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

In some patients, triptans are not effective for the acute treatment of migraine attacks or are contraindicated due to concomitant vascular diseases. For these patients, there was a need to develop new substances for the acute treatment of migraine, which can be used specifically for patients with contraindications to triptans, as they do not have vasoconstrictive properties. Patients with frequent and severe migraine attacks require a preventive treatment. Until a few years ago, migraine prevention included substances originally developed for other indications, such as the betablockers, flunarizine, valproic acid, topiramate, and amitriptyline. OnabotulinumtoxinA, which is indicated for the prevention of chronic migraine, was originally developed for the treatment of focal dystonia. Most oral preventive drugs induce a 50% reduction of monthly migraine days in a percentage of patients that varies between 30% and 50%. The main problem with traditional oral migraine prophylactics has been adverse drug reactions, which have led to discontinuation of therapy in 10% to 40% of patients within the first six to 12 months. In recent years, there have been spectacular advances in the development of specific drugs for the acute treatment of migraine attacks and for migraine prevention. One approach is monoclonal humanized or fully human antibodies against the polypeptide CGRP or the CGRP-receptor. Another approach is antagonists at the CGRP receptor itself such as rimegepant and atogepant. There has also been progress in the acute therapy of migraine especially for patients who have contraindication to triptans. New drugs for the acute treatment of migraine include the 5HT1F-agonist lasmiditan (belonging to the “ditans” family) and the CGRP receptor blockers rimegepant and ubrogepant (so called “gepants”). All publications on phase II and phase III studies of the new migraine preventive drugs, as well as of gepants and ditans, respectively, were written with the support of pharmaceutical companies. This also applies to secondary analyses and subgroup analyses. Naturally, there is a conscious or unconscious bias in the presentation of study results in these publications. The International Headache Society has therefore decided to present the current state of knowledge on the new migraine drugs in a special issue of Cephalalgia. To ensure this is as uninfluenced as possible, two or more members of the junior headache research group with no or minimal conflicts of interest were selected for each of the reviews. The author group was supplemented by an experienced senior author and, when required, by a statistician. The International Headache Society deems, therefore, that the composition of the author groups will provide a presentation of the efficacy and potential side effects or safety aspects of the new drugs for the treatment of acute migraine attacks and for the prevention of migraine that is as objective as possible and can be used for clinical practice. In addition to meta-analyses of efficacy and tolerability or safety for both acute and preventive medications (1–3), some of the publications address

New migraine drugs

Background The coronavirus disease 2019 (COVID-19) pandemic has severely impacted the Italian healthcare system, underscoring a dramatic shortage of specialized doctors in many disciplines. The situation affected the activity of the residents in neurology, who were also offered the possibility of being formally hired before their training completion. Aims (1) To showcase examples of clinical and research activity of residents in neurology during the COVID-19 pandemic in Italy and (2) to illustrate the point of view of Italian residents in neurology about the possibility of being hired before the completion of their residency program. Results Real-life reports from several areas in Lombardia-one of the Italian regions more affected by COVID-19-show that residents in neurology gave an outstanding demonstration of generosity, collaboration, reliability, and adaptation to the changing environment, while continuing their clinical training and research activities. A very small minority of the residents participated in the dedicated selections for being hired before completion of their training program. The large majority of them prioritized their training over the option of earlier employment. Conclusions Italian residents in neurology generously contributed to the healthcare management of the COVID-19 pandemic in many ways, while remaining determined to pursue their training. Neurology is a rapidly evolving clinical field due to continuous diagnostic and therapeutic progress. Stakeholders need to listen to the strong message conveyed by our residents in neurology and endeavor to provide them with the most adequate training, to ensure high quality of care and excellence in research in the future.

/pdf/the-contribution-of-the-italian-residents-in-neurology-to-5arnlllbk6.pdf

The contribution of the Italian residents in neurology to the COVID-19 crisis: admirable generosity but neurological training remains their priority.

Nevralgie craniche e dolori facciali di origine centrale

Age-, gender- and body site-specific reference values of thermal Quantitative Sensory Testing in the Italian population using the Q-sense device.

Primary headaches represent a common and major health problem worldwide and significantly impair patients’ quality of life; however, pathophysiological mechanisms remain obscure. While migraine is the most studied of the primary headaches, several others also exist that are differentiated from migraine by their characteristic symptomatology and pathophysiology. These include tension-type headache and the trigeminal autonomic cephalalgias, such as cluster headache. Several animal models have provided a translational knowledge on migraine pathophysiology; however, animal models for studies of other primary headaches, such as tension-type headache and cluster headache, evaluating their underlying pathophysiology are very limited. In this chapter, we will briefly review the known putative mechanisms of some of the other primary headaches and the current animal models for these headache types that are used to aid our understanding of their pathophysiology.

Cristina Tassorelli

Papers

New migraine drugs

The contribution of the Italian residents in neurology to the COVID-19 crisis: admirable generosity but neurological training remains their priority.

Nevralgie craniche e dolori facciali di origine centrale

Age-, gender- and body site-specific reference values of thermal Quantitative Sensory Testing in the Italian population using the Q-sense device.

Animal Models of Tension-Type Headache and Trigeminal Autonomic Cephalalgias