Background: The relationship between essential tremor (ET) and Parkinson's disease (PD) remains controversial. Beyond viewing ET as a discrete risk factor for PD, recent frameworks propose that an ET phenotype may represent a clinical presentation of prodromal PD (pPD), consistent with the current reconceptualization of ET as a syndrome. Whether co-occurring subtle motor signs alter pPD probability in ET remains unknown. Methods: Using the MDS research criteria, we calculated pPD probability in a large cohort of ET patients with and without subtle motor signs (rest tremor, hypomimia, isolated rigidity, reduced arm swing, altered repetitive movements, global slowing). Multivariable regression was used to identify independent predictors of pPD probability. Results: Among 599 ET patients (median disease duration: 12 years), only 6 (1.0%) met criteria for probable pPD. Although ET patients with subtle motor signs exhibited higher continuous pPD probability scores than those without, the frequency of possible or probable pPD did not differ significantly between groups. In multivariable regression, neither ET nor individual subtle motor signs, but hypomimia, were independent predictors of pPD probability, which was primarily driven by older age and male sex. Conclusions: Long-standing ET, whether isolated or accompanied by subtle motor signs, is not associated with pPD, with the possible exception of co-occurring hypomimia.
C. Sorrentino, I. Carotenuto, F. di Biasio et al.· medRxiv· 0 citations
A sex-specific pattern within the dopaminergic pathways may underlie the clinical divergences between male and female patients with Parkinson’s disease (PD) over the disease course. One hundred forty-seven drug-naive PD patients and 38 controls were enrolled. Anatomical and rs-fMRI images were acquired at baseline. Clinical assessments were performed at baseline and (yearly) at follow-ups for 4 years. Using connectivity-based parcellation, we obtained three ROIs for the sensorimotor, limbic, and cognitive striatal functional subregions, which were used as seeds for functional connectivity (FC) analyses. Baseline and longitudinal clinical data at 4 years were correlated with baseline imaging findings. Female PD showed reduced sensorimotor FC with the superior frontal gyrus compared with male PD patients, while no significant sex-related effects emerged for limbic or cognitive striatal seeds. Compared with controls, PD males and females showed both increased and decreased FC involving the three striatal subregions and frontal, insula, hippocampus, and cingulate areas, while voxel-based morphometry revealed no significant sex-related structural differences. Baseline FC changes in limbic and cognitive striatal circuits were associated with slower motor and cognitive progression over 4 years. Although not supported by formal interaction effects, this pattern may underlie sex-specific vulnerability, possibly reflecting different plasticity responses shaped by biological sex.
R. de Micco, S. Satolli, Noemi Piramide et al.· npj Parkinson's Disease· 0 citations
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