The Mediterranean (MEDI) and Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diets have been associated with a reduced risk of Parkinson’s disease (PD) diagnosis. However, studies evaluating whether these diets are associated with disease progression in those patients already diagnosed are lacking. The objective of this study was to evaluate whether MIND and MEDI scores were associated with improved patient-reported outcomes. Additionally, we sought to explore which questions on the MIND and MEDI scales were more strongly correlated with PD symptom severity. Data were obtained from the ongoing Modifiable Variables in Parkinsonism study, using patient-reported outcomes in Parkinson’s disease (PRO-PD) as the primary measure for symptom severity, and MIND and MEDI scales for diet score. After adjusting for age, gender, income, and years since diagnosis, for each 1-point increase in the MIND and MEDI scores, PRO-PD scores were 52.9 points lower (95%CI: −66.4, −39.4; p < 0.001) and 25.6 points lower (95%CI: −37.2, −14.0; p < 0.001), respectively (N = 1205). This study suggests MIND and MEDI scores are associated with fewer patient-reported symptoms over time, with each MIND point being twice as strong as a MEDI point in reducing symptom severity. Future dietary intervention trials should consider the MIND diet as a therapeutic strategy for improving long-term PD outcomes.

BACKGROUND An enhanced understanding of Parkinson’s disease (PD) in recent years has led to the revelation that the motor symptoms by which we’ve been defining and describing PD are late-stage, downstream consequences of a degenerative process decades in the making. The objective outcome measures traditionally used in clinic and PD research rely heavily on motor symptoms and have been shown to lack sensitivity early in the disease. The Patient-Reported Outcomes in PD (PRO-PD) scale is an entirely subjective, patient-centered tool designed to be useful to patients, providers, and researchers as a remote patient monitoring system. OBJECTIVE The goal was to create a continuous outcome measure that does not require a clinic visit, is sensitive early in the disease, does not fluctuate throughout the day, captures severity of both motor and non-motor symptoms, and correlates with quality of life (QoL) and existing measures of severity. METHODS Two datasets were used with a total of 13,349 participants with PRO-PD scores. Data quality, feasibility, Cronbach’s alpha, and confirmatory factor analysis was conducted. Longitudinal analysis to determine change over time was completed. Response to change was evaluated by initiation of levodopa. RESULTS The PRO-PD scale shows acceptable validity with a 95.1% completion rate, non-significant floor and ceiling effects, acceptable skew and kurtosis, Cronbach’s alpha of >0.75 for the total scale and subscales with acceptable unidimentionality (r between 0.37 and 0.84). Confirmatory factor analysis (CFI = 0.841, Tucker Lewis Index = 0.829, SRMSEA = 0.054) shows room for improvement for factors. Responsiveness has been shown by mean change per year in PRO-PD score of 38 (±14) and significant improvement in PRO-PD score with initiation of dopamine replacement therapy. CONCLUSIONS These analyses suggest the PRO-PD is a feasible and valid tool for remote patient monitoring in PD.

Background Psoriasis is a common psychocutaneous disorder, frequently associated with reduced quality of life (QoL) and psychiatric comorbidities, including anxiety and mood disorders. Although pharmacological interventions and phototherapy may provide effective, albeit temporary, relief in the skin, they frequently fail to address the psychological impact of the disease. Heart rate variability biofeedback (HRVB) is a specific mind-body therapy that provides real-time visual feedback on an individual’s autonomic functioning in order to modify their physiological stress response through diaphragmatic, paced breathing. Objective To explore the impact of a seven-week HRVB protocol on skin severity (SS), QoL, and mental health (MH) in individuals with psoriasis and to determine whether the effects, if any, can be maintained after the intervention has concluded. Methods This was a single-arm, proof-of-concept clinical case series conducted at Bastyr University Clinic in San Diego, California. Five participants were recruited through flyers and referrals and were screened for eligibility prior to undergoing a seven-week HRVB protocol. SS was assessed by both the participant and clinician using the Psoriasis Area and Severity Index (PASI-P and PASI-C), QoL was assessed using the Cardiff Dermatology Life Quality Index (DLQI), and MH was measured using the Generalized Anxiety Disorder-7 (GAD-7), and the Patient Health Questionnaire-9 (PHQ-9). These outcomes were collected at baseline (T1), post-protocol (T2), and follow-up (T3) between June 2022 to December 2022. Results There were significant differences in scores between T1 and T2 for PASI-P, DLQI, and GAD-7. There was also a significant difference between T1 and T3 for GAD-7. PASI-C and PHQ-9 had no significant difference between any time points. All scales were non-significant for T2 and T3. PASI-P, PASI-C, DLQI, and PHQ-9 were non-significant between T1 to T3. Linear regressions for each participant showed a majority decreasing rate of change. Conclusion In this real-life setting, HRVB was associated with significant improvements in participant perception of SS, QoL, and anxiety over a seven-week period. Future studies should include a larger cohort with more variation in SS, QoL, and MH scores at T1 and compare the HRVB protocol against a control group. NCT05506644, retrospectively registered on 16 August 2022. Trial registration ClinicalTrials.gov