What is this summary about?: This is a plain language summary of an article published in Future Neurology. In it, we look at why it is important to diagnose Alzheimer's disease as early as possible, and think about why it can be difficult to reach an early diagnosis. Why is early diagnosis important?: Early diagnosis refers to people being diagnosed with Alzheimer's disease when their symptoms are classified as mild. This may allow people to make lifestyle changes that help them to stay independent for longer or plan for the future, which may lead to an improved quality of life. It also means treatment can be given as soon as possible, which may slow down disease progression at an earlier stage. Understanding the benefits as well as the difficulty in identifying symptoms at an early stage helps healthcare professionals and researchers to better understand the diagnosis, treatment, and care of people with Alzheimer's disease. What are the key takeaways?: Healthcare professionals need easy-to-use tools that help them diagnose Alzheimer's disease. Research means that information about diagnosis and treatment is often changing. As a result, healthcare systems should give healthcare professionals clear and up-to-date guidelines for diagnosing and caring for people with Alzheimer's disease.

What is this summary about? Clinical studies test whether a new treatment is safe and if the treatment works in people who have a particular condition. Most current questionnaires used in clinical studies investigating Parkinson's measure symptoms in people who have been diagnosed for many years. This means that these existing questionnaires may not be useful for people living with early-stage Parkinson's, where the symptoms experienced can be quite different to later stages, or may not show if a new treatment is helpful for them. The most common symptoms in Parkinson's are involuntary shaking of parts of the body (“tremor”), slow movement (“bradykinesia”) and stiff, inflexible muscles (“rigidity”), which worsen with time. Symptoms specific to early-stage Parkinson's are not fully understood and research is ongoing in this area. New measures are therefore needed to assess the symptoms affecting people living with early-stage Parkinson's, especially the symptoms that they find most troublesome. This study investigated which symptoms are of most importance to people in the earlier stages of their condition and which would be appropriate to measure in future clinical studies. Who was involved in the study? The research team that led the study was made up of people living with Parkinson's, as well as technical experts and representatives from Parkinson's patient organizations (Parkinson's UK and the Parkinson's Foundation). The participants in the study were people living with early-stage Parkinson's and their care partners. What were the results? Slowness of movement (called “bradykinesia”) was noted as a key symptom. “Functional slowness” was especially noted. This symptom caused people to feel slower during many daily tasks, such as brushing teeth, walking and cooking. The loss of ability to move easily and freely, termed “mobility”, was also a key symptom. It was noticeable in walking abnormalities and difficulties performing “fine motor skills”. These are tasks that require precision, dexterity and coordination. Other impactful symptoms were: tremor, rigidity/stiffness, feelings of exhaustion (fatigue), depression, sleeping problems and pain. What do the results of the study mean? The personal views gathered in this study show the wide-ranging effects of early-stage Parkinson's. The study also identifies functional slowness and loss of mobility as key symptoms that would be appropriate to measure in future early-stage Parkinson's clinical studies to test if treatments are working or not.

Aim: Correctly diagnosing repetitive behaviors in patients with Tourette syndrome (TS) can be challenging. The differential diagnosis between tics and stereotypies is of particular importance, because of treatment implications. Methods: We assessed the prevalence and clinical characteristics of stereotypies in a large sample of adult patients with TS attending a specialist clinic. Results: Mild stereotypies were reported by 21/148 patients (14.2%). Patients with stereotypies were significantly more likely to have a comorbid diagnosis of Asperger syndrome, attention-deficit and hyperactivity disorder, and obsessive-compulsive disorder, compared with patients without stereotypies. Multiple linear regression analysis revealed that the presence of Asperger syndrome significantly predicted stereotypy severity. Conclusion: Stereotypies are not rare in adults with TS and other neurodevelopmental conditions, especially Asperger syndrome.

Chronic stress undermines physical and mental health, in part via dysregulation of the neuroendocrine stress system. Key to understand this dysregulation is recognizing that the problem is not stress per se, but rather its chronicity. The optimally functioning stress system is highly dynamic, and negative feedback regulation enforces transient responses to acute stressors. Chronic stress overrides this, and adaptation to the chronicity can result in persistent dysregulation by altering sensitivity thresholds critical for control of system dynamics. Such adaptation involves plasticity within the central nervous system (CNS) as well as epigenetic regulation. When it occurs during development, it can have persistent effects on neuroendocrine regulation. Understanding how chronic stress programs development of the neuroendocrine stress system requires elucidation of stress-responsive gene regulatory networks that control CNS plasticity and development.

The significance of cerebral small vessel disease Heterogeneity of cerebrovascular disorders has been realized for eons but brain or cerebral small vessel disease (SVD) is now in vogue. SVD seems to be distinguished in all types of dementias. This is largely due to advances in neuroimaging given that the resolution of magnetic resonance imaging (MRI) appears to improve day by day. We can now detect a repertoire of SVD features once only visible with the simple microscope. The definition of SVD presupposes to sharpen even more with the advent of high tensile MR scanners. White matter hyperintensities (WMH) on T2-weighted MRI have been the focus of a raft of well-meaning studies. They are regarded as the radiological signature of SVD. Frequencies of WMH or white matter (WM) lesions range 11-21% in 64 year olds and increase to 94% by age 82, with slightly higher frequency in women. WMH are more common and extensive in patients with cardiovascular risk factors and increase risk of stroke, dementia and death The heritability of WMH is as high as 45-73%. WMHs are also associated with a greater decline in global cognitive performance and many domains of executive function Diffusion tensor imaging indicates microstructural changes within WM fibers in the frontal lobe are correlated with performance in cognitive domains including executive function, working memory and processing speed. Furthermore, lesion symptom mapping data and information from probabilistic WM atlases suggest that the anterior thalamic radiation is the major anatomical structure involving processing speed. These findings provide support for the role of frontal-subcortical circuits in cerebral SVD and vascular cognitive impairment. However, these tract changes are also apparent in variants of frontotemporal dementias. The current radiological definition of SVD includes lacunar infarcts, perivascular spacing, focal atrophy, microbleeds and microinfarcts These SVD features are invariably described to be present in different dementias even if thought to result from parallel processes with no interactions between vascular and neurodegenerative changes