ABSTRACT
At present, the incidence of Parkinson's disease (PD) is gradually increasing. This seriously affects the quality of life of patients, and the burden of diagnosis and treatment is increasing. However, the disease is difficult to intervene in early stage as early monitoring means are limited. Aiming to find an effective biomarker of PD, this work extracted correlation between each pair of electroencephalogram (EEG) channels for each frequency band using weighted symbolic mutual information and k-means clustering. The results showed that State1 of Beta frequency band ( P = 0.034) and State5 of Gamma frequency band ( P = 0.010) could be used to differentiate health controls and off-medication Parkinson's disease patients. These findings indicated that there were significant differences in the resting channel-wise correlation states between PD patients and healthy subjects. However, no significant differences were found between PD-on and PD-off patients, and between PD-on patients and healthy controls. This may provide a clinical diagnosis reference for Parkinson's disease.
Subject(s)
Humans , Parkinson Disease/diagnosis , Quality of Life , Cluster Analysis , Electroencephalography , Healthy VolunteersABSTRACT
The increasing prevalence of the aging population, and inadequate and uneven distribution of medical resources, have led to a growing demand for telemedicine services. Gait disturbance is a primary symptom of neurological disorders such as Parkinson's disease (PD). This study proposed a novel approach for the quantitative assessment and analysis of gait disturbance from two-dimensional (2D) videos captured using smartphones. The approach used a convolutional pose machine to extract human body joints and a gait phase segmentation algorithm based on node motion characteristics to identify the gait phase. Moreover, it extracted features of the upper and lower limbs. A height ratio-based spatial feature extraction method was proposed that effectively captures spatial information. The proposed method underwent validation via error analysis, correction compensation, and accuracy verification using the motion capture system. Specifically, the proposed method achieved an extracted step length error of less than 3 cm. The proposed method underwent clinical validation, recruiting 64 patients with Parkinson's disease and 46 healthy controls of the same age group. Various gait indicators were statistically analyzed using three classic classification methods, with the random forest method achieving a classification accuracy of 91%. This method provides an objective, convenient, and intelligent solution for telemedicine focused on movement disorders in neurological diseases.
Subject(s)
Humans , Aged , Parkinson Disease/diagnosis , Aging , Algorithms , Gait , Lower ExtremityABSTRACT
ABSTRACT Background: Parkinson's disease (PD) is a chronic disease that presents a multitude of symptoms, with symptoms of both motor and nonmotor nature. The Delphi method is widely used to create consensuses among experts in a field of knowledge. Objective: In order to reach a consensus on the values that should be assigned to the different motor and nonmotor manifestations of Parkinson's disease, a linear evaluation index (LEI) was created. Subsequently, the metric properties of this index were studied. Methods: 120 consecutive patients with a Parkinson's diagnosis were chosen in accordance with the UKPDSBB criteria. The Delphi method was used to reach a consensus among experts regarding the values of each of the manifestations included. Subsequently, the following attributes were analyzed: quality and acceptability of the data; reliability, in terms of internal consistency, reliability index, Cronbach's alpha and standard error of measurement; and validity, in terms of convergent validity and validity for known groups. Results: Twenty-five experts participated. The importance factor did not differ between the first round and the second round (chi-square test). We analyzed the responses that assigned percentage values to the 10 dimensions of the LEI. Both in the first and in the second round, the values of the scattering coefficient Vr were always close to 0. The homogeneity index was 0.36; the corrected-item total correlation values ranged from 0.02 to 0.7; Cronbach's α was 0.69; and the SEM was 4.23 (55.1%). Conclusions: The LEI was obtained through rigorous recommended methodology. The results showed adequate metric properties.
RESUMO Antecedentes: La enfermedad de Parkinson (EP) es una enfermedad crónica que presenta una multitud de síntomas, tanto de naturaleza motora cuanto no motora. El método Delphi se utiliza ampliamente para crear un consenso entre expertos de un campo del conocimiento. Objetivos: Con el fin de llegar a un consenso sobre los valores que deben asignarse a las diferentes manifestaciones motoras y no motoras de la enfermedad de Parkinson, se creó el "Índice de Evaluación Lineal" (linear evaluation index - LEI). Posteriormente, se estudiaron las propiedades métricas de este índice. Métodos: Se eligieron 120 pacientes consecutivos con diagnóstico de Parkinson según los criterios del UKPDSBB. Se utilizó el método Delfos para llegar a un consenso entre los expertos sobre los valores de cada una de las manifestaciones incluidas. Posteriormente, se analizaron los siguientes atributos: Calidad y aceptabilidad de los datos. Fiabilidad: consistencia interna, índice de fiabilidad, alfa de Cronbach y error estándar de medida. Finalmente, Validez: validez convergente y validez para grupos conocidos. Resultados: Participaron 25 expertos, el factor de importancia entre la primera y la segunda rondas (prueba chi-cuadrado), no fue diferente. Analizamos las respuestas que asignaron valores porcentuales a las 10 dimensiones del LEI; tanto en la primera como en la segunda rondas, los valores del coeficiente de dispersión Vr siempre estuvieron cerca de 0. El índice de homogeneidad fue de 0,36; los valores corregidos de correlación ítem-total variaron de 0,02 a 0,7; alpha de Cronbach fue de 0,69. El SEM fue 4,23 (55,1%). Conclusiones: El LEI se ha obtenido siguiendo una rigurosa metodología recomendada. Los resultados han mostrado propiedades métricas adecuadas.
Subject(s)
Humans , Parkinson Disease/diagnosis , Surveys and Questionnaires , Reproducibility of Results , ConsensusABSTRACT
Abstract Background: Fatigue is a disabling symptom in the spectrum of Parkinson's disease (PD), affecting from 30% to 70% of the persons. Even though it is a common symptom, with negative repercussions for PD individuals, its correlation with balance is not established. Aim: The aims of this study were to verify the correlation between fatigue and balance in individuals with PD and to compare balance in individuals with PD that presents low fatigue or high fatigue. Methods: This study included 37 individuals with PD, who were divided into two groups: low fatigue (n = 25) and high fatigue (n = 12). Fatigue was evaluated using the Parkinson's disease Fatigue Scale and a force platform was used to assess four balance tasks: bipedal, tandem with eyes open/closed, and tandem with the dual-task, in three parameters: (1) 95% confidence ellipse area of the center of pressure (COP) (2) mean velocity (3) root mean square of COP. To verify the correlation between fatigue and balance, the Spearman rank-order correlation coefficient was assessed. Comparison of medians between the groups was analyzed using the Mann-Whitney test. Results: There was no significant correlation between fatigue and balance. There was no difference between the groups with low and high fatigue. Conclusion: This study's findings, together with those reported in the literature, suggest there is no correlation between fatigue and balance, and even though individuals with PD report fatigue or experience situations of fatigue, they do not present greater posture instability than individuals with PD who do not report fatigue. Fatigue is a disabling symptom in the spectrum of Parkinson's disease (PD), affecting from
Subject(s)
Humans , Parkinson Disease/diagnosis , Postural Balance , Fatigue , Cross-Sectional Studies/instrumentation , Statistics, NonparametricABSTRACT
RESUMO Objetivo identificar os fatores associados ao risco de quedas entre as pessoas com doença de Parkinson cadastradas na Associação Parkinson Santa Catarina. Método estudo transversal exploratório descritivo e de abordagem quantitativa, realizado com 53 pessoas cadastradas na Associação Parkinson Santa Catarina, no município de Florianópolis, Brasil, no período de junho a setembro de 2019. Foram aplicados questionário sociodemográfico, Escala de Hoehn e Yahr, Mini Exame do Estado Mental e Teste de Rastreio do Risco de Queda no Idoso. Os dados foram tabulados e analisados por meio do Sistema online de Ensino-Aprendizagem de Estatística SEstatNet®. Resultados foram identificados fatores de risco, como sexo, aumento da idade, redução da força muscular, instabilidade postural e diminuição da velocidade da marcha. Em relação aos estágios da doença, foi constatado que em todos houve piora da velocidade da marcha e o medo de cair é constante, aumentando com o agravamento da doença e o tempo de diagnóstico. Conclusão e implicações para a prática ao aprofundar o estudo do tema, o enfermeiro consegue compreender os acometimentos motores que levam à fragilização e à queda em pessoas com doença de Parkinson, elaborando estratégias para preveni-las.
RESUMEN Objetivo identificar los factores asociados al riesgo de caídas en personas con enfermedad de Parkinson registradas en la Asociación de Parkinson Santa Catarina. Método estudio descriptivo exploratorio transversal, con abordaje cuantitativo realizado con 53 personas registradas en la Asociación Parkinson Santa Catarina, en la ciudad de Florianópolis, Brasil, de junio a septiembre de 2019. Se aplicaron un cuestionario sociodemográfico, la Escala de Hoehn y Yahr, el Mini Examen del Estado Mental y la Prueba de Detección del Riesgo de Caídas en Ancianos. Los datos se tabularon y analizaron utilizando el Sistema en línea de enseñanza-aprendizaje de estadísticas SEstatNet®. Resultados se identificaron factores de riesgo como sexo, mayor edad, disminución de la fuerza muscular, inestabilidad postural y disminución de la velocidad de la marcha. En cuanto a las etapas de la enfermedad, se encontró que en todas ellas se produjo un empeoramiento de la velocidad de la marcha y el miedo a caer es constante, aumentando con el empeoramiento de la enfermedad y el momento del diagnóstico. Conclusión e implicaciones para la práctica al profundizar en el estudio del tema, el enfermero es capaz de comprender las deficiencias motoras que conducen a la fragilidad y caída en personas con enfermedad de Parkinson, ideando estrategias para prevenirlas.
ABSTRACT Objective to identify the factors associated with risk of falls among people with Parkinson's disease registered at the Parkinson Santa Catarina Association. Method this is a cross-sectional exploratory descriptive study with a quantitative approach, carried out with 53 people registered at the Parkinson Santa Catarina Association, in the city of Florianópolis, Brazil, from June to September 2019. Sociodemographic questionnaire, Hoehn and Yahr scale, Mini Mental State Examination and Simple Screening Test for Risk of Falls in the Elderly were applied. The data were tabulated and analyzed using the SEstatNet® Statistics Teaching-Learning Online System. Results risk factors were identified, such as sex, increased age, reduced muscle strength, postural instability and decreased gait speed. Regarding the stages of the disease, it was found that in all of them there was a worsening of gait speed and the fear of falling is constant, increasing with the worsening of the disease and diagnosis time. Conclusion and implications for practice by deepening the study of the topic, nurses are able to understand the motor impairments that lead to frailty and fall in people with Parkinson's disease, developing strategies to prevent them.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Parkinson Disease/diagnosis , Accidental Falls/statistics & numerical data , Risk Groups , Levodopa/therapeutic use , Visual Acuity , Comorbidity , Chronic Disease , Cross-Sectional Studies , Risk Factors , Drug Interactions , Walking Speed , Pramipexole/therapeutic useABSTRACT
Parkinson's disease is a neurodegenerative disease understood as a complex syndrome with motor and non-motor symptoms, including sleep-related conditions, such as periodic limb movements in sleep (PLMS). This paper presents issues regarding Parkinson's disease, motor and non-motor symptoms, sleep physiology, and PLMS. In conclusion, both conditions seem to be correlated through impairment of the dopaminergic system.
A doença de Parkinson é uma doença neurodegenerativa entendida como uma síndrome complexa com sintomas motores e não motores, incluindo condições relacionadas ao sono, como movimentos periódicos dos membros durante o sono (MPMS). Este artigo apresenta questões relacionadas à doença de Parkinson, sintomas motores e não motores, fisiologia do sono e MPMS. Em conclusão, ambas as condições parecem estar correlacionadas por comprometimento do sistema dopaminérgico.
Subject(s)
Humans , Aged , Aged, 80 and over , Parkinson Disease/complications , Parkinson Disease/diagnosis , Restless Legs Syndrome , Sleep Wake Disorders/etiology , Neuroimaging/methods , Cognitive Dysfunction/etiology , Disorders of Excessive SomnolenceABSTRACT
ABSTRACT Parkinson's disease (PD), known since ancient times as paralysis agitans, was studied and described by James Parkinson in 1817 in his work "An Essay on the Shaking Palsy". Fifty years later, Charcot and his students delved into the disease, naming it as we know it today, as well as defining the classic disease and its variants. One of these students, Arthur Dutil, addressed patients' abnormal eye movements. Nowadays, it is known that the differential diagnosis of PD is relevant for prognosis, treatment and research, and, despite the advances in the area, it remains largely clinical. The relevance of the eye movement exam has grown along with the history of PD and it has proved to be an excellent tool for the differential diagnosis of parkinsonism. Additionally, it can become a support to identify different types of genetic PD and be useful for improving early recognition of cognitive decline in patients with PD.
RESUMO A doença de Parkinson (DP), conhecida desde a antiguidade como paralysis agitans, foi estudada e descrita por James Parkinson em 1817 em seu trabalho An Essay on the Shaking Palsy. Cinquenta anos depois, Charcot e seus alunos aprofundaram os estudos na doença, nomeando-a como a conhecemos atualmente, bem como definindo a doença clássica e suas variantes. Um desses estudantes, Arthur Dutil, investigou os movimentos oculares anormais nos pacientes. Hoje, sabe-se que o diagnóstico diferencial da DP é relevante para o prognóstico, tratamento e pesquisa, e, apesar dos grandes avanços na área, ainda permanece amplamente clínico. A relevância do exame de movimentação ocular cresceu com a história da DP e este se mostrou uma excelente ferramenta para o diagnóstico diferencial do parkinsonismo. Além disso, pode se tornar um auxílio para identificar diferentes formas de DP genética e útil para melhorar o reconhecimento precoce do declínio cognitivo em pacientes com DP.
Subject(s)
Humans , Parkinsonian Disorders , Parkinson Disease/diagnosis , Students , Diagnosis, Differential , Eye MovementsABSTRACT
Aiming at the limitations of clinical diagnosis of Parkinson's disease (PD) with rapid eye movement sleep behavior disorder (RBD), in order to improve the accuracy of diagnosis, an intelligent-aided diagnosis method based on few-channel electroencephalogram (EEG) and time-frequency deep network is proposed for PD with RBD. Firstly, in order to improve the speed of the operation and robustness of the algorithm, the 6-channel scalp EEG of each subject were segmented with the same time-window. Secondly, the model of time-frequency deep network was constructed and trained with time-window EEG data to obtain the segmentation-based classification result. Finally, the output of time-frequency deep network was postprocessed to obtain the subject-based diagnosis result. Polysomnography (PSG) of 60 patients, including 30 idiopathic PD and 30 PD with RBD, were collected by Nanjing Brain Hospital Affiliated to Nanjing Medical University and the doctor's detection results of PSG were taken as the gold standard in our study. The accuracy of the segmentation-based classification was 0.902 4 in the validation set. The accuracy of the subject-based classification was 0.933 3 in the test set. Compared with the RBD screening questionnaire (RBDSQ), the novel approach has clinical application value.
Subject(s)
Humans , Electroencephalography , Intelligence , Parkinson Disease/diagnosis , Polysomnography , REM Sleep Behavior Disorder/diagnosisABSTRACT
For speech detection in Parkinson's patients, we proposed a method based on time-frequency domain gradient statistics to analyze speech disorders of Parkinson's patients. In this method, speech signal was first converted to time-frequency domain (time-frequency representation). In the process, the speech signal was divided into frames. Through calculation, each frame was Fourier transformed to obtain the energy spectrum, which was mapped to the image space for visualization. Secondly, deviations values of each energy data on time axis and frequency axis was counted. According to deviations values, the gradient statistical features were used to show the abrupt changes of energy value in different time-domains and frequency-domains. Finally, KNN classifier was applied to classify the extracted gradient statistical features. In this paper, experiments on different speech datasets of Parkinson's patients showed that the gradient statistical features extracted in this paper had stronger clustering in classification. Compared with the classification results based on traditional features and deep learning features, the gradient statistical features extracted in this paper were better in classification accuracy, specificity and sensitivity. The experimental results show that the gradient statistical features proposed in this paper are feasible in speech classification diagnosis of Parkinson's patients.
Subject(s)
Humans , Cluster Analysis , Parkinson Disease/diagnosis , SpeechABSTRACT
RESUMEN La enfermedad de Parkinson según la Organización Mundial de Salud, en el año 2016, afectó una persona por cada 100 mayores de 60 años, siendo en cifras absolutas 6,3 millones de personas, y para el año 2030 serán aproximadamente 12 millones de personas en todo el mundo con dicha patología. Este desorden neurodegenerativo, caracterizado por la degradación nigro-estriatal y potenciación de la vía indirecta del circuito motor de los Ganglios Basales sumado al acúmulo de Cuerpos de Lewy en diversas estructuras del Sistema Nervioso Central, afecta progresiva e inevitablemente la calidad de vida de los pacientes, los procederes ablativos del núcleo subtalámico constituyen una alternativa que propicia efecto y seguridad probada en el control de los síntomas de esta enfermedad. Por lo cual se decide describir la ablación del Núcleo subtalámico como tratamiento de la Enfermedad de Parkinson avanzada (AU).
Summary According to the World Health Organization, in 2016 Parkinson's disease affected one person per every 100 people elder 60 years, meaning 6.3 millions of people, and by 2030 it will be around 12 million persons across the world. This neurodegenerative disorder, characterized by the nigro-striatal degradation and potentiation of the indirect route of the basal ganglia motor circuit, added to the accumulation of Lewy bodies in several structures of the Central Nervous System, progressively and inevitably affects the life quality of patients. The ablative procedures of the subthalamic nucleus are an alternative that propitiates proven effect and safety in the control of this disease symptoms. Therefore, the authors decided to describe the subthalamic nucleus ablation as a treatment for advanced Parkinson's disease (AU).
Subject(s)
Humans , Male , Female , Parkinson Disease/surgery , Subthalamic Nucleus/surgery , Parkinson Disease/complications , Parkinson Disease/diagnosis , Quality of Life , Surgical Procedures, Operative/methods , Therapeutics/methods , Central Nervous System/abnormalitiesABSTRACT
O fenômeno do congelamento é considerado um sintoma incapacitante para indivíduos acometidos pela doença de Parkinson, gerando impactos negativos na mobilidade, funcionalidade e qualidade de vida. O congelamento pode acometer membros inferiores (congelamento da marcha) e/ou membros superiores, sendo caracterizado por súbita incapacidade de iniciar ou manter a amplitude dos movimentos. A fisiopatologia do congelamento ainda não é compreendida, porém atribui-se às alterações em diferentes estruturas neuroanatômicas, tais como: núcleo pedúnculo-pontino, locus ceruleus, circuitaria dos núcleos da base, pedúnculo cerebelar e córtices cerebrais e sistema límbico. Fatores que contribuem para o surgimento do congelamento são: tempo de duração da doença, idade avançada, subtipo acinético-rígido da doença, ansiedade ou depressão, perfil de tratamento farmacológico. Sugere-se que o congelamento da marcha e dos membros superiores compartilhem das mesmas características espaço-temporais. A avaliação clínica do congelamento da marcha é melhor estabelecida quando comparada com a avaliação do congelamento dos membros superiores. Estratégias para minimizar o fenômeno do congelamento são descritas no presente artigo.
The phenomenon of freezing is a disabling symptom for subjects with Parkinson's disease, causing impairment in mobility, functionality and quality of life. Freezing may aï¬ect lower limbs (freezing of gait) or upper limbs, and is characterized by sudden inability to initiate or maintain range of motion. The pathophysiology of freezing is not yet understood, but it is attributed to changes in diï¬erent neuroanatomical structures, such as: pedunculopontine nucleus, locus ceruleus, basal ganglia circuitry, pedunculocerebellar and cerebral cortices and limbic system. Factors that contribute to the appearance of freezing are: advanced age, akinetic-rigid subtype of the disease, anxiety or depression, pharmacological treatment strategies. It is suggested that the freezing of gait and upper limbs share the same spatiotemporal characteristics. The clinical evaluation of freezing of gait is better established when compared to the freezing of upper limbs. Strategies to minimize the phenomenon of freezing are described in this article.
Subject(s)
Humans , Aged , Parkinson Disease/complications , Parkinson Disease/diagnosis , Gait Disorders, Neurologic/diagnosis , Gait Disorders, Neurologic/physiopathology , Upper Extremity/physiopathology , Surveys and Questionnaires , Reproducibility of ResultsABSTRACT
Os derivados canabinoides podem ser vistos como novos potenciais terapêuticos para o tratamento da doença de Parkinson e Alzheimer. Assim, esta revisão teve como objetivo descrever os efeitos terapêuticos e adversos do uso de canabidiol e de delta-9-tetrahidrocanabinol nas doenças de Parkinson e de Alzheimer. Para tanto, foi realizada uma busca na base de dados Medline no período entre 2007 e 2017. Os descritores utilizados foram (Tetrahydrocannabinol OR Cannabidiol) AND (Parkinson OR Alzheimer) AND (Treatment OR Therapeutics). Os resultados mostraram efeitos terapêuticos promissores do canabidiol e do delta-9-tetrahidrocanabinol nestas doenças, tais como redução de sintomas motores e cognitivos, e ação neuroprotetora. Estes resultados podem ser explicados, em parte, pelos efeitos antioxidante, antiinflamatório, antagonista de receptores CB1, ou pela ativação de receptores PPAR-gama produzido por estas substâncias. Além disso, poucos efeitos adversos foram descritos, como boca seca e sonolência. Nesse contexto, estes resultados evidenciam a necessidade de novas pesquisas a respeito dos efeitos terapêuticos e adversos de canabinoides com maiores doses e períodos de exposição, para quem sabe, em um futuro próximo, ser possível olhar estas substâncias como uma opção terapêutica mais eficaz e segura para estes pacientes.
Cannabinoid derivatives can be viewed as a novel therapeutic potentials for the treatment of Parkinson's and Alzheimer's disease. Thus, this review aimed to describe the therapeutic and adverse eï¬ects of the use of cannabidiol and delta-9-tetrahydrocannabinol in Parkinson's and Alzheimer's disease. A search of the Medline database was carried out between 2007 and 2017. The descriptors used were (Tetrahydrocannabinol OR Cannabidiol) AND (Parkinson OR Alzheimer) AND (Treatment OR Therapy). The results showed promising therapeutic eï¬ects of cannabidiol and delta-9-tetrahydrocannabinol in Parkinson and Alzheimer's diseases, such as the reduction of motor and cognitive symptoms and neuroprotective action. These results may be explained, in part, by the anti-inï¬ammatory and antioxidant eï¬ects, by CB1 receptor antagonism, or by the activation of PPAR-gamma receptors, produced by these substances. In addition, few adverse eï¬ects have been reported, such as dry mouth and drowsiness. In this context, these results highlight the need for further research on the therapeutic and adverse eï¬ects of cannabinoids with higher doses and periods of exposure, for whom, in the near future, it is possible to view these substances as a more eï¬ective and safe therapeutic option for these patients.
Subject(s)
Humans , Animals , Aged , Rats , Parkinson Disease/diagnosis , Parkinson Disease/drug therapy , Cannabinoids/therapeutic use , Alzheimer Disease/diagnosis , Alzheimer Disease/drug therapy , Cannabinoids/administration & dosage , Cannabinoids/adverse effects , Double-Blind Method , Surveys and Questionnaires , Treatment Outcome , Animal ExperimentationABSTRACT
ABSTRACT: Several screening tests have been used for cognitive evaluation in Parkinson's disease (PD). Objective: To evaluate the usefulness of the Montreal Cognitive Assessment (MoCA) in patients with Parkinson's disease and no cognitive impairment complaints. Methods: A total of 40 PD patients with no complaints of cognitive problems were included. Patients were selected using the Mini-Mental State Examination (MMSE) and the MoCA was then administered. Results: 80% of patients exhibited Mild Cognitive Impairment (MCI) according to the MoCA. Statistically significant differences in visuospatial, attention and delayed recall functions were evident between the normal and abnormal MoCA groups. Conclusion: The study results suggest that MoCA may be a good screening test in patients with PD who do not present cognitive complaints.
RESUMO: Vários testes de triagem foram utilizados para avaliação cognitiva na doença de Parkinson (DP). Objetivo: Avaliar a utilidade da Avaliação Cognitiva de Montreal (MoCA) em pacientes com doença de Parkinson sem queixa de comprometimento cognitivo. Métodos: Um total de 40 pacientes com TP sem queixas de problemas cognitivos foram admitidos e com o Estado de Exame do Estado Mental Mini (MEEM) foram selecionados e receberam o MoCA. Resultados: 80% apresentaram dados de Comprometimento Cognitivo Leve (ICM) segundo o MoCA, sendo as funções visoespaciais, atenção e memória atrasada aquelas que apresentaram diferenças estatisticamente significantes entre os grupos MoCA normal e anormal. Conclusão: Este estudo sugere que o MoCA pode ser um bom teste de triagem em pacientes com DP que não apresentam queixas cognitivas.
Subject(s)
Humans , Parkinson Disease/diagnosis , Triage , Cognitive Dysfunction , Mental Status and Dementia TestsABSTRACT
ABSTRACT Parkinson's disease (PD) and restless legs syndrome/Willis-Ekbom disorder (RLS/WED) are relatively common diseases in the realm of movement disorders. The fact that both may, as expected, co-occur and typically share a similar remarkable response to dopaminergic treatment raised the interest in exploration of additional shared features that throughout the years cruised fields as diverse as phenomenology, epidemiology, genetics, pathology, and clinical studies. In this review, we describe and critically examine the evidence and biases of a conceivable overlap of these two disorders, trying to shed light onto two main sources of confusion: (1) are PD and RLS/WED reciprocal risk factors? and (2) what are the main mimics of RLS/WED in PD?
RESUMO A doença de Parkinson (DP) e a síndrome das pernas inquietas/doença de Willis-Ekbom (SPI/DWE) são doenças relativamente comuns no campo dos distúrbios do movimento. O fato de que ambas podem, como esperado, ocorrer de forma simultânea e usualmente apresentarem resposta favorável ao tratamento dopaminérgico levaram ao interesse em explorar características compartilhadas adicionais. Ao longo dos últimos anos, essa busca percorreu campos diversos como a fenomenologia, epidemiologia, genética, patologia e estudos clínicos. Nesta revisão, analisamos e discutimos criticamente as evidências e os vieses de sobreposição concebíveis dessas duas doenças, tentando esclarecer duas perguntas sem resposta precisa até o momento: (1) DP e SPI/DWE representam fatores de risco recíprocos? e (2) quais são os principais mimetizadores da SPI/DWE na DP?
Subject(s)
Humans , Parkinson Disease/physiopathology , Parkinson Disease/drug therapy , Restless Legs Syndrome/physiopathology , Restless Legs Syndrome/drug therapy , Dopamine Agents/therapeutic use , Parkinson Disease/diagnosis , Parkinson Disease/genetics , Restless Legs Syndrome/diagnosis , Restless Legs Syndrome/genetics , Risk Factors , Treatment Outcome , Diagnosis, DifferentialABSTRACT
Introduction: actuellement nous n'avons pas de données précises sur les syndromes parkinsoniens à Madagascar. Nous voulions rassembler des données sur ces maladies. Alors l'objectif de notre étude étant de décrire la fréquence et le profil clinique des syndromes parkinsoniens dans notre Service de Neurologie.Méthodes: il s'agit d'une étude rétrospective descriptive allant de janvier 2014 à juin 2018 dans le Service de Neurologie, Befelatanana. Les données démographiques et cliniques des patients diagnostiqués comme ayant un syndrome parkinsonien étaient collectées. Nous en avons évalué les fréquences et les caractéristiques puis comparé les patients avec Maladie Parkinson idiopathique et les autres syndromes parkinsoniens. Les données étaient traitées par le logiciel R.Résultats: nous avons retenus 104 patients sur 3528, vus dans notre service. Parmi les patients avec un syndrome parkinsonien, 67(64,42%) avaient une maladie de Parkinson idiopathique (MP) et 37 (35,47%) un syndrome parkinsonien autre. L'intervalle moyen entre le début de la maladie et la consultation ou l'hospitalisation dans le service était de 2,5 ans. Pour les MP, l'âge moyen de début était à 58,5 [23; 80] ans, l'âge du diagnostic à 62 [28; 83] ans et la sex-ratio était de 1,97. La médiane de score de Hoehn et Yahr était de 2.0. Les formes de MP étaient tremblantes dans 24(35,42%), mixte 28(41,71%) et akineto-rigide 15(22,38%) des cas. Pour les autres syndromes parkinsoniens, 27(72,97%) étaient des hommes, l'âge moyen de début était à 57,5 [26; 83] ans, l'âge du diagnostic à 59,3 [26; 83] ans, les étiologies étaient dominées par l'Atrophie Multi-Systématisée avec 17/37(46,64%). Les patients atteints d'autres syndromes parkinsoniens avaient plus de troubles cognitifs (p=0,0306) et les MP étaient plus sensible au DOPAMINE (p=0,006).Conclusion: les patients parkinsoniens idiopathiques avaient des caractéristiques différentes de ceux avec autre parkinsonisme. Il y a avaient eu un retard diagnostique comme dans les autres pays en voie de développement
Subject(s)
Madagascar , Parkinson Disease/diagnosis , Parkinson Disease/epidemiology , Parkinson Disease/therapy , Signs and SymptomsABSTRACT
ABSTRACT Objective: To identify biomarkers for Parkinson's disease, cerebrospinal fluid, blood, saliva, and urine. Method: The studies were collected from the Cochrane, LILACS, PubMed, SCOPUS, WEB OF SCIENCE, OpenGrey, ProQuest and Google Scholar databases starting from May 3, 2016 and updated on March 20, 2017. Twenty-two studies were evaluated, by the Quality Assessment Tool for Diagnostic Accuracy Studies and Review Manager 5.3. Results: Evidence shows that serum antibodies can be used as highly specific and accurate biomarkers for the diagnosis of Parkinson's disease at the outset. Biomarkers in the cerebrospinal fluid are related to increased motor severity, postural instability, gait abnormality, and cognitive impairment. Conclusion: Serum and cerebrospinal antibodies can be used as diagnostic biomarkers at the onset of the disease.
RESUMEN Objetivo: Identificar los biomarcadores para la enfermedad de Parkinson, el líquido cefalorraquídeo, la sangre, la saliva y la orina. Método: Los estudios fueron recolectados en las bases de datos Cochrane, LILACS, PubMed, SCOPUS, WEB OF SCIENCE, OpenGrey, ProQuest y Google Scholar, a partir del 3 de mayo de 2016 y actualizados el 20 de marzo de 2017. Se seleccionaron 22 estudios, evaluados por la Quality Assessment Tool for Diagnostic Accuracy Studies y el Review Manager 5.3. Resultados: La evidencia muestra que los anticuerpos séricos pueden ser utilizados como biomarcadores altamente específicos y precisos para el diagnóstico de la enfermedad de Parkinson en su inicio. Los biomarcadores en el líquido cefalorraquídeo están relacionados con el aumento de la severidad motora, la inestabilidad postural, el disturbio de la marcha y la declinación cognitiva. Conclusión: Los anticuerpos séricos y cefalorraquídeos pueden utilizarse como biomarcadores de diagnóstico al inicio de la enfermedad.
RESUMO Objetivo: Identificar os biomarcadores para a doença de Parkinson, no líquido cefalorraquidiano, sangue, saliva e urina. Método: Os estudos foram coletados nas bases de dados Cochrane, LILACS, PubMed, SCOPUS, WEB OF SCIENCE, OpenGrey, ProQuest e Google Scholar, a partir de 3 de maio de 2016 e atualizados em 20 de março de 2017. Foram selecionados 22 estudos, avaliados pelo Quality Assessment Tool for Diagnostic Accuracy Studies e o Review Manager 5.3. Resultados: A evidência mostra que os anticorpos séricos podem ser usados como biomarcadores altamente específicos e precisos para o diagnóstico da doença de Parkinson em seu início. Os biomarcadores no líquido cefalorraquidiano estão relacionados ao aumento da severidade motora, à instabilidade postural, ao distúrbio da marcha e ao declínio cognitivo. Conclusão: Os anticorpos séricos e cefalorraquidianos podem ser utilizados como biomarcadores de diagnóstico no início da doença.
Subject(s)
Humans , Parkinson Disease/diagnosis , Biomarkers/analysis , Sensitivity and Specificity , Parkinson Disease/blood , Biomarkers/blood , Antibodies/analysis , Antibodies/bloodABSTRACT
FUNDAMENTO: A dor é um sintoma não motor frequente em indivíduos com doença de Parkinson (DP). Pode estar associada aos sinais motores ou surgir no início da doença. Os mecanismos subjacentes à dor na DP ainda não são bem elucidados e muitos fatores podem influenciá-la, como o uso de levodopa e a presença de outros sintomas não motores, como depressão. OBJETIVOS: Descrever a prevalência e caracterizar a dor em pacientes com DP de um centro terciário referência em pesquisa e assistência clínica. MÉTODOS: Foram recrutados pacientes com diagnóstico de DP idiopática a partir do ambulatório de neurologia do Centro de Especialidades Médicas (CEM) da Santa Casa de Belo Horizonte/MG. Um questionário para coleta de dados sociodemográficos e clínicos foi aplicado. A função cognitiva, gravidade dos sinais e sintomas, depressão, distúrbios de sono e fadiga foram avaliados. A dor foi mensurada por meio do Questionário de McGill e Escala Visual Numérica. RESULTADOS: Participaram do estudo 45 pacientes, sendo que 19 (42,2%) apresentavam queixa de dor e, em sua maioria, após o diagnóstico de DP (74%). Não houve diferença entre os grupos com dor e sem dor para os parâmetros clínicos avaliados, com exceção da fadiga que foi mais prevalente (p=0,036) e mais grave (p=0,031) nos pacientes com dor. CONCLUSÃO: A dor é um sintoma prevalente em pacientes com DP atendidos no CEM. A partir dos resultados obtidos pelo McGill, observou-se que a dor crônica e profunda, acometendo principalmente os membros inferiores, com importantes aspectos sensoriais e afetivos, foi comum nos pacientes avaliados.
BACKGROUND: Pain is a common non-motor symptom in Parkinson´s Disease (PD). It can be associated to motor signs or can arise in the beginning of the disease. Mechanisms of pain in PD are not completely understood. Moreover, many factors can interfere, such as use of levodopa and presence of other non-motor symptoms as depression. OBJECTIVES: The aim of this study was to describe prevalence and characterization of pain in PD patients from a research and clinical terciary care center in Belo Horizonte, Minas Gerais, Brazil. METHODS: PD patients from the Neurology Center of Santa Casa Hospital (Belo Horizonte, MG, Brazil) were recruted. Socio-demographic and clinical data were collected. Cognitive function, severity of PD signs and symptoms, depression, sleep disturbance and fatigue were evaluated. Pain was measured by McGill Pain Questionnaire and Visual Numeric Scale (VNS). RESULTS: Forty-five PD patients participated in the study and 42,2% had pain complaints, mostly (74%) after PD diagnosis. No difference between group with pain or without pain for clinical parameters was detected, except for fatigue, which was more prevalent (p=0,036) and more severe (p=0.031) in patients with pain. CONCLUSION: Pain was very prevalent in PD patients from CEM. Results obtained from McGill showed that chronic and deep pain, mostly in lower limbs, with important physical and affective features was very common in this sample of PD patients.
Subject(s)
Humans , Male , Female , Aged , Parkinson Disease/complications , Parkinson Disease/diagnosis , Chronic Pain/diagnosis , Chronic Pain/epidemiology , Prevalence , Cross-Sectional Studies , Surveys and Questionnaires/standards , Lower Extremity , Fatigue , Chronic Pain/etiologyABSTRACT
A doença de Parkinson (DP) consiste de uma alteração neurológica decorrente da destruição generalizada de parte da substantia nigra, dos gânglios basais, onde se localizam os neurônios dopaminérgicos, que por fatores ainda não muito esclarecidos se degeneram. É considerada uma moléstia idiopática, possivelmente multifatorial, e de incidência relativamente alta, justificando mais estudos sobre esse assunto. OBJETIVO: analisar a relação entre o estilo de vida e a etiologia da Doença de Parkinson em pacientes do município de Jequié - BA, correlacionando o estilo de vida desses indivíduos com o desenvolvimento da Doença de Parkinson. MÉTODOS: Trata-se de um estudo do tipo caso-controle, com um desenho observacional, analítico e transversal de base populacional, que envolveu a identificação de indivíduos portadores (casos) e não portadores (controles) da Doença de Parkinson. Uma amostra de 38 participantes, tendo por casos 17 indivíduos diagnosticados com DP casos e 21 controles. O estilo de vida foi avaliado, relacionando com possíveis fatores de risco e proteção. RESULTADOS: Verificamos diferenças estatisticamente significativas para a exposição à praguicidas (p = 0,03), consumo de água de poço (p < 0,0001), uso continuado de medicamentos (p = 0,02), ao consumo de carne vermelha (p = 0,01), ao histórico familiar de DP (p = 0,004), todos apontados como fatores de risco, enquanto que apenas a carga tabágica de 50 cigarros/ano/dia mostrou diferença estaticamente significativa (p = 0,0002), sendo associada como fator protetor. CONCLUSÃO: Esses resultados parecem consistentes com a literatura atual, que sugere um modelo multifatorial para etiologia da DP.
Parkinson's disease (PD) consists of a neurological alteration resulting from the widespread destruction of part of the substantia nigra, of the basal ganglia, where dopaminergic neurons are located, which, due to factors not yet well understood, degenerate. It is considered an idiopathic disease, possibly multifactorial, and of relatively high incidence, justifying further studies on this subject. OBJECTIVE: to analyze the relationship between lifestyle and the etiology of Parkinson's Disease in patients from the municipality of Jequié - BA, correlating the lifestyle of these individuals with the development of Parkinson's Disease. METHODS: This is a case-control study with an observational, analytical, cross-sectional population-based design that involved the identification of individuals (cases) and non-carriers (controls) of Parkinson's Disease. A sample of 38 participants, having 17 cases diagnosed with PD cases and 21 controls. Lifestyle was assessed, relating to possible risk factors and protection. RESULTS: We found statistically significant differences for pesticide exposure (p = 0.03), well water consumption (p <0.0001), continued use of medications (p =0.02), and red meat consumption ( p = 0.01), the family history of PD (p = 0.004), all of which were identified as risk factors, whereas only the tabacic load of 50 cigarettes / year / day showed a statistically significant difference (p = 0.0002), being associated as a protective factor. CONCLUSION: These results seem consistent with the current literature, which suggests a multifactorial model for the etiology of PD.