Brazilian headache registry: methods and preliminary data of the pilot study / Registro brasileiro de cefaleia: métodos e dados preliminares do estudo piloto

Abstract Background Evaluation and treatment of primary and secondary headaches is a global public health challenge. Recognizing the epidemiological impact of headaches, a group of researchers linked to the Brazilian Headache Society proposed the Brazilian Headache Registry and drew up its initial protocol. Objective Here we describe the methods and preliminary data obtained from the pilot study. Methods This was a multicenter longitudinal observational study conducted between September 2020 and August 2021. Prospective data were collected in three specialist centers for headache care in states in southern and southeastern Brazil. Patients aged 18 years or older who sought care for headache in tertiary centers and who agreed to participate in the study, were considered eligible. Results Sixty-six patients were included in the pilot study: 43 (65%) from Rio Grande do Sul state and 23 (35%) from Minas Gerais state. Overall, 90% were female, and the subjects' mean age was 38.2 ± 11.2 years. Primary headaches accounted for 85.3% of the diagnoses made. Among secondary headaches, medication overuse headache was the most frequent type (7.1%). Conclusions The pilot study showed the feasibility of the research protocol developed for tertiary centers. The Brazilian Headache Registry will form a source of longitudinal data with the aim of contributing to better characterization of the various phenotypes of patients with primary and secondary headaches, and to detailing the use of health resources and identifying predictors of better clinical outcomes.

Resumo Antecedentes A avaliação e o tratamento das cefaleias primárias e secundárias são um desafio global de saúde pública. Reconhecendo o impacto epidemiológico das cefaleias, um grupo de pesquisadores vinculados à Sociedade Brasileira de Cefaleia propôs a criação de um Registro Brasileiro de Cefaleia e elaborou seu protocolo inicial. Objetivo Nesta publicação descrevemos os métodos e dados preliminares obtidos a partir do estudo piloto. Métodos Trata-se de um estudo prospectivo observacional longitudinal multicêntrico, realizado entre setembro de 2020 e agosto de 2021. Foram coletados dados em três centros especializados no atendimento de cefaleia, em estados da região sul e sudeste do Brasil. Pacientes com idade igual ou superior a 18 anos que procuraram os centros terciários por queixa de cefaleia e concordaram em participar do estudo foram considerados elegíveis. Resultados Sessenta e seis pacientes foram incluídos no estudo piloto, 43 (65%) do Rio Grande do Sul e 23 (35%) de Minas Gerais. Da amostra total, 90% eram do sexo feminino e a idade média dos sujeitos foi de 38,2 ± 11,2 anos. As cefaleias primárias representaram 85,3% dos diagnósticos realizados. Entre as cefaleias secundárias, a cefaleia por uso excessivo de medicamentos foi a mais frequente (7,1%). Conclusões O estudo piloto evidenciou a viabilidade do protocolo de pesquisa desenvolvido para centros terciários. O Registro Brasileiro de Cefaleia constituirá uma fonte de dados longitudinais com o objetivo de contribuir para melhor caracterização dos diversos fenótipos de pacientes com cefaleias primárias e secundárias, detalhar o uso de recursos de saúde e identificar preditores de melhores desfechos clínicos.

When should a university student be allowed academic accommodations for attention-deficit/hyperactivity disorder? A position statement for a unified procedure for use in Brazil

In higher education, reasonable accommodations are increasingly made for students with a wide range of disabilities. However, rigorous assessment is paramount to ensure these students are supported while preventing ineligible students from gaining unfair advantages. In this context, we sought to identify under which circumstances a university student should be allowed academic accommodation for attention-deficit/hyperactivity disorder (ADHD) and to outline an evidence-based policy for use in Brazil based on the global experience. We reviewed the literature to acquire information on what documents are commonly required by disability services before accommodations for ADHD are provided (including detection of malingering) and scrutinized the eligibility criteria of leading universities worldwide. Finally, renowned experts in the field and national stakeholders were consulted. Despite an exhaustive search, we found no international standard for the assessment of students with ADHD who request academic accommodation; even renowned institutions worldwide differ in their approaches to granting accommodations on the grounds of ADHD. Therefore, we propose a unified set of nationwide criteria for Brazilian universities, which could be generalized internationally. Higher education institutions in Brazil and beyond may benefit from adoption of such criteria.

Low serum uric acid levels and levodopa-induced dyskinesia in Parkinson's disease / Níveis séricos baixos de ácido úrico e discinesia induzida por levodopa na doença de Parkinson

Abstract Background Levodopa is the most used and effective medication for motor symptoms of Parkinson disease (PD), its long-term use is associated with the appearance of levodopa-induced dyskinesia (LID). Uric acid (UA) is believed to play an important neuroprotective role in PD. Objective To investigate if serum UA levels are related with the presence of LIDs in PD patients. Also, we investigated the associations among UA levels and clinical features of PD. Methods We enrolled 81 PD patients (dyskinesia = 48; no dyskinesia = 33) in the present study. A blood sample was collected to evaluate serum UA levels, clinical evaluation included the following instruments: Montreal Cognitive Assessment (MoCA), Beck Depression Inventory II (BDI-II), MDS-Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Hoehn and Yahr (HY), and the sub-item 4.1 of MDS-UPDRS IV (score ≥ 1). Additional relevant clinical information was obtained by a clinical questionnaire. Results Serum UA levels were lower in the dyskinesia group when compared with the no dyskinesia group. The same result was found in the UA levels of both men and women. The multivariate analysis showed lower uric acid levels were significantly associated with having dyskinesia (odds ratio [OR] = 0.424; 95% confidence interval [CI]: 0.221-0.746; p= 0.005). Additional analysis verified that serum UA levels are inversely correlated with depressive symptoms, disease duration, MDS-UPDRS IV and time spent with dyskinesia. A positive correlation was found with age at onset of PD symptoms. Conclusions The present study provides a possible role of serum UA levels in LID present in PD patients.

Resumo Antecedentes A levodopa é a medicação mais utilizada e eficaz para os sintomas motores da doença de Parkinson (DP); seu uso a longo prazo está associado ao aparecimento de discinesia induzida por levodopa (LID). Acredita-se que o ácido úrico desempenhe um importante papel neuroprotetor na DP. Objetivo Investigar se os níveis séricos de AU estão relacionados com a presença de LID em pacientes com DP. Além disso, investigamos as associações entre os níveis de AU e as características clínicas da DP. Métodos Foram incluídos 81 pacientes com DP (discinesia = 48; sem discinesia = 33) no presente estudo. Uma amostra de sangue foi coletada para avaliar os níveis séricos de AU, a avaliação clínica incluiu os seguintes instrumentos: Avaliação Cognitiva de Montreal (MoCA), Inventário de Depressão de Beck (BDI-II), MDS-Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Hoehn and Yahr (HY) e o subitem 4.1 da MDS-UPDRS IV (escore ≥ 1). Informações clínicas relevantes adicionais foram obtidas por meio de um questionário clínico. Resultados Os níveis séricos de AU foram menores no grupo com discinesia quando comparados ao grupo sem discinesia. O mesmo resultado foi encontrado nos níveis de AU de homens e mulheres. A análise multivariada mostrou que níveis mais baixos de ácido úrico foram significativamente associados a ter discinesia (odds ratio [OR] = 0,424; intervalo de confiança (IC) de 95%: 0,221-0,746; p= 0,005). Análises adicionais verificaram que os níveis séricos de AU estão inversamente correlacionados com sintomas depressivos, duração da doença, MDS-UPDRS IV e tempo gasto com discinesia. Uma correlação positiva foi encontrada com a idade de início dos sintomas da DP. Conclusões O presente estudo fornece um possível papel dos níveis séricos de AU na LID presente em pacientes com DP.

Floor and ceiling effects on the Montreal Cognitive Assessment in patients with Parkinson's disease in Brazil / Efeitos solo e teto na Avaliação Cognitiva de Montreal em pacientes com doença de Parkinson no Brasil

ABSTRACT Parkinson's disease (PD) is a common neurodegenerative disease associated with cognitive impairment. The Montreal Cognitive Assessment (MoCA) has been used as a recommended global cognition scale for patients with PD, but there are some concerns about its application, partially due to the floor and ceiling effects. Objective: To explore the floor and ceiling effects on the MoCA in patients with PD in Brazil. Methods: Cross-sectional study with data from patients with PD from five Brazilian Movement Disorders Clinics, excluding individuals with a possible diagnosis of dementia. We analyzed the total score of the MoCA, as well as its seven cognitive domains. The floor and ceiling effects were evaluated for the total MoCA score and domains. Multivariate analyses were performed to detect factors associated with floor and ceiling effects. Results: We evaluated data from 366 patients with PD and approximately 19% of individuals had less than five years of education. For the total MoCA score, there was no floor or ceiling effect. There was a floor effect in the abstraction and delayed memory recall domains in 20% of our sample. The ceiling effect was demonstrated in all domains (80.8% more common in naming and 89% orientation), except delayed recall. Education was the main factor associated with the floor and ceiling effects, independent of region, sex, age at evaluation, and disease duration. Conclusion: The floor and ceiling effects are present in specific domains of the MoCA in Brazil, with a strong impact on education. Further adaptations of the MoCA structure for underrepresented populations may reduce these negative effects.

RESUMO A doença de Parkinson (DP) é uma doença neurodegenerativa comum associada ao declínio cognitivo. A Avaliação Cognitiva de Montreal (Montreal Cognitive Assessment — MoCA) tem sido usada como uma escala de cognição global recomendada para pacientes com DP, mas existem algumas preocupações sobre sua aplicação, em parte pelos efeitos solo e teto. Objetivo: Explorar os efeitos solo e teto na MoCA em pacientes com DP no Brasil. Métodos: Estudo transversal com dados de pacientes com DP oriundos de cinco Clínicas de Distúrbios de Movimento no Brasil, excluindo-se pessoas com possível diagnóstico de demência. Nós analisamos a pontuação total da MoCA, assim como a de seus sete domínios cognitivos. Os efeitos solo e teto foram avaliados para a pontuação total da MoCA e seus domínios. Foram feitas análises multivariadas para a detecção de fatores associados os efeitos solo e teto. Resultados: Nós avaliamos dados de 366 pacientes com DP, e aproximadamente 19% das pessoas tinham menos que cinco anos de escolaridade. Para a pontuação total do MoCA, não houve efeito solo ou teto. Houve efeito solo nos domínios abstração e memória de evocação tardia em 20% de nossa amostra. O efeito teto foi demonstrado em todos os domínios (80,8% mais comum em nomeação e 89% orientação), com exceção de memória de evocação tardia. A educação foi o principal fator associado aos efeitos solo e teto, independentemente de região, sexo, idade na avaliação e duração da doença. Conclusão: Os efeitos solo e teto estão presentes em domínios específicos da MoCA no Brasil, com forte impacto da educação. Adaptações adicionais à estrutura da MoCA para populações vulneráveis podem reduzir esses efeitos negativos.

Depressive symptoms and axial motor disorders in individuals with Parkinson's disease: a cross-sectional study / Sintomas depressivos e distúrbios motores axiais em indivíduos com doença de Parkinson: um estudo transversal

Abstract Background Depression is an important nonmotor symptom of Parkinson's disease (PD) and has been associated with the motor symptoms in these individuals. Objectives To determine whether there are relationships between depressive symptoms and abnormalities in axial postural alignment and axial motor deficits, especially postural instability, and trunk rigidity in PD. Methods In this cross-sectional study, 65 individuals were evaluated using the Beck Depression Inventory-II (BDI-II) for the analysis of depressive symptoms and underwent a postural assessment of head, trunk, and hip sagittal alignment through computerized photogrammetry. The MDS-UPDRS was used to assess clinical aspects of PD, the Trunk Mobility Scale was used to assess axial rigidity, and the MiniBESTest to assess balance. To determine the relationship between depressive symptoms and postural alignment, multiple linear regression analysis was performed. Results The participants with depressive symptoms had more severe motor deficits as well as greater trunk rigidity and worse postural instability (p < 0.05). When the postural angles were compared between men and women using Student's t-test, it was found that men had greater flexion angles of the head (p = 0.003) and trunk (p = 0.017). Using multiple linear regression analysis corrected for the age and sex of the participants, we verified that the anterior trunk inclination was significantly larger in the PD population with depressive symptoms (R2 = 0.453, β = 0.116, and p = 0.045). Conclusion PD individuals with depressive symptoms have more severe flexed trunk posture, mainly in older men. Additionally, more severe depressive symptoms are associated with worsening postural instability, trunk rigidity and motor deficits in this population.

Resumo Antecedentes A depressão é um sintoma não motor importante da doença de Parkinson (DP) e tem sido associada aos sintomas motores nesses indivíduos. Objetivos Determinar se existem relações entre sintomas depressivos e anormalidades no alinhamento postural axial e déficits motores axiais, especialmente instabilidade postural e rigidez de tronco na DP. Métodos Neste estudo transversal, 65 indivíduos foram avaliados pelo BDI-II para análise de sintomas depressivos e submetidos à avaliação postural do alinhamento sagital de cabeça, tronco e quadril por meio de fotogrametria computadorizada. A MDS-UPDRS avaliou os aspectos clínicos, TMS avaliou rigidez axial e o MiniBESTest equilíbrio. Para determinar a relação entre sintomas depressivos e alinhamento postural, realizou-se uma análise de regressão linear múltipla. Resultados Os participantes com sintomas depressivos apresentaram déficits motores mais graves, bem como maior rigidez de tronco e pior instabilidade postural (p < 0,05). Quando comparados os ângulos posturais entre homens e mulheres pelo teste t de Student, verificou-se que os homens apresentaram maiores graus de flexão da cabeça (p = 0,003) e do tronco (p = 0,017). Por meio da análise de regressão linear múltipla corrigida para a idade e sexo dos participantes, verificamos que a inclinação anterior do tronco foi significativamente maior nos indivíduos com DP com sintomas depressivos do que sem sintomas depressivos (R2 = 0,453, β = 0,116 e p = 0,045) Conclusão Indivíduos com DP com sintomas depressivos apresentam postura de tronco flexionado mais severa, principalmente em homens mais idosos. Além disso, os sintomas depressivos mais graves pioram significativamente a instabilidade postural, a rigidez do tronco e os déficits motores nessa população.

The whistle-smile reflex: a missed sign / O reflexo do assobio-sorriso: um sinal esquecido

Abstract In this paper, we present a historical review of the whistle-smile reflex, a semiological sign missed in the literature and clinical practice.

Resumo Apresentamos neste artigo uma revisão histórica do reflexo do assovio-sorriso, um sinal semiológico esquecido na literatura e na prática clínica.

Evaluation of the complete Sniffin Sticks Test versus its subtests in differentiating Parkinson's disease patients from healthy controls / Avaliação do Sniffin Sticks Test completo versus seus subtestes na diferenciação de pacientes com doença de Parkinson de controles sem a doença

Abstract Background Hyposmia is one of the most common, as well as the first nonmotor condition in Parkinson disease (PD). The sniffin sticks test (SST) evaluates three different aspects of olfactory function: threshold (T), discrimination (D), and identification (I). The sum of the scores of these three subtests produce a global score of olfaction, the Threshold-Discrimination-Identification (TDI) score. Objective The aim of this study was to investigate if the TDI score or one of its subtests is better to discriminate PD patients from controls. Methods We recruited 27 PD patients and 17 healthy age-matched controls (HC) who were evaluated through a clinical interview, the Montreal Cognitive Assessment and Movement Disorders Society - Unified Parkinson Disease Rating Scale. The olfaction was assessed using the complete SST. Results The performance of PD patients on the olfactory test was significantly worse when compared with the HC (T: 3.0 vs. 6.5, p < 0.001; D: 8.1 vs. 11.2, p <0.001; I: 7.3 vs. 11.7, p < 0.001; TDI: 18.8 vs. 29.9, p < 0.001). The prevalence of olfaction impairment in our study (PD: 100%, and HC: 56%) was greater than that found in the literature. Cognition influenced the performance on TDI. The olfactory subtests were impaired proportionally between patients and controls. Furthermore, D and I were correlated, but only in PD patients. The TDI showed a tendency to better discriminate PD patients from HC, when compared with its subtests. Conclusions Although the complete olfactory evaluation is time consuming, it seems to be a superior tool to identify olfaction impairment in PD patients, when compared with the isolated subtests.

Resumo Antecendentes Hiposmia é um dos sintomas mais comuns da doença de Parkinson (DP), além de ser um de seus primeiros sintomas não-motores. O Sniffin Sticks Test avalia três diferentes aspectos da função olfatória: limiar (L), discriminação (D) e identificação (I). A soma dos escores desses três subtestes produz um escore global do olfato, o Threshold-Discrimination-Identification (TDI). Objetivo O objetivo deste estudo foi investigar se oTDI ou um de seus subtestes seria melhor em discriminar pacientes com DP de controles saudáveis. Métodos Foram recrutados 27 pacientes com DP e 17 controles saudáveis de mesma faixa etária, que foram avaliados através de uma entrevista clínica, a Montreal Cognitive Assessment e Movement Disorders Society - Unified Parkinson Disease Rating Scale. O olfato foi examinado através da bateria completa do Sniffin Sticks Test (SST). Resultados Os pacientes com DP tiveram pior performance no teste olfatório quando comparados com os controles (L: 3,0 vs. 6,5; p < 0,001; D: 8,1 vs. 11,2; p <0,001; I: 7,3 vs. 11,7; p <0,001; TDI: 18,8 vs. 29,9; p < 0,001). A prevalência de comprometimento olfatório no nosso estudo (DP: 100%, e controles: 56%) foi maior do que a reportada na literatura. A cognição influenciou a performance no TDI. Os subtestes olfatórios foram afetados proporcionalmente entre pacientes e controles. Além disso, D e I se correlacionaram, mas apenas em pacientes de DP. O TDI mostrou uma tendência em melhor discriminar pacientes de DP dos controles, quando comparado com os seus subtestes. Conclusões Embora a avaliação olfatória completa consuma tempo, ela parece ser superior aos subtestes isolados para identificar comprometimento olfatório em pacientes com DP.

Characterization of the nigroestriatal system in a sample of patients with amyotrophic lateral sclerosis / Caracterização do sistema nigroestriatal em uma amostra de pacientes com esclerose lateral amiotrófica

Abstract Background The coexistence of amyotrophic lateral sclerosis (ALS) with clinical forms of Parkinson disease (PD), although uncommon, is found to a greater degree than one would expect by chance. The pathological mechanisms of ALS and PD are still not fully understood, and the coexistence of these two diseases suggests that they could share mechanisms in common. Objective Here we present a sample of patients with clinically definitive or probable ALS who were evaluated with single-photon emission computed tomography SPECT/TRODAT and compared with non-ALS controls. Methods Patients with clinically definite or probable ALS were assessed with the amyotrophic lateral sclerosis functional rating scale (ALSFRS) to define severity and had their demographic data collected. The TRODAT results of patients with ALS were compared with those of patients with a diagnosis of PD with less than 10 years of duration, and with patients with a diagnosis of others movement disorders not associated with neurodegenerative diseases. Results A total of 75% of patients with ALS had TRODAT results below the levels considered normal; that was also true for 25% of the patients in the control group without neurodegenerative disease, and for 100% of the patients in the PD group. A statistically significant difference was found between patients with ALS and the control group without neurodegenerative disease in the TRODAT values < 0.05. Conclusions Our study fits with the neuropathological and functional evidence that demonstrates the existence of nigrostriatal dysfunction in patients with ALS. Further research to better understand the role of these changes in the pathophysiological process of ALS needs to be performed.

Resumo Antecedentes A coexistência da esclerose lateral amiotrófica (ELA) com formas clínicas da doença de Parkinson (DP), embora incomum, é encontrada em um grau maior do que seria esperado ao acaso. Os mecanismos patológicos da ELA e da DP ainda não são totalmente compreendidos e a coexistência dessas duas doenças sugere que elas podem compartilhar mecanismos em comum. Objetivo Apresentamos uma amostra de pacientes com ELA clinicamente definida ou provável que foram avaliados com tomografia computadorizada por emissão de fóton único (SPECT)/TRODAT e comparados com controles sem ELA. Métodos Pacientes com ELA clinicamente definida ou provável foram avaliados com a escala funcional de esclerose lateral amiotrófica (ALSFRS) para definir a gravidade e foram coletados os seus dados demográficos. Os resultados do TRODAT de pacientes com ELA foram comparados com aqueles de pacientes com diagnóstico de DP com menos de 10 anos de duração e com pacientes com diagnóstico de outros distúrbios do movimento não associados a doenças neurodegenerativas. Resultados Um total de 75% dos pacientes com ELA apresentou resultados de TRODAT abaixo dos níveis considerados normais; 25% no grupo controle sem doença neurodegenerativa e 100% no grupo DP. Uma diferença estatisticamente significativa foi encontrada entre os pacientes com ELA e o grupo controle sem doença neurodegenerativa nos valores de TRODAT p< 0,05. Conclusões Nosso estudo está de acordo com as evidências neuropatológicas e funcionais que demonstram a existência de disfunção nigroestriatal em pacientes com ELA. Mais pesquisas para entender melhor o papel dessas mudanças no processo fisiopatológico da ELA precisam ser realizadas.

Guidelines for Parkinson's disease treatment: consensus from the Movement Disorders Scientific Department of the Brazilian Academy of Neurology - motor symptoms / Diretrizes para o tratamento da doença de Parkinson: consenso do Departamento Científico de Transtornos do Movimento da Academia Brasileira de Neurologia - sintomas motores

ABSTRACT The treatment of Parkinson's disease (PD) is challenging, especially since it is considered highly individualized. The Brazilian Academy of Neurology has recognized the need to disseminate knowledge about the management of PD treatment, adapting the best evidence to the Brazilian reality. Thus, the main published treatment guidelines were reviewed based on the recommendations of group from the Movement Disorders Scientific Department of the Brazilian Academy of Neurology.

Resumo O tratamento da doença de Parkinson (DP) constitui um desafio, especialmente por ser considerado muito individualizado. A Academia Brasileira de Neurologia (ABN) identificou a necessidade de disseminar o conhecimento sobre o manejo do tratamento da DP, adaptando as melhores evidências à realidade brasileira. Assim, foi realizada uma revisão sobre as principais orientações de tratamento publicadas, baseada nas recomendações elaboradas por um grupo de especialistas em transtornos do movimento do departamento científico da ABN.

Deglutition Impairment during Dual Task in Parkinson Disease Is Associated with Cognitive Status

Abstract Introduction Dysphagia is a relevant symptom in Parkinson disease (PD), and its pathophysiology is poorly understood. To date, researchers have not investigated the effects of combined motor tasks on swallowing. Such an assessment is of particular interest in PD, in which patients have specific difficulties while performing two movements simultaneously. Objective The present study tested the hypothesis that performing concurrent tasks could decrease the safety of swallowing in PD patients as visualized using fiberoptic endoscopic evaluation of swallowing (FEES). Methods A total of 19 patients and 19 controls matched by age, gender, and level of schooling were compared by FEES under two conditions: isolated swallowing and dual task (swallowing during non-sequential opposition of the thumb against the other fingers). The two tasks involved volumes of food of 3 mL and 5 mL. The PD subjects were classified according to the Hoehn & Yahr (H&Y) Scale, the Mini Mental State Examination (MMSE), and the Montreal Cognitive Assessment (MoCA). The FEES assessment was performed according to the Boston Residue and Clearance Scale (BRACS). Results The data showed a significant worsening of swallowing in the dual task assessment for both volumes (3 mL: p ≤ 0.001; 5 mL: p ≤ 0.001) in the PD group. A correlation between the MoCA and dual-task swallowing of 3 mL was also found. Conclusion These findings suggest that additional tasks involving manual motor movements result in swallowing impairment in patients with PD. Moreover, these data highlight the need to further evaluate such conditions during treatment and assessment of PD patients.

Validation of 19-items wearing-off (WOQ-19) questionnaire to Portuguese / Validação do questionário de 19 itens de wearing-off (WOQ-19) para a língua portuguesa

ABSTRACT Background: The treatment of Parkinson disease with dopaminergic therapy improves functionality and quality of life. However, as the disease progresses, the wearing-off phenomenon develops. To improve the recognition of this phenomenon, the 19-item wearing-off questionnaire (WOQ-19) was developed. Objective: To translate and validate the WOQ-19 into Portuguese. Methods: The questionnaire was translated into Portuguese and, subsequently, back-translated into English and analyzed. The final version was tested in Parkinson disease patients for reliability through the test-retest paradigm and internal consistency. Also, sensitivity and specificity were obtained in different cut-off positive items. Results: The WOQ-19 showed good test stability, with an intraclass correlation coefficient of 0.877 (95%CI 0.690-0.951; p<0.001), and good internal consistency, with Cronbach alpha of 0.815. Two items of positive cut-off showed the best accuracy: 0.873 (95%CI 0.791-0.954). Sensitivity was 0.975 (95%CI 0.892-1) and specificity was 0.714 (95%CI 0.565-0.863). Conclusion: The Portuguese version of the WOQ-19 showed excellent diagnostic properties and can be used to diagnose wearing-off phenomena.

RESUMO Introdução: O tratamento da doença de Parkinson com terapia dopaminérgica melhora a funcionalidade e a qualidade de vida. Entretanto, com a progressão da doença, os fenômenos de flutuação motora e não motora se desenvolvem. Para melhorar o reconhecimento dessa situação, foi desenvolvido o questionário de 19 itens de wearing-off (WOQ-19) Objetivo: Traduzir e validar o questionário WOQ-19 para a língua portuguesa. Métodos: O questionário foi traduzido do inglês para o português. Em seguida, foi retrotraduzido para o inglês e analisado. A versão final foi testada em pacientes parkinsonianos com paradigma teste-reteste e consistência interna. A sensibilidade e especificidade foram medidas em relação a vários pontos de cortes de itens positivos. Resultados: O questionário apresenta boa estabilidade de teste, com coeficiente de correlação intraclasse de 0,877 (IC95% 0,690-0,951; p<0,001), e boa consistência interna, com alfa de Cronbach de 0,815. O ponto de corte com dois itens positivos teve a melhor acurácia: 0,873 (IC95% 0,791-0,954). A sensibilidade foi de 0,975 (IC95% 0,892-1) e a especificidade foi 0,714 (0,565-0,863). Conclusão: A versão em português do WOQ-19 mostrou excelentes propriedades diagnósticas e pode ser utilizada para diagnosticar as condições de flutuações motoras e não motoras na doença de Parkinson.

Diagnostic prediction model for levodopa-induced dyskinesia in Parkinson's disease / Modelo de predição diagnóstica para discinesias induzidas por levodopa na doença de Parkinson

Abstract Background: There are currently no methods to predict the development of levodopa-induced dyskinesia (LID), a frequent complication of Parkinson's disease (PD) treatment. Clinical predictors and single nucleotide polymorphisms (SNP) have been associated to LID in PD. Objective: To investigate the association of clinical and genetic variables with LID and to develop a diagnostic prediction model for LID in PD. Methods: We studied 430 PD patients using levodopa. The presence of LID was defined as an MDS-UPDRS Part IV score ≥1 on item 4.1. We tested the association between specific clinical variables and seven SNPs and the development of LID, using logistic regression models. Results: Regarding clinical variables, age of PD onset, disease duration, initial motor symptom and use of dopaminergic agonists were associated to LID. Only CC genotype of ADORA2A rs2298383 SNP was associated to LID after adjustment. We developed two diagnostic prediction models with reasonable accuracy, but we suggest that the clinical prediction model be used. This prediction model has an area under the curve of 0.817 (95% confidence interval [95%CI] 0.77‒0.85) and no significant lack of fit (Hosmer-Lemeshow goodness-of-fit test p=0.61). Conclusion: Predicted probability of LID can be estimated with reasonable accuracy using a diagnostic clinical prediction model which combines age of PD onset, disease duration, initial motor symptom and use of dopaminergic agonists.

Resumo Introdução: No momento, não há métodos para se predizer o desenvolvimento de discinesias induzidas por levodopa (DIL), uma frequente complicação do tratamento da doença de Parkinson (DP). Preditores clínicos e polimorfismos de nucleotídeo único (SNP) têm sido associados às DIL na DP. Objetivo: Investigar a associação entre variáveis clínicas e genéticas com as DIL e desenvolver um modelo de predição diagnóstica de DIL na DP. Métodos: Foram avaliados 430 pacientes com DP em uso de levodopa. A presença de DIL foi definida como escore ≥1 no item 4.1 da MDS-UPDRS Parte IV. Nós testamos a associação entre variáveis clínicas específicas e sete SNPs com o desenvolvimento de DIL, usando modelos de regressão logística. Resultados: Em relação às variáveis clínicas, idade de início da doença, duração da doença, sintomas motores iniciais e uso de agonistas dopaminérgicos estiveram associados às DIL. Apenas o genótipo CC do SNP rs2298383 no gene ADORA2A esteve associado com DIL após o ajuste. Nós desenvolvemos dois modelos preditivos diagnósticos com acurácia razoável, mas sugerimos o uso do modelo preditivo clínico. Esse modelo de predição tem uma área sob a curva de 0,817 (intervalo de confiança de 95% [IC95%] 0,77‒0,85) e sem perda significativa de ajuste (teste de qualidade de ajuste de Hosmer-Lemeshow p=0,61). Conclusão: A probabilidade prevista de DIL pode ser estimada, com acurácia razoável, por meio do uso de um modelo preditivo diagnóstico clínico, que combina a idade de início da doença, duração da doença, sintomas motores iniciais e uso de agonistas dopaminérgicos.

Acoustic voice modifications in individuals with Parkinson disease submitted to deep brain stimulation

Introduction: Subthalamic nucleus deep brain stimulation (STN-DBS) improvesmotor function in individuals with Parkinson disease (PD). The evidence about the effects of STN-DBS on the voice is still inconclusive. Objective: To verify the effect of STN-DBS on the voice of Brazilian individuals with PD. Methods: Sixteen participants were evaluated on the Unified Parkinson Disease Rating Scale-Part III, and by the measurement of the acoustic modifications in on and off conditions of stimulation. Results: The motor symptoms showed significant improvement with STN-DBS on. Regarding the acoustic measures of the voice, only the maximum fundamental frequency (fhi) showed a statistical difference between on- and off-conditions, with reduction in off-condition. Conclusion: Changes in computerized acoustic measures are more valuable when interpreted in conjunction with changes in other measures. The single finding in fhi suggests that DBS-STN increases vocal instability. The interpretation of this result should be done carefully, since it may not be of great value if other measures that also indicate instability are not significantly different (AU)

Validação de conteúdo e confiabilidade do Protocolo de Avaliação dos Distúrbios Adquiridos de Fala em Indivíduos com Doença de Parkinson (PADAF) / Validation of Content and Reliability of the Protocol for the Evaluation of Acquired Speech Disorders in Individuals with Parkinson's Disease (PADAF)

RESUMO Objetivo Elaborar e realizar a validação de conteúdo, assim como verificar a confiabilidade entre examinador do Protocolo de Avaliação dos Distúrbios Adquiridos de Fala em Indivíduos com Doença de Parkinson (PADAF). Método O estudo foi realizado em três etapas. Na primeira, foi elaborado o protocolo e validado seu conteúdo mediante análise de sete especialistas. Na segunda, aplicou-se o instrumento em 25 indivíduos com doença de Parkinson (DP) idiopática. Na terceira e última etapa, verificou-se a confiabilidade entre-examinador. Resultados A versão final do PADAF foi composta de 32 itens que avaliam a respiração, a fonação, a ressonância, a articulação e a prosódia. Mostrou-se válido, com índice de validade de conteúdo (IVC) bem acima daquele estabelecido na literatura e com perfeita concordância na verificação da confiabilidade entre examinador. Conclusão O PADAF para indivíduos com DP foi desenvolvido e teve seu conteúdo validado com perfeita confiabilidade do instrumento.

ABSTRACT Purpose To develop a protocol for the evaluation of acquired speech disorders in individuals with Parkinson's disease (PADAF) and to validate its content and determine its inter-judge reliability. Methods The study was carried out in three stages: in the first one, the protocol was prepared and its content validated through the analysis of seven specialists; in the second, the instrument was applied to 25 individuals with idiopathic Parkinson's disease (PD); in the third and last stage, the inter-judge reliability was determined. Results The final version of PADAF consisted of 32 items that evaluated breathing, phonation, resonance, articulation, and prosody. It was shown to be valid, with a content validity index (CVI) much higher than that established in the literature, and with perfect agreement in the determination of inter-judge reliability. Conclusion PADAF for PD individuals was developed and its content was validated, showing perfect instrument reliability.

Does dual-tasking, swallow performance and attention, influence dysphagia in Parkinson disease? / A dupla tarefa, desempenho na deglutição e atenção, influencia a disfagia em pacientes com doença de Parkinson?

The primary purpose of this study was to investigate the effect of dual-tasking on swallowing performance and attention in patients with Parkinson Disease (PD). Twenty six participants were included, thirteen patients with PD and thirteen controls matched by age and education. All subjects were evaluated at single swallowing task and attentional dual-tasking. Swallowing parameters were analyzed by using Fiberoptic Endoscopic Evaluation Swallowing Safety Study (FEESS). The attentional dual-tasking was realized using an adaptation of "Stroop color test" on video. Images about swallowing parameters in both conditions were analyzed by three experienced evaluators using literature definitions. Both groups underwent cognitive screening using MoCA. Although significant difference between swallowing parameters in both conditions were not found, in PD group there was an association between changes in parameters according to graduation and cognitive performance. The results show the dual-tasking influence worsening in PD patients with low scores on cognitive screening and low graduation. The results suggest more attention to PD patients that have worse cognitive status and / or low levels of education as the worsening of dysphagia and aspiration risk in performing dual-tasks to feed themselves.

O objetivo principal deste estudo foi investigar o efeito da dupla tarefa atencional no desempenho da deglutição em pacientes com doença de Parkinson (DP). Vinte e seis participantes foram incluídos, treze pacientes com DP e treze controles pareados por idade e escolaridade. Todos os sujeitos foram avaliados em tarefa única de deglutição e dupla tarefa atencional. Os parâmetros da deglutição foram analisados por meio do Fiberoptic Endoscopic Evaluation Swallowing Safety Study (FEESS). O attentional dual-tasking foi realizado usando uma adaptação do "Stroop color test" em vídeo. Imagens sobre os parâmetros de deglutição em ambas as condições foram analisadas por três avaliadores experientes utilizando definições da literatura. Ambos os grupos foram submetidos a triagem cognitiva usando MoCA. Embora não tenha sido encontrada diferença significativa entre os parâmetros da deglutição nas duas condições, no grupo DP foi encontrada associação entre alterações nos parâmetros de acordo com a graduação e desempenho cognitivo. Os resultados mostram que a influência da dupla tarefa piorou nos pacientes com TP, com baixa pontuação na triagem cognitiva e baixa graduação. Os resultados sugerem maior atenção para os pacientes com DP que apresentam pior estado cognitivo e / ou baixos níveis de escolaridade como o agravamento da disfagia e risco de aspiração na realização de tarefas duplas para se alimentar.

The Impact of Deep Brain Stimulation on the Quality of Life and Swallowing in Individuals with Parkinson's Disease

Abstract Introduction Deep brain stimulation (DBS) is an established treatment for Parkinson's disease (PD). However, there is little evidence regarding the effect of DBS on dysphagia. Objective To assess the swallowing and quality of life of individuals with PD before and after DBS surgery. Methods Our sample consisted of people who had undergone DBS surgery in a referral hospital in the state of Rio Grande do Sul, Brazil. The inclusion criteria were a diagnosis of PD and having undergone DBS surgery. A cognitive screening, through a questionnaire about depression and quality of life, was conducted. Evaluations of each patient's swallowing were performed before and after surgery. The assessment consisted of anamnesis, clinical assessment, the Functional Oral Intake Scale, clinical evaluation of swallowing, and the Hoehn and Yahr scale. Results The sample included 10 individuals, all male, with a mean age of 57.3 years (±4.7), a mean disease duration of 13.0 years (±2.4), and mean level education of 8.1 years (±4.0). In the clinical evaluation of the swallowing, a significant improvement after DBS was not observed. However, little changes in the signs and symptoms of dysphagia that had a positive impact on the quality of life were observed. Furthermore, there was no relation between the patients' motor subtype and swallowing pre- and post-DBS. Conclusion There was an improvement in the quality of life of the patients after DBS. However, the improvement in the clinical signs and symptoms of dysphagia did not cause an overall improvement in the swallowing function.