ABSTRACT
INTRODUCTION: Physical rehabilitation is commonly used in patients with Parkinson's disease (PD) to improve their health and alleviate the symptoms. OBJECTIVE: We compared the effects of three programs, strength training (ST), aerobic training (AT), and physiotherapy, on motor symptoms, functional capacity, and electroencephalographic (EEG) activity in PD patients. METHODS: Twenty-two patients were recruited and randomized into three groups: AT (70% of maximum heart rate), ST (80% of one repetition maximum), and physiotherapy (in groups). Subjects participated in their respective interventions twice a week for 12 weeks. The assessments included measures of disease symptoms (Unified Parkinson's Disease Rating Scale [UPDRS]), functional capacity (Senior Fitness Test), and EEG before and after 12 weeks of intervention. RESULTS: The PD motor symptoms (UPDRS-III) in the group of patients who performed ST and AT improved by 27.5% (effect size [ES]=1.25, confidence interval [CI]=-0.11, 2.25) and 35% (ES=1.34, CI=-0.16, 2.58), respectively, in contrast to the physiotherapy group, which showed a 2.9% improvement (ES=0.07, CI=-0.85, 0.99). Furthermore, the functional capacity of all three groups improved after the intervention. The mean frequency of the EEG analysis mainly showed the effect of the interventions on the groups (F=11.50, P=0.0001). CONCLUSION: ST and AT in patients with PD are associated with improved outcomes in disease symptoms and functional capacity.
Subject(s)
Exercise/physiology , Parkinson Disease/rehabilitation , Physical Therapy Modalities , Quality of Life , Resistance Training/methods , Activities of Daily Living , Aged , Electroencephalography/methods , Female , Gait , Humans , Male , Middle Aged , Parkinson Disease/physiopathology , Parkinson Disease/psychology , Pilot Projects , Severity of Illness Index , Treatment Outcome , WalkingABSTRACT
CONTEXTO: Evidências demonstram benefícios para a saúde mental com o treinamento aeróbico orientado em percentuais do VO2max, indicando a importância dessa variável para a prática clínica. OBJETIVO: Validar um método para estimar o VO2max por meio de um protocolo submáximo em idosos com diagnóstico clínico de transtorno depressivo maior (DM) e doença de Parkinson (DP). MÉTODOS: A amostra foi composta por 18 pacientes (64,22 ± 9,92 anos; sete pacientes com DM e 11 com DP). Foram realizadas três avaliações: I) estadiamento da doença, II) mensuração direta de VO2max e III) teste de esforço submáximo. Foi realizada regressão linear para verificar a precisão de estimativa do VO2max estabelecido na ergoespirometria pelo VO2max predito no teste submáximo. Também foi analisada a concordância de Bland-Altman entre os procedimentos. RESULTADOS: A análise de regressão mostrou que os valores de VO2max estimados pelo protocolo submáximo associam-se com o VO2max medido, tanto no valor absoluto (R2 = 0,65; EPE = 0,26 ; p < 0,001) quanto no relativo (R2 = 0,56; EPE = 3,70; p < 0,001). A análise de concordância de Bland-Altman mostrou boa associação entre as duas medidas. CONCLUSÃO: O VO2max predito por meio do protocolo submáximo demonstrou satisfatória validade de critério e simples execução comparado à ergoespirometria.
BACKGROUND: Evidence has shown benefits for mental health through aerobic training oriented in percentage of VO2max, indicating the importance of this variable for clinical practice. OBJECTIVE: To validate a method for estimating VO2max using a submaximal protocol in elderly patients with clinically diagnosis as major depressive disorder (MDD) and Parkinson's disease (PD). METHODS: The sample comprised 18 patients (64.22 ± 9.92 years) with MDD (n = 7) and with PD (n = 11). Three evaluations were performed: I) disease staging, II) direct measurement of VO2max and III) submaximal exercise test. Linear regression was performed to verify the accuracy of estimation in VO2max established in ergospirometry and the predicted VO2max from the submaximal test measurement. We also analyzed the correlation between the Bland-Altman procedures. RESULTS: The regression analysis showed that VO2max values estimated by submaximal protocol associated with the VO2max measured, both in absolute values (R2 = 0.65; SEE = 0.26; p < 0.001) and the relative (R2 = 0.56; SEE = 3.70; p < 0.001). The Bland-Altman plots for analysis of agreement of showed a good correlation between the two measures. DISCUSSION: The VO2max predicted by submaximal protocol demonstrated satisfactory criterion validity and simple execution compared to ergospirometry.
Subject(s)
Parkinson Disease , Exercise Therapy , Exercise Test , Bipolar Disorder , Mood DisordersABSTRACT
Strategic regions correspond to associative, limbic and paralimbic structures and related circuits, that underpin cognitive/behavioral functions. Strokes in these eloquent sites produce pictures of vascular dementia with syndromic features due to specific site lesion and/or interruption of their interconnections. This study aims at analysing subcortical strategic strokes that express similar cognitive/behavioral elements, by sharing common pathways. Patients (n=6) who attended in specialized ambulatory, were submitted to neuropsychological and neuroimaging assessments through MRI (GE Signa Horizon 1.5T) and brain SPECT (Millennium MG, ECD [TC-99m]). Stroke locations and respective main symptoms were: 1. anteromedian thalamus [L]: anterograde and retrograde amnesia (ARA), expression aphasia (EA), executive dysfunction (ED), apathy, and depression; 2. anterior thalamus [R]: ARA, inattention, apathy, and aggressiveness; 3. dorsomedian thalamus [L]: inattention, ED, anosognosia, and aggressiveness; 4. central paramedian thalamus [R]: EA, visual perception deficits (VPD), ED, infantility, and personality disorder; 5. caudate nucleus (ventral-head) [L]: VPD, ED, delirium, visual hallucinations, and personality disorder; and 6. anterior capsule [L]: VPD, ED, apathy, and depression. Vascular strategic syndromes connote the predominantly impaired cognitive/behavioral symptom of each site. Temporal and frontal disconnection symptoms were produced by disrupted MTT/hippocampal and IML/amygdala circuits expressing amnesic syndrome associated with heterogeneous dysexecutive syndrome, in all the cases, by disrupting frontal-basal ganglia-thalamus-cortical net, in three different levels of their pathway.
Subject(s)
Behavioral Symptoms/etiology , Brain/pathology , Cognition Disorders/etiology , Dementia, Vascular/complications , Stroke/complications , Aged , Aged, 80 and over , Behavioral Symptoms/diagnosis , Behavioral Symptoms/diagnostic imaging , Brain/diagnostic imaging , Brain Mapping , Cognition Disorders/diagnosis , Cognition Disorders/diagnostic imaging , Dementia, Vascular/diagnostic imaging , Diterpenes, Clerodane , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Neuropsychological Tests , Psychiatric Status Rating Scales , Severity of Illness Index , Stroke/diagnostic imaging , Stroke/pathology , Tomography, Emission-Computed, Single-PhotonABSTRACT
OBJECTIVE: To compare magnetic resonance proton spectroscopic with clinical data and to propose a spectroscopic staging of Alzheimer's disease (AD). METHOD: Subjects (n = 46), normals (12) and with AD (34), paired to age (CDR0-CDR3); AD diagnosis according to DSM-IV/NINCDS-ADRDA criteria; 1H-MRS with Signa Horizon LX-GE, 1.5T; single voxel at hippocampal region/HCR and posterior cingulate area/PCA. RESULTS: Statistically significant decrease (p < 0.01) only of Naa/Cr--at HCR among the CDR0, CDR1+CDR2, and CDR3, and at PCA between CDR0 and CDR1+CDR2 in relation to CDR3. CONCLUSION: The HCR is the first to show Naa reduction (CDR1). The PCA suffers later (CDR3). These values decline progressively according to the severity stages. Considering the disparities between the HCR and PCA it is possible to suggest a spectroscopic (metabolite) staging (MS) of AD, as follows: MS0 (-CDR0) = both normal HCR and PCA, MS1-2 (approximately CDR1-2) = abnormal HCR and normal PCA, and MS3 (approximately CDR3) = both abnormal HCR and PCA. These results make possible the early diagnosis, to follow the degenerative process throughout the course, and to suggest a spectroscopic staging related to the clinical stages of AD.
Subject(s)
Alzheimer Disease/diagnosis , Limbic System/metabolism , Aged , Aged, 80 and over , Alzheimer Disease/metabolism , Alzheimer Disease/pathology , Analysis of Variance , Animals , Aspartic Acid/analogs & derivatives , Aspartic Acid/metabolism , Case-Control Studies , Creatine/metabolism , Female , Humans , Magnetic Resonance Spectroscopy , Male , Middle Aged , Psychiatric Status Rating Scales , Severity of Illness IndexABSTRACT
OBJETIVO: Comparar dados de espectroscopia de prótons por ressonância magnética com clínicos e propor um estadiamento espectroscópico da doença de Alzheimer(DA).MÉTODO: Sujeitos (n=46), normais (12) e com DA (34), emparelhados por idade (CDR0-CDR3); diagnóstico de DA de acordo com os critérios DSM-IV/NINCDS-ADRDA; 1H-MRS com Signa Horizon LX-GE, 1.5T; voxel único em região hipocampal/RHC e área posterior do cíngulo/APC. RESULTADOS: Redução estatisticamente significativa (p<0.01) apenas de Naa/Cr - na RHC entre CDR0, CDR1+CDR2 e CDR3, e na APC entre CDR0 e CDR1+CDR2 em relação a CDR3. CONCLUSÃO: A RHC é a primeira a apresentar redução de Naa (CDR1). A APC é acometida mais tardiamente (CDR3). Esses valores declinam progressivamente de acordo com os estágios de gravidade. Considerando as disparidades entre a RHC e a APC é possível sugerir um estadiamento espectroscópico (metabólico) (MS) da DA como segue: MS0 (CDR0)=RHC e APC ambos normais, MS1-2 (CDR1-2)=RHC anormal e APC normal e MS3 (CDR3)=RHC e APC ambos anormais. Esses resultados permitem um diagnóstico precoce, o seguimento do processo degenerativo ao longo da evolução e sugerir um estadiamento espectroscópico relacionado aos estágios clínicos da DA.
