There are significant differences between people with PD who exercise regularly and those who do not in terms of motivators and barriers. These findings should be considered when tailoring recommendations for PD patients to encourage exercise, and in designing future interventions.

Objective This study was undertaken to compare the rate of change in cognition between glucocerebrosidase (GBA) mutation carriers and noncarriers with and without subthalamic nucleus deep brain stimulation (STN‐DBS) in Parkinson disease. Methods Clinical and genetic data from 12 datasets were examined. Global cognition was assessed using the Mattis Dementia Rating Scale (MDRS). Subjects were examined for mutations in GBA and categorized as GBA carriers with or without DBS (GBA+DBS+, GBA+DBS‐), and noncarriers with or without DBS (GBA‐DBS+, GBA‐DBS‐). GBA mutation carriers were subcategorized according to mutation severity (risk variant, mild, severe). Linear mixed modeling was used to compare rate of change in MDRS scores over time among the groups according to GBA and DBS status and then according to GBA severity and DBS status. Results Data were available for 366 subjects (58 GBA+DBS+, 82 GBA+DBS‐, 98 GBA‐DBS+, and 128 GBA‐DBS‐ subjects), who were longitudinally followed (range = 36–60 months after surgery). Using the MDRS, GBA+DBS+ subjects declined on average 2.02 points/yr more than GBA‐DBS‐ subjects (95% confidence interval [CI] = −2.35 to −1.69), 1.71 points/yr more than GBA+DBS‐ subjects (95% CI = −2.14 to −1.28), and 1.49 points/yr more than GBA‐DBS+ subjects (95% CI = −1.80 to −1.18). Interpretation Although not randomized, this composite analysis suggests that the combined effects of GBA mutations and STN‐DBS negatively impact cognition. We advise that DBS candidates be screened for GBA mutations as part of the presurgical decision‐making process. We advise that GBA mutation carriers be counseled regarding potential risks associated with STN‐DBS so that alternative options may be considered. ANN NEUROL 2022;91:424–435

ObjectiveTelemedicine is rapidly becoming a major vehicle of delivering neurologic care to patients who have limited access to subspecialists and exaggerated travel hardship. However, neurology residents receive little to no training in telemedicine in outpatient clinics.MethodsWe piloted, to our knowledge, the first formalized, experiential outpatient teleneurology curriculum. Neurology residents in their third and fourth postgraduate years (PGY3 and PGY4) at the University of California San Francisco completed an interactive lecture and 4 weeks of teleneurology clinics at the San Francisco Veterans Affairs Medical Center. Change in residents' telemedicine knowledge and perspectives on the utility, challenges, benefits, and future practice implementation of teleneurology were evaluated in 11 residents using precurriculum and postcurriculum quizzes and surveys after 2 of 4 weeks on the rotation.ResultsResidents' performance on quizzes improved from 53% to 88% (p = 0.002). Residents' impression of video visits compared to in-person visits changed, with more individuals indicating video visits to be the same if not somewhat superior with regards to obtaining a focused history, formulating a focused assessment and plan, communicating recommendations, and the overall care provided (p ≤ 0.04). All residents felt more competent using telemedicine for patient care in their eventual career.ConclusionOur formal didactic and clinic-based teleneurology curriculum for neurology residents, which shared core themes suggested by the 2017 American Academy of Neurology Telemedicine Work Group's published recommendations, showed a statistically significant improvement in knowledge and perspectives about the promise and limitations of teleneurology practice, as well as increased comfort levels in future implementation.