***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The present study investigated memory for intention in individuals with Parkinson 's disease ( PD ) who were newly diagnosed and not yet treated to avoid the effect of therapy as a potential confounding variable . A comprehensive neuropsychological battery and an event-based prospect i ve memory task were administered to 41 subjects with de novo PD and 40 control subjects . Separate scores were computed for correct execution of intended action ( prospect i ve component ) and recall of intention ( retrospective component ) . PD patients performed marginally worse ( p = .053 ) than controls on the prospect i ve component of the task . On the other h and , the performance of the two groups was comparable for the retrospective component . Neuropsychological findings revealed lower performance of the PD group in episodic memory and in some measures of executive functions . These results suggested a subtle prospect i ve memory dysfunction present at the initial stage of PD , which may be related to disruption of fronto-striatal circuitry BACKGROUND The clinical manifestations of drug-induced parkinsonism ( DIP ) and Parkinson disease ( PD ) are nearly indistinguishable , making it difficult to differentiate DIP from PD , especially in the early stages . We compared non-motor symptoms between patients with DIP and those with drug-naïve PD in the early stages using the Non Motor Symptoms Scale ( NMSS ) . METHODS We prospect ively enrolled 28 patients with DIP , 35 patients with drug-naïve PD , and 32 controls with no history of neurological diseases or related medical problems . We investigated demographic characteristics , medical and drug history , parkinsonian motor symptoms , and non-motor symptoms . We used the NMSS to evaluate non-motor symptoms in all patients . RESULTS The total NMSS scores were higher in patients with PD than those with DIP , as were the scores for certain domains , including the cardiovascular , sleep/fatigue , urinary , sexual , and miscellaneous domains . When controlling for age and gender , the correlation analysis revealed that scores for urinary symptoms ( urgency , frequency and nocturia ) , sleep disturbances ( daytime sleep , restless legs ) , concentration , taste or smell were significantly associated with PD . CONCLUSIONS Our data suggest that non-motor symptoms , particularly urinary symptoms , excessive daytime sleepiness , restless leg syndrome , attention deficit and hyposmia may be helpful to differentiate between DIP and PD in the early stages Background Non-motor symptoms are very common among patients with Parkinson 's disease since the earliest stage , but little is known about their progression and their relationship with dopaminergic replacement therapy . Methods We studied non-motor symptoms before and after 2 years from dopaminergic therapy introduction in ninety-one newly diagnosed previously untreated PD patients . Results At baseline , nearly all patients ( 97.8 % ) referred at least one non-motor symptom . At follow-up , only few non-motor symptoms significantly changed . Particularly , depression and concentration became less frequent , while weight change significantly increased after introduction of dopamine agonists . Conclusions We reported for the first time a 2-year prospect i ve study on non-motor symptoms before and after starting therapy in newly diagnosed PD patients . Even if non-motor symptoms are very frequent in early stage , they tend to remain stable during the early phase of disease , being only few non-motor symptoms affected from dopaminergic therapy and , specifically , by the use of dopamine agonists BACKGROUND It is accepted that orthostatic hypotension is a clinical marker for the diagnosis of multiple system atrophy , but conflicting data indicate that it may also be present in Parkinson disease ( PD ) . OBJECTIVES To evaluate the prevalence of autonomic cardiovascular impairment and orthostatic hypotension in a large group of patients with de novo PD , followed up for at least 7 years , to clinical ly confirm the diagnosis of the disease . METHODS During a 2-year recruiting period , 60 untreated patients diagnosed as having idiopathic PD underwent autonomic cardiovascular function evaluation using the Ewing test . Patients subsequently received dopaminergic therapy and their condition was followed up for at least 7 years . RESULTS Nine ( 15 % ) of 60 patients were excluded from the study because during the follow-up period a parkinsonian syndrome was diagnosed ( 5 had multiple system atrophy and 4 had progressive supranuclear palsy ) . Data from 51 patients with PD underwent final statistical analysis and the results were compared with those of 51 age-matched healthy control subjects who had taken the same battery of autonomic tests . A statistically significant difference was found in postural hypotension ( P = .02 ) and deep breathing test results ( P = .03 ) between patients and controls . Seven ( 14 % ) of 51 patients with PD and 3 ( 60 % ) of 5 patients with multiple system atrophy had a decrease of more than 20 mm Hg in systolic blood pressure on st and ing . CONCLUSIONS Data from this study indicate a high prevalence of sympathetic and parasympathetic failure in patients with de novo PD , and when using a decrease of at least 20 mm Hg in systolic blood pressure , manometric orthostatic hypotension was found in 7 ( 14 % ) of the 51 patients with de novo PD BACKGROUND Gastrointestinal tract ( GIT ) dysfunction is common in Parkinson 's disease ( PD ) patients . However , it remains unclear whether levodopa affects GIT function in PD . OBJECTIVE To perform an open study of levodopa 's effects on anorectal constipation in de novo PD patients by the quantitative lower-gastrointestinal autonomic test ( QL-GAT ) . METHODS Nineteen unselected de novo PD patients ( 10 men , 9 women ; mean age , 66 years ; mean duration of the disease , 2.2 years ) were recruited for the study . Eighteen of the patients reported constipation .  These patients were treated with 200/20 mg b.i.d . of levodopa/carbidopa for 3 months . Pre- and post-treatment , objective parameters in the QL-GAT that comprised the colonic transit time ( CTT ) and rectoanal videomanometry were obtained . RESULTS Levodopa was well tolerated by all patients . There was a trend toward subjective improvements in bowel frequency and difficulty defecating . Levodopa did not significantly change CTT of the total colon or any segment of the colon . During rectal filling , levodopa significantly lessened the first sensation ( p < 0.05 ) . It also tended to augment the amplitude of spontaneous phasic rectal contraction ( not statistically significant ) . During defecation , levodopa significantly lessened the amplitude in paradoxical sphincter contraction upon defecation ( PSD ) ( p < 0.01 ) . It also tended to augment the amplitude of rectal contraction and lessen the amplitude of abdominal strain ( not statistically significant ) . Overall , levodopa significantly lessened post-defecation residuals ( p < 0.05 ) . CONCLUSIONS The QL-GAT in the present study showed for the first time that levodopa augmented rectal contraction , lessened PSD , and thereby ameliorated anorectal constipation in de novo PD patients Objective : To determine nonmotor signs ( NMS ) and evaluate the utility of several diagnostic tools in patients with de novo Parkinson disease ( PD ) . Methods : This is a large single-center study of the DeNoPa cohort , including frequency-matched healthy controls . This study covers motor signs , NMS , and a combination of diagnostic tests including olfactory testing , transcranial sonography of substantia nigra ( TCS ) , and polysomnography ( PSG ) . We report the frequency and characteristics of NMS and the outcomes of nonmotor tests at the time of diagnosis . Results : Cross-sectional analyses of baseline investigations identified significant differences in the NMS Question naire ( NMSQuest ) and the Scopa-AUT Gastrointestinal score in 159 drug-naïve PD patients vs 110 controls . In addition , patients with PD showed reduced olfactory function , hyperechogenicity on TCS , and higher frequency of REM sleep behavior disorder ( RBD ) . In exploring predictive markers , we found that the combination of several investigations , i.e. , the NMSQuest , Scopa-AUT Gastrointestinal score , and Smell Identification Test reached an area under the receiver operating characteristic curve ( AUC ) of 0.913 ( 95 % confidence interval [ CI ] 0.878–0.948 ) . With the addition of serum cholesterol and mean heart rate values , the AUC value reached 0.919 ( 95 % CI 886–0.953 ) ; when TCS and PSG were added , the AUC increased to 0.963 ( 95 % CI 0.943–0.982 ) . Conclusions : We show feasibility and utility of st and ardized data acquisition in a large , single-center cohort of patients with de novo PD and matched healthy controls . The baseline results from our prospect i ve investigations reached a value of > 0.9 sensitivity and specificity for biological markers when we added routine laboratory investigations and quantified nonmotor features including sleep Objectives : Fatigue is common in Parkinson 's disease ( PD ) , causing serious negative effects on quality of life . Despite its clinical importance , the nature of fatigue in PD is poorly understood because its underlying neurobiology is unknown . Fatigue can be more complicated in advanced PD because of its chronicity . In order to find features that are innate to fatigue in PD , it would be useful to conduct a study looking at de novo PD . Assessing fatigue in de novo patients allows excluding at least one confounding factor . Methods : We prospect ively investigated 87 drug-naïve PD patients . Thirty-nine patients ( 44.8 % ) were found to have fatigue around the time of diagnosis of PD . Results : We found that depression and difficulties with activities of daily living were independent risk factors for fatigue ; however , motor dysfunction was not related . Clinical ly meaningful responses to dopaminergic medication were observed . Discussion : Our study determined that fatigue occurs in the early stages of PD . It can inform clinical decision-making to significantly benefit PD patients with fatigue Background : Fatigue is a common complaint in Parkinson disease ( PD ) . We investigated fatigue in a cohort of previously untreated patients with early PD enrolled in the Earlier vs Later Levodopa ( ELLDOPA ) clinical trial . Methods : A total of 361 patients were enrolled in the r and omized , double-blind , placebo-controlled ELLDOPA trial and assigned to receive placebo or carbidopa-levodopa 37.5/150 mg , 75/300 mg , or 150/600 mg daily for 40 weeks , followed by a 2-week medication washout period . Subjects who scored > 4 on the Fatigue Severity Scale  were classified as fatigued . PD severity was assessed using the Unified Parkinson 's Disease Rating Scale ( UPDRS ) , Hoehn-Yahr scale , and Schwab-Engl and Activities of Daily Living Scale . A subgroup of subjects underwent [123I]-β-CIT SPECT to measure striatal dopamine transporter density . Results : Of the 349 ELLDOPA subjects who completed fatigue measures , 128 were classified as fatigued at baseline . The fatigued group was significantly more impaired neurologically ( UPDRS , all subscales and Hoehn and Yahr staging ) and functionally ( Schwab-Engl and Scale ) but no significant differences were observed in β-CIT measurements between the two groups . Analysis of covariance showed a greater increase in fatigue score from baseline to the end of the 2-week washout in the placebo group ( 0.75 points ) than in the three groups receiving levodopa ( increases of 0.30 [ 150 mg/day ] , 0.36 [ 300 mg/day ] , and 0.33 [ 600 mg/day ] ; p = 0.03 for heterogeneity ) . Conclusions : Fatigue is a frequent symptom in early , untreated , non-depressed patients with Parkinson disease ( PD ) , affecting over 1/3 of the patients in this cohort at baseline and 50 % by week 42 . Fatigue was associated with the severity of PD , and progressed less in patients treated with levodopa OBJECTIVE Rapid eye movement ( REM ) sleep behavior disorder ( RBD ) is a risk factor for dementia in Parkinson disease ( PD ) patients . The objectives of our study were to prospect ively evaluate the frequency of RBD in a sample of treatment-naïve , newly diagnosed PD patients and compare sleep characteristics and cognition in RBD and non-RBD groups . METHODS Fifty-seven newly diagnosed PD patients were consecutively recruited in a university medical center . All patients underwent two overnight polysomnography ( PSG ) sessions and were diagnosed with RBD according to the International Classification of Sleep Disorders , Second Revision criteria . Daytime sleepiness was measured in a multiple sleep latency test ( MSLT ) . Cognition was assessed in a st and ard neuropsychologic examination . RESULTS Seventeen PD patients ( 30 % ) met the criteria for RBD . The RBD patients and non-RBD patients did not significantly differ in mean age , gender ratio , disease duration , motor symptom subtype and severity , total sleep time , percentage of REM sleep , apnea-hypopnea index , mean oxygen saturation , and importantly cognitive performance . However , non-RBD patients had a significantly shorter mean daytime sleep latency than RBD patients ( 15 vs. 18 min , respectively ; P=.0 
    Output:
    
The current review confirms the increasing research being conducted into NMS in DNPD patients as well as the necessity for further investigation into less-studied NMS , such as pain .