Background: This literature review evaluates the use and efficacy of telemedicine in cognitive and psychological treatment in Parkinson’s disease. Methods: Studies performed between 2016 and 2021 that fulfilled inclusion criteria were selected from PubMed, Scopus, Cochrane, and Web of Science databases. All articles were evaluated by title, abstract, and text. All studies that examined the cognitive and psychological/psychotherapy treatment of patients with Parkinson’s disease by telemedicine were included. Results: Telehealth improved cognitive status and emotional/behavioral disorders in this population, and had positive effects on the patients’ and caregivers’ quality of life. Conclusions: Our literature review supports the development and efficacy of cognitive and psychological treatment with telemedicine, but the methodology of the study must be reviewed considering its limitations so as to highlight the benefits and risks of treatment via telemedicine.

Background: Pathological gambling (PG) is a significant non-motor complication in Parkinson’s disease (PD), often linked to dopaminergic therapies. PG impacts the quality of life of patients and their families, presenting unique challenges due to its interplay with motor symptoms and cognitive impairments in PD. This scoping review synthesized current evidence on rehabilitation strategies for PG in PD. Methods: A systematic review was conducted across the PubMed, Web of Science, Embase, and Scopus databases to identify studies addressing pharmacological, psychological, and neuromodulatory approaches. The scoping objective was to map the available evidence on treatment strategies and identify research gaps. Results: Of 537 studies, 5 met the inclusion criteria. Pharmacological strategies included dopamine agonist adjustments, naltrexone, and amantadine, which showed partial efficacy but were often limited by significant side effects. Neuromodulation via deep brain stimulation (DBS) demonstrated potential by modulating limbic circuits, though risks like apathy and transient symptom exacerbation were noted. Psychological interventions, particularly cognitive-behavioral therapy (CBT), were the most effective in modifying gambling behaviors, though adaptations are needed for PD-specific cognitive and psychiatric challenges. Conclusions: Effective rehabilitation for PG in PD requires a multidisciplinary approach to balance motor symptom management with impulse control disorders. While pharmacological, psychological, and neuromodulatory interventions show promise, gaps remain regarding their long-term efficacy, combined use, and tailoring to PD-specific needs. The lack of large-scale, comparative studies and limited exploration of novel therapeutic combinations underscore the need for further research to optimize patient outcomes and develop comprehensive treatment frameworks.

Purpose: To determine the best predictor of lesion volume induced by magnetic resonance (MR)-guided focused ultrasound (MRgFUS) thalamotomy in patients with tremor-dominant symptoms in Parkinson’s disease (PD) and essential tremor (ET) patients. Methods: Thirty-six neurological patients with medication-refractory tremor (n°19 PD; n°17 ET) were treated using a commercial MRgFUS brain system (Exablate Neuro 4000, Insightec) integrated with a 1.5 T MRI unit (Sigma HDxt; GE Medical System). Linear regression analysis was used to determine how the demographic, clinical, radiological (Fazekas scale), volumetric (total GM/WM/CSF volume, cortical thickness), and MRgFUS-related parameters [Skull Density Ratio (SDR), n° of transducer elements, n° of sonications, skull area, maximal energy delivered (watt), maximal power delivered (joule), maximal sonication time delivered, maximal mean temperature reached (T°C_max), accumulated thermal dose (ATD)] impact on ventral intermediate (VIM)-thalamotomy-related 3D volumetric lesions of necrosis and edema. Results: The VIM thalamotomy was clinically efficacious in improving the tremor symptoms of all the patients as measured at 1 week after treatment. Multiple regression analysis revealed that T°C_max and n° of transducer elements were the best predictors of the necrosis and edema volumes. Moreover, total WM volume also predicted the size of necrosis. Conclusions: Our study provides new insights into the clinical MRgFUS procedures that can be used to forecast brain lesion size and improve treatment outcomes.

Background/Objectives: Assertiveness, defined as the positive affirmation of oneself, encompasses the ability to refuse requests, express anger, disagree or oppose others, show affection, and uphold personal beliefs without causing conflict. Deficits in assertive behavior are often linked to pathological changes in the basal ganglia and prefrontal dopaminergic systems, commonly observed in Parkinson’s disease (PD), and are predictive of poor clinical outcomes. Psychological factors such as mood alterations and cognitive dysfunction may also impact assertiveness. This study investigated the psychological factors influencing assertiveness in individuals with PD. Methods: A cross-sectional study was conducted, involving 160 patients with PD attending a movement disorders outpatient clinic. The participants underwent assessment using a battery of standardized neuropsychological tests to evaluate cognitive function, assertiveness, mood, dysarthria, and quality of life (QoL). Results: All dimensions of assertiveness correlated with depression and anxiety. Individuals experiencing mood disturbances may struggle to express themselves assertively. Similarly, some dimensions of assertiveness correlated also with the QoL, indicating that, overall, well-being affects assertive behavior. Gender emerged as a significant influencer of assertiveness across all dimensions. Specifically, in subjects with PD, the male gender was associated with lower scores in assertiveness compared to women. No significant correlations were found between assertiveness and dysarthria. Conclusions: The findings highlight the importance of adopting a holistic approach to PD management, addressing not only motor symptoms but also psychological challenges which patients may encounter in their daily lives.

Parkinson’s disease (PD) is characterized by asymmetric motor symptoms (MSs), which may influence non-motor symptoms (NMSs). This study investigated the relationship between NMSs and the neurometabolic profile of the substantia nigra (SN) and globus pallidus (GP) of patients with PD, examining how these associations vary according to MS asymmetry. Forty-three PD patients (20 with right-predominant motor symptoms—RPD, and 23 with left-predominant motor symptoms—LPD) and 20 healthy controls (HCs) underwent single-voxel proton magnetic resonance spectroscopy, along with comprehensive clinical assessments of MSs and NMSs. Compared with HCs, PD patients showed higher N-acetylaspartate (NAA) levels in the SN, lower myo-inositol (Ins) levels in both sides of the SN, and higher glutamate/glutamine (Glx) levels in the right GP. Choline (Cho) in the left GP was positively associated with cognitive performance. In LPD patients, compared with HCs, NAA levels were increased in the right SN, whereas Ins levels were reduced in both hemispheres. These patients reported higher anxiety and exhibited marked hemispheric asymmetry of SN NAA. In this group, higher NAA levels in the right SN were associated with fewer sleep disturbances, while Ins in the right GP was related to both cognitive function and NMS severity. RPD patients showed elevated Glx levels in the right GP compared with HCs, with no significant hemispheric differences in metabolite levels. Nevertheless, Cho in the right SN was positively associated with sleep disturbances. Overall, these findings suggest that motor asymmetry in PD influences the neurometabolic correlates of NMSs, revealing distinct metabolic-clinical profiles in RPD and LPD patients.