A review of skin microbiome and new challenges to cosmetic microbiome-friendly formulations.

Parkinson's disease (PD) is a progressive neurodegenerative disorder characterized by typical motor and various non-motor symptoms. As PD advances, patients become increasingly vulnerable to difficulties in activities of daily living (ADL), such as bathing, dressing, walking, and eating. Assessing ADL function is critical for evaluating disease impact and treatment efficacy. Caregivers play an increasingly important role in supporting the daily lives of people with moderate to advanced stages of the disease. Alongside this growing involvement, caregivers develop their own perceptions of the patient's functional abilities and needs. These perceptions may not always align with the patients’ self-assessments. It is often observed anecdotally that some patients with PD underestimate their difficulties (or overestimate their independence), while in other cases, patients may perceive themselves as more disabled than what their caregivers believe. Such patient-caregiver discrepancies in reporting ADL can have important implications; they might lead to under- or over-estimation of care needs, affect clinical decision-making, and even contribute to caregiver strain if a caregiver feels that the patient lacks insight. Despite these implications, the extent and determinants of discrepancies between patient and caregiver reports on ADLs in PD have not been fully elucidated. Previous research on self vs. informant ratings has yielded mixed results. Some earlier studies have suggested a relatively good agreement between patients and caregivers. For instance, one study reported moderate agreement between patient and care partner subjective reports of cognitive deficits, despite discrepancies between these reports and objective neuropsychological evaluations. However, that study was limited by a small sample size of 42 PD patients and by the fact that patient and care partner reports were not collected independently. Conversely, other studies have found significant divergence. For example, in the context of motor symptoms, one study noted that patients with PD and their communication partners both tended to misjudge the severity of certain symptoms (such as rest tremor) compared to clinical ratings, indicating possible perceptual deficits in both groups. Although this study also had a relatively small sample size of only 20 PD patients, it nonetheless demonstrated a contrasting pattern of perceptual discrepancy. More recently, Becker et al. examined patient vs. informant ratings of ADL using the 10-item Functional Activities Questionnaire and, in a study involving a comparatively larger sample of 150 PD patients, further analyzed ADL performance based on patient's cognitive status, ultimately reporting an overall fair to moderate agreement between patient and informant ratings. In that study, greater discrepancies were observed in patients with cognitive impairment, and factors such as motor severity, non-motor symptom burden, and depression influenced both patient and informant ADL scores. These findings suggest that disease severity and certain symptoms (particularly cognitive deficits) can widen the gap between patient and caregiver perceptions. However, which specific motor or non-motor features are most associated with differing views of daily disability and how caregiver-related factors (such as caregiver mood or burden) contribute to these differences remain unclear. In this study, we aimed to investigate the difference between patient- and caregiver-reported ADL abilities in a cohort of PD patient-caregiver pairs using the Activities of Daily Living Questionnaire (ADLQ). Our objectives were: (1) to characterize the distribution of patient-caregiver ADL score discrepancies, and (2) to identify clinical correlates of greater discrepancies through the application of a comprehensive battery of standardized clinical assessments. We hypothesized that more complex and severe diseases (both motor and non-motor aspects) would yield greater patient-caregiver differences in perceived ADL performance and that psychological distress in either the patient or caregiver might further exacerbate these differences.