ABSTRACT
OBJECTIVES: Parkinson's disease (PD) and the parkinsonian variant of multiple system atrophy (MSA-P) are distinct neurodegenerative disorders that share similar clinical features of parkinsonism. The morphological alterations of these diseases have yet to be understood. The purpose of this study was to evaluate gray matter atrophy in PD and MSA-P using regions of interest (ROI)-based measurements and voxel-based morphometry (VBM). METHODS: We studied 41 patients with PD, 20 patients with MSA-P, and 39 controls matched for age, sex, and handedness using an improved T1-weighted sequence that eased gray matter segmentation. The gray matter volumes were measured using ROI and VBM. RESULTS: ROI volumetric measurements showed significantly reduced bilateral putamen volumes in MSA-P patients compared with those in PD patients and controls (p<0.05), and the volumes of the bilateral caudate nucleus were significantly reduced in both MSA-P and PD patients compared with those in the controls (p<0.05). VBM analysis revealed multifocal cortical and subcortical atrophy in both MSA-P and PD patients, and the volumes of the cerebellum and temporal lobes were remarkably reduced in MSA-P patients compared with the volumes in PD patients (p<0.05). CONCLUSIONS: Both PD and MSA-P are associated with gray matter atrophy, which mainly involves the bilateral putamen, caudate nucleus, cerebellum, and temporal lobes. ROI and VBM can be used to identify these morphological alterations, and VBM is more sensitive and repeatable and less time-consuming, which may have potential diagnostic value.
Subject(s)
Humans , Male , Female , Parkinson Disease/classification , Parkinson Disease/diagnostic imaging , Atrophy/pathology , Magnetic Resonance Imaging/methods , Multiple System Atrophy/pathology , Gray Matter/diagnostic imaging , Case-Control Studies , ROC Curve , Parkinsonian Disorders/pathology , Gray Matter/pathologyABSTRACT
OBJETIVO: realizar o mapeamento cruzado dos diagnósticos de enfermagem não padronizados com o sistema de classificação NANDA Internacional, presentes nos domínios "Atividade/Repouso" e "Segurança/proteção" e relacionados à capacidade funcional de pacientes com doença de Parkinson de um programa de reabilitação. MÉTODO: estudo descritivo com pesquisa documental para realização do mapeamento cruzado. Amostra aleatória simples de 67 prontuários e 335 registros de enfermagem, no período de março/2009 a abril/2013. RESULTADOS: Dos 93 termos da linguagem de enfermagem, emergiram do mapeamento cruzado 15 diagnósticos padronizados com NANDA Internacional. Os mais mapeados foram "Mobilidade física prejudicada" (22%) e "Risco de quedas" (11%). Para "Mobilidade Física prejudicada", foram mapeadas sete características definidoras. Dois termos da linguagem de enfermagem não foram passíveis de mapeamento com a taxonomia. CONCLUSÃO: O mapeamento cruzado permitiu identificar os diagnósticos padronizados com NANDA Internacional. Isso possibilita a universalização e a consolidação do papel do enfermeiro reabilitador na doença de Parkinson.
AIM: to carry out a cross mapping of the nursing diagnoses not standardized with the NANDA International classification system, present in the domains "Activity/rest" and "Safety/protection" and related to the functional capacity of patients with Parkinson's disease in a rehabilitation program. METHOD: a descriptive study with documentary research for the development of a cross-mapping. Simple random sample of 67 medical records and 335 nursing registers, from March 2009 to April 2013. RESULTS: 15 NANDA International standardized diagnostics emerged from the cross mapping of the 93 terms of the nursing language. The most mapped terms were "Impaired physical mobility" (22%) and "Risk of falling" (11%). For "Impaired physical mobility" seven defining characteristics were mapped. Two terms of nursing language could not be mapped through the taxonomy. CONCLUSION: The cross mapping identified the standardized diagnoses related to the NANDA International. This enables the universalization and the consolidation of the role of nurses in Parkinson's disease rehabilitation.
OBJETIVO: realizar el mapeo cruzado de los diagnósticos de enfermería no estandarizados con el sistema de clasificación NANDA Internacional, presente en los dominios "Actividad/Reposo" y "Seguridad/protección" y relacionados a la capacidad funcional de pacientes con enfermedad de Parkinson de un programa de rehabilitación. MÉTODO: estudio descriptivo con investigación documental para realización del mapeo cruzado. Muestra aleatoria simple de 67 archivos y 335 registros de enfermería en el período de marzo/2009 a abril/2013. RESULTADOS: De los 93 términos del lenguaje de enfermería, surgieron del mapeo cruzado 15 diagnósticos estandarizados con NANDA Internacional. Los más mapeados fueron "Movilidad física perjudicada" (22%) y "Riesgo de caídas" (11%). Para "Movilidad Física perjudicada", fueron mapeadas siete características definidoras. Dos términos del lenguaje de enfermería no fueron susceptibles de mapeo con la taxonomía. CONCLUSIÓN: El mapeo cruzado permitió identificar los diagnósticos estandarizados con NANDA Internacional. Eso posibilita la universalización y la consolidación del papel del enfermero rehabilitador en la enfermedad de Parkinson.
Subject(s)
Humans , Parkinson Disease/classification , Nursing Diagnosis/classification , Rehabilitation Services , Standardized Nursing Terminology , Mobility Limitation , Patient SafetySubject(s)
Humans , Male , Female , Dementia , Parkinson Disease/classification , Parkinson Disease/diagnosisABSTRACT
Differentiation of idiopathic Parkinson's disease from other causes of Parkinsonism, mainly multiple system atrophy, and progressive supranuclar palsy can be difficult and clinicopathological studies suggest that the clinical diagnosis of idiopathic Parkinson's disease is only 76% reliable. Also, clinical differentiation of tremor prominent Parkinsonism from essential tremors may be problematic, especially in early stages of the disease. Since these disorders are obviously different in clinical progress, it is important for the clinician to address the patient's and family's concerns about prognosis from a firm diagnostic footing. In this article the clinical features of the common and important causes of Parkinsonism and tremor disorders are reviewed and a practical approach to these patients is suggested