{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T06:55:46Z","timestamp":1790751346543,"version":"4.1.0"},"reference-count":44,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["movementdisorders.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Movement Disord Clin Pract"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The coexistence of Parkinson's disease (PD) and myasthenia gravis (MG) is poorly characterized. Overlapping axial symptoms and fatigability may complicate diagnosis and interpretation of PD\u2010related milestones.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The aim of the study was to characterize the phenotype of coexistent PD and MG (PD\u2009+\u2009MG) and explore differences in the timing of PD\u2010related milestones compared to matched PD\u2010only controls.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this matched\u2010cohort study, PD patients with serologically and\/or electrophysiologically confirmed MG were retrospectively identified from clinical records and compared with sex\u2010, race\u2010, age\u2010at\u2010PD\u2010onset\u2013, disease\u2010duration\u2013matched PD (PD\u2010only) controls prospectively assessed within the Cincinnati Cohort Biomarker Program. Disease milestones were Hoehn &amp; Yahr (H&amp;Y)\u2009\u2265\u20093 and Montreal Cognitive Assessment (MoCA)\u2009&lt;\u200926. Time\u2010to\u2010event analyses used Kaplan\u2013Meier and Cox proportional\u2010hazards models adjusted for sex, race, age\u2010at\u2010PD onset, and disease duration.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We identified 21 PD\u2009+\u2009MG patients with predominantly ocular MG and autoimmune diseases. Compared to 210 matched PD\u2010only controls, postural instability (71% vs. 12%) and cognitive impairment (57% vs. 4.8%) were more prevalent (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001). Median time from PD onset to H&amp;Y\u2009\u2265\u20093 and MoCA\u2009&lt;\u200926 was shorter in PD\u2009+\u2009MG, with milestones documented at or near PD diagnosis, versus 5 and 7\u2009years in controls (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001). PD\u2009+\u2009MG patients showed increased adjusted hazard ratios (HR) for H&amp;Y\u2009\u2265\u20093 (HR: 10.6; 95% confidence interval [CI], 3.83\u201329.4;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001) and MoCA\u2009&lt;\u200926 (HR: 35.3; 95% CI, 12.8\u201397.1;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>PD\u2009+\u2009MG was associated with earlier documented postural and cognitive milestones than matched PD\u2010only controls, although interpretation warrants caution given the retrospective ascertainment for PD\u2009+\u2009MG cases. Oculobulbar symptoms, disproportionate axial impairment, or fluctuating weakness should prompt investigation as potential indicators of concomitant MG.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/mdc3.70838","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T06:02:15Z","timestamp":1790748135000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Earlier Postural and Cognitive Milestones in Parkinson's Disease with Comorbid Myasthenia Gravis"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6186-8020","authenticated-orcid":false,"given":"Pasquale Maria","family":"Pecoraro","sequence":"first","affiliation":[{"name":"Operative Research Unit of Neurology Fondazione Policlinico Universitario Campus Bio\u2010Medico  Rome Italy"},{"name":"Research Unit of Neurology, Neurophysiology and Neurobiology, Department of Medicine and Surgery Universit\u00e0 Campus Bio\u2010Medico di Roma  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4473-2807","authenticated-orcid":false,"given":"Marilena","family":"Mangiardi","sequence":"additional","affiliation":[{"name":"San Camillo\u2010Forlanini Hospital  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6073-7974","authenticated-orcid":false,"given":"Jesus","family":"Abanto","sequence":"additional","affiliation":[{"name":"James J. and Joan A. Gardner Center for Parkinson's disease and Movement disorders, Department of Neurology University of Cincinnati  Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5981-3140","authenticated-orcid":false,"given":"Kevin R.","family":"Duque","sequence":"additional","affiliation":[{"name":"James J. and Joan A. Gardner Center for Parkinson's disease and Movement disorders, Department of Neurology University of Cincinnati  Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7692-0186","authenticated-orcid":false,"given":"Blanca Talavera","family":"de la Esperanza","sequence":"additional","affiliation":[{"name":"James J. and Joan A. Gardner Center for Parkinson's disease and Movement disorders, Department of Neurology University of Cincinnati  Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7717-9091","authenticated-orcid":false,"given":"Zheming","family":"Yu","sequence":"additional","affiliation":[{"name":"James J. and Joan A. Gardner Center for Parkinson's disease and Movement disorders, Department of Neurology University of Cincinnati  Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heba A.","family":"Deraz","sequence":"additional","affiliation":[{"name":"James J. and Joan A. Gardner Center for Parkinson's disease and Movement disorders, Department of Neurology University of Cincinnati  Cincinnati Ohio USA"},{"name":"Neurology Department Cairo University Hospitals  Cairo Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ansley","family":"Bell","sequence":"additional","affiliation":[{"name":"James J. and Joan A. Gardner Center for Parkinson's disease and Movement disorders, Department of Neurology University of Cincinnati  Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3389-136X","authenticated-orcid":false,"given":"Alberto J.","family":"Espay","sequence":"additional","affiliation":[{"name":"James J. and Joan A. Gardner Center for Parkinson's disease and Movement disorders, Department of Neurology University of Cincinnati  Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6438-9911","authenticated-orcid":false,"given":"Luca","family":"Marsili","sequence":"additional","affiliation":[{"name":"James J. and Joan A. 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