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.

The implementation of cognitive health apps in patients with mild cognitive impairment (MCI) is challenging because of their cognitive, age, and other clinical characteristics. In this project, we aimed to evaluate the usability and feasibility of the Rehastart app tested in MCI patients. Eighteen subjects affected by MCI due to neurodegenerative disorders (including Parkinson’s disease, multiple sclerosis, and amnestic/multidomain MCI) and eighteen healthcare professionals were recruited to this study. Patients were registered on the app by clinicians and they were assigned a protocol of specific cognitive exercises. The recruitment was conducted in the period between March and June 2023. The trial testing of the app consisted of three sessions per week for three weeks, with each session lasting about 30 min. After three weeks, the participants as well as medical personnel were invited to rate the usability and feasibility of the Rehastart mobile application. The instruments employed to evaluate the usability and feasibility of the app were the System Usability Scale (SUS), The Intrinsic Motivation Inventory (IMI) and the Client Satisfaction Questionnaire (CSQ). We did not find statistically significant differences on the SUS (p = 0.07) between healthcare professionals and patients. In addition, we found promising results on subscales of the Intrinsic Motivation Inventory, suggesting high levels of interest and enjoyment when using the Rehastart app. Our study demonstrated that smartphone-based telerehabilitation could be a suitable tool for people with MCI due to neurodegenerative disorders, since the Rehastart app was easy to use and motivating for both patients and healthy people.

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/Objective: Parkinson’s disease (PD) is characterized by motor and cognitive impairments that significantly affect quality of life. Robotic-assisted therapies, such as the AMADEO^® system, have shown potential in rehabilitating upper limb function but are underexplored in PD. This study aimed to assess the effects of Robotic-Assisted Therapy (RAT) compared to Conventional Physical Therapy (CPT) on cognitive, motor, and functional outcomes in PD patients. Methods: A single-blind, randomized controlled trial was conducted with PD patients allocated to RAT or CPT. Participants were assessed at baseline (T0) and post-intervention (T1) using measures including MoCA, FAB, UPDRS-III, 9-Hole Peg Test, FMA-UE, FIM, and PDQ-39. Statistical analyses included ANCOVA and regression models. Results: RAT led to significant improvements in global cognition (MoCA, p < 0.001) and executive functioning (FAB, p = 0.0002) compared to CPT. Motor function improved, particularly in wrist and hand control (FMA-UE), whereas changes in fine motor dexterity (9-Hole Peg Test) were less consistent and did not reach robust significance. No significant improvements were observed in broader quality of life domains, depressive symptoms, or memory-related cognitive measures. However, quality of life improved significantly in the stigma subdomain of the PDQ-39 (p = 0.0075). Regression analyses showed that baseline motor impairment predicted cognitive outcomes. Conclusions: RAT demonstrated superior cognitive and motor benefits in PD patients compared to CPT. These results support the integration of robotic rehabilitation into PD management. Further studies with larger sample sizes and long-term follow-up are needed to validate these findings and assess their sustainability.

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.