Dementia has been increasingly more recognized to be a common feature in patients with Parkinson's disease (PD), especially in old age. Specific criteria for the clinical diagnosis of dementia associated with PD (PD-D), however, have been lacking. A Task Force, organized by the Movement Disorder Study, was charged with the development of clinical diagnostic criteria for PD-D. The Task Force members were assigned to sub-committees and performed a systematic review of the literature, based on pre-defined selection criteria, in order to identify the epidemiological, clinical, auxillary, and pathological features of PD-D. Clinical diagnostic criteria were then developed based on these findings and group consensus. The incidence of dementia in PD is increased up to six times, point-prevelance is close to 30%, older age and akinetic-rigid form are associated with higher risk. PD-D is characterized by impairment in attention, memory, executive and visuo-spatial functions, behavioral symptoms such as affective changes, hallucinations, and apathy are frequent. There are no specific ancillary investigations for the diagnosis; the main pathological correlate is Lewy body-type degeneration in cerebral cortex and limbic structures. Based on the characteristic features associated with this condition, clinical diagnostic criteria for probable and possible PD-D are proposed.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/mds.21507

Clinical diagnostic criteria for dementia associated with Parkinson's disease.

Temporomandibular disorders (TMD) are a significant public health problem affecting approximately 5% to 12% of the population.1 TMD is the second most common musculoskeletal condition (after chronic low back pain) resulting in pain and disability.1 Pain-related TMD can impact the individual's daily activities, psychosocial functioning, and quality of life. Overall, the annual TMD management cost in the USA, not including imaging, has doubled in the last decade to $4 billion.1

Patients often seek consultation with dentists for their TMD, especially for pain-related TMD. Diagnostic criteria for TMD with simple, clear, reliable, and valid operational definitions for the history, examination, and imaging procedures are needed to render physical diagnoses in both clinical and research settings. In addition, biobehavioral assessment of pain-related behavior and psychosocial functioning—an essential part of the diagnostic process—is required and provides the minimal information whereby one can determine whether the patient's pain disorder, especially when chronic, warrants further multidisciplinary assessment. Taken together, a new dual-axis Diagnostic Criteria for TMD (DC/TMD) will provide evidence-based criteria for the clinician to use when assessing patients, and will facilitate communication regarding consultations, referrals, and prognosis.2

The research community benefits from the ability to use well-defined and clinically relevant characteristics associated with the phenotype in order to facilitate more generalizable research. When clinicians and researchers use the same criteria, taxonomy, and nomenclature, then clinical questions and experience can be more easily transferred into relevant research questions, and research findings are more accessible to clinicians to better diagnose and manage their patients. The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) have been the most widely employed diagnostic protocol for TMD research since its publication in 1992.3 This classification system was based on the biopsychosocial model of pain4 that included an Axis I physical assessment, using reliable and well-operationalized diagnostic criteria, and an Axis II assessment of psychosocial status and pain-related disability. The intent was to simultaneously provide a physical diagnosis and identify other relevant characteristics of the patient that could influence the expression and thus management of their TMD. Indeed, the longer the pain persists, the greater the potential for emergence and amplification of cognitive, psychosocial, and behavioral risk factors, with resultant enhanced pain sensitivity, greater likelihood of additional pain persistence, and reduced probability of success from standard treatments.5

The RDC/TMD (1992) was intended to be only a first step toward improved TMD classification, and the authors stated the need for future investigation of the accuracy of the Axis I diagnostic algorithms in terms of reliability and criterion validity—the latter involving the use of credible reference standard diagnoses. Also recommended was further assessment of the clinical utility of the Axis II instruments. The original RDC/TMD Axis I physical diagnoses have content validity based on the critical review by experts of the published diagnostic approach in use at that time and were tested using population-based epidemiologic data.6 Subsequently, a multicenter study showed that, for the most common TMD, the original RDC/TMD diagnoses exhibited sufficient reliability for clinical use.7 While the validity of the individual RDC/TMD diagnoses has been extensively investigated, assessment of the criterion validity for the complete spectrum of RDC/TMD diagnoses had been absent until recently.8

For the original RDC/TMD Axis II instruments, good evidence for their reliability and validity for measuring psychosocial status and pain-related disability already existed when the classification system was published.9–13 Subsequently, a variety of studies have demonstrated the significance and utility of the original RDC/TMD biobehavioral measures in such areas as predicting outcomes of clinical trials, escalation from acute to chronic pain, and experimental laboratory settings.14–20

Other studies have shown that the original RDC/TMD biobehavioral measures are incomplete in terms of prediction of disease course.21–23 The overall utility of the biobehavioral measures in routine clinical settings has, however, yet to be demonstrated, in part because most studies have to date focused on Axis I diagnoses rather than Axis II biobehavioral factors.24

The aims of this article are to present the evidence-based new Axis I and Axis II DC/TMD to be used in both clinical and research settings, as well as present the processes related to their development.

Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications: recommendations of the International RDC/TMD Consortium Network* and Orofacial Pain Special Interest Group†

Sex, Gender, and Pain: A Review of Recent Clinical and Experimental Findings

The self-medication hypothesis of addictive disorders derives primarily from clinical observations of patients with substance use disorders. Individuals discover that the specific actions or effects of each class of drugs relieve or change a range of painful affect states. Self-medication factors occur in a context of self-regulation vulnerabilities--primarily difficulties in regulating affects, self-esteem, relationships, and self-care. Persons with substance use disorders suffer in the extreme with their feelings, either being overwhelmed with painful affects or seeming not to feel their emotions at all. Substances of abuse help such individuals to relieve painful affects or to experience or control emotions when they are absent or confusing. Diagnostic studies provide evidence that variously supports and fails to support a self-medication hypothesis of addictive disorders. The cause-consequence controversy involving psychopathology and substance use/abuse is reviewed and critiqued. In contrast, clinical observations and empirical studies that focus on painful affects and subjective states of distress more consistently suggest that such states of suffering are important psychological determinants in using, becoming dependent upon, and relapsing to addictive substances. Subjective states of distress and suffering involved in motives to self-medicate with substances of abuse are considered with respect to nicotine dependence and to schizophrenia and posttraumatic stress disorder comorbid with a substance use disorder.

The Self-medication Hypothesis of Substance Use Disorders: A Reconsideration and Recent Applications

Purpose—The aim of this guideline is to provide a synopsis of best clinical practices in the rehabilitative care of adults recovering from stroke. Methods—Writing group members were nominated by th...

Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association

Introduction: Migraine is currently listed as the second cause of ‘years lived with disability’ and the sixth cause of global disability. Despite the burden associated to the disease, availability ...

Lasmiditan: an additional therapeutic option for the acute treatment of migraine.

Objective: To evaluate whether a short training focused on improving dementia care practices of the hospital staff was able to counteract functional loss and to decrease negative outcomes at discharge among hospitalized older adults with cognitive impairment.Method: Sixty-eight hospitalized participants aged 65 and over with cognitive impairment were included in the study, allocated in the control group (n = 34) and intervention group (n = 34). The intervention consisted of a short training of the hospital staff aimed at improving the management of patients with cognitive impairment. Participants were evaluated within 48 h of hospital admission and at discharge using a battery of tests including Barthel Index, Mini-Mental State Examination, and Hospital Anxiety and Depression Scale.Results: The intervention group demonstrated shorter hospital length of stay and a maintenance of the functional status at discharge compared to the control group. We observed no differences in cognitive ability between the two groups, and a trend towards a decrease of anxious symptoms in the intervention group compared to the control group.Conclusion: The results suggest that an intervention, focused on improving dementia care practices in healthcare staff, has the potential to improve the outcomes for hospitalized older adults with cognitive impairment.

Dementia-friendly intervention for hospitalized older adults with cognitive impairments: results of the Italian Dementia-Friendly Hospital Trial (IDENTITÀ)

Objective: To determine the efficacy of erenumab, a human anti-CGRP receptor antibody, in episodic migraine patents with aura in a subgroup analysis of a phase 3 trial. Background: It is unknown whether monoclonal antibody treatments for migraine, which have little CNS penetration, are equally effective in patients with and without aura. Design/Methods: Patients were randomized 1:1:1 to erenumab (70-mg or 140-mg) or placebo monthly for 6 months. This subgroup analysis of patients with/without history of aura (self-reported) assessed changes in monthly migraine days (MMD), acute migraine-specific medication days (MSMD), and proportion of patients achieving ≥50% reduction in MMD averaged over months 4–6. Nominal p-values presented without multiplicity adjustment and not used for pre-planned hypothesis testing. Results: Of 955 patients randomized, 52% (n=492) had history of aura. Baseline characteristics were similar among groups. Compared with placebo, erenumab induced greater reductions in MMD in both subgroups. In patients without aura history, least-squares mean (SE) changes from baseline were −1.5 (0.3) for placebo vs −2.7 (0.3) for 70-mg (p=0.002) and −3.8 (0.3) for 140-mg (p Conclusions: These data indicate that erenumab is efficacious in migraine patients with and without history of aura. Study Supported by: This study was fully funded by Amgen. Erenumab is co-developed in partnership with Amgen and Novartis. Disclosure: Dr. McAllister has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Amgen Inc., Teva, Allergan. Dr. McAllister has received research support from Allergan, Amgen Inc., Eli Lilly, Teva, Scinovion, San Bio, Novartis. Dr. Pascual has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Allergan, Amgen, and Novartis. Dr. McGill has nothing to disclose. Dr. Newman has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Allergan, Alder,Amgen,Novartis, Teva, and Supernus. Dr. Tassorelli has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Allergan. Dr. Tassorelli has received personal compensation in an editorial capacity for Specialty Section Editor for Frontiers in Neurology and Associated Editor for The Journal of Headache and Pain. Dr. Zhang has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Amgen. Dr. Zhang has received compensation for serving on the Board of Directors of Amgen. Dr. Picard has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Amgen. Dr. Picard has received compensation for serving on the Board of Directors of Amgen. Dr. Mikol has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Amgen. Dr. Mikol has received compensation for serving on the Board of Directors of Amgen.

Efficacy of Erenumab For the Treatment of Patients with Episodic Migraine with Aura (P4.094)

Experimental evidence demonstrates the antinociceptive action of endocannabinoids (eCBs) and their role in the modulation of trigeminovascular system activation, suggesting that the endocannabinoid system (ECS) may be dysfunctional in migraine, a neurovascular disorder characterized by recurrent episodic headaches. It is well known that eCBs may inhibit the release of neurotransmitters controlling nociceptive inputs through cannabinoid receptor-dependent retrograde mechanism and that the levels of these lipids are high in those regions known to be involved in transmission and modulation of pain signals. In this chapter, we shall describe experimental and clinical data that demonstrate the link between eCBs and migraine. Although the exact ECS-dependent mechanisms underlying migraine are not fully understood, the available results strongly suggest that activation of the ECS could represent a promising therapeutic strategy to counter migraine attacks.

Endocannabinoids and migraine

We describe a patient affected by migraine with visual and somatosensory aura, whose symptoms were consistently attenuated by noninvasive peripheral vagal nerve stimulation (nVNS) in multiple prosp...

Cristina Tassorelli

Papers

Lasmiditan: an additional therapeutic option for the acute treatment of migraine.

Dementia-friendly intervention for hospitalized older adults with cognitive impairments: results of the Italian Dementia-Friendly Hospital Trial (IDENTITÀ)

Efficacy of Erenumab For the Treatment of Patients with Episodic Migraine with Aura (P4.094)

Endocannabinoids and migraine

Noninvasive peripheral vagal nerve stimulation prevents migraine aura: A case report: