BACKGROUND:UK Biobank (UKBB) provides extensive genetic, imaging, and health data for ~500,000 participants, enabling studies of prodromal phases of diseases like Parkinson's disease (PD). However, during analysis, we became concerned about the accuracy of diagnosis timing. OBJECTIVE:To evaluate the accuracy of PD diagnosis timing in UKBB. METHODS:We examined PD diagnosis timing using hospital, primary care, death records, and self-reported data. We assessed discrepancies between sources and identified co-occurring diagnoses recorded on the same date as PD. RESULTS:Among 3979 PD cases, 97% of the 786 participants with both self-reported and electronic health records (EHRs) reported their diagnosis earlier than recorded in the EHR, with a typical delay of 5 to 7 years. Multiple codiagnoses were often logged on the same date, suggesting retrospective or batch data entry. CONCLUSIONS:Substantial delays in PD documentation may misclassify already diagnosed individuals as prodromal. This introduces significant bias into studies of early disease markers and distorts the timing between risk factors and clinical onset. © 2025 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Introduction: Evidence suggests an inverse correlation between smoking and Parkinson's disease (PD), yet the mechanisms remain unclear. This study examines the changing risk relationship between smoking and PD diagnosis using alcohol consumption, another reward-driven behavior, as a comparative measure. Methods: A nested case-control study was conducted using the UK Biobank (UKBB) database. Participants in the prediagnostic phase of PD were identified, and self- reported data on tobacco and alcohol use were analyzed employing conditional binary logistic regression. Polynomial and piece-wise regression models were employed to discern shifting associations with PD over time. Results: Of 502,304 participants (63 +/- 5.3 years, 63 % male), 3049 prediagnostic PD cases were identified. Non-smokers had a heightened PD risk, and this association strengthened closer to diagnosis. The odds ratio (OR [95 % CI]) associated with PD in non-smokers was 2.02 [1.07-3.81] 1-4 years before diagnosis, compared to 1.36 [1.02-1.83] at >10-year intervals (linear trend, p = 0.012). The time trajectory of ORs was best depicted by a quadratic function, identifying a shift in risk 7.5 years before diagnosis documentation. Similar patterns emerged among alcohol non-consumers, with an 8.5-year interval inflection point. Conclusion: This study identified two disparate risk trajectories among non-smokers: an initial low-amplitude increased risk at prolonged prediagnostic intervals possibly related to genetic/personality factors, followed by a sharp escalation in risk association commencing 7-8 years before diagnosis, possibly propelled by reverse causality. Similar trends in alcohol consumption reinforce these conclusions. These findings could suggest that smoking cessation may serve as an early indicator of PD.

Background and objectives: Sleep disorders are commonly linked to various health conditions, although it remains unclear to what degree they are linked with overall mortality. We compared mortality in different self -reported sleep disorders in a large population -based prospective study. Methods: In this case -control study within the CLSA cohort, participants completed a questionnaire at baseline (2011-2015) measuring overall sleep satisfaction, daily sleep duration, sleep -onset and sleep -maintenance insomnia, daytime somnolence, REM sleep behavior disorder (RBD), restless leg syndrome (RLS), and obstructive sleep apnea (OSA). The vital status of participants was assessed in July 2019. Baseline sleep problems of participants who died (cases) were compared to those who survived (controls). For each case, five age/sexmatched controls were selected. Binary logistic regression was used to estimate the association between sleep symptoms and mortality, adjusting for age, sex, marital status, province, education, alcohol consumption, smoking, caffeine, and body mass index. In a complementary model, anxiety and depression were also added. Results: Among 30,097 participants at baseline, 974 deaths were reported in 2019 (60.7 % male, age = 72.3 +/- 9.4 years). In the initial analysis, mortality cases reported more baseline sleep -maintenance insomnia (12.1 % vs. 8.0 %, Adjusted OR[95%CI] = 1.62[1.15,2.29]), daytime somnolence (2.4 % vs. 1.1 %, AOR = 2.70[1.34,5.44]), and higher possible RLS (16.4 % vs. 12.4 %, AOR = 1.50[1.09,2.05]). They were also more likely to screen positive for possible OSA (33.8 % vs. 24.2 %, AOR = 1.32[1.07,1.64]); however, this effect was not related to core apnea symptoms. Sleep durations exceeding 10 h/day were also associated with increased mortality (3.4 % vs. 1.9 %, AOR = 1.83[1.04,3.24]). Other sleep symptoms/disorders, such as sleep -onset insomnia (7.3 % vs. 4.3 %, AOR = 1.54 [1.00,2.37]), possible RBD (5.3 % vs. 5.1 %, AOR = 1.02[0.62,1.69]), and overall sleep dissatisfaction (26.5 % vs. 22.6 %, AOR = 1.14[0.93,1.41]) were not different among these groups. After adding anxiety and depression to the adjustment model, all differences attenuated to become statistically nonsignificant, except for daytime somnolence disorder. When stratified by sex, the association between sleep disorders and mortality was only observed in women, with men showing no association. Discussion: We confirm a relationship between numerous sleep disorders and mortality. This effect is most evident in women, and appears to be strongly related to co -existing anxiety and depression.

Background and Objectives: There has been conflicting evidence regarding the association between seasonal changes and daylight-savings time and sleep disorders. This topic is of current particular interest, as the United States and Canada are considering the elimination of seasonal clock changes. The aim of this study is to compare sleep symptoms among participants who were interviewed in different seasons, and before/after the transition into daylight saving time (DST) and standard time (ST). Methods: 30,097 people aged 45–85 years taking part in the Canadian Longitudinal Study on Aging (CLSA) were studied. Participants completed a questionnaire on sleep duration, satisfaction, sleep-onset insomnia, sleep-maintenance insomnia, and hypersomnolence symptoms. Sleep disorders were compared between participants who were interviewed during different seasons and at different times of the year (DST/ST). Data was analyzed using Chi Square, ANOVA, binary logistic, and linear regression tests. Results: Among participants interviewed in different seasons, we found no difference in dissatisfaction with sleep, sleep-onset, sleep-maintenance, and hypersomnolence. Those interviewed in summer had slightly shorter sleep duration compared to winter (6.76±1.2 vs. 6.84±1.3 hours). Participants interviewed one week before versus one week after DST transition showed no difference in sleep symptoms, except for a 9-minute decrease in sleep duration a week after transition. However, those who were interviewed a week after transition to ST compared to a week before reported more dissatisfaction with sleep (28% vs. 22.6%, adjusted odds ratio [95%CI]=1.34 [1.02,1.76]), higher sleep-onset insomnia (7.1% vs. 3.3%, AOR=2.26 [1.19,4.27]), higher sleep-maintenance insomnia (12.9% vs. 8.2%, AOR=1.64 [1.02,2.66]), and more hypersomnolence with adequate sleep (7.3% vs. 3.6%, AOR=2.08 [1.14,3.79]. Discussion: We found small seasonal variations in sleep duration but no difference in other sleep symptoms. The transition from DST to ST was associated with a transient increase in sleep disorders.

Several studies have suggested that atherosclerotic diseases and diabetes may be risk factors for α-synucleinopathies. This prospective cohort study evaluated whether cardiovascular diseases and metabolic risk factors alter the rate or type of phenoconversion from idiopathic/isolated REM sleep behavior disorder (iRBD) to parkinsonism or dementia. Polysomnography-confirmed iRBD patients recruited between 2004 and 2020 were followed annually. Baseline history of cardiovascular disorders, hypertension, hypercholesterolemia, and diabetes were compared among patients who developed outcomes versus those who remained outcome-free. No atherosclerotic risk factors were associated with development of α-synucleinopathies. Patients with hypercholesterolemia were somewhat more likely to develop dementia with Lewy bodies rather than Parkinson's disease.

Evaluating the discrepancies between patient‐reported measures and clinician examination has implications for formulating individual treatment regimens.

Background: Earlier detection of parkinsonism, specifically during its prodromal stage, may be key to preventing its progression. Previous studies have produced contradictory results on the association between sleep symptoms and prodromal parkinsonism. Objective: We conducted a prospective study within the Canadian Longitudinal Study on Aging (CLSA) to determine whether self-reported symptoms of insomnia, somnolence, apnea, and restless legs syndrome predate the diagnosis of parkinsonism after three years of follow-up. Methods: At baseline, amongst other information, participants completed a questionnaire for difficulty initiating or maintaining sleep, daytime somnolence, snoring or stopping breathing during sleep, and symptoms of restless legs syndrome. After 3 years of follow-up, baseline responses from participants who self-reported a new diagnosis of parkinsonism (cases) were compared to those who did not (controls). For each case, 10 controls were individually matched by age, sex, education, BMI, caffeine, smoking, and alcohol. Binary unconditional logistic regression models were used to estimate the association between sleep symptoms and new-onset parkinsonism, adjusting for age, sex, education, BMI, smoking, alcohol, and caffeine. Results: We identified 58 incident-parkinsonism cases and 580 matched controls (65.5% male, mean age = 69.60, SD = 8.0). Baseline symptoms of sleep-onset insomnia (12.1% vs. 13.0%, Adjusted OR[95%CI] = 0.87[0.32,2.33]), sleep-maintenance insomnia (24.1% vs. 20.2%, AOR = 1.01[0.46,2.20]), daytime somnolence (8.6% vs. 7.4%, AOR = 1.11[0.37,3.39]), obstructive sleep apnea (27.3% vs. 26.2%, AOR = 0.84[0.40,1.79]), and restless leg syndrome (20.6% vs. 9.9%, AOR =1.34[0.42,4.25]) were similar among those who developed parkinsonism and those who did not. Conclusion: Symptoms of insomnia, somnolence, apnea, and restless legs did not predate a new diagnosis of parkinsonism over 3 years.

Background: This scoping review aimed to investigate the status of breast cancer (BC) preventive behaviors and screening indicators among Iranian women in the past 15 years. BC, as the most common cancer in women, represents nearly a quarter (23%) of all cancers. Presenting the comprehensive view of preventive modalities of BC in the past 15 years in Iran may provide a useful perspective for future research to establish efficient services for timely diagnosis and control of the disease. Materials and Methods: The English and Persian articles about BC screening modalities and their indicators in Iran were included from 2005 to 2020. English electronic databases of Web of Science, PubMed, and Scopus, and Persian databases of Scientific Information Database (SID) and IranMedex were used. The critical information of articles was extracted and classified into different categories according to the studied outcomes. Results: A total of 246 articles were assessed which 136 of them were excluded, and 110 studies were processed for further evaluation. Performing breast self-examination, clinical breast examination, and mammography in Iranian women reported 0%–79.4%, 4.1%–41.1%, and 1.3%-45%, respectively. All of the educational interventions had increased participants' knowledge, attitude, and practice in performing the screening behaviors. The most essential screening indicators included participation rate (3.8% to 16.8%), detection rate (0.23–8.5/1000), abnormal call rate (28.77% to 33%), and recall rate (24.7%). Conclusion: This study demonstrated heterogeneity in population and design of research about BC early detection in Iran. The necessity of a cost-effective screening program, presenting a proper educational method for increasing women's awareness and estimating screening indices can be the priorities of future researches. Establishing extensive studies at the national level in a standard framework are advised

Abstract Introduction To date, studies have estimated the phenoconversion rate from sleep clinics, using polysomnography proven RBD. However, no population-based estimates have been reported, testing to what degree possible RBD, screened by questionnaire is associated with increased risk of neurodegeneration. Methods We included those aged 45–85 years, living in one of 10 Canadian provinces in between 2012–2015 (at the baseline), recruited via three population-based sampling methods. Dream enactment behavior/possible RBD was screened using the RBD1Q single question-questionnaire. De-novo parkinsonism was defined as free of pre-existing diagnosis at the baseline with a ‘new’ diagnosis at the follow-up (205–2019). Relative risk (log-binomial regression), hazard ratio (Cox regression), incidence rate (Poisson regression) between the affected group and the symptom naïve group were assessed, adjusting for age and sex (and total years of education and language). Results Overall, 58 participants phenoconverted into parkinsonism and 53 into dementia at the follow-up (mean intervals=3.06±0.37 years). Participants with dream enactment behavior had 2.75 times higher risk to phenoconvert into parkinsonism than the symptom-free. Similarly, those with dream enactment behavior at the baseline possessed higher risk to screening positive of parkinsonism. No difference in time to phenoconversion was found between groups, The results remained robust after excluding non-RBD related symptoms, such as apnea and non-REM sleep parasomnia. Conclusion Compared to symptom-free, those with pRBD had higher risk to developing parkinsonism in near future. Support (if any):

threshold for probable prodromal PD using original criteria as compared with 16 using updated criteria. A correlation analysis between original probabilities and updated probabilities is presented in upper row of Fig. 1. Updated probabilities in participants with incident PD were higher than the original ones (Fig. 1, middle row), while in participants who remained free of PD during follow-up, updated probabilities were lower than the original ones (P < 0.001; Table S1). However, these significant divergent changes (Fig. 1, lower row) did not translate into higher predictive accuracies of the updated criteria for incident PD in our sample, as in absolute numbers only a few participants with incident PD were reclassified (Tables S1 and S2). In summary, we previously reported our findings of the original criteria in the unselected population-based Bruneck Study cohort showing a moderate to high predictive accuracy in identifying cases of incident PD over up to 10 years of follow-up. Predictive accuracy did not change when using the updated criteria, probably due to the low sample size and thus low number of converters despite the long follow-up time. Nevertheless, the updated MDS criteria were superior to the original MDS criteria with regard to separating individuals with low and high probabilities likely indicating presence of prodromal PD. Therefore, together with one other study published to date that has applied the updated criteria, our findings speak to the MDS Task Force Bayesian classifier methodology that allows for sequential inclusion of new markers as they become available. The results of the present study should be confirmed by larger prospective populationbased studies, which should include markers with high LR.

ABSTRACT Background Previous studies suggest associations between restless leg syndrome (RLS) and atherosclerosis, but these have primarily been based upon subjective atherosclerotic measures. Objective We evaluated associations between RLS and an objective indicator of atherosclerosis, namely carotid intima‐media thickness (cIMT). Methods In this cross‐sectional study among 30,097 Canadian Longitudinal Study on Aging (CLSA) participants, we used a four‐item questionnaire to screen for probable‐RLS. cIMT was measured at the bifurcation of the common carotid artery. Associations were tested with linear regression adjusting for age, sex, ferritin, pulmonary disease, smoking, alcohol, physical activity, anxiety, depression, and other sleep diagnoses. Results Among 26,304 included participants, 2047 (7.8%) had probable‐RLS. Mean cIMT was higher (0.755 ± 0.17 vs 0.736 ± 0.17, P < 0.001) in those with RLS, even after excluding those without prior atherosclerotic diseases (0.740 ± 0.17 vs 0.723 ± 0.16, P = 0.016). Conclusion RLS is associated with objective measures of atherosclerosis. © 2020 International Parkinson and Movement Disorder Society

Objectives: Sleep complaints are common during the menopause transition. However, it is difficult to disentangle changes in sleep related to aging from those directly due to menopause. We compared sleep disorders in 45 to 60-year-old women in a large population-based study, according to menopausal status. Methods: Women aged between 45 and 60 years who self-reported menopausal status were selected from the Canadian Longitudinal Study of Aging, excluding those with prior hysterectomy. Participants completed assessments for overall sleep satisfaction, hours of daily sleep, sleep-onset insomnia, sleep-maintenance insomnia, daytime somnolence, rapid eye movement sleep behavior disorder (RBD), restless leg syndrome (RLS), and obstructive sleep apnea (OSA). Each sleep variable was compared between postmenopausal and pre/perimenopausal women using multivariate regression, adjusting for potential confounders. Results: Among 6,179 women included, 3,713 (60.1%; age 55.7 +/- 3.3 years) were postmenopausal and 2,466 (39.9%) were pre/perimenopausal (age 49.80 +/- 3.1 years). Compared with pre/perimenopausal women, postmenopausal women were more often reported requiring >= 30 minutes to fall asleep (20.4% vs 15.5%; adjusted odds ratio [AOR] 1.24, 95% confidence interval [CI] 1.00-1.53) and were more likely to meet criteria for possible sleep-onset insomnia disorder (10.8% vs 7.3%; AOR 1.51, 95% CI 1.07-2.12). Postmenopausal women were also more likely to screen positive for OSA (14.6% vs 10.4%; AOR 1.48, 95% CI 1.14-1.92). The two groups did not differ on sleep dissatisfaction (32.4% vs 29%), daytime somnolence disorder (1.6% vs 1.3%), sleep-maintenance insomnia disorder (17% vs 14.5%), RLS (23.5% vs 20.9%), or RBD (3.9% vs 4.0%). Conclusions: Menopause is associated with increased sleep-onset insomnia. Postmenopausal women also are more likely to screen positive for OSA. However, menopausal status is not associated with sleep maintenance, somnolence, or RLS, and RBD. Video Summary:.