Apathy is a salient feature of various neuropsychiatric disorders, from depression to Alzheimer's disease. We formally assess its prevalence in idiopathic Parkinson's disease (PD) together with its clinical, neuropsychological, and morphometric correlates. Thirty patients with PD and 25 normal controls were assessed using an extensive neuropsychological battery and Marin's Apathy Scale; parkinsonian patients also underwent MRI scan, followed by linear measurement of various frontotemporal structures. Approximately 45% of the PD sample showed apathy. For comparison analysis, given the unimodal distribution of the apathy scores, the PD sample was divided into three groups on the basis of the apathy tertiles. All three PD groups had worse cognitive and depression scores than controls, whereas they did not differ in terms of demographic, neurological, general cognitive, or affective features. By contrast, a significant positive association was found between apathy scores and performance on tests of executive function. As regards the morphometric data, we failed to find any specific measure of frontotemporal atrophy correlating with the presence or severity of apathy. Thus, apathy seems to be a frequent and important companion of PD, in many cases probably due to a primary motivational impairment, possibly related to a frontosubcortical dysfunction.

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Although triptans are highly effective for the acute treatment of migraine, sustained pain-free rates--considered the optimal end-point--are in the range of 18%-27% for all triptans in clinical trials. A recently proposed strategy for treating migraine attacks is that triptans should be given early, when the pain is mild, rather than moderate or severe. Studies with different triptans have shown that early intervention can result in higher pain-free rates, together with reductions in rescue medication use and recurrence rates. However these studies suffer from methodological pitfalls: most were retrospective analyses of trials not designed to evaluate the benefit of early intervention; the definition of "early" differed from study to study; and placebo effects were not correctly evaluated. Furthermore, the disadvantages of this strategy in clinical practice, particularly the risk of medication overuse, have not been evaluated. We propose that only patients with particularly severe migraines and in whom attacks are always characterised by rapid progression of pain and other symptoms, should be advised to take a triptan as early as possible.