Reliability and Validity of the Turkish Version of the Barnes Akathisia Rating Scale

Objective: Akathisia, characterized by a sense of inner restlessness and a constant need for motion is a condition that relies on subjective symptoms. Thus, physicians can easily overlook akathisia due to the lack of objective findings. In this study, we aimed to investigate the validity and reliability of the Turkish version of the Barnes Akathisia Rating Scale (BARS) to help with the diagnosis and to provide an objective tool for research studies. Materials and Methods: The BARS was translated and back-translated by a group of five doctors. Forty patients with schizophrenia who were taking antipsychotic drugs were evaluated using the Turkish version of the BARS by two raters independently. Cronbach’s alpha for internal consistency and Cohen’s kappa for inter-rater reliability was calculated. Results: In terms of internal consistency, Cronbach’s alpha values for each rater were above 0.8 (0.820 and 0.836), which show high reliability for the scale. In terms of inter-rater reliability, all Cohen’s kappa values were above 0.7 (0.706, 0.804, 0.864, 0.881), showing high agreement between the raters. Conclusion: High values of inter-rater reliability for all items in the scale and high internal consistency values indicate that the Turkish version of the BARS can be used reliabl

Gastrointestinal barriers to levodopa transport and absorption in Parkinson's disease

Levodopa is the gold standard for the symptomatic treatment of Parkinson's disease (PD). There are well documented motor and non-motor fluctuations, however, that occur almost inevitably once levodopa is started after a variable period in people with PD. Whilst brain neurodegenerative processes play a part in the pathogenesis of these fluctuations, a range of barriers across the gastrointestinal (GI) tract can alter levodopa pharmacokinetics, ultimately contributing to non-optimal levodopa response and symptoms fluctuations. GI barriers to levodopa transport and absorption include dysphagia, delayed gastric emptying, constipation, Helicobacter pylori infection, small intestinal bacterial overgrowth and gut dysbiosis. In addition, a protein-rich diet and concomitant medication intake can further alter levodopa pharmacokinetics. This can result in unpredictable or sub-optimal levodopa response, 'delayed on' or 'no on' phenomena. In this narrative review, we provided an overview on the plethora of GI obstacles to levodopa transport and absorption in PD and their implications on levodopa pharmacokinetics and development of motor fluctuations. In addition, management strategies to address GI dysfunction in PD are highlighted, including use of non-oral therapies to bypass the GI tract