Jones et al's review of the assessment and management of the neuropsychiatric manifestations of Parkinson's disease serves as a practical guide to clinicians. This commentary outlines some of the underlying neuroscience and psychological sequelae of this range of conditions, offering a takeaway message to the clinician with an interest in Parkinson's neuropsychiatry.

Historically, Parkinson's disease was viewed as a motor disorder and it is only in recent years that the spectrum of non-motor disorders associated with the condition has been fully recognised. There is a broad scope of neuropsychiatric manifestations, including depression, anxiety, apathy, psychosis and cognitive impairment. Patients are more predisposed to delirium, and Parkinson's disease treatments give rise to specific syndromes, including impulse control disorders, dopamine agonist withdrawal syndrome and dopamine dysregulation syndrome. This article gives a broad overview of the spectrum of these conditions, describes the association with severity of Parkinson's disease and the degree to which dopaminergic degeneration and/or treatment influence symptoms. We highlight useful assessment scales that inform diagnosis and current treatment strategies to ameliorate these troublesome symptoms, which frequently negatively affect quality of life.

Parkinson's disease and Alzheimer's disease are progressive nervous system disorders that affect physical and cognitive capacities of individuals, including memory loss, motion impairment, or problem-solving dysfunctions. Leisure activities are associated with reducing the risk of dementia and are preventive policies for delaying the cognitive impairment in later stages of those neurodegenerative diseases. Electronic games related to cognitive abilities are an easy and inexpensive alternative for stimulating brain activity in this kind of patients. The previous research demonstrated the acceptance of these activities in the environment of Connected TV when playing at home and in daily care centers. Interaction in Connected TV applications has its own particularities that influence the design of the interface, including the viewing distance, the type of interaction through a remote control or other techniques, the size of the screen, or the collectiveness of consumption. Iterative testing with patients of these groups revealed how the physical characteristics and cognitive impairment of these concrete end-users affect the human–computer interaction, offering guidelines and recommendations in good practices for the Smart TV interface design. On the other hand, data analytics extracted from the interaction and evolution of the game offer important information enabling the creation of estimation prediction models about the cognitive state of the patient.

Background: Mindfulness-based cognitive therapy (MBCT) has evidence of efficacy in a range of populations, but few studies to date have reported on MBCT for treatment of anxious and depressive symptoms in Parkinson's disease (PD). Aims: The aim of this study was to examine the efficacy of modified MBCT in reducing symptoms of anxiety and depression and improving quality of life in PD. Method: Thirty-six individuals with PD were randomly assigned to either modified MBCT or a waitlist control. Changes in symptoms of anxiety, depression and quality of life were compared at group level using generalized linear mixed models and at individual level using reliable change analysis. Results: At post-treatment, there was a significant reduction in depressive symptoms for people undertaking modified MBCT at both group and individual levels compared with controls. There was no significant effect on anxiety or quality of life at the group level, although significantly more people had reliable improvement in anxiety after modified MBCT than after waitlist. Significantly more waitlist participants had reliable deterioration in symptoms of anxiety and depression than those completing modified MBCT. Most participants stayed engaged in modified MBCT, with only three drop-outs. Discussion: This proof-of-concept study demonstrates the potential efficacy of modified MBCT as a treatment for depressive symptoms in Parkinson's disease and suggests further research is warranted.

Based on previous community research, we prioritise the need to understand better how experiences and feelings of invisibility could be shaped by relational dynamics, interfacing with service provision, and social forces, with the overarching view of understanding better the experiences of participants living with Parkinson's disease. A photovoice methodology was employed. A discussion of one case study of Bindy and Volta leads to a better understanding of how strong spousal support can significantly alter how one individual experiences and defines living with Parkinson's.

Background: The spousal care givers of people with Parkinson's (PwP) have unique, first-hand information that is invaluable in the effective management of Parkinson's disease (PD). However, there is a dearth of research that specifically focuses on health professionals’ experiences of engagement with the spousal care givers of PwP.

Methods: Interpretative phenomenological analysis (IPA) was used to describe and identify the meaning that health professionals working with PD (HPPs) gave to their engagement experiences with spousal care givers of PwP. Semi-structured interviews with a purposive sample of 12 HPPs were digitally recorded, transcribed verbatim and analysed for emerging themes.

Results: Two major themes emerged from the interviews with HPPs: (i) the Philosophy of Care (PoC) is an Intrinsic Element in the Engagement Experience; and (ii) HPPs Expressed a Deep Appreciation of Partners’ Support of the PwP. HPPs experienced significant tensions and challenges in their engagements with the partners of PwP, as a result of the interaction between their lived reality and their PoC. They also appreciated greatly the caregiving provided by the partners. The insights gained have the potential to ease or resolve problematic tensions within the engagement process.

Against the backdrop of a four-year study into dance for people with Parkinson's, I examine one woman's claim that dancing makes her feel beautiful, and, as such, is fundamental to her well-being. I debate the challenge that this claim poses to those who argue that beauty in dance is at best unimportant, at worst disenfranchising. In debating this challenge, I create a link between aesthetics and health through a reformulation of the value of beauty in the context of chronic illness and well-being. This link then allows me to discuss how feeling lovely could become relevant and meaningful within the context of participating in dance.

This study investigated the speed of short-term memory scanning in two groups of patients: patients with Parkinson's disease (PD) (primarily subcortical pathology) and patients with a presumptive diagnosis of dementia of the Alzheimer type (DAT) (primarily cortical pathology). Non-demented PD patients (M age = 58.3), mildly demented DAT patients (M age = 67.0), and normal control (NC) subjects (M age = 58.9) were compared to one another in order to determine whether the presence of slowed scanning differentiates subcortical from cortical pathology. The three groups did not differ significantly on the memory scanning task. Slowed scanning speed does appear to occur in some patients with PD, however. This may relate to age, duration of disease, or an interaction between these two. Despite normal scanning speed, most DAT patients required highly structured instructions to be able to carry out the item-recognition task, and many remainedunable to perform this task even with additional instructions.

A meta-analysis of 68 studies with a total of 4644 participants was conducted to investigate the sensitivity of tests of verbal fluency to the presence of Parkinson's disease (PD) relative to healthy controls. Both phonemic and semantic fluency were moderately impaired but neither deficit qualified as a differential deficit relative to verbal intelligence or psychomotor speed. However, PD patients were significantly more impaired on semantic relative to phonemic fluency (rs = .37 vs. .33, respectively), and confrontation naming, a test of semantic memory that imposes only minimal demands upon cognitive speed and effortful retrieval, was associated with a deficit that was of a comparable magnitude to the deficits upon each of these types of fluency. Thus, the disorder appears to be associated with particular problems with semantic memory. Tests that impose heavy demands upon switching may also be disproportionately affected. Demented and non-demented PD patients differ quantitatively but not qualitatively in terms of the relative prominence of deficits on tests of phonemic and semantic fluency. However, patients with dementia of the Alzheimer's type and demented PD patients can be differentiated from one another by the relative magnitude of deficits upon these two measures. (JINS, 2004, 10, 608–622.)