Efectos del entrenamiento sensoriomotor en balance, deambulación y calidad de vida en personas con enfermedad de Parkinson / Effects of sensorimotor training on balance, ambulation and quality of life in people with Parkinson's disease

La enfermedad de Parkinson (EP) es el segundo trastorno neurodegenerativo más frecuente del envejecimiento y el trastorno del movimiento más común. En Chile, de un total de 17.514.003 habitantes un 11,4% de la población es adulto mayor, y aproximadamente un 1-2% de la población de 65 años vive con EP, cifra que se eleva a un 3-5% en aquellos mayores de 85 años. Dentro de las alteraciones del movimiento que genera, se describen trastornos de la marcha y caídas, afectando la calidad de vida de los pacientes, por lo tanto, es fundamental generar estrategias que combatan estas alteraciones. La investigación tuvo como objetivo evaluar la efectividad de un plan de entrenamiento sensoriomotor para mejorar el balance, deambulación y calidad de vida en personas con Parkinson de la ciudad de Valdivia. Estudio cuasiexperimental con medida pre-post test tras 18 sesiones de entrenamiento sensoriomotor de 45 minutos, 3 veces por semana en días no consecutivos, durante 6 semanas. Se evaluó 8 participantes utilizando los test Timed Up and Go (TUG), Gait Speed (GS), Sharpened Romberg (SR) y la escala Unified Parkinson's Disease Rating Scale (UPDRS). Los resultados revelaron que se obtuvo una mejora significativa en las pruebas TUG y GS, con un porcentaje de cambio de 32,1% y 84,61% respectivamente, disminución de compensaciones en test SR y disminución de 2 puntos en la UPDRS. Se concluye que el entrenamiento sensoriomotor a corto plazo logra mejoras significativas en las variables de balance deambulación y calidad de vida(Au)

Introduction. Parkinson's disease (PD) is the second most common neurodegenerative disorder of aging and the most common movement disorder. In Chile, there is a total of 17,574,003 inhabitants, where 11.4% of the total population is older adult, and approximately 1-2% of the population of 65 years lives with PD, a figure that rises to 3-5% in those over 85 years old. Within the alterations of the movement that it generates, disorders of the gait and falls are described, affecting the quality of life of the patients, therefore, it is fundamental to generate strategies that combat these alterations. Objective: Evaluate the effectiveness of a sensorimotor training plan to improve balance, walking and quality of life in people with Parkinson's disease in the city of Valdivia. Methods: Quasi-experimental study with pre-post measurement after 18 sessions of sensorimotor training of 45 minutes, 3 times a week on nonconsecutive days, for 6 weeks. Eight 2 participants were evaluated using the Timed Up and Go (TUG), Gait Speed (GS), Sharpened Romberg (SR) and the escalation of the Unified Parkinson's Disease Classification Scale (UPDRS). Results: A significant improvement was obtained in the TUG and GS tests, with a percentage of change of 32.1% and 84.61% respectively, decrease of compensations in SR test and decrease of 2 points in the UPDRS. Conclusion: Short-term sensorimotor training in the short term achieved significant improvement in variables of balance, ambulation and quality of life(AU)

Intranasal mucoadhesivemicroemulsion for neuroprotective effect of curcuminin mptp induced Parkinson model

ABSTRACT This study was to investigate the neuroprotective effect of curcumin against inflammation-mediated dopaminergic neurodegeneration in 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) mice model of Parkinson's disease (PD). Curcumin loaded sodium hyaluronate based mucoadhesive microemulsion (CMME) was developed by using Box Behnken design of Response surface method (RSM) and was characterized. Male C57BL/6 mice were first treated with four intraperitoneal injections of MPTP (20 mg/kg of body weight) at 2 h intervals followed CMME intranasal administration for 14 days at 2.86 mg of curcumin/kg of body weight per once a day. Optimal CMME containing 3% Capmul MCM as oil phase, 37 % of Accenon CC and Transcutol HP at 2.5:1 ratio and 0.5% sodium hyaluronate was stable, non-ciliotoxic with 57.66 nm±3.46 as average globule size. PdI value (0.190 ± 0.19) and TEM result depicted the narrow size distribution of CMME.All three independent variables had a significant effect (p<0.05) on the responses and the designed model was significant for all taken responses. In-vivo results revealed significant reduction of MPTP-mediated dopamine depletion after nasal administration of CMME. MPTP intoxication significantly decreased striatal DA content to 21.29 % which was then elevated to 55.37% after intranasal curcumin treatment. Significant improvement in motor performance as well as gross behavioural activity of mice was observed from rota-rod and open field test findings. Findings of the investigation revealed the symptomatic neuroprotection of curcumin against MPTP-induced neurodegradation in the striatum and hence could be considered as a promising approach to treat PD.

Efeito do 8-metoxipsoraleno(8-mop)na citotoxicidade da retonona sobre células do sistema nervoso central, um modelo de doença de parkinson in vitro / Effect of 8-methoxypsoralen (8-MOP) on the cytotoxicity of rotenone on the central nervous system cells, a model of Parkinson's disease in vitro

Doença de Parkinson (DP) é caracterizada por uma perda seletiva e profunda dos neurônios dopaminérgicos da substância nigra pars compacta (SNpc) do mesencéfalo, acompanhada pela espoliação de dopamina no corpo estriado. A maioria dos casos de DP apresenta etiologia multifatorial, com a presença de componentes genéticos e ambientais. Embora existam diferentes causas possíveis, a patogênese da desordem parece convergir para mecanismos relacionados à disfunção mitocondrial, estresse oxidativo e mau enovelamento proteico. Um modelo estabelecido na literatura para estudo desta doença, tanto in vitro quanto in vivo é a administração de rotenona, um pesticida derivado de plantas que inibe o complexo I mitocondrial e favorece a geração de espécies reativas de oxigênio (ERO), levando a uma espoliação de glutation reduzido (GSH) através do processo de detoxificação destes compostos eletrofílicos, catalisados por glutation S-transferases (GSTs). Sendo assim, a busca por novas substâncias com atividade neuroprotetora é atualmente o foco de estudos, e metabólitos isolados de plantas podem ser fontes destas moléculas. Dessa forma, o 8-metoxipsoraleno (8-MOP), uma furocumarina, foi testado como um possível agente protetor sobre a citotoxicidade causada pela rotenona em modelos in vitro de gliomas, considerando o papel do glutation neste processo. O estudo adotou uma abordagem que associa técnicas bioquímicas e de biologia celular. Ensaios de viabilidade celular foram realizados em células de glioma murino (C6) e glioblastoma multiforme humano (U251) através da redução do brometo de 3-(4,5-dimetiltiazol-2-il)-2,5-difeniltetrazolium (MTT)...

Parkinson’s disease (PD) is characterized by a profound and selective loss of dopaminergic neurons in the substantia nigra pars compacta (SNpc) accompanied by midbrain dopamine depletion in the striatum. Most cases of PD present multifactorial etiologies, with the presence of genetic and environmental components. Although there are different possible causes, the pathogenesis of the disorder seems to converge to mechanisms related to mitochondrial dysfunction, oxidative stress and bad protein folding. An established model in the literature to study this disease, both in vitro and in vivo is rotenone administration, a pesticide derived from plants that inhibits the mitochondrial complex I and favors the generation of reactive oxygen species (ROS), leading to reduced glutathione (GSH) depletion through the detoxification process of this electrophilic compound catalyzed by glutathione S-transferases (GSTs). Thus, the search for new substances with neuroprotective activity is currently the focus of studies, and plant isolated metabolites can be sources of these molecules. Thus, 8-methoxypsoralen (8-MOP), a furocoumarin, was tested as a potential protective agent on the cytotoxicity caused by rotenone in glioma cells in vitro models, considering the role of glutathione in the process. The study adopted an approach that combines biochemical and cell biology techniques. Cell viability assays were performed in murine glioma cells (C6) and human glioblastoma (U251) cells through the reduction of 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT)...

Effects of a multimodal exercise program on the functional capacity of Parkinson's disease patients considering disease severity and gender / Efeitos de um programa de exercícios multimodal na capacidade funcional de pacientes com doença de Parkinson considerando a gravidade da doença e sexo / Efectos de un programa de ejercicio multimodal en la capacidad funcional de los pacientes con enfermedad de Parkinson teniendo en cuenta la gravedad de la enfermedad y el sexo

The purpose of this study was to investigate the effects of a multimodal exercise program (MEP) on the functional capacity of patients with Parkinson's disease (PD) according to disease severity and gender. Fourteen patients with PD participated in the study and were distributed into groups according to 1) stage of disease and 2) gender. Functional capacity was evaluated before and after 6 months of intervention. The overall PD patient group improved their coordination and strength. Men and women improved in strength performance after exercise. Men also improved on coordination. For severity of disease, the unilateral group improved in strength, while the bilateral group improved in strength, balance, coordination and the UPDRS-functional score. In conclusion, a MEP is efficient in improving components of functional capacity in patients with PD, especially in strength. Gender may be considered in the exercise program. Individuals in the bilateral disease group appeared to benefit more from exercise.

O objetivo deste estudo foi investigar o efeito de um programa de exercício multimodal (PEM) na capacidade funcional de pacientes com doença de Parkinson (DP), de acordo com a severidade da doença e gênero. Catorze pacientes com DP participaram do estudo, distribuídos em dois grupos: 1) severidade da doença, 2) gênero. A capacidade funcional foi avaliada antes e após 6 meses de intervenção. Em geral, os pacientes melhoraram a coordenação e força. Homens e mulheres melhoraram o desempenho da força após o exercício. Os homens também melhoraram a coordenação. Para a severidade da doença, o grupo unilateral melhorou a força, enquanto o grupo bilateral melhorou força, equilíbrio, coordenação e UPDRS funcional. Portanto, o PEM é eficiente na melhoria dos componentes da capacidade funcional de pacientes com DP, especialmente a força. O gênero deve ser considerado no programa de exercício. Pacientes no estágio bilateral parecem ter mais benefícios do exercício.

Esto estudio investigó el efecto de un programa de ejercicio multimodal (PEM) en la capacidad funcional de pacientes con enfermedad de Parkinson (EP), considerando la severidad de la enfermedad y el género. Catorce pacientes con EP participaron del estudio, distribuidos en grupos: 1) severidad de la enfermedad, 2) género. La capacidad funcional fue avaluada antes y después de 6-meses de intervención. En general, los pacientes mejoraron coordinación y fuerza. Hombres y mujeres mejoraron el desempeño de la fuerza después del ejercicio. Todavía, los hombres también mejoraron coordinación. Considerando la gravedad de la enfermedad, el grupo unilateral mejoró fuerza y el grupo bilateral mejoró fuerza, equilibrio, coordinación y la UPDRS-funcional. Así, el PEM fue eficaz en mejorar los componentes de la capacidad funcional de pacientes con EP, especialmente la fuerza. El género debe ser considerado en el programa de ejercicios. Individuos con enfermedad bilateral parecen beneficiarse más de los ejercicios.

Dual task and postural control in Alzheimer's and Parkinson's disease / Tarefa dupla e controle da postura na doença de Alzheimer e na doença de Parkinson / Doble tarea y el control postural en la enfermedad de Alzheimer y la enfermedad de Parkinson

Patients with neurodegenerative diseases are required to use cognitive resources while maintaining postural control. The aim of this study was to investigate the effects of a frontal cognitive task on postural control in patients with Alzheimer, Parkinson and controls. Thirty-eight participants were instructed to stand upright on a force platform in two experimental conditions: single and dual task. Participants with Parkinson's disease presented an increase in the coefficient of variation greater than 100% in the dual task as compared to the single task for center of pressure (COP) area and COP path. In addition, patients with Parkinson's and Alzheimer's disease had a higher number of errors during the execution of the cognitive task when compared to the group of elderly without neurodegenerative diseases. The motor cortex, which is engaged in postural control, does not seem to compete with frontal brain regions in the performance of the cognitive task. However, patients with Parkinson's and Alzheimer's disease presented worsened performance in cognitive task.

Pacientes com doenças neurodegenerativas utilizam recursos cognitivos para manutenção do controle postural. O objetivo deste estudo foi investigar os efeitos de uma tarefa cognitiva frontal no controle postural em pacientes com Alzheimer, com Parkinson e idosos sem doenças neurodegenerativas. Trinta e oito participantes foram instruídos a ficar em pé sobre uma plataforma de força em duas condições experimentais: tarefa simples e tarefa dupla com uma tarefa cognitiva frontal. Foi observado aumento no coeficiente de variação superior a 100% na área e na trajetória do centro de pressão (COP) em condição de tarefa dupla em pacientes com Parkinson. Foi observada também, diferença significativa na comparação entre grupos, mostrando que pacientes com Parkinson e Alzheimer tiveram maior número de erros durante a execução da tarefa cognitiva, quando comparado ao grupo de idosos sem doenças neurodegenerativas. O córtex motor envolvido na manutenção do controle postural parece não competir com regiões frontais cerebrais no desempenho desse tipo de tarefa cognitiva, no entanto, os pacientes com doença de Parkinson e doença de Alzheimer apresentaram pior desempenho durante a execução de uma tarefa cognitiva frontal.

Pacientes con enfermedades neurodegenerativas utilizan de recursos cognitivos para el mantenimiento del control postural. El objetivo de este estudio fue investigar los efectos de una tarea cognitiva frontal en el control postural de pacientes con enfermedad de Alzheimer, enfermedad de Parkinson y ancianos sin enfermedades neurodegenerativas. Treinta y ocho participantes fueron instruidos para mantenerse en pie sobre una plataforma de fuerza en dos condiciones experimentales: tarea simple y doble tarea con una tarea cognitiva frontal. Hubo un aumento en el coeficiente de variación superior a 100% en el área y en la trayectoria del centro de presión (CP) en condiciones de doble tarea en los pacientes con Parkinson. También fue observada diferencia significativa entre los grupos, revelando que los pacientes con Parkinson y Alzheimer tuvieron un número de errores más grande durante la realización de la tarea cognitiva en comparación con el grupo de sujetos sin enfermedades neurodegenerativas. La corteza motora que participa en el mantenimiento del control postural parece no competir con las regiones frontales del cerebro en el rendimiento de este tipo de tarea cognitiva, sin embargo, los pacientes con enfermedad de Parkinson y la enfermedad de Alzheimer presentaron peor rendimiento durante la ejecución de una tarea cognitiva frontal.

Pharmaceutical care as a strategy to improve the safety and effectiveness of patients? pharmacotherapy at a pharmacy school: a practical proposal

Several patients experience at least one drug-related problem and Pharmaceutical Care can change this reality. This work describes a model for structuring the pharmaceutical care service at a pharmacy training unit of the Brazilian Public Health System based on pharmacotherapy follow-up program of Parkinson’s disease patients’ results. From the follow-up results (phase 1), a Therapy Management Scheme was designed (phase 2). Of the 57 patients followed-up, 30 presented at least one drug-related problem and 42% were non-adherent to treatment, which supported the need of pharmacotherapy management. The Pharmacotherapy Management Scheme was proposed as a pharmaceutical care service model, which presents 6 steps: first, the pharmacist fills out the dispensing form and assesses patient´s pharmacotherapy, if there is a suspect problem, he is invited to the follow-up (steps 1 and 2) and they agree the first appointment. After that, pharmacist studies the patient’s case (study phase, steps 3 and 4). At the second meeting, the pharmacist proposes the intervention needed, and at the third, assesses the intervention results and new problems (steps 5 and 6, respectively). The process ends when all therapeutics outcomes are reached. This practical model can significantly contributed to the development and organization of pharmaceutical care services.

Muitos pacientes vivenciam pelo menos um problema relacionado ao medicamento e à atenção farmacêutica pode mudar este fato. Este trabalho descreve um modelo para estruturar o serviço de atenção farmacêutica numa farmácia escola do Sistema Único de Saúde brasileiro baseado nos resultados de um programa de seguimento farmacoterapêutico de pacientes com Doença de Parkinson. A partir dos resultados do seguimento, um esquema de gerenciamento da farmacoterapia foi desenhado. Dos 57 pacientes acompanhados, 30 apresentaram um problema relacionado ao medicamento e 42% não aderiram ao tratamento, o que reforça a necessidade de gerenciar a farmacoterapia. O esquema proposto apresenta 6 passos: primeiro, o farmacêutico preenche o formulário de dispensação e avalia a farmacoterapia do paciente; caso haja suspeita de um problema, ele é convidado a participar do seguimento farmacoterapêutico (passos 1 e 2) e marcam a primeira consulta. Após esta, o farmacêutico estuda o caso (fase de estudo, passos 3 e 4). Na segunda consulta, o farmacêutico propõe as intervenções necessárias e, na terceira, avalia seus resultados e novos problemas (passos 5 e 6, respectivamente). O processo termina quando todos os objetivos terapêuticos são alcançados. Este modelo de prática pode contribuir significativamente para o desenvolvimento e organização de serviços de atenção farmacêutica.

Influence of Propofol and Fentanyl on Deep Brain Stimulation of the Subthalamic Nucleus

We investigated the effect of propofol and fentanyl on microelectrode recording (MER) and its clinical applicability during subthalamic nucleus (STN) deep brain stimulation (DBS) surgery. We analyzed 8 patients with Parkinson's disease, underwent bilateral STN DBS with MER. Their left sides were done under awake and then their right sides were done with a continuous infusion of propofol and fentanyl under local anesthesia. The electrode position was evaluated by preoperative MRI and postoperative CT. The clinical outcomes were assessed at six months after surgery. We isolated single unit activities from the left and the right side MERs. There was no significant difference in the mean firing rate between the left side MERs (38.7+/-16.8 spikes/sec, n=78) and the right side MERs (35.5+/-17.2 spikes/sec, n=66). The bursting pattern of spikes was more frequently observed in the right STN than in the left STN. All the electrode positions were within the STNs on both sides and the off-time Unified Parkinson's Disease Rating Scale part III scores at six months after surgery decreased by 67% of the preoperative level. In this study, a continuous infusion of propofol and fentanyl did not significantly interfere with the MER signals from the STN. The results of this study suggest that propofol and fentanyl can be used for STN DBS in patients with advanced Parkinson's disease improving the overall experience of the patients.

Estudo da fadiga e qualidade de vida nos pacientes com doença de Parkinson / Study of fatigue and quality of life in patients with Parkinson' s disease

Objetivo - Analisar a ocorrência da fadiga na doença de Parkinson e sua relação na qualidade de vida desses indivíduos. A fadiga é um sintoma comum e debilitante em muitas doenças neurológicas. Estudos demonstram que vem sendo uma queixa frequente em pacientes com Parkinson. Métodos - Participaram da pesquisa 12 indivíduos de ambos os sexos, com doença de Parkinson, esses indivíduos não apresentaram problemas cognitivos que pudesse influenciar o resultado da pesquisa. A fadiga foi medida pela Escala de severidade da fadiga (FSS). Para análise da qualidade de vida foi aplicado o questionário PDQ-39 que é específico para avaliação da qualidade de vida na doença de Parkinson. Resultados - Dos sujeitos da amostra 50% apresentaram escore > 4 na escala FSS e foram definidos como portadores de fadiga, esta não apresentou significância com a idade dos sujeitos e nem com o tempo de lesão. Observou-se correlação muito significativa entre as dimensões fadiga e mobilidade e correlação significativa entre as dimensões fadiga e bem-estar emocional, estas dimensões analisadas abrangem aspectos motores da doença de Parkinson, e tais limitações físicas, contribuem para uma má qualidade de vida destes indivíduos. Conclusão - É possível observar o impacto substancialmente negativo da fadiga na qualidade de vida dos pacientes com doença de Parkinson, porém a escassez de estudos com esse tipo de análise limita a discussão desta associação, sendo que novas pesquisas precisam ser realizadas.

Objective - To analyze the occurrence of fatigue in Parkinson's disease and their relationship in the quality of life of individuals. Fatigue is a common and debilitating symptom in many neurological diseases. Studies show that has been a frequent complaint in patients with Parkinson's disease. Methods -We studied 12 individuals of both sexes with Parkinson's disease, these subjects had no cognitive problems that could influence the outcome of the research. Fatigue was measured by the Fatigue severity scale (FSS). For analysis the quality of life was applied the PDQ-39 that is specific for assessing the quality of life in Parkinson's disease. Results - From the studied individuals, 50% of the sample had of a score > 4 on a scale FSS and were defined as patients with fatigue did not show significance at the age of the subjects nor the time of injury. There was very significant correlation between the dimensions mobility and fatigue, and a significant correlation between the dimensions of fatigue and emotional well-being, those dimensions analyzed include motor aspects of Parkinson's disease, and such physical limitations, contribute to poor quality of life of individuals. Conclusion - It was possible to observe the substantial negative impact of fatigue on quality of life of patients with Parkinson's disease, but the scarcity of studies with this type of analysis limits the discussion of this association, and further research must be performed.

Predication of Parkinson's disease using data mining methods: A comparative analysis of tree, statistical, and support vector machine classifiers.

The prediction of Parkinson's disease in early age has been challenging task among researchers, because the symptoms of disease came into existence in middle and late middle age. There are lots of symptoms that lead to Parkinson's disease. But this article focuses on the speech articulation difficulty symptoms of PD affected people and try to formulate the model on the behalf of three data mining methods. These three data mining methods are taken from three different domains of data mining i.e., from tree classifier, statistical classifier, and support vector machine classifier. Performance of these three classifiers is measured with three performance matrices i.e., accuracy, sensitivity, and specificity. Hence, the main task of this article is tried to find out which model identified the PD affected people more accurately.

Diagnóstico premotor de la enfermedad de Parkinson / Premotor diagnosis of Parkinson's disease

Parkinson is a neurodegenerative disease that compromises brain nuclei in an ordered pattern. Only when Sustancia Nigra compromise becomes severe, motor signs are noticed. This occurs late in Parkinson course, so there is a long time period before in which no motor signs are evident. This is “premotor phase” of Parkinson disease. To make diagnosis early in premotor phase, would allow beginning a potential treatment that modify disease course. In this article we discuss clinical picture of premotor phase of Parkinson disease, local reality about ancillary tests to improve diagnosis sensibility of it and we suggest treatment approach.

Materiales de capacitación en enfermedad de Parkinson: GES 2008 / Training materials in Parkinson's disease: GES 2008

La Enfermedad de Parkinson se inicia en las personas entre los 50 y 60 años, aunque se encuentra en personas de menor edad, es crónica y progresiva, causando una pérdida paulatina de la capacidad física y mental, hasta llegar a la discapacidad total. En Chile, el grupo etáreo de mayores de 60 años tiene cada vez más peso relativo en el total de la población, alcanzando un 11,4% con 1.717.478 de personas y el grupo etáreo de 65 años y más es de 1.217.576 corresponde al 8% de la población. De este total destaca el grupo de personas mayores de 80 años, los que alzanzan el 14% con 250.840 personas. La esperanza de vida al nacer en Chile es hoy día de 77,36 años (74,42 años para los hombres y 80,41 para las mujeres). Para el 2050 se estima un 23,5% de la población mayor de 60 años (5.229.000. La vejez es un proceso global que no sólo afecta a la persona, a su familia o a los grupos poblacionales; constituye un verdadero fenómeno social, económico, político y cultural que por su magnitud supone múltiples consecuencias frente a las cuales las sociedades organizadamente deben asumir su responsabilidad. En este escenario, el número de pacientes de Parkinson aumentará en forma directamente proporcional al aumento en la edad de la población de sesenta años y más. Por otra parte, la observación clínica actual, encuentra casos de Parkinson "de novo" en pacientes hasta de 18 años de edad ...

Doença de Parkinson em idosos / Aged Parkinson disease

Doença de Parkinson e Parkinsonismo não são sinônimos. Parkinsonismo é um termo genérico que designa uma síndrome secundária a doenças como causas diferentes e que têm em comum a presença de sinais e sintomas parkinsonianos, ou seja, aqueles sintomas encontrados na Doença de Parkinson – bradicinesia, rigidez, tremor e instabilidade postural

Cuidados com o paciente portador da Doença de Parkinson / Care with Parkinson disease pacient

A doença de Parkinson é progressiva e apresenta várias fases e acometimentos diferentes. Caracteriza-se por bradicinesia (lentidão dos movimentos), tremor de repouso, rigidez, endurecimento dos músculos e articulações e alteração do equilíbrio e postura