The prevalence of impulsive compulsive behaviors in patients treated with apomorphine infusion: a retrospective analysis / Prevalência de comportamentos impulsivo-compulsivos em pacientes tratados com infusão de apomorfina: análise retrospectiva

ABSTRACT Background: Impulsive compulsive behaviors (ICBs) can affect a significant number of Parkinson's disease (PD) patients. Objective: We have studied brain samples from a brain bank of PD patients who received apomorphine via continuous infusion in life to assess the prevalence and outcome of ICBs. Methods: A search on the Queen Square Brain Bank (QSBB) database for cases donated from 2005 to 2016 with a pathological diagnosis of idiopathic PD was conducted. Notes of all donors who used apomorphine via continuous infusion for at least three months were reviewed. Clinical and demographic data were collected, as well as detailed information on treatment, prevalence and outcomes of ICBs. Results: 193 PD cases, 124 males and 69 females, with an average age at disease onset of 60.2 years and average disease duration of 17.2 years were reviewed. Dementia occurred in nearly half of the sample, depression in one quarter, and dyskinesias in a little over 40%. The prevalence of ICBs was 14.5%. Twenty-four individuals used apomorphine infusion for more than three months. Patients on apomorphine had younger age at disease onset, longer disease duration, and higher prevalence of dyskinesias. The prevalence of de novo ICB cases among patients on apomorphine was 8.3%. Apomorphine infusion was used for an average of 63.1 months on an average maximum dose of 79.5 mg per day. Ten patients remained on apomorphine until death. Conclusions: Apomorphine can be used as an alternative treatment for patients with previous ICBs as it has low risk of triggering recurrence of ICBs.

RESUMO Antecedentes: Comportamentos impulsivo-compulsivos (CICs) podem acometer uma parcela significativa de indivíduos com doença de Parkinson (DP). Objetivo: Nós estudamos amostras de tecido cerebral de uma população de pacientes com DP de um banco de cérebros que receberam apomorfina por infusão contínua em vida, com a finalidade de avaliar a prevalência e o desfecho dos CICs. Métodos: Uma pesquisa no banco de dados do Banco de Cérebros de Queen Square foi conduzida à procura de doações recebidas entre 2005 e 2016 com diagnóstico anatomopatológico de DP idiopática. Os prontuários de todos os doadores que usaram apomorfina por infusão contínua por um período mínimo de três meses foram revisados. Dados clínicos e demográficos foram coletados, assim como informações detalhadas sobre o tratamento, prevalência e desfecho dos CICs. Resultados: 193 casos de DP, 124 do sexo masculino e 69 do sexo feminino, com idade média de início da doença de 60,2 anos e tempo médio de duração da doença de 17,2 anos, foram revisados. Aproximadamente metade dos casos apresentaram demência, um quarto depressão, e um pouco mais de 40% discinesias. A prevalência de CICs foi 14,5%. Vinte e quatro indivíduos usaram infusão de apomorfina por mais de três meses. Os pacientes que usaram apomorfina apresentaram DP mais cedo, maior duração da doença, e uma maior prevalência de discinesias. A prevalência de novos casos de CICs entre pacientes usando apomorfina foi de 8,3%. Infusão de apomorfina foi usada em média por 63,1 meses a um dose máxima média de 79,5 mg por dia. Dez pacientes permaneceram usando apomorfina até o óbito. Conclusões: Apomorfina pode ser usada como opção de tratamento alternativo para pacientes que apresentarem CICs no passado considerando seu baixo risco de causar recorrência de CICs.

NeuroPark: Una aplicación interactiva para el aprendizaje de la enfermedad de Parkinson / NeuroPark: An Interactive Application for Learning about Parkinson's disease

Introducción: La enfermedad de Parkinson (EP) es un desorden neurodegenerativo motor que afecta a más del 1 por ciento de la población mayor de 65 años. Objetivo: desarrollar e implementar una aplicación interactiva para el conocimiento sobre la EP en los estudiantes de 3er año de medicina. Métodos: la aplicación se desarrolló en el periodo de enero a mayo del 2018 en la Facultad de Ciencias Médicas de Bayamo (FCMB) con el empleo de las herramientas Android Studio y GIMP de licencia libre. Para determinar su efectividad se realizaron encuestas a profesores y estudiantes de la FCMB. El universo estuvo constituido por todos los estudiantes del 3er año de la carrera de medicina (279 alumnos) y la muestra por los estudiantes seleccionados que realizaron las dos primeras rotaciones por la sala de Medicina Interna (60 estudiantes). El grupo control, estuvo formado por la primera rotación, mientras que el experimental correspondió a la segunda rotación, ambos seleccionados por muestreo aleatorio simple, en un período desde enero a mayo de 2018, en el Hospital Docente Universitario Carlos Manuel de Céspedes. Resultados: las mejores calificaciones comprendidas entre 4 y 5 puntos, correspondieron al grupo experimental con 30 estudiantes para el 100 por ciento, mientras que para el control se encontraron 9 estudiantes, para un 30 por ciento. Conclusiones: la aplicación NeuroPark para el aprendizaje sobre la enfermedad de Parkinson constituye una alternativa para incrementar el nivel de conocimientos en los estudiantes evaluados(AU)

Introduction: Parkinson's disease (PD) is a neurodegenerative motor disorder that affects more than 1 percent of the population over 65 years. Objective: develop and implement an interactive application for PD awareness in 3rd year medical students. Methods: the application was developed in the period from January to May 2018 at the Faculty of Medical Sciences of Bayamo (FMSB) with the free-use Android Studio and GIMP tools. To determine its effectiveness, surveys were conducted on professors and students of the FMSB. The universe constituted all the students of the 3rd year of the medical career (279 students) and the sample by the selected students who made the first two rotations through the Internal Medicine room (60 students). The control group was formed by the first rotation, while the experimental group corresponded to the second rotation, both selected by simple random sampling, in a period from January to May 2018, at the Carlos Manuel de Céspedes University Teaching Hospital. Results: it was obtained as a result that the best grades between 4 and 5 points corresponded to the experimental group with 30 students for 100 percent, while for the control 9 students were found, for 30 percent. Conclusions: the NeuroPark application for learning about Parkinson's disease is an alternative to increase the level of knowledge in the students evaluated(AU)

Relación entre el sexo y los síntomas motores y no motores en pacientes con Parkinson / Relationship between sex and motor and non - motor symptoms in Parkinson's patients

Introducción: La enfermedad de Parkinson es una entidad neurodegenerativa caracterizada por bradicinesia, temblor en reposo y rigidez. Objetivo: Determinar la relación entre el sexo y los síntomas motores y no motores en pacientes con enfermedad de Parkinson. Métodos: Se realizó un estudio observacional analítico transversal sobre la relación entre el sexo y los síntomas motores y no motores en pacientes con enfermedad de Parkinson en el Hospital Clínico Quirúrgico Lucía Íñiguez Landín en el año 2018. El universo estuvo constituido por los 675 pacientes con Parkinson atendidos en consulta. La muestra fue de 110 pacientes. Resultados: Predominó el grupo etario 60-69 años (34,55 por ciento). Los síntomas no motores al inicio de la enfermedad fueron mayores para un 68,18 por ciento. Dentro de los síntomas motores, prevalecieron el temblor (80 por ciento) y la rigidez (72,72 por ciento). El síntoma más prevalente en el sexo masculino fue el temblor y en el femenino la rigidez. Dentro de los síntomas no motores destacaron los trastornos del sueño para un 92,72 por ciento y alteraciones neuropsiquiátricas para un 86,36 por ciento. Conclusiones: En el presente estudio se encontraron diferencias significativas entre hombres y mujeres en la prevalencia de algunos síntomas motores y no motores(AU)

Introduction: Parkinson's disease is a neurodegenerative entity characterized by bradykinesia, tremor at rest and rigidity. Objective: To determine the relationship between sex and motor and non-motor symptoms in patients with Parkinson's disease. Methods: A cross-sectional analytical observational study was carried out on the relationship between sex and motor and non-motor symptoms in patients with Parkinson's disease at Lucía Íñiguez Landín Clinical Surgical Hospital in 2018. The universe consisted of 675 Parkinson's patients seen in consultation. The sample consisted of 110 patients. Results: The age group 60-69 years (34.55percent) predominated. Non-motor symptoms predominated at the beginning of the disease in 68.18percent. Tremor (80percent) and rigidity (72.72percent) predominated within the motor symptoms. The most prevalent symptom in males was tremor and rigidity in females. While as the non-motor symptoms, sleep disorders predominated in 92.72percent and neuropsychiatric disorders in 86.36percent. Conclusions: In the present study, significant differences were found between men and women in the prevalence of some motor and non-motor symptoms(AU)

Descriptive epidemiological study on patients with movement disorders, with emphasis on Parkinson's disease

ABSTRACT BACKGROUND: Knowing the epidemiological profile is relevant for improving healthcare practices. Movement disorders are neurological disorders characterized by the presence of involuntary movements. They have a negative impact on patients' quality of life. OBJECTIVES: To outline the frequencies of the different diagnoses seen among patients, along with their demographic characteristics, at a hospital in São Paulo (SP), Brazil, and to highlight the clinical aspects of those with Parkinson's disease. DESIGN AND SETTING: Retrospective descriptive epidemiological analysis at a specialized outpatient clinic in a state public hospital in São Paulo. METHODS: Patients treated at this clinic over a four-year period were analyzed. Diagnoses, demographic variables and associations with clinical aspects of Parkinson's disease were evaluated. RESULTS: Out of the 680 medical records analyzed, 58.4% related to females. Most patients were over 60 years of age, white, married and teachers. The most frequent diagnosis was Parkinson's disease, followed by essential tremor and dystonia. Parkinson's disease presented in the mixed clinical form; the most common initial symptom was tremor. The akinetic-rigid clinical form occurred in younger individuals and mostly presented with postural instability and freezing of gait in the early years of disease. CONCLUSIONS: Parkinson's disease, essential tremor and dystonia were the most frequent diagnoses. Characteristics like sex, frequency of other pathological conditions and the clinical and demographic aspects of Parkinson's disease were consistent with the data in the relevant literature.

Is restless legs syndrome in Parkinson disease patients associated with any specific factor? / A síndrome das pernas inquietas nos pacientes com doença de Parkinson está associada a algum fator específico?

ABSTRACT Background: Restless legs syndrome or Willis-Ekbom disease is a disorder characterized by unpleasant sensations associated with the need to mobilize the lower limbs. In Parkinson disease patients, restless legs syndrome is associated with worse quality of life and excessive sleepiness. Regarding other factors, results of different studies are controversial. Objective: To determine the factors associated with the restless legs syndrome presence in Parkinson disease patients. Methods: A cross-sectional study was conducted in 88 consecutive Parkinson disease patients from the outpatient clinic for 21 months. Participants underwent a clinical interview, assessment based on standardized scales (Epworth Sleepiness Scale, Parkinson Disease Questionnaire - 39, Pittsburgh Sleep Quality Index, International Restless Legs Syndrome Study Group rating scale), and video-polysomnography. Results: Out of the 88 participants, 25 had restless legs syndrome. In the multivariate analysis, restless legs syndrome in Parkinson disease has been associated with the symptom of smell loss and quality of sleep and life. In the univariate analysis, restless legs syndrome in Parkinson disease has occurred more frequently in women with higher frequency of insomnia, constipation, and anosmia than in the group without restless legs syndrome. Conclusion: Restless legs syndrome is a prevalent condition in patients with Parkinson disease and is associated with specific characteristics in this group of patients.

RESUMO Introdução: A síndrome das pernas inquietas, ou doença de Willis-Ekbom, é um transtorno caracterizado por sensações de desconforto associadas à necessidade de movimentar os membros inferiores. Nos pacientes com doença de Parkinson, a síndrome das pernas inquietas está associada a uma qualidade de vida inferior e sonolência excessiva. Em relação a outros fatores, resultados de diferentes estudos mostraram resultados controversos. Objetivo: Determinar os fatores associados à presença da síndrome das pernas inquietas nos pacientes com doença de Parkinson. Métodos: Um estudo transversal foi conduzido com 88 pacientes com doença de Parkinson, consecutivos, acompanhados em ambulatório especializado, durante 21 meses. Participantes passaram por uma entrevista clínica, avaliação por meio de escalas padronizadas (Escala de Sonolência de Epworth, Questionário de Qualidade de Vida da Doença de Parkinson, Índice de Qualidade de Sono de Pittsburgh, Escala de Gravidade Internacional da Síndrome das Pernas Inquietas) e videopolissonografia. Resultados: Do total de 88 participantes, 25 tinham síndrome das pernas inquietas. Na análise multivariada, a síndrome das pernas inquietas na doença de Parkinson esteve associada à perda de olfato, assim como à qualidade de vida e ao sono. Na análise univariada, a síndrome das pernas inquietas na doença de Parkinson ocorreu mais frequentemente em mulheres, com maior frequência de insônia, constipação e anosmia, do que no grupo sem síndrome das pernas inquietas. Conclusão: A síndrome das pernas inquietas é uma condição prevalente na doença de Parkinson e está associada a características específicas neste grupo de pacientes.

Características clínicas da doença de Parkinson associadas à dor ao tratamento odontológico / Clinical characteristics of Parkinson's disease associated with dental treatment-related pain

Resumo Introdução A Doença de Parkinson (DP) resulta em condições clínicas desfavoráveis para a saúde bucal e não existe estudo publicado sobre dor ao tratamento odontológico em pacientes com DP. Objetivo Pesquisar associação entre características clínicas da DP e a intensidade de dor em decorrência de tratamentos odontológicos. Material e método Foi utilizada uma amostra consecutiva de 70 pacientes com DP, nos quais foram realizados 217 procedimentos odontológicos invasivos. Tempo de DP foi coletado do prontuário odontológico; estágio da DP foi definido por meio da escala de Hoehn e Yahr; défice cognitivo, por meio do Mini Exame do Estado Mental; depressão, por meio do Inventário de Depressão de Beck; e comprometimento motor, por meio da escala UPDRS/AVD. Os pacientes foram questionados se no último mês sentiram alguma sensação de dormência, formigamento, queimação ou dor bem como dificuldade para sentir cheiros ou gostos. A dor relacionada ao tratamento foi coletada por meio de uma escala numérica de dor com valores de 0 a 10. Resultado O nível de dor percebida pelos pacientes durante o tratamento odontológico não apresentou associação significativa com tempo de DP, estágio da DP, comprometimento motor nem ocorrência de depressão. Maior nível de dor foi estatisticamente mais frequente entre aqueles com défice cognitivo e aqueles que relataram a presença de maior número de sintomas sensitivos, sobretudo dormência e queimação. Conclusão A dor ao tratamento odontológico em pacientes com DP está associada aos sintomas não motores desses pacientes, especificamente o défice cognitivo e a presença de sintomas sensitivos.

Abstract Introduction Parkinson's disease (PD) results in unfavorable clinical conditions for oral health and there is no published study on pain during dental treatment in PD patients. Objective To investigate association between clinical characteristics of PD and the intensity of pain due to dental treatments. Material and method A consecutive sample of 70 patients with PD was used, in which 217 invasive dental procedures were performed. PD duration was collected from dental records; PD stage was defined using the Hoehn and Yahr scale; cognitive deficit, using the Mini Mental State Examination; depression, using the Beck Depression Inventory; and motor impairment, using the UPDRS-AVD scale. Patients were asked whether in the last month they felt any numbness, tingling, burning or pain sensation; as well as difficulty in smelling or tasting. Treatment-related pain was collected using a Numerical Pain Scale with values ranging from 0 to 10. Result the level of pain perceived by patients during dental treatment was not significantly associated with PD duration, PD stage, motor impairment or occurrence of depression. The frequency of patients who reported a higher level of pain was statistically higher among those with cognitive impairment and those who reported the presence of a greater number of sensory symptoms, especially numbness and burning. Conclusion Pain related to dental treatment in PD patients is associated with non-motor symptoms of these patients, specifically the cognitive impairment and the presence of sensory symptoms.

Obstructive sleep apnea and Parkinson's disease: characteristics and associated factors / Apneia obstrutiva do sono e doença de Parkinson: características e fatores relacionados

ABSTRACT Obstructive sleep apnea (OSA) occurs in up to 66% of Parkinson's disease (PD) patients, higher than in the general population. Although it is more prevalent, the relationship between OSA and PD remains controversial, with some studies confirming and others denying the relationship of OSA with some risk factors and symptoms in patients with PD. Objective: To determine the factors associated with OSA in PD patients com DP. Methods: A cross-sectional study was performed with 88 consecutive patients with PD from the outpatient clinic. Participants underwent clinical interviews with neurologists and a psychiatrist, assessment using standardized scales (Epworth Sleepiness Scale, Parkinson's Disease Questionnaire, Pittsburgh Sleep Quality Index and, for individuals with a diagnosis of restless legs syndrome/Willis-Ekbom disease, the International Restless Legs Syndrome Rating Scale), and video-polysomnography. Results: Individuals with PD and OSA were older and had less insomnia than those with PD without OSA. Regarding the polysomnographic variables, we observed a lower percentage of stage N3 sleep, a higher arousal index, and a higher oxygen desaturation index in those individuals with OSA, relative to those without OSA. In the multivariate analysis, only the percentage of stage N3 sleep and the oxygen desaturation index were significantly different. Besides this, most of the PD patients with OSA had a correlation with sleeping in the supine position (58% of OSA individuals). Conclusion: The PD patients showed a high prevalence of OSA, with the supine position exerting a significant influence on the OSA in these patients, and some factors that are associated with OSA in the general population did not seem to have a greater impact on PD patients.

RESUMO A Apneia Obstrutiva do Sono (AOS) chega a acometer até 66% dos pacientes com doença de Parkinson (DP), prevalência maior, portanto, que a da população geral. Embora seja mais prevalente, a relação entre AOS e DP permanence controversa, com trabalhos confirmando e outros afastando a relação de AOS com alguns fatores de risco e sintomas em pacientes com DP. Objetivo: Determinar quais fatores estão relacionados à AOS em pacientes com DP. Métodos: Estudo transversal, observacional, realizado com 88 pacientes com DP, provenientes do ambulatório de hospital público. Os pacientes foram submetidos à entrevista clínica com neurologista e psiquiatra, à aplicação de escalas padronizadas (escala de sonolência de Epworth, questionário de qualidade de vida da DP, índice de qualidade de sono de Pittsburgh e, para os indivíduos com diagnóstico de Síndrome das Pernas Inquietas, a escala internacional de graduação da SPI), e vídeo-polissonografia. Resultados: Indivíduos com DP e AOS apresentaram maior idade e menor prevalência de insônia crônica que os indivíduos com DP, sem AOS. Em relação às variáveis polissonográficas, observamos uma baixa proporção de sono N3, elevado índice de microdespertares e maior índice de desaturações nos indivíduos com AOS, em comparação ao grupo sem AOS. Na análise multivariada, apenas a porcentagem de sono N3 e o índice de dessaturação permaneceu significativo. Além disso, a maior parte dos pacientes tem relação com a posição supina (58% dos pacientes com AOS). Conclusão: Pacientes com DP apresentaram prevalência elevada de AOS, a posição supina exerceu influência importante na AOS destes pacientes e alguns fatores que estão associados à AOS na população geral não mostraram impacto significativo nos pacientes com DP.

Oral health condition of elderly people with Parkinson disease / Condição de saúde bucal de idosos com doença de Parkinson

The oral hygiene of individuals with Parkinson disease (PD) is markedly impaired by difficulties in toothbrushing due to motor impairment and tremors. Additionally, it appears that other features associated with PD have an impact on the quality of oral health. Objective: this cross-sectional observational study characterized the oral health condition of individuals with PD. Methods: fifty individuals with PD, aged 53 to 94 years, users of medication for such condition were examined. The research participants had their oral cavities examined to assess prosthetic use and need; index of Decayed, Missing and Filled Teeth (DMFT); Community Periodontal Index (CPI); Periodontal Attachment Loss (PAL); and oral mucosa. In addition, a questionnaire was applied to obtain personal data, general health, and oral health. The data were analyzed using descriptive statistics. Results: a high prosthetic use was observed in the upper arch (92%), while the lower arch revealed high prosthetic need (66%). The DMFT index showed a high number of missing teeth, CPI showed a prevalence of 43% of dental calculus, and PAL revealed 28% of attachment loss of 4-5 mm. The most frequent findings in the assessment of oral mucosa were denture stomatitis and inflammatory fibrous hyperplasia. Conclusion: PD patients refer xerostomia and present high number of missing teeth, a minority of healthy teeth, and oral lesions, representing a target population for specialized oral health care. (AU)

A higiene bucal de indivíduos com doença de Parkinson (DP) é claramente prejudicada por dificuldades na escovação devido ao comprometimento motor e aos tremores. Além disso, outros aspectos relacionados à doença parecem impactar a qualidade da saúde bucal. Objetivo: este estudo observacional seccional caracterizou a condição de saúde bucal de indivíduos com DP. Métodos: foram examinados cinquenta indivíduos com DP, com idades variando entre 53 e 94 anos, que utilizavam medicamentos para DP. Os participantes da pesquisa foram submetidos a exame bucal para avaliar: uso e necessidade de prótese, índice de dentes cariados, perdidos e obturados (CPOD), Índice Periodontal Comunitário (IPC), Índice de Perda de Inserção Periodontal (PIP) e mucosa bucal. Além disso, foi aplicado um questionário para obtenção de dados pessoais e sobre saúde geral e saúde bucal. Os dados foram analisados usando estatística descritiva. Resultados: observou-se alto percentual de uso de prótese superior (92%), enquanto o arco inferior apresentou elevada necessidade de prótese (66%). O CPOD revelou um alto número de dentes perdidos; o IPC apresentou prevalência de 43% de cálculo dentário; e o PIP revelou 28% de perda de inserção de 4-5 mm. Os achados mais frequentes na avaliação da mucosa bucal foram estomatite por dentadura e hiperplasia fibrosa inflamatória. Conclusão: os indivíduos com DP mencionam xerostomia, apresentam alto número de dentes faltantes, um número reduzido de dentes saudáveis e lesões bucais, representando uma população-alvo para o cuidado de saúde bucal especializado. (AU)

Fréquence et profil clinique de la maladie de Parkinson et des autres syndromes Parkinsoniens vus au service de neurologie de l'hôpital Befelatanana Antananarivo

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

Relação entre estilo de vida e a etiologia da doença de Parkinson em pacientes do Município de Jequié ­ BA / Relationship between lifestyle and etiology of Parkinson disease in patients of Jequié ­ Municipality

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.

Restless legs syndrome in Parkinson's disease and increased cardiovascular risk / Síndrome das pernas inquietas em doença de Parkinson e aumento do risco cardiovascular

ABSTRACT Restless legs syndrome (RLS) is a disorder commonly found in patients with Parkinson's disease, with descriptions for both conditions impairing dopaminergic transmission in central nervous system. Previous studies in varied populations indicate an association between the presence of RLS and increased cardiovascular risk and, so far, there are no consistent studies of this association in Parkinson's disease. Objective: To analyze the influence of RLS on cardiovascular risk in patients with Parkinson's disease. Methods: We reviewed the medical records of 202 patients diagnosed with Parkinson's disease and verified the presence of RLS, cardiovascular comorbidities, blood pressure measurements, lipid profiles and Framingham Risk Scores. Results: Statistically significant higher values of total cholesterol were found for the RLS group (mean 216.6 mg/dL), as well as for LDL cholesterol (mean 145 mg/dL). No statistical difference was found among the other factors. Conclusion: Patients with Parkinson's disease and RLS have a higher prevalence of dyslipidemia than patients without RLS, suggesting a correlation between restless legs and hyperlipidemia. It is questioned whether the dopaminergic substrate is the main factor in the genesis of the syndrome, as even with the use of dopaminergic agonists by both groups, it was possible to observe differences between groups. The hypothesis of the real interference of the syndrome treatment as a protective factor for cardiovascular risk was generated.

RESUMO Síndrome das pernas inquietas é um distúrbio comumente encontrado em pacientes com doença de Parkinson (DP), havendo descrições para ambas as condições de prejuízos na transmissão dopaminérgica no sistema nervoso central. Estudos prévios em populações diversas indicam associação entre a presença da síndrome e aumento do risco cardiovascular, não havendo, até o momento, pesquisas consistentes a respeito desta associação em DP. Objetivo: Analisar a influência da síndrome das pernas inquietas no risco cardiovascular em pacientes com DP. Métodos: Foram revisados prontuários de 202 pacientes com diagnóstico de DP e verificada a presença de síndrome das pernas inquietas, comorbidades cardiovasculares, aferições de pressão arterial, lipidograma e escore de Framingham. Resultados: Valores maiores e estatisticamente significativos de colesterol total foram encontrados para o grupo com pernas inquietas (média de 216.6 mg/dL), assim como para colesterol LDL (média de 145 mg/dL). Não foi encontrada diferença estatística entre os demais fatores. Conclusões: Pacientes com DP e síndrome das pernas inquietas têm maior prevalência de dislipidemia do que pacientes sem a síndrome, o que sugere correlação entre síndrome das pernas inquietas e hiperlipidemia. É posto em prova o substrato dopaminérgico como principal na gênese da síndrome, uma vez que, mesmo sob o uso de agonistas dopaminérgicos por ambos os grupos, foi possível observar diferenças entre os estratos. Gerada a hipótese da real interferência do tratamento da síndrome como fator de proteção para o risco cardiovascular.

The Prevalence of Parkinson Disease Among Patients With Hepatitis C Infection

ABSTRACT Introduction. HCV has been suspected to potentially cause degenerations in the central nervous system. Parkinson's disease is the second most common neurodegenerativo disorder. Our aim was to assess the prevalence of Parkinson's disease among patients with HCV infection. Material and methods. For this study, we used Medicare database from 2005-2010. Medicare database contains information on enrollment, coverage, diagnosis recorded with International Classification of Disease, Ninth Revision (ICD- 9). From combined inpatient and outpatient files, Parkinson's disease was identified as the first diagnosis by ICD-9 code 332.0. Other study variables were; age, gender, race (White and No White), and Medicare eligibility status. Simple distribution comparison by HCV status examined with t-test for numerical variables and χ2 test for categorical variables in the main analytical cohort as well as in the propensity score matched cohort. Results. A total of 1,236,734 patients (median age 76 years, 41% male, and 85% White) was identified among over 47 million claims. Of these, 6040 patients (0.5%) were infected with HCV. Overall, 0.8% (N = 49) of the HCV group and 1.3% (N = 16,004) of the Non-HCV group had Parkinson's disease (P < 0.001). When the study groups matched for age, gender and race, the prevalence of Parkinson's disease was similar between HCV and Non-HCV groups (P > 0.05). Discussion. This study revealed that, among Medicare population, HCV was not associated with Parkinson disease.

Factores de riesgo y precursores del deterioro cognitivo leve (DCL): una mirada sinóptica / Anticipatory signs and risk factors for mild cognitive impairment (MCI): a synoptic view

Este artículo presenta una breve reseña sobre el Deterioro cognitivo leve en adultos mayores, considerando los principales precursores que anuncian, y los factores de riesgo que aceleran los procesos de envejecimiento cognitivo, los cuales aumentan la probabilidad de recibir un diagnóstico de DCL. A su vez, la presencia de DCL aumenta el riesgo y eventual tránsito hacia la demencia, especialmente la demencia de tipo Alzheimer por otra parte, en el artículo se describen las diferentes modalidades de presentación del deterioro cognitivo, revisando también el DCL asociado a la sintomatología depresiva, a la enfermedad de Parkinson y otras enfermedades degenerativas del SNC. La presente revisión, permite dar cuenta de hallazgos recientes y relevantes con relación a la disfunción cognitiva en adultos mayores, quienes representan una proporción cada vez mayor de la población nacional y mundial.

This article presents a brief overview of mild cognitive impairment in older adults, considering its main anticipating precursors, and the risk factors that may accelerate the processes of cognitive aging, which increases the likelihood of being diagnosed with MCI. In turn, the presence of MCL increases the risk and eventual transition to dementia, particularly Alzheimer’s dementia. Moreover, the article describes the different forms cognitive impairment may present itself, and also reviews MCI associated with depressive symptoms, Parkinson’s disease and other degenerative diseases of the CNS. This revision accounts for recent and relevant findings regarding cognitive dysfunction in the elderly, who represent a growing share of national and global populations.

Clinical Findings and Genetic Screening for Copy Number Variation Mutations in a Cohort of South African Patients with Parkinson's Disease

BACKGROUND:Parkinson's disease (PD); with a prevalence of up to 4% in Western countries; appears to be less common in Africa; possibly in part because of genetic factors. African studies investigating the genetic causation of PD are limited. OBJECTIVE:To describe the clinical and genetic findings in a group of black South African patients with PD.METHODS:All black African patients with PD from a tertiary hospital neurology clinic were examined. Symptoms were scored according to the Unified Parkinson's Disease Rating Scale (UPDRS); and patients were classified according to motor features. Genomic DNA was extracted and multiplex ligation-dependent probe amplification was used for detection of copy number variation (CNV) mutations in the known PD-causing genes.RESULTS:Sixteen patients were identified (ages 56 - 82 years). Three had a family history of PD. Classification into motor subtypes showed 44% mixed; 31% akinetic-rigid; and 25% tremor-dominant subtypes. UPDRS scores ranged from 7 to 88; with dementia in 20%. No patient had G2019S LRRK2 and A30P SNCA mutations; and all except one had no CNV mutations in the known PD-causing genes. A female patient (age of onset 50 years; no family history) had a parkin gene heterozygous deletion of exon 4. She had hyperreflexia; bilateral Hoffmann's reflexes; normal plantar responses and no dystonia.CONCLUSION:This group of black African patients showed similar characteristics to patients in Western studies; possibly with a higher proportion having tremor-dominant disease. Genetic analysis showed one parkin gene mutation. The limited knowledge on PD-causing genes and mutations in black populations warrants further studies involving next-generation sequencing approaches

Perfil dos indivíduos com doença de Parkinson atendidos no setor de fisioterapia de um hospital universitário no Rio de Janeiro / Profile of individuals with Parkinson's disease cared in a physical therapy sector of an university hospital in Rio de Janeiro

Na doença de Parkinson (DP), uma desordem neurológica complexa, ocorre depleção de dopamina por degeneração dos neurônios da substância negra, ocasionando perdas motoras e cognitivas. Os quatro principais sintomas que acometem indivíduos com DP são o tremor de repouso, a rigidez, a bradicinesia e a instabilidade postural. Essas alterações podem aumentar o risco de quedas e trazer prejuízos para as atividades e participação social dos indivíduos. O objetivo deste estudo é avaliar a funcionalidade, incapacidade e qualidade de vida dos pacientes com DP em atendimento fisioterapêutico em um hospital universitário no Rio de Janeiro. Os pacientes foram avaliados por meio dos seguintes instrumentos: escala de Hoehn e Yahr, questionário sobre a qualidade de vida na doença de Parkinson - PDQ-39 -, Miniexame do Estado Mental, Escala de Equilíbrio de Berg, teste de caminhada de 10 metros, timed up and go test, Dynamic Gait Index, Escala Unificada de Avaliação para a Doença de Parkinson e Escala de Schwab e England. Embora a maior parte dos indivíduos estivesse no estágio 3 de Hoehn e Yahr, a maioria apresentou risco de queda diminuído, bom estado cognitivo e emocional, qualidade de vida moderada e pouca dificuldade para a marcha e realização de atividades de vida diária (AVD). Os dados obtidos com este estudo servirão para a orientação da implementação de medidas fisioterapêuticas voltadas para essa amostra de pacientes, orientações de gestores para uma política de saúde efetiva e orientação de profissionais em busca de atendimento mais eficaz.

In Parkinson's disease (PD), a complex neurologic disorder, occurs dopamine depletion by lesions of the neurons that produce it, causing motor and cognitive impairments. The four main symptoms that affect individuals with PD are resting tremor, rigidity, bradykinesia and postural instability. These changes may increase the risk of falls and bring impairments to their activities and social participation. The aim of this study is to evaluate the functioning, disability and quality of life of PD patients cared in a physical therapy sector of an university hospital in Rio de Janeiro. Patients were assessed through the following instruments: Hoehn & Yahr Scale, quality of life questionnaire in Parkinson's disease - PDQ-39 -, Mini-mental, Berg Balance Scale, walk test of 10 meters, timed up and go test, Dynamic Gait Index, Unified Rating Scale for Parkinson's Disease and Schwab and England Scale. Although most of the individuals were on stage Hoehn & Yahr three, most showed decreased risk of fall, good cognitive and emotional state, a moderate quality of life and little difficulty in walking and performing activities of daily living (ADL). The data obtained here will serve to guide the implementation of physiotherapy measures aimed at this group of patients, managers of guidelines for an effective health policy and for the orientation of professionals in search of a more effective service.

Manifestaciones cutáneas en pacientes con Enfermedad de Parkinson en una población chilena / Cutaneous manifestations in patients with Parkinson's disease In a Chilean population

IINTRODUCCIÓN: Las alteraciones cutáneas asociadas a la Enfermedad de Parkinson (EP) constituyen un área poco estudiada. OBJETIVOS: Describir las alteraciones cutáneas de un grupo de pacientes con EP y su asociación a parámetros cutáneos funcionales (sebo y humedad). PACIENTES Y MÉTODOS: Estudio observacional descriptivo prospectivo de pacientes con EP evaluados entre los meses de febrero y octubre del 2010. RESULTADOS: Se observó dermatitis seborreica (DS) en un 9,58 por ciento, no correlacionándose con seborrea (p=0,415), tiempo de evolución (p=0,338) ni severidad de la EP (p=0,787). Además, se observó un 6.84 por ciento de cáncer de piel no melanoma. La sebometría se asoció de forma inversa con la edad y mayores dosis de L-dopa. La higrometría no se asoció con tiempo de evolución, severidad de la EP ni fluctuaciones motoras. CONCLUSIONES: Los pacientes con EP evaluados tienen una mayor frecuencia de cáncer de piel no melanoma y DS, sin embargo, se necesitan más estudios para determinar su real asociación.

INTRODUCTION: Skin disorders associated with Parkinson’s disease (PD) are a poorly studied area. OBJECTIVES: To describe skin changes in a group of PD patients and its association with cutaneous functional parameters (sebum and humidity). PATIENTS AND METHODS: Descriptive prospective observational study of PD patients evaluated between February and October 2010. RESULTS: Seborrheic dermatitis (SD) was observed in 9.58 percent and not correlated with seborrhea (p = 0.415), duration (p = 0.338) and severity of PD (p = 0.787). In addition, a 6.84 percent of non-melanoma skin cancer was observed. Sebometry was inversely associated with age and higher doses of L-dopa. Humidity was not associated with time of evolution, severity of PD or motor fluctuations. CONCLUSIONS: The evaluated patients with PD have a higher frequency of non-melanoma skin cancer and SD. However, more studies are needed to establish their real association.

Clinical profile of Parkinson's disease in the Gumei community of Minhang district, Shanghai

OBJECTIVE: We examined the demographic and clinical profiles of Parkinson's disease in Shanghai, China, to assist in disease management and provide comparative data on Parkinson's disease prevalence, phenotype, and progression among different regions and ethnic groups. METHODS: A door-to-door survey and follow-up clinical examinations identified 180 community-dwelling Han-Chinese Parkinson's disease patients (104 males, 76 females). RESULTS: The average age at onset was 65.16±9.60 years. The most common initial symptom was tremor (112 patients, 62.22%), followed by rigidity (38, 21.11%), bradykinesia (28, 15.56%) and tremor plus rigidity (2, 1.11%). Tremor as the initial symptom usually began in a single limb (83.04% of patients). The average duration from onset to mild Parkinson's disease (Hoehn-Yahr phase 1-2) was 52.74±45.64 months. Progression from mild to moderate/severe Parkinson's disease (phase≥3) was significantly slower (87.07±58.72 months; p<0.001), except for patients presenting initially with bradykinesia (53.83±24.49 months). Most patients (149/180, 82.78%) took levodopa with or without other drugs. The Hamilton Anxiety Scale revealed symptoms of clinical anxiety in 35 patients, and the Hamilton Depression Scale revealed depressive symptoms in 88 patients. The depressed or anxious subgroup (123 patients) demonstrated a significantly younger age at onset (55.54±7.68 years) compared with the overall mean (p<0.05). CONCLUSION: Unilateral limb tremor was the most common initial symptom, and motor function deteriorated slowly over ≅4−9 years. Earlier-onset patients experience greater psychiatric dysfunction. .