and Trail Making Test) and four tests assessing executive abilities (WAIS‐IV Similarities, Wisconsin Card Sorting Test, Fluency Tests, and Stroop Color‐Word Test). These tests demonstrated good to excellent levels of reliability and validity, have normative datasets, and are sensitive to change. Eight other tests were “recommended with caveats”, eleven were “suggested,” and three were “listed.”Conclusions: The recommended tests for attention/working memory and executive functioning in PD can guide PD cognitive assessment. Other tests were identified as potentially useful; however, caution is advised due to their clinimetric limitations. Further validation studies are required for these tests. © 2025 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Background: Cognitive impairment in Parkinson's disease (PD) is a key non‐motor complication during the disease course.Objectives: A review of detailed cognitive instruments to detect mild cognitive impairment (PD‐MCI) or dementia (PDD) is needed to establish optimal tests that facilitate diagnostic accuracy.Methods: We performed a systematic literature review of tests that assess memory, language including premorbid intelligence, and visuospatial domains (for tests of attention and executive functions see accompanying review) to determine suitability to assess cognition in PD. Based on in‐depth scrutiny of psychometric and other relevant clinimetric properties, tests were rated as “recommended,” “recommended with caveats,” “suggested,” or “listed” by the International Parkinson and Movement Disorder Society (IPMDS) panel of experts according to the IPMDS Clinical Outcome Assessment Scientific Evaluation Committee guidelines.Results: We included 39 tests encompassing 48 outcome measures. Seven tests (different versions or subtests of the test counted once) were recommended, including four for memory, one for visuospatial domains, one for language (including three measures), and one for estimated premorbid intelligence. Furthermore, 10 tests (12 measures) were “recommended with caveats,” 11 were “suggested,” and 11 (15 measures) were “listed.”Conclusions: Recommended neuropsychological tests in memory, visuospatial functions, and language are proposed to guide the assessment of cognitive impairment and its progression in PD‐MCI and PDD, and for use in clinical trials to stratify participants or as outcome measures. Novel measures being developed will need extensive validation research to be “recommended.” © 2025 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Background: The burden of non‐motor symptoms in Parkinson's disease (PD) can be measured with the Non‐Motor Symptoms Scale (NMSS) and the International Parkinson and Movement Disorder Society Non‐Motor Rating Scale (MDS‐NMS), for which scoring systems, structure and clinical coverage differ.Objectives: The goal was to develop conversion formulas between the NMSS and the MDS‐NMS scores.Methods: Data from 402 patients with PD participating in the primary MDS‐NMS validation study were used. The association between domain and total scores of both scales was assessed by the Spearman rank correlation coefficient and Kendall's W concordance coefficient. Equations for between‐scale transformation of total score were constructed from weighted linear regression models.Results: Spearman rank correlations showed that MDS‐NMS domains correlated 0.39 to 0.88 with the corresponding NMSS domains. The equation for transforming the NMSS total score to MDS‐NMS total score is: MDS‐NMS = 11.629 + 1.624 × NMSS (P < 0.001, R² = 0.748). For converting the MDS‐NMS total score to NMSS total score, the formula is NMSS = 2.475 + 0.495 × MDS‐NMS (P < 0.001, R² = 0.771).Conclusions: Our conversion equations enable direct comparison of the NMSS and MDS‐NMS instruments, facilitating data comparability across studies. © 2025 International Parkinson and Movement Disorder Society.

Patients with mild cognitive impairment due to Alzheimer’s disease (ADMCI) typically show abnormally high delta (p < 0.001). Negative associations between the CSF phospho-tau and total tau levels and posterior rsEEG alpha source activities were observed in the ADMCI group (p < 0.001), whereas those with CSF amyloid beta 42 levels were marginal. These results suggest that neurophysiological brain neural oscillatory synchronization mechanisms regulating cortical arousal and vigilance through rsEEG alpha rhythms are mainly affected by brain tauopathy in ADMCI patients.

The present study was developed based on the data of The PDWAVES Consortium (www.pdwaves.eu) and the PharmaCog project. The Partners and institutional affiliations are reported on the cover page of this manuscript. In this study, the clinical, neuropsychological, and magnetic resonance imaging data collection and analysis in patients with ADMCI and healthy control participants were partially supported by the funds of “Ricerca Corrente 2022-2023” (Italian Ministry of Health) to the IRCCS Synlab SDN of Naples (Italy), IRCCS Ospedale San Martino of Genoa (Italy), Oasi Research Institute-IRCCS, Troina (Italy), IRCCS Fatebenefratelli of Brescia (Italy), and IRCCS San Raffaele Pisana of Rome (Italy). Prof. Claudio Del Percio’s and Dr. Roberta Biundo’s work for this study was supported by funds of the “PRIN-2022” project entitled "AmyEEG” (Italian Ministry of University and Research, Prot. 2022FJAXY8). At the same time, Prof. Claudio Babiloni’s work was supported by funds of the “Horizon Marie S. Curie Doctoral Network ” project entitled "CombiDiag” (European Committee, Proposal: 101071485).

A key distinguishing factor between mild cognitive impairment (MCI) and dementia in Parkinson’s disease (PD) lies in the notable decrease in functioning due to cognitive impairment. The Parkinson’s Disease-Cognitive Functional Rating Scale (PD-CRFS) was developed to assess functional limitations caused by cognitive impairment, while reducing the influence of motor impairment. The aim of this multicenter study was to (i) validate the Italian version of the PD-CFRS in PD, (ii) determine optimal cut-off scores for detecting MCI and dementia in PD, (iii) compare its performances with the most established functional assessment tool (IADL). Six hundred and sixty nine PD participants were recruited from 4 Italian Movement Disorders centers (Venice, Milan, Gravedona, and Salerno). They underwent Level-II cognitive evaluation, which resulted in 282 PD-NC, 310 PD-MCI, and 77 PDD. The PD-CFRS’s psychometric and clinimetric properties, applicability, and responsiveness were analyzed. The PD-CFRS showed high acceptability. Floor and ceiling effects were acceptable. It also displayed strong internal consistency (Cronbach’s α = 0.738), and test–retest reliability (ICC = .854). The PD-CFRS demonstrated higher coefficient of variation to detect dysfunction in PD-MCI patients in comparison to the IADL scale (PD-CFRS 96% vs IADL 22.5%). Convergent validity with the IADL was r = − 0.638 and − 0.527 in males and females, respectively. PD-CFRS total score negatively correlated with global cognition (MoCA corrected score r = − 0.61; p < 0.001). A cut-off score > 6.5 identified PDD with a sensitivity of 90% and specificity of 88% (AUC = .959). A cut-off value of > 1 detected PD-MCI with a sensitivity of 68% and specificity of 69% (AUC = .695). The Italian version of the PD-CFRS demonstrated to be an easy, valid and reliable tool that properly captures functional impairment due to cognitive decline in PD. It also proved to be particularly effective in the advanced stages of PD, and would be a useful support for the diagnosis of PD-MCI and PDD.