Disfunción urinaria en la enfermedad de Parkinson: una revisión práctica / Urinary dysfunction in Parkinson's disease: a practical review

Resumen La enfermedad de Parkinson (EP) es una enfermedad multisistémica de naturaleza neurodegenerativa, que clínicamente se caracteriza por presencia de síntomas motores como bradicinesia, rigidez, temblor en reposo e inestabilidad postural. Sin embargo, también pueden estar presentes síntomas no motores que constituyen trastornos del ánimo, trastornos del sueño, disfunción cognitiva o disfunción autonómica. Dentro de las disfunciones autonómicas, los síntomas urinarios se han documentado en los pacientes con enfermedad de Parkinson. Los síntomas urinarios más comunes son la nicturia, urgencia urinaria, aumento de la frecuencia miccional e incontinencia de urgencia. El presente artículo hace una revisión narrativa de la literatura actual sobre los mecanismos fisiopatológicos, manifestaciones clínicas, diagnóstico y tratamiento de la disfunción urinaria en pacientes con enfermedad de Parkinson.

Parkinson's disease (PD) is a neurodegenerative multisystemic diseases, which is clinically characterized by the presence of motor symptoms such as bradykinesia, rigidity, resting tremor, and postural instability. However, non-motor symptoms constituting mood disorders, sleep disorders, cognitive dysfunction, or autonomic dysfunction may also be present. Within autonomic dysfunctions, urinary symptoms have been documented in patients with Parkinson's disease. The most common urinary symptoms are nocturia, urinary urgency, increased urinary frequency, and urge incontinence. This article makes a narrative review of the current literature on the pathophysiological mechanisms, clinical manifestations, diagnosis and treatment of urinary dysfunction in patients with Parkinson's disease.

Multimodal exercise program contributes to balance and motor functions in men and women with Parkinson's disease differently: an intervention study

Abstract Aim: To verify the effects of a multimodal exercise program on balance and motor functions, and the differences by sex, in people with Parkinson's disease (PD). Methods: The intervention study, was composed of 16 people with PD, that were assessed before and after 16 weeks of interventions with the multimodal exercise program. The effects were analyzed generally and by sex, using the Wilcoxon Test. The significance level was established at 5%. Results: Overall, there was an improvement in the strength of the lower limbs (LL) (p = 0.035) and upper limbs (UL) (p = 0.009), functional mobility (p = 0.003), gait (p = 0.050), balance (p = 0.001) and in motor scores of UPDRS III (p = 0.005), which categorize motor symptoms of the disease. In regards to sex, women affected muscle strength (p = 0.044) and flexibility of LL (p = 0.028), gait (p = 0.018), and motor aspects of the UPDRS III (p = 0.042). The men presented effects in muscle strength of the UL (p = 0.042). Women and men had a significant increase in functional mobility (p = 0.046 and p = 0.027, respectively) and in balance (p = 0.012 and p = 0.042, respectively). There was no significant difference for both sexes, in body mass and the reach behind the backtest. Conclusion: the multimodal exercise program contributed to the improvement in motor function and balance in men and women with PD. Nevertheless, the effects were more significant in women. The comprehension of the differences between men and women grants us a more directional and efficient approach to their treatment.

Pre-treatment by Rosemary Extract or Cell Transplantation Improves Memory Deficits of Parkinson's Disease: When Tradition Meets the Future

ABSTRACT The therapeutic effect of adipose tissue-derived stem cells (ADSCs) or RE on hippocampal neurogenesis and memory in Parkinsonian rats were investigated. Male rats were lesioned by bilateral intra-nigral injections of 6-OHDA and divided into six groups: 1. Lesion 2 and 3: RE and water groups were lesioned rats pretreated with RE or water, from 2weeks before neurotoxin injection and treated once a day for 8weeks post lesion. 4&5: Cell and α-MEM (α-minimal essential médium) received intravenous injection of BrdU-labeled ADSCs or medium, respectively from 10days post lesion until 8weeks later. 6: Sham was injected by saline instead of neurotoxin. Memory was assessed using Morris water Maze (MWM), one week before and at 1, 4 and 8weeks post 6-OHDA lesion. After the last probe, the animals were sacrificed and brain tissue obtained. Paraffin sections were stained using cresyl violet, anti-BrdU (Bromodeoxyuridine / 5-bromo-2'-deoxyuridine), anti-GFAP (Glial fibrillary acidic protein) and anti-TH antibodies. There was a significant difference of time spent in the target quadrant between groups during probe trial at 4 and 8 weeks' post- lesion. Cell and RE groups spent a significantly longer period in the target quadrant and had lower latency as compared with lesion. Treated groups have a significantly higher neuronal density in hippocampus compared to water, α-MEM and lesion groups. BrdU positive cells were presented in lesioned sites. The GFAP (Glial fibrillary acidic protein) positive cells were reduced in treated and sham groups compared to the water, α-MEM and lesion groups. Oral administration of RE (Rosemary extract) or ADSCs injection could improve memory deficit in the Parkinsonian rat by neuroprotection.

Sociodemographic Profile of Elderly People with Temporomandibular Disorder and Depression in Combination with Parkinson's Disease

ABSTRACT Objective: To describe the sociodemographic profile of elderly people with temporomandibular disorder and depression in Parkinson's disease cases. Material and Methods: It is a cross-sectional cohort cut study, which used secondary data from 124 elderly people with Parkinson's disease (PD). To diagnose temporomandibular disorder (TMD), the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) questionnaire was used, and the variables studied were: age, sex, race, education, marital status, family income, stage of the disease, and depression. The statistical analysis performed was descriptive and used absolute numbers and a frequency count. Results: After the application of the eligibility criteria, the patient records of 81 elderly people with Parkinson's disease were selected; 15 presented associated TMD and depression. The average age was 69 years old; 66.67% were male; 46.67% had more than 9 years of schooling; 60% were married or had a partner; 53.33% received between 1 and 2 minimum wages; 33.33% stated they were brown; 80% were in the moderate stage of the disease; 46.66% were in group II according to the RDC/TMD, presenting disk displacement; and 53.33% presented severe depression. Conclusion: It was verified that the elderly people with Parkinson's and associated TMD and depression were male, married or with a partner, on a low income, with nine or more years of schooling, and were in the moderate stage of the disease.

Sociodemographic profile and stages of Parkinson's disease associated with predictors of Temporomandibular Disorder / Perfil sociodemográfico e estágios da doença de Parkinson associados com os preditores de disfunção temporomandibular

ABSTRACT Purpose: to analyze the predictors of temporomandibular disorder in people with Parkinson's disease, verifying their associations with sociodemographic aspects and stages of the disease. Methods: a study based on secondary data from research conducted in 2017 with 110 people with Parkinson's disease. They were assessed with the Research Diagnostic Criteria for Temporomandibular Disorders and the Parkinson's disease staging scale. The studied predictive variables for temporomandibular disorder were pain, crepitation, clicking, nighttime and daytime clenching/gnashing, uncomfortable/non-habitual bite, morning rigidity, and tinnitus. The sociodemographic aspects assessed were age, sex, schooling level, marital status, income, and stages 1 to 3 of the disease. The chi-squared odds ratio was used with a 95% confidence interval and significance level at p < 0.05. Results: an association was verified between nighttime clenching/gnashing and income (p = 0.006); tinnitus and income range from ½ to 3 (p = 0.003) and from 4 to 10 minimum wages (p = 0.004); and between tinnitus and stage 1 (p = 0.02). Conclusion: this study verified that the predictors associated with temporomandibular disorder in people with Parkinson's disease were pain, clicking, crepitation, uncomfortable/non-habitual bite, and morning rigidity. It was verified that income and stage 1 of the disease had an association with nighttime clenching/gnashing and tinnitus.

RESUMO Objetivo: analisar os preditores de disfunção temporomandibular em pessoas com doença de Parkinson (DP) verificando suas associações com aspectos sociodemográficos e estágios da doença. Métodos: estudo que utilizou fonte de dados secundários de uma pesquisa realizada em 2017, com 110 pessoas com DP que foram avaliadas pelo questionário para Pesquisa em Disfunção Temporomandibular (RDC/TMD) e pela escala de estadiamento da DP. As variáveis preditoras de DTM estudadas foram: dor, crepitação, estalido, apertamento/rangido noturno e diurno, mordida desconfortável/não habitual, rigidez matinal e zumbido. Os aspectos sociodemográficos avaliados foram: idade, sexo, escolaridade, estado civil, renda e estágios da doença de 1 a 3. Utilizou-se o Odds ratio do Qui-quadrado com intervalo de confiança de 95% e nível de significância de p<0,05. Resultados: verificou-se associação entre os preditores: apertamento/rangido noturno e renda (p=0,006); zumbido e grupos de renda ½ a 3 (p=0,003) e de 4 a 10 salários mínimos (p=0,004). Além da associação do zumbido e estágio 1 (p=0,02). Conclusão: nesse estudo verificou-se que os preditores associados com a DTM em pessoas com DP foram: dor, estalido, crepitação, mordida desconfortável/não habitual e rigidez matinal. E destes verificou-se associação entre renda e estágio 1 da doença com apertamento/rangido noturno e zumbido.

Validity and reliability of the 12-item Berg Balance Scale in an Italian population with Parkinsons disease: A cross sectional study / Validade e confiabilidade da Escala de Equilíbrio de Berg de 12 itens em uma população italiana com doença de Parkinson: um estudo transversal

ABSTRACT Background: The Berg Balance Scale is widely used to measure balance ability in clinical practice. Recently, the original version was redefined from 14 into 12 items. Its psychometric properties were investigated for different populations. However, for Parkinson disease the new version has not been validated yet. Objective: The purpose of the present study was to evaluate psychometric properties of the 12-item Berg Balance Scale (BBS-12) in a population with Parkinson disease. Methods: Internal consistency was evaluated with Cronbach's alpha coefficient, whereas reliability was assessed with the intraclass correlation coefficient. For validity analysis, the Pearson correlation coefficient of the BBS-12 was evaluated with the Tinetti Scale and the Physical Activity Scale for the Elderly. Results: The BBS-12 was applied to 50 individuals with a mean age of 65.6 years (SD 11.8). The internal consistency showed a good value (Cronbach's alpha 0.886) and reproducibility reveled very high performances for both inter-rater and intra-rater reliabilities (ICC 0.987 and 0.986, respectively). The validity study demonstrated good linear correlation with the Tinetti Scale (p<0.01) and with the Sport and Home Subscales of the Physical Activity Scale for the Elderly (p<0.01). Conclusions: The present findings revealed the BBS-12 as a reliable and valid assessment tool to measure balance ability in Parkinson disease. Italian health professionals can now use it with more confidence.

RESUMO Introdução: A Escala de Equilíbrio de Berg é amplamente usada para medir a capacidade de equilíbrio na prática clínica. Recentemente, a versão original foi redefinida de 14 para 12 itens. Suas propriedades psicométricas foram investigadas para diferentes populações. No entanto, para a doença de Parkinson, a nova versão ainda não foi validada. Objetivo: O objetivo do presente estudo foi avaliar as propriedades psicométricas da Escala de Equilíbrio de Berg de 12 itens (Berg Balance Scale - BBS-12) em uma população com doença de Parkinson. Métodos: A consistência interna foi avaliada pelo coeficiente alfa de Cronbach, ao passo que a confiabilidade foi avaliada pelo coeficiente de correlação intraclasse. Para análise de validade, foi avaliado o coeficiente de correlação de Pearson da BBS-12 com a escala de Tinetti e a escala de atividade física para idosos. Resultados: A BBS-12 foi administrada a 50 indivíduos com idade média de 65,6 anos (DP 11,8). A consistência interna mostrou um valor bom (alfa de Cronbach 0.886) e a reprodutibilidade revelou desempenhos muito altos para a confiabilidade inter e intra-avaliadores (ICC 0.987 e 0.986, respectivamente). O estudo de validade demonstrou boa correlação linear com a Escala de Tinetti (p<0,01) e com as Subescalas de Esporte e Doméstica da Escala de Atividade Física para Idosos (p<0,01). Conclusões: Os resultados encontrados revelaram a BBS-12 como uma ferramenta de avaliação válida e confiável para medir a capacidade de equilíbrio na doença de Parkinson. Os profissionais de saúde italianos agora podem usá-la com mais confiança.

Voxel-wise meta-analysis of structural changes in gray matter of Parkinsons disease patients with mild cognitive impairment

Evidence from previous voxel-based morphometry (VBM) studies indicates that widespread brain regions are involved in Parkinson's disease with mild cognitive impairment (PD-MCI). However, the spatial localization reported for gray matter (GM) abnormalities is heterogeneous. The aim of the present study was to quantitatively integrate studies on GM abnormalities observed in PD-MCI in order to determine whether a pattern exists. Eligible whole-brain VBM studies were identified by a systematic search of articles in PubMed and EMBASE databases spanning from 1995 to January 1, 2019. A meta-analysis was performed to investigate regional GM abnormalities in PD-MCI. The anisotropic effect size version of seed-based d mapping (AES-SDM) meta-analysis was conducted to explore the GMV differences of PD-MCI compared with PD patients with normal cognitive function (PD-NC). A total of 12 studies comprising 243 PD-MCI patients and 326 PD-NC were included in the meta-analysis. PD-MCI patients showed a robust GM decrease in the left insula and left superior temporal gyrus. Moreover, meta-regression analysis demonstrated that age, PD duration and stage, and Unified Parkinson's Disease Rating Scale III and Mini-Mental State Examination scores might be partly correlated with the GM abnormalities observed in PD-MCI patients. The convergent findings of this quantitative meta-analysis revealed a characteristic neuroanatomical pattern in PD-MCI. The findings provide some evidence that MCI in PD may result in the breakdown of the insula and temporal gyrus, which may serve as specific regions of interest for further investigations.

Falls in persons with Parkinson's disease: Do non-motor symptoms matter as much as motor symptoms? / Caídas en personas con enfermedad de Parkinson: ¿Los síntomas no motores importan tanto como los síntomas motores?

ABSTRACT Falls are common among persons with Parkinson's disease (PD). On the other hand, predicting falls is complex as there are both generic and PD-specific contributors. In particular, the role of non-motor symptoms has been less studied. Objective: The objective of this study was to identify the role of non-motor predictors of falling in persons with PD (PwP). Methods: A cross-sectional study was carried out in PwP recruited from a movement disorders clinic. Clinical and demographical data were collected. All PwP were assessed using the Movement Disorders Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) and the Non-Motor Symptoms Scale (NMSS). Variables were assessed at the bivariate level. Significant variables were put into a logistic regression model. Results: A total of 179 PwP were included. Overall, 16.8% of PwP had fallen in the past 12 months, with 53.3% of them being recurrent fallers. The mean number of monthly falls was 2.5 ± 3.3. Factors associated with falling in the bivariate analysis included the disease duration, Hoehn and Yahr stage, MDS-UPDRS part I and II, postural instability/gait disturbance (PIGD) subtype, NMSS urinary domain, NMSS miscellaneous domain, and non-motor severity burden (all p-values < 0.05). After multivariate analysis, only the disease duration (p = 0.03) and PIGD (p = 0.03) remained as independent risk factors. Conclusion: Disease duration and the PIGD subtype were identified as relevant risk factors for falls in PwP Non-motor symptoms appear to have a less important role as risk factors for falls.

RESUMEN Las caídas son frecuentes entre las personas con Parkinson (EP). La predicción de caídas es compleja ya que existen contribuyentes genéricos y específicos. El papel de los síntomas no motores ha sido menos estudiado. Objetivo: Identificar el papel de los factores no motores en caídas en personas con EP (PcP). Métodos: Estudio transversal en PcP reclutadas en una clínica de trastornos del movimiento. Se incluyeron datos clínicos y demográficos. Todos los PcP se evaluaron con la Escala Unificada de Enfermedad de Parkinson modificada por la Sociedad Internacional de Trastornos del Movimiento (MDS-UPDRS) y la Escala de Síntomas No Motores (NMSS). Se incluyeron variables significativas en un modelo de regresión logística. Resultados: Se incluyeron un total de 179 PcP El 16.8% había presentado una caída en los últimos doce meses y el 53.3% de forma recurrente. El número medio de caídas mensuales fue de 2.5 ± 3.3. Los factores asociados con la caída en el análisis bivariado fueron la duración de la enfermedad, Hoehn e Yahr, MDS-UPDRS parte I y II, subtipo de alteración de la marcha/inestabilidad postural (PIGD), dominio urinario del NMSS, dominio misceláneo del NMSS y carga de severidad no motora (todos los valores de p < 0.05). Después del análisis multivariado, solo la duración de la enfermedad (p = 0.03) y PIGD (p = 0.03) permanecieron como un factor de riesgo independiente. Conclusión: La duración de la enfermedad y PIGD se identificaron como factores de riesgo para caídas. Los síntomas no motores parecen tener un papel menos relevante en las caídas.

Parkinson's disease and wearable devices, new perspectives for a public health issue: an integrative literature review

SUMMARY Parkinson's disease is the second most common neurodegenerative disease, with an estimated prevalence of 41/100,000 individuals affected aged between 40 and 49 years old and 1,900/100,000 aged 80 and over. Based on the essentiality of ascertaining which wearable devices have clinical literary evidence and with the purpose of analyzing the information revealed by such technologies, we conducted this scientific article of integrative review. It is an integrative review, whose main objective is to carry out a summary of the state of the art of wearable devices used in patients with Parkinson's disease. After the review, we retrieved 8 papers. Of the selected articles, only 3 were not systematic reviews; one was a series of cases and two prospective longitudinal studies. These technologies have a very rich field of application; however, research is still necessary to make such evaluations reliable and crucial to the well-being of these patients.

RESUMO A doença de Parkinson figura como a segunda doença neurodegenerativa mais comum. Sua prevalência é estimada de 41 por 100.000 pessoas entre 40 e 49 anos a 1.900 por 100.000 pessoas com 80 anos ou mais. Baseando-se na essencialidade de averiguar os dispositivos vestíveis que possuem evidências clínicas literárias e com o objetivo de analisar as informações reveladas por tais tecnologias, temos a construção deste artigo científico de revisão integrativa. Trata-se de uma revisão integrativa que tem como principal objetivo realizar um sumário do estado da arte de dispositivos vestíveis utilizados em pacientes com doença de Parkinson. Após realizada a revisão, obtiveram-se oito artigos. Pode-se observar que dos artigos selecionados, apenas três não eram revisões sistemáticas, sendo um deles uma série de casos e outros dois, estudos longitudinais prospectivos. A utilização dessas tecnologias possui um campo muito rico para atuar, contudo ainda são necessárias pesquisas para que tais avaliações sejam fidedignas e cruciais para o bem-estar desses pacientes.

Priming semántico directo y mediado ortofonológicamente en pacientes con enfermedad de Parkinson: un estudio de tiempos de reacción / Direct and orthophonologically mediated semantic priming in patients with Parkinson's disease: evidence from reaction times

El presente estudio aborda el impacto de la enfermedad de Parkinson en el procesamiento de información semántica durante una tarea de reconocimiento visual de palabras. Para ello, se comparó el rendimiento de un grupo de pacientes con Parkinson con el rendimiento de sujetos sin daño neurológico en dos experimentos. Se evaluaron los efectos de tiempo de presentación de un prime semántico directo (Experimento 1) y un prime semántico mediado orto-fonológicamente (Experimento 2). Además, se evaluó la influencia de la frecuencia léxica tanto del prime como la palabra target, sobre el acceso léxico. Los participantes estaban divididos en tres grupos (grupo clínico, grupo de control etario, y grupo de adultos jóvenes). Los tres grupos completaron una tarea de decisión léxica de tiempo de reacción en la modalidad go-no-go. Los participantes debían responder presionando una tecla del computador si el estímulo presentado en la pantalla era una palabra. En el caso contrario cuando era una pseudo palabra, los participantes no debían presionar ninguna tecla. Los resultados en base al número de respuestas correctas y los tiempos de reacción muestran dificultades de procesamiento semántico en el grupo clínico. Sin embargo, este grupo mostró ser sensible a la frecuencia de las palabras y los tiempos de presentación de estas. En su conjunto, los resultados son coherentes con la literatura existente, y contribuyen a comprender de mejor manera el déficit lingüístico presente en la enfermedad de Parkinson.

The present study addresses the incidence of Parkinson's disease in the processing of semantic information during visual word recognition tasks. In order to do so, the performance of a group of patients with Parkinson's was compared with the performance of subjects without neurological impairment in two experiments. We evaluate the effects of presentation time of a semantic prime (Experiment 1) and anortho-phonologically mediated semantic prime (Experiment 2), and the impact of the lexical frequency of both the prime and the target words. Participants divided into three groups (a clinical group, an age control group and a group of young adults), completed a reaction time lexical decision task in the go-no-go modality. They had to respond by pressing a computer key if the stimulus presented on the screen was a word. Otherwise, the participants should not press any key. The results, based on response accuracy and reaction times, show a semantic deficit in the clinical group, while this group was, nevertheless, sensitive to the frequency of the words and their presentation time. As a whole, the results are consistent with the existing literature, and contribute to a better understanding of the linguistic deficit present in Parkinson's disease.

Deep brain stimulation in parkinson disease

The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.

Efectos de un programa de entrenamiento multicomponente en la marcha funcional en pacientes con Parkinson / Multicomponent physical training in patients with Parkinson disease

Background: Multicomponent physical training in patients with Parkinson disease may improve their functional independence, especially in terms of gait speed and coordination. Aim: To assess the effects of an eight weeks multicomponent physical training program in patients with Parkinson disease. Material and Methods: Fourteen patients with Parkinson disease participated in a physical training program that lasted eight weeks. Three sessions lasting 60 minutes per week were carried out. Patients were assessed using the six minutes walk, timed up and go and the unipodal stance test. Results: After the training period, significant improvements in the six minute walk test and timed up and go were observed. No significant changes were observed in the unipodal stance test. Conclusions: The eight weeks training program improved gait speed and functional status in these patients with Parkinson disease.

The Parkinson's disease and restless legs syndrome/Willis-Ekbom disorder link: evidences, biases and clinical relevance / A conexão doença de Parkinson: síndrome das pernas inquietas / doença de Willis-Ekbom: evidências, vieses e relevância clínica

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?

Resíduos faríngeos nas disfagias orofaríngeas neurogênicas / Pharyngeal residue in neurogenic oropharyngeal dysphagia

RESUMO Objetivo Comparar os resíduos faríngeos por consistência de alimento entre indivíduos com disfagia orofaríngea neurogênica. Método Estudo clínico transversal. Realizada análise de 30 exames de videoendoscopia de deglutição de indivíduos com diagnóstico de doenças neurológicas e disfagia orofaríngea, independentemente do tempo ou estágio das doenças. Os indivíduos foram divididos em três grupos: o grupo I composto por 10 indivíduos pós-Acidente Vascular Cerebral, 8 homens e 2 mulheres, faixa etária entre 51 e 80 anos (média 67 anos); o grupo II por 10 indivíduos com Esclerose Lateral Amiotrófica, 5 homens e 5 mulheres, faixa etária entre 39 e 78 anos (média 57 anos), e o grupo III por 10 indivíduos com Doença de Parkinson (DP), 5 homens e 5 mulheres, faixa etária entre 65 e 88 anos (média 74 anos). Para análise dos resíduos faríngeos em valéculas e seios piriformes, foi aplicada a Yale Pharyngeal Residue Severity Rating Scale, considerando a primeira deglutição de 5 mL nas consistências pastosa e líquida espessada, por dois juízes independentes e de forma cega. Resultados Não houve diferença estatística significativa nos resíduos faríngeos, em valéculas (p= 0,25/ p= 0,18) e seios piriformes (p= 1,41/ 0,49), respectivamente nas consistências pastosa e líquida espessada, nas diferentes doenças estudadas. Conclusão Os níveis de resíduos faríngeos na consistência pastosa ou líquida espessada na população estudada foram semelhantes e mais frequentes nos níveis menos grave.

ABSTRACT Purpose To compare pharyngeal residues of different consistencies among groups of individuals with neurogenic oropharyngeal dysphagia. Methods In a cross-sectional study, a fiberoptic endoscopic evaluation was performed in 30 swallowing exams of individuals diagnosed with neurological disease and oropharyngeal dysphagia, regardless of the time or stage of the disease. The individuals were divided into three groups according to etiology: group I, 10 post-stroke, 8 male and 2 female, aged 51 to 80 years (average age: 67 years); group II, 10 individuals with amyotrophic lateral sclerosis, 5 male and 5 female, aged 39 to 78 years (average age: 57 years); group III, 10 examinations of individuals with Parkinson's disease, 5 male and 5 female aged 65-88 years (average age: 74 years). The Yale Pharyngeal Residue Severity Rating Scale was applied by two independent raters in a blind manner for the analysis of pharyngeal residues in valleculae and pyriform sinuses based on the first swallowing of 5 mL of pureed and thickened liquid. Results No statistically significant difference was observed among groups in the degree of pharyngeal residues of puree food or thickened liquid in the valleculae (p = 0.25/p = 0.18) or the pyriform sinuses (p = 1.41/0.49). Conclusion The pharyngeal residue levels of pureed and thickened liquid were similar for the groups studied, with less severe levels being more frequent.

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

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

Respiratory muscle strength and lung function in the stages of Parkinson's disease / Força muscular respiratória e função pulmonar nos estágios da doença de Parkinson

ABSTRACT Objective: To investigate parameters of lung function and respiratory muscle strength in different stages of Parkinson's disease (PD), as well as to determine their correlation with motor function and quality of life. Methods: This was a cross-sectional study conducted at a referral center for PD in the city of Recife, Brazil. Respiratory muscle strength and lung function, as well as their relationship with motor function and quality of life, were evaluated in patients with PD, stratified by the level of severity, and were compared with the data obtained for a control group. After confirming the normality of data distribution, we performed one-way ANOVA with a post hoc t-test. Results: The sample comprised 66 individuals, in two groups: PD (n = 49) and control (n = 17). All of the parameters investigated showed inverse correlations with PD severity, and there were significant differences among the levels of severity, as well as between the PD and control groups, in terms of the MIP, MEP, FVC, FEV1, and FEF25-75%. The lung function parameters also showed moderate to weak inverse correlations with bradykinesia and rigidity. On a quality of life questionnaire, the total score and mobility domain score both presented a moderate inverse correlation with FVC, FEV1, PEF, and MEP. Conclusions: Respiratory muscle strength and some lung function parameters are impaired from the early stages of PD onward, bradykinesia and rigidity being the cardinal signs that correlate most strongly with impairment of those parameters. Such alterations negatively affect the quality of life of patients with PD.

RESUMO Objetivo: Investigar a repercussão de parâmetros de função pulmonar e de força muscular respiratória nos diversos estágios da doença de Parkinson (DP) e suas correlações com a funcionalidade e a qualidade de vida desses pacientes. Métodos: Estudo de corte transversal realizado em um serviço de referência para DP em Recife (PE). Foram avaliadas a força muscular respiratória e a função pulmonar, assim como suas relações com a funcionalidade e a qualidade de vida, em pacientes com DP estratificados por gravidade da DP e comparados a um grupo controle. Após a verificação da normalidade da amostra, foi realizada one-way ANOVA e teste t post hoc. Resultados: A amostra foi composta por 66 indivíduos, sendo 49 no grupo DP e 17 no grupo controle. Houve reduções nos parâmetros investigados com a progressão da doença, em comparação com o grupo controle, sendo encontradas diferenças significativas em PImáx, PEmáx, CVF, VEF1 e FEF25-75% em todos os estágios da DP. Houve correlações inversas (de fraca a moderada) de alguns parâmetros estudados com bradicinesia e rigidez. Os escores totais do questionário de qualidade de vida e de seu domínio mobilidade apresentaram moderada correlação inversa com CVF, VEF1, PFE e PEmáx. Conclusões: A força muscular respiratória e alguns parâmetros de função pulmonar encontram-se reduzidos desde os estágios iniciais da DP, sendo a bradicinesia e a rigidez os sinais cardinais mais correlacionados ao prejuízo desses parâmetros. Essas alterações repercutem negativamente na qualidade de vida desses pacientes.

The effect of resistance training on the anxiety symptoms and quality of life in elderly people with Parkinson's disease: a randomized controlled trial / O efeito do treinamento resistido sobre sintomas de ansiedade e qualidade de vida em idosos com doença de Parkinson's: ensaio randomizado controlado

ABSTRACT Objective: To assess the effects of resistance training on the anxiety symptoms and quality of life in patients with Parkinson's disease. Methods: Thirty-five elderly patients were randomly divided into two groups: 17 patients in the control group and 18 in the intervention group. All patients maintained standard pharmacological treatment for Parkinson's disease, but the intervention group participated in a 24-week resistance training program. The anxiety symptoms were assessed through the Beck's Anxiety Inventory, and quality of life by the Parkinson's Disease Questionnaire-39. Results: There was a significant reduction in anxiety level and increase in quality of life after 24 weeks of resistance training. Conclusion: The results of the present study indicate that resistance training is an effective intervention in the reduction of anxiety symptoms and improves the quality of life in elderly people with Parkinson's disease.

RESUMO Objetivo: avaliar os efeitos do treinamento resistido nos sintomas de ansiedade e na qualidade de vida em pacientes com doença de Parkinson. Métodos: Trinta e cinco pacientes idosos foram divididos randomicamente em dois grupos: 17 indivíduos no grupo controle e 18 no grupo de intervenção. Todos os sujeitos mantiveram o tratamento farmacológico padrão para a doença de Parkinson, mas o grupo de intervenção participou de um programa de treinamento resistido de 24 semanas. Os sintomas de ansiedade foram avaliados através do inventário de ansiedade de Beck e a qualidade de vida pelo questionário da doença de Parkinson-39. Resultados: Houve redução significativa no nível de ansiedade e melhora da qualidade de vida após 24 semanas de treinamento resistido. Conclusão: Os resultados do presente estudo indicam que o treinamento resistido é uma intervenção efetiva na redução dos sintomas de ansiedade e melhora a qualidade de vida em idosos com doença de Parkinson.

Motor and non-motor wearing-off and its impact in the quality of life of patients with Parkinson's disease / Flutuações motoras e não-motoras e seu impacto na qualidade de vida de pacientes com doença de Parkinson

ABSTRACT The wearing-off phenomenon is common in patients with Parkinson's disease. Motor and non-motor symptoms can fluctuate in relation to the "on/off" periods. Objective: To assess the impact of motor and non-motor wearing-off on activities of daily living and quality of life of patients with PD. Methods: A cross-sectional study was carried out. All patients were evaluated using the Movement Disorders Society Unified Parkinson's Disease Rating Scale. Wearing-off was assessed using the Wearing-Off Questionnaire-19, and quality of life was assessed using the Parkinson's Disease Questionnaire-8. Results: A total of 271 patients were included; 73.4% had wearing-off; 46.8% had both motor and non-motor fluctuations. Patients with both motor and non-motor wearing-off had a worst quality of life compared with those with only motor fluctuations (p = 0.047). Conclusions: Motor and non-motor fluctuations have an impact on activities of daily living and quality of life. Non-motor wearing-off may have a higher impact.

RESUMO O fenômeno de encurtamento do fim de dose é comum em pacientes com doença de Parkinson. Tanto os sintomas motores quanto os não motores podem flutuar em relação aos períodos de "on/off". Objetivo: Avaliar o impacto das flutuações motoras e não-motoras nas atividades da vida diária e qualidade de vida em pacientes com doença de Parkinson. Métodos: Um estudo transversal foi realizado. Todos os sujeitos foram avaliados utilizando a escala unificada para a doença de Parkinson da Sociedade de Distúrbios do Movimento. O encurtamento do fim de dose foi avaliado através do questionário WOQ-19 e a qualidade de vida foi avaliada através do PDQ-8. Resultados: Um total de 271 pacientes foram incluídos, 73,4% tiveram deterioração de fim de dose. A maioria dos pacientes tiveram tanto flutuações motoras quanto não-motoras (46,8%). Os pacientes com ambos os tipos de flutuações motoras e não-motoras tiveram pior qualidade de vida do que pacientes apenas com flutuações motoras (p = 0.047). Conclusões: Pacientes com flutuações motoras e não-motoras tiveram impacto significativo nas atividades da vida diária e na qualidade de vida. As flutuações não-motoras parecem ter um impacto maior que as flutuações motoras sobre a qualidade de vida.