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Background Patients with Parkinsonian syndromes, including Parkinson’s disease (PD) and atypical parkinsonism (AP), are at increased risk of disability following hip fracture. Limited data are available on their functional recovery after inpatient rehabilitation. This study aimed to compare rehabilitation outcomes in patients with parkinsonism versus non-parkinsonian controls after hip fracture surgery and to identify clinical predictors of worse recovery within the parkinsonian group. Methods A retrospective study was conducted on 60 patients with parkinsonism (45 PD, 15 AP) and 60 age- and sex-matched non-parkinsonian controls undergoing inpatient rehabilitation after hip fracture surgery. Functional status was assessed at admission and discharge using the Modified Barthel Index (MBI) and modified Rankin Scale (mRS). Linear mixed-effects models were applied to explore associations between clinical variables (including diagnosis, dementia, dysphagia, postural instability) and outcomes. Results Patients with parkinsonism had significantly lower functional scores at both admission and discharge as compared to controls ( p  < 0.001), with AP patients performing worse than PD patients ( p  = 0.02). Among parkinsonian individuals, dementia, dysphagia, and postural instability were independently associated with worse outcomes ( p  < 0.001). Although MBI change scores (delta-MBI) did not differ significantly between groups, mRS change (delta-mRS) was greater in controls, suggesting that parkinsonian patients experienced a higher overall disability burden at both admission and discharge, despite a smaller relative improvement. These findings indicate that non-motor symptoms substantially influence rehabilitation trajectories and should be considered in planning care. Conclusions Parkinsonian patients, particularly those with atypical parkinsonism, experience worse functional outcomes after hip fracture rehabilitation when compared with non-parkinsonian individuals. The presence of dementia, dysphagia, and postural instability further impairs recovery.

BackgroundParkinson’s disease (PD) is the second most common neurodegenerative disorder, affecting both motor and non-motor systems. Deep brain stimulation of the subthalamic nucleus (STN-DBS) has been an approved treatment for PD for more than 30 years, but few data are available regarding its long-term effectiveness.ObjectiveThe aim of this study is to evaluate patients’ outcome, both from a motor and non-motor perspective, 9 to 14 years after DBS implantation. We have investigated patients with advanced PD and treated with STN-DBS, in relation to key clinical features of PD.Methods18 patients were assessed both retrospectively and prospectively. They underwent motor examination, neuropsychological evaluation and questionnaires on the quality of life, preoperatively, as well as 1, 9 and 14 years after DBS surgery. All patients were implanted with STN-DBS at San Raffaele Hospital between 2004 and 2010.Results13 males and five females underwent DBS implantation with a mean PD duration of 11 years. Stimulation significantly improved med-off/stim-on condition up to 9 years, compared to the preoperative off state, and med-on/stim-on condition at 14 years, compared to med-on/stim-off state. Long term improvement specifically involved tremor and rigidity, as well as dopaminergic daily dose. At the same time, STN-DBS had no long-lasting effect on axial symptoms and cognitive functions.ConclusionsSTN-DBS remains an effective therapy for advanced PD, also over the years. Despite the underlying progression of the disease, this treatment extends the period in which the overall quality of life is still acceptable.

Abstract IntroductionDementia with Lewy bodies (DLB) may represent a diagnostic challenge, since its clinical picture overlaps with other dementia. Two toolkits have been developed to aid the clinician to diagnose DLB: the Lewy Body Composite Risk Score (LBCRS) and the Assessment Toolkit for DLB (AT-DLB). We aim to evaluate the reliability of these two questionnaires, and their ability to enhance the interpretation of the international consensus diagnostic criteria.MethodsLBCRS and AT-DLB were distributed to 135 Italian Neurological Centers for Cognitive Decline and Dementia (CDCDs), with the indication to administer them to all patients with dementia referred within the subsequent 3 months. We asked to subsequently apply consensus criteria for DLB diagnosis, to validate the diagnostic accuracy of the two toolkits.ResultsA total of 23 Centers joined the study; 1854 patients were enrolled. We found a prevalence of possible or probable DLB of 13% each (26% total), according to the consensus criteria. LBCRS toolkit showed good reliability, with a Cronbach alpha of 0.77, stable even after removing variables from the construct. AT-DLB toolkit Cronbach alpha was 0.52 and, after the subtraction of the “cognitive fluctuation” criterion, was only 0.31. Accuracy, sensitivity, and specificity were higher for LBCRS vs. AT-DLB. However, when simultaneously considered in the logistic models, AT-DLB showed a better performance (p < 0.001). Overall, the concordance between LBCRS positive and AT-DLB possible/probable was of 78.02%ConclusionsIn a clinical setting, the LBCRS and AT-DLB questionnaires have good accuracy for DLB diagnosis.