Direct and indirect assessment of functional abilities in patients with Parkinsons disease transitioning to dementia / Avaliação direta e indireta das habilidades funcionais em pacientes com doença de parkinson em transição para demência

ABSTRACT. Cognitive impairment is common in patients with Parkinson's disease (PD), and evaluation of functional abilities is crucial for diagnosis of dementia. Objective: We evaluated differences between direct and indirect functional assessment methods to evaluate functional abilities in PD patients. Methods: We evaluated 32 patients with PD and suspected mild dementia using direct and indirect assessment methods. Results: There was a significant difference between the scores of direct and indirect methods of assessment. Patients and close informants usually overestimated their abilities in many ADL. However, all functional assessment tools used in this study had a relatively good accuracy to predict abnormal performance in a global cognitive scale. Patients with normal cognition according to scores in a global cognitive scale may have some functional impairment in ADL. Direct Assessment of Functional Ability (DAFA) scores correlated linearly with scores in global cognitive scales, and especially with scores in the domains of memory and concentration. Conclusion: Patients and close informants usually overestimate their instrumental abilities in ADL. The direct assessment of daily functioning was more reliable than indirect tools to assess functional losses in patients with PD. Finally, some patients with PD but no dementia may present functional losses in ADL.

RESUMO. O comprometimento cognitivo é comum em pacientes com doença de Parkinson (DP), e a avaliação das habilidades funcionais é crucial para o diagnóstico de demência. Objetivo: Avaliamos diferenças entre os métodos de avaliação funcional direta e indireta para avaliar habilidades funcionais em pacientes com DP. Métodos: Foram avaliados 32 pacientes com DP e suspeita de demência inicial usando métodos de avaliação direta e indireta. Resultados: Houve uma diferença significativa entre os escores dos métodos diretos e indiretos de avaliação. Pacientes e informantes geralmente superestimaram suas habilidades em muitas atividades da vida diária (AVD). No entanto, todas as ferramentas de avaliação funcional utilizadas neste estudo tiveram uma precisão relativamente boa para prever desempenho anormal em uma escala cognitiva global. Pacientes com cognição normal, de acordo com os escores em uma escala cognitiva global, podem apresentar algum comprometimento funcional nas AVD. As pontuações do Direct Assessment of Functional Ability (DAFA) correlacionaram-se linearmente com as pontuações nas escalas cognitivas globais e, especialmente, com as pontuações nos domínios da memória e concentração. Conclusão: Pacientes e informantes próximos geralmente superestimam suas habilidades instrumentais nas AVD. A avaliação direta do funcionamento diário foi mais confiável do que ferramentas indiretas para avaliar perdas funcionais em pacientes com DP. Finalmente, alguns pacientes com DP, mas sem demência, podem apresentar perdas funcionais nas AVD

Can anxiety increase tremors in patients with Parkinson's disease? An experimental model

Abstract Background Among non-motor symptoms of Parkinson's disease (PD), anxiety occurs in up to 67% of patients. Clinically, PD patients report worsening of tremors in anxiogenic situations. Objective The aim of this study was to evaluate the association between motor symptoms and anxiety in PD patients and compare their performances with those of healthy volunteers. Methods Fifteen volunteers with PD and 15 healthy volunteers without clinically significant psychiatric disorders were evaluated. Both groups were subjected to a simulated public speaking test (SPST). The following parameters were measured: visual analog mood scale (VAMS), items related to tremors of UPDRS, bradykinesia tests, blood pressure, and heart rate. Results Results of repeated measures ANOVA indicated a significant effect on group × phase interaction (F3.7,105.6 = 2.56; p = 0.046) for VAMS anxiety factor. Regarding tremors, ANOVA indicated significant differences in group × phase interaction (F4.5,121 = 2.88; p = 0.021) and between the groups (F1,27 = 45.88, p < 0.001), with differences in the anticipatory phase, performance, and post-speech, compared with those in the baseline. There were no significant differences between the groups with regard to other factors of VAMS, physiological measurements, and bradykinesia. Discussion Worsening of tremors occurred during SPST, particularly in phases with higher anxiety scores.

Adaptação transcultural de instrumentos de avaliação psicológica: levantamento dos estudos realizados no Brasil de 2000 a 2010 / Cross-cultural adaptation of psychological assessment instruments: Brazilian literature review from 2000 to 2010

Diante da busca de aprimoramento técnico-científico nos processos de avaliação psicológica, este trabalho apresenta um panorama das investigações científicas brasileiras acerca da adaptação de instrumentos de avaliação psicológica. Com base em levantamento bibliográfico dos estudos publicados no período de 2000 a 2010, foram selecionados 24 estudos que constituíram o corpusanalisado. A maioria dos trabalhos seguiu diretrizes internacionais e nacionais de adaptação de instrumentos, sendo que 24 estudos realizaram processo de tradução, 18 apresentaram análise de fidedignidade e 16, evidências de validade. Pôde-se depreender, dentre os estudos analisados, que há uma variedade de procedimentos empregados para a adaptação de instrumentos de avaliação psicológica no contexto brasileiro. Ainda, puderam ser observadas algumas diferenças quanto à utilização de termos referentes à taxonomia psicométrica. Nesse sentido, pretende-se oferecer elementos para reflexão de pesquisadores e profissionais no que diz respeito à adaptação de instrumentos de avaliação psicológica no Brasil.

Given the search for technical-scientific improvement in the psychological assessment processes, this paper presents an overview of the Brazilian research about the cross-cultural adaptation of psychological assessment instruments. Based in a literature review of studies published between the period from 2000 to 2010, 24 studies were selected that formed the corpus analyzed. Most studies have followed international and national guidelines, among which 24 studies performed translation process, 18 showed analysis of reliability and 16 studies presented validity evidences. It can be concluded, among the analyzed studies, that there are a variety of procedures employed for the adaptation of psychological assessment instruments in the Brazilian context. Still, some differences were observed regarding the use of terms referring to the psychometric taxonomy. It is intended to provide reflection elements to researchers and professionals regarding the adaptation of psychological assessment instruments in Brazil. .