Older adults with epilepsy: memory complaints and objective neuropsychological performance.

INTRODUCTION: People with epilepsy frequently complain of poor memory. OBJECTIVE: To assess the occurrence of memory complaints in older adults with epilepsy (OAE) and whether it is associated with clinical variables, objective cognitive performance, and quality of life (QoL). METHODS: The Memory Complaint Questionnaire (MAC-Q) was related to objective cognitive performance, the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), the Quality of Life in Epilepsy Inventory (QOLIE-31), and the clinical characteristics of 83 OAE. RESULTS: OAE showed worse cognitive performance and higher MAC-Q scores when compared to a similar control group (n=40). Impairment in multiple cognitive domains occurred in 34 (41%) OAE and was associated with older age and lower educational level. Memory complaints (MAC-Q≥25) were reported by 45 (54.2%) OAE and associated with older age, lower educational level, onset at ≥60 years, higher NDDI-E scores, lower QOLIE-31 scores, and impairment in multiple cognitive domains. CONCLUSIONS: OAE presented worse cognitive performance and greater memory complaints. Episode onset at ≥60 years of age was associated with complaints, but not with objective cognitive deficit. We found an association between subjective and objective cognitive performance, with aspects of epilepsy and worse QoL scores.

Older adults with epilepsy: memory complaints and objective neuropsychological performance / Idosos com epilepsia: queixa de memória e desempenho neuropsicológico objetivo

ABSTRACT Introduction: People with epilepsy frequently complain of poor memory. Objective: To assess the occurrence of memory complaints in older adults with epilepsy (OAE) and whether it is associated with clinical variables, objective cognitive performance, and quality of life (QoL). Methods: The Memory Complaint Questionnaire (MAC-Q) was related to objective cognitive performance, the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), the Quality of Life in Epilepsy Inventory (QOLIE-31), and the clinical characteristics of 83 OAE. Results: OAE showed worse cognitive performance and higher MAC-Q scores when compared to a similar control group (n=40). Impairment in multiple cognitive domains occurred in 34 (41%) OAE and was associated with older age and lower educational level. Memory complaints (MAC-Q≥25) were reported by 45 (54.2%) OAE and associated with older age, lower educational level, onset at ≥60 years, higher NDDI-E scores, lower QOLIE-31 scores, and impairment in multiple cognitive domains. Conclusions: OAE presented worse cognitive performance and greater memory complaints. Episode onset at ≥60 years of age was associated with complaints, but not with objective cognitive deficit. We found an association between subjective and objective cognitive performance, with aspects of epilepsy and worse QoL scores.

RESUMO Introdução: A queixa de memória fraca é frequente em pessoas com epilepsia. Objetivo: Avaliar a ocorrência de queixas de memória em idosos com epilepsia (IE) e se há associação com variáveis clínicas, desempenho cognitivo objetivo e qualidade de vida (QV). Métodos: O questionário de queixa de memória (memory complaint questionnaire — MAC-Q) foi relacionado ao desempenho cognitivo objetivo, o inventário de depressão de transtornos neurológicos para epilepsia (neurological disorders depression inventory for epilepsy — NDDI-E), o QOLIE-31 e com as características clínicas de 83 IE. Resultados: Houve desempenho cognitivo inferior e maiores escores no MAC-Q em IE quando comparados aos de um grupo controle similar (n=40). Comprometimento de múltiplos domínios cognitivos ocorreu em 34 (41%) IE e associou-se a maior idade e menor escolaridade. Queixas de memória (MAC-Q≥25) foram observadas em 45 (54,2%) IE e associadas a idade mais elevada, menor escolaridade, início das crises aos ≥60 anos, maiores escores no NDDI-E, menores escores no QOLIE-31 e comprometimento de múltiplos domínios cognitivos. Conclusões: Pior desempenho cognitivo e maiores queixa de memória ocorreram em IE. Crises com início aos ≥60 anos foram associadas a queixas, mas não a déficit objetivo cognitivo. Houve associação entre desempenho cognitivo subjetivo e objetivo, com aspectos da epilepsia e pior QV.

Cognition and epilepsy: Cognitive screening test.

Cognitive deficits often occur in people with epilepsy (PWE). However, in Brazil, PWE might not undergo neurocognitive evaluation due to the low number of validated tests available and lack of multidisciplinary teams in general epilepsy outpatient clinics. OBJECTIVE: To correlate Brief Cognitive Battery-Edu (BCB-Edu) scores with epilepsy characteristics of 371 PWE. METHODS: Clinical and cognitive assessment (MMSE, BCB-Edu) of 371 PWE aged >18 years was performed. The clinical aspects of epilepsy were correlated with BCB-Edu data. Cognitive data of PWE were compared against those of 95 healthy individuals (NC), with p-<0.05. RESULTS: People with epilepsy had lower cognitive performance than individuals in the NC group. Cognitive aspects also differed according to epilepsy characteristics. Predictive factors for impairment in multiple cognitive domains were age and use of more than one antiepileptic drug (logistic regression; R2 Nagelkerke=0.135). CONCLUSION: Worse cognitive performance was found in PWE on different domains. There was a relationship between cognitive impairment and the aspects of epilepsy. BCB-Edu proved to be effective as a cognitive assessment screening test for epilepsy in adults.

É frequente a ocorrência de déficits cognitivos em pessoas com epilepsia (PWE). Entretanto, no Brasil, as PWE podem ficar sem avaliação neurocognitiva pelo reduzido número de testes disponíveis e validados para nossa cultura e pela ausência de equipes multidisciplinares em ambulatórios gerais de epilepsia. OBJETIVO: Relacionar os escores do Brief Cognitive Battery-Edu (BCB-Edu) aos aspectos da epilepsia de 371 PWE. MÉTODOS: Foi feita avaliação clínica e cognitiva (MMSE, BCB-Edu) de 371 PWE com idade > 18 anos. Foram relacionados os aspectos da epilepsia com os dados do BCB-Edu. Os dados cognitivos foram comparados aos de 95 indivíduos normais (NC), com p<0.05. RESULTADOS: PWE apresentam desempenho cognitivo inferior ao do grupo NC. Os aspectos cognitivos foram distintos, segundo aspectos da epilepsia. Na regressão logística, os fatores preditivos para comprometimento em múltiplos domínios cognitivos foram a idade e a utilização de mais de uma droga antiepiléptica (R2 Nagelkerke=0.135). CONCLUSÃO: Houve, nas PWE, pior desempenho cognitivo em diferentes domínios. Houve relação entre déficit cognitivo com aspectos da epilepsia. O BCB-Edu mostrou-se eficaz como teste de triagem cognitiva na epilepsia em adultos.

Cognition and epilepsy: Cognitive screening test / Cognição e epilepsia: teste de triagem cognitiva

ABSTRACT. Cognitive deficits often occur in people with epilepsy (PWE). However, in Brazil, PWE might not undergo neurocognitive evaluation due to the low number of validated tests available and lack of multidisciplinary teams in general epilepsy outpatient clinics. Objective: To correlate Brief Cognitive Battery-Edu (BCB-Edu) scores with epilepsy characteristics of 371 PWE. Methods: Clinical and cognitive assessment (MMSE, BCB-Edu) of 371 PWE aged >18 years was performed. The clinical aspects of epilepsy were correlated with BCB-Edu data. Cognitive data of PWE were compared against those of 95 healthy individuals (NC), with p-<0.05. Results: People with epilepsy had lower cognitive performance than individuals in the NC group. Cognitive aspects also differed according to epilepsy characteristics. Predictive factors for impairment in multiple cognitive domains were age and use of more than one antiepileptic drug (logistic regression; R2 Nagelkerke=0.135). Conclusion: Worse cognitive performance was found in PWE on different domains. There was a relationship between cognitive impairment and the aspects of epilepsy. BCB-Edu proved to be effective as a cognitive assessment screening test for epilepsy in adults.

RESUMO. É frequente a ocorrência de déficits cognitivos em pessoas com epilepsia (PWE). Entretanto, no Brasil, as PWE podem ficar sem avaliação neurocognitiva pelo reduzido número de testes disponíveis e validados para nossa cultura e pela ausência de equipes multidisciplinares em ambulatórios gerais de epilepsia. Objetivo: Relacionar os escores do Brief Cognitive Battery-Edu (BCB-Edu) aos aspectos da epilepsia de 371 PWE. Métodos: Foi feita avaliação clínica e cognitiva (MMSE, BCB-Edu) de 371 PWE com idade > 18 anos. Foram relacionados os aspectos da epilepsia com os dados do BCB-Edu. Os dados cognitivos foram comparados aos de 95 indivíduos normais (NC), com p<0.05. Resultados: PWE apresentam desempenho cognitivo inferior ao do grupo NC. Os aspectos cognitivos foram distintos, segundo aspectos da epilepsia. Na regressão logística, os fatores preditivos para comprometimento em múltiplos domínios cognitivos foram a idade e a utilização de mais de uma droga antiepiléptica (R2 Nagelkerke=0.135). Conclusão: Houve, nas PWE, pior desempenho cognitivo em diferentes domínios. Houve relação entre déficit cognitivo com aspectos da epilepsia. O BCB-Edu mostrou-se eficaz como teste de triagem cognitiva na epilepsia em adultos.

The relationship between dysphagia and clinical and cognitive aspects in elderly patients presented with dementia

ABSTRACT Objective: to relate the risk of dysphagia and aspects of eating behavior to the cognitive aspects of elderly people with dementia. Methods: 35 elderly patients with Alzheimer or vascular dementia were submitted to clinical and cognitive assessments as well as to a questionnaire for assessing appetite/eating disorder and the Dysphagia Risk Evaluation Protocol (DREP). Appropriate statistical tests were applied adopting a significance level lower than 0.05. Results: mild dementia occurred in 16 cases, moderate, in 14, and severe, in 5. Complaints of choking/coughing in the medical history, and signs of dysphagia in the DREP, occurred in 9 and 25 elderly patients, respectively, with no differences regarding the type and severity of dementia. Patients presented with dysphagia and alterations in the oral and pharyngeal phases of DREP, were older. Alterations in the pharyngeal phase were associated with poorer performance in the Mini-Mental State Examination (total score, attention/calculation, language). Changes in appetite/weight/eating habits were associated with signs of dysphagia, increasing severity of dementia and functional impairment. Conclusion: choking/coughing and signs of dysphagia were high. Changes in appetite/weight/eating habits were related to the severity of dementia and presence of dysphagia, and cognitive disorders and old age were associated with dysphagia.

Major depressive episode, cognition, and epilepsy.

PURPOSE: In patients with epilepsy (PWE), relationships between depression, epilepsy characteristics, and cognitive aspects are complex. This study aimed to assess the occurrence of possible major depressive episode in PWE and to verify whether it is associated with the clinical aspects of the disease and cognition. METHODS: Two hundred consecutive PWE with a mean age and standard deviation of 47.6 (±15.1) years were included in the study. We determined whether their Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) scores were associated with their clinical, cognitive, and QOLIE-31 aspects using a significance level of 5% (p<0.05). RESULTS: Twenty-six patients (13%) had an NDDI-E score >15, suggestive of major depressive episode. Logistic regression showed that NDDI-E >15 was associated with seizure frequency (p=0.022) and worse performance in the category fluency test (p=0.003). An NDDI-E >15 was also correlated with lower quality of life (p<0.001). CONCLUSION: The present findings suggest that possible major depressive episode is associated not only with epilepsy characteristics but also with cognitive aspects, such as category fluency, and quality of life.

Religiosity aspects in patients with epilepsy.

The objectives of this study were to assess religiosity aspects in patients with epilepsy (PWEs) and controls and to determine whether such aspects were related to the samples' clinical, sociodemographic, and QOL-31 data. The Duke Religion Index was administered to 159 adult PWEs and 50 controls. The relationships between the Duke Religion Index and the study variables of the two groups were compared. Intrinsic religiosity (IR) and nonorganizational religiosity (NOR) were higher in PWEs than in controls. Logistic regression showed that being female (p=0.022) and having mesial temporal lobe epilepsy with hippocampus sclerosis (MTLE-HS) (p=0.003) were predictors of high organizational religiosity (OR) and that high NOR was associated with MTLE-HS (p=0.026) and controlled seizures. Further, only MTLE-HS (p=0.002) was predictive of high IR. The Duke Religion Index and QOLIE-31 scores were not related. Different forms of interictal religiosity are related to clinical aspects of epilepsy.

Marital status of patients with epilepsy: factors and quality of life.

PURPOSE: The study investigated how marital status relates to clinical aspects and quality of life (QOL) in patients with epilepsy (PWE). METHOD: The clinical data and Quality of Life in Epilepsy Inventory (QOLIE-31) scores of 252 PWE were regressed against their marital status with a significance level of 5% (p < 0.05). RESULTS: Logistic regression for single and married PWE revealed that singles had more abnormalities in the neurological examination (p = 0.029) and earlier seizure onset (p < 0.001), while for married and divorced PWE revealed the latter more psychiatric comorbidities (p = 0.002) and longer disease duration (p = 0.011). Regarding QOL score, linear regression showed that psychiatric comorbidity was the only factor (p < 0.001). CONCLUSION: The marital status of PWE is negatively associated with clinical aspects of epilepsy.

Spirituality aspects in patients with epilepsy.

PURPOSE: Do epilepsy and spirituality interact? This study aimed to determine whether an easy-to-administer scale, such as the spirituality self-rating scale (SSRS), could detect increased religiousness in people with epilepsy and verify how epilepsy influences spirituality. METHODS: A total of 196 consecutive patients with epilepsy (epilepsy group, EG) with a mean age and standard deviation of 46.5 ± 14.8 years and 66 subjects with no history of neurological or other chronic disorders (control group, CG) were assessed by the SSRS and neurologically. RESULTS: The SSRS scores of the EG and CG did not differ significantly (22.8 ± 5.1 and 22.0 ± 5.7, respectively). Patients with mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS) had significantly higher SSRS scores than those with other epileptic syndromes and, than in individuals of the CG. Multiple regression showed that the factors significantly associated with greater spirituality (greater SSRS score) for the EG, were lower education level, abnormal background EEG activity, and MTLE-HS. Other relationships with the clinical features of epilepsy and with the presence of psychiatric co-morbidity were not found. CONCLUSION: The present findings do not confirm a specific role of epilepsy in spirituality or of "epileptic hyperreligiosity," but suggest that spirituality in people with epilepsy is influenced by education level, and may also stem from epilepsy-related factors such as abnormal background EEG activity and the presence of MTLE-HS.

Spiritual/religious coping in patients with epilepsy: relationship with sociodemographic and clinical aspects and quality of life.

One hundred and ten patients with epilepsy with a mean age of 45.9 were assessed by a clinical-neurological evaluation, Quality of Life in Epilepsy Inventory-31 (QOLIE-31), and the Spiritual/Religious Coping (SRCOPE) Scale. The objective of this study was to evaluate if patients with epilepsy used positive and/or negative spiritual/religious coping and the relationships between this type of coping and the sociodemographic and clinical aspects of epilepsy and the QOLIE-31. A greater use of positive coping (3.0±0.7) than negative coping (2.3±0.7) was found. The use of the positive factor was greater in mesial temporal lobe epilepsy (MTLE) than in other types of epilepsy. The ratio of negative/positive coping was associated with lower scores in the QOLIE-31 (-0.222; p=0.036). Patients with epilepsy appear to use spiritual/religious coping, especially those with MTLE, and a predominance of negative coping was associated with a reduced quality of life. Future studies should evaluate interventions considering the knowledge of spiritual/religious strategies by the patients.

Neurobehavior inventory: correlation with clinical aspects and quality of life in patients with epilepsy.

Fifty-five adult patients with epilepsy were evaluated, and the Neurobehavior Inventory (NBI) was administered. The relationship between the NBI data and clinical aspects and quality of life (QoL) was studied. The total NBI score was 58 ± 18.2. The domains with the highest scores were "religious conviction", "orderliness", and "sense of personal destiny". There was a significant difference in "hatred and revenge" and "religious conviction" according to the epileptic syndrome. The "physical well-being" score was higher for patients with mesial temporal lobe epilepsy with right hippocampal sclerosis than for left sclerosis (2.77 ± 1.6 × 1.57 ± 0.5, respectively, p = 0.002). The total NBI score was higher in patients with psychiatric comorbidities and with depression according to the Hamilton Depression Scale and was negatively correlated with the "emotional well-being" QOLIE score (-0.398, p = 0.005). The NBI findings showed that behavioral changes can be present in various epilepsies and that there is a complex bidirectional neurobiological relationship between epilepsy and psychiatric comorbidity, sustained by common physiopathological mechanisms.

Epilepsy with onset at over 50 years of age: clinical and electroencephalographic characteristics.

Epilepsy in older individuals has an elevated incidence. The objective of the present work was to evaluate the clinical, EEG and brain imaging aspects in patients showing late-onset epilepsy. Fifty-five patients with late-onset epilepsy (older than 50 years) were evaluated. They were composed of two groups according to the onset age of the epilepsy seizure (ES): 51-60 (G51-60) and over 60 (G60+) years. Focal ES predominated although they were less frequent in G60+. The occurrence of status epilepticus was high and more frequent in G60+ whereas seizures in series predominated in G51-60. Symptomatic epilepsy was more frequent and the vascular etiology predominated. Epileptiform activity was associated with a greater number of ES, and background activity abnormalities were more frequent in G60+. In conclusion, epilepsy with onset at over 50 was predominantly focal and symptomatic, with a high occurrence of status epilepticus and of seizures in series.

Epilepsy with onset at over 50 years of age: clinical and electroencephalographic characteristics / Epilepsia com início após os 50 anos de idade: características clínicas e eletrencefalográficas

Epilepsy in older individuals has an elevated incidence. The objective of the present work was to evaluate the clinical, EEG and brain imaging aspects in patients showing late-onset epilepsy. Fifty-five patients with late-onset epilepsy (older than 50 years) were evaluated. They were composed of two groups according to the onset age of the epilepsy seizure (ES): 51-60 (G51-60) and over 60 (G60+) years. Focal ES predominated although they were less frequent in G60+. The occurrence of status epilepticus was high and more frequent in G60+ whereas seizures in series predominated in G51-60. Symptomatic epilepsy was more frequent and the vascular etiology predominated. Epileptiform activity was associated with a greater number of ES, and background activity abnormalities were more frequent in G60+. In conclusion, epilepsy with onset at over 50 was predominantly focal and symptomatic, with a high occurrence of status epilepticus and of seizures in series.

Epilepsia no idoso tem elevada incidência e peculiaridades pouco estudadas. O objetivo do presente trabalho foi avaliar aspectos clínicos e eletrencefalográficos de pacientes que apresentaram a primeira crise epiléptica (CE) tardiamente. Foram avaliados 55 pacientes com epilepsia tardia (com início após os 50 anos), divididos em dois grupos segundo a idade de início das CE: de 51-60 anos (G51-60) e após os 60 anos (G60+). Predominaram as CE focais, que foram menos frequentes em G60+. A ocorrência de status epilepticus foi elevada e mais frequente em G60+, enquanto as CE em série predominaram em G51-60. A epilepsia sintomática foi a mais frequente e de etiologia vascular. Atividade epileptiforme esteve associada ao maior número de crises epilépticas. Anormalidades da atividade de base ao EEG foram mais frequentes em G60+. Em conclusão, a epilepsia iniciada após os 50 anos é predominantemente focal e sintomática, com alta ocorrência de status epilepticus e CE em série.

Quantitative electroencephalography power and coherence measurements in the diagnosis of mild and moderate Alzheimer's disease.

OBJECTIVE: To evaluate the contribution of quantitative electroencephalographic (qEEG) analyses in the diagnosis of Alzheimer's disease (AD). METHOD: Thirty-five patients from the Neurology Outpatients Clinic of PUC-Campinas, diagnosed with AD according to the NINCDS/ADRDA were evaluated, and compared with a control group consisting of 30 individuals with no cognitive deficit. The procedures consisted of clinical-neurological, cognitive and behavioral analyses and the qEEG (absolute power and coherence). RESULTS: The AD group presented greater absolute power values in the delta and theta bands, greater theta/alpha indices and less frontal alpha and beta coherence. Logistic multiple regression models were constructed and those only showing variations in the qEEG (frontal alpha coherence and left frontal absolute theta power) showed an accuracy classification (72.3%) below that obtained in the mini-mental state examination (93%). CONCLUSION: The study of coherence and power in the qEEG showed a relatively limited accuracy with respect to its application in routine clinical practice.

Parkinson disease: impact of clinical and cognitive aspects on quality of life / Doença de Parkinson: impacto de aspectos clínicos e cognitivos na qualidade de vida

Parkinson disease (PD) is a chronic disease manifested principally by motor signs and symptoms, but with frequent neuropsychological alterations. Objectives: To study the relationship between clinical and cognitive aspects and the perception of quality of life (QOL) in PD patients. Methods: Twenty consecutive patients (13 men) with idiopathic PD (mean age: 64.5y), mean disease time of 7.8 years and at stages 1-3 according to the modified Hoehn and Yahr staging scale (HYS), all outpatients from the Neurology Department of the Celso Pierro General and Maternity Hospital (PUC-Campinas), were analyzed. The following were applied: a clinical-neurological assessment, the Mini-Mental State Examination (MMSE), standard neuropsychological battery of the CERAD (Consortium to Establish a Registry for Alzheimer Disease), Hamilton Depression Rating Scale (HAM-D) and a QOL questionnaire (Parkinson Disease Questionnaire - PDQ-39). Statistical analysis was carried out at a significance level of p<0.05. Results: On the PDQ-39 under the sections total, mobility and activities of daily living, and the items motor compromise (HYS) and language of the MMSE were predictors of worse QOL. Verbal fluency was a factor for emotional well-being on the PDQ-39, whereas higher scores for HAM-D and worse performance on the item attention and calculation of the MMSE were associated with worse QOL in the social support section. Total score on the MMSE and educational level were QOL factors in cognition. Conclusions: The findings of the present study suggest that clinical, cognitive, motor or other depression-related factors contribute differently to the domains of QOL.

Doença de Parkinson (DP) é uma doença crônica que se manifesta principalmente por sinais e sintomas motores, mas com alterações neuropsicológicas frequentes. Objetivos: Estudar a relação de aspectos clínicos e cognitivos com a percepção da qualidade de vida (QV) em pacientes com DP. Métodos: Foram analisados 20 pacientes (13 do gênero masculino) consecutivos com DP idiopática (idade média: 64,5 anos), tempo médio de doença de 7,8 anos e estágio 1-3 na escala Hoehn e Yarh modificada (HY), procedentes do ambulatório de Neurologia do Hospital e Maternidade Celso Pierro (PUC-Campinas). Foram realizados: anamnese, exame neurológico, mini-exame do estado mental (MEEM), bateria neurospicológica do CERAD, escala de depressão de Hamilton (EDH) e questionário de QV (Parkinson Disease Questionnaire - PDQ-39). Foi feito o estudo estatístico, com nível de significância p<0.05. Resultados: Comprometimento motor e no item linguagem do MEEM foram preditores de pior QV no PDQ-39 total, mobilidade e atividades da vida diária. A fluência verbal foi fator de bem estar emocional do PDQ-39, enquanto maiores escores na EDH e desempenho inferior no item atenção e calculo do MEEM estiveram associados a pior QV em apoio social. O escore total do MEEM e o nivel de escolaridade foram fatores de QV em cognição. Conclusões: Nossos achados sugerem que diferentes fatores clínicos, cognitivos, da motricidade ou ligados a depressão contribuem de modo diferenciado para os diversos domínios da QV.

Parkinson's disease: Impact of clinical and cognitive aspects on quality of life.

Parkinson's disease (PD) is a chronic disease manifested principally by motor signs and symptoms, but with frequent neuropsychological alterations. OBJECTIVES: To study the relationship between clinical and cognitive aspects and the perception of quality of life (QOL) in PD patients. METHODS: Twenty consecutive patients (13 men) with idiopathic PD (mean age: 64.5y), mean disease time of 7.8 years and at stages 1-3 according to the modified Hoehn and Yahr staging scale (HYS), all outpatients from the Neurology Department of the Celso Pierro General and Maternity Hospital (PUC-Campinas), were analyzed. The following were applied: a clinical-neurological assessment, the Mini-Mental State Examination (MMSE), standard neuropsychological battery of the CERAD (Consortium to Establish a Registry for Alzheimer's Disease), Hamilton Depression Rating Scale (HAM-D) and a QOL questionnaire (Parkinson's Disease Questionnaire - PDQ-39). Statistical analysis was carried out at a significance level of p<0.05. RESULTS: On the PDQ-39 under the sections total, mobility and activities of daily living, and the items motor compromise (HYS) and language of the MMSE were predictors of worse QOL. Verbal fluency was a factor for emotional well-being on the PDQ-39, whereas higher scores for HAM-D and worse performance on the item attention and calculation of the MMSE were associated with worse QOL in the social support section. Total score on the MMSE and educational level were QOL factors in cognition. CONCLUSIONS: The findings of the present study suggest that clinical, cognitive, motor or other depression-related factors contribute differently to the domains of QOL.

Doença de Parkinson (DP) é uma doença crônica que se manifesta principalmente por sinais e sintomas motores, mas com alterações neuropsicológicas frequentes. OBJETIVOS: Estudar a relação de aspectos clínicos e cognitivos com a percepção da qualidade de vida (QV) em pacientes com DP. MÉTODOS: Foram analisados 20 pacientes (13 do gênero masculino) consecutivos com DP idiopática (idade média: 64,5 anos), tempo médio de doença de 7,8 anos e estágio 1-3 na escala Hoehn e Yarh modificada (HY), procedentes do ambulatório de Neurologia do Hospital e Maternidade Celso Pierro (PUC-Campinas). Foram realizados: anamnese, exame neurológico, mini-exame do estado mental (MEEM), bateria neurospicológica do CERAD, escala de depressão de Hamilton (EDH) e questionário de QV (Parkinson's Disease Questionnaire - PDQ-39). Foi feito o estudo estatístico, com nível de significância p<0.05. RESULTADOS: Comprometimento motor e no item "linguagem" do MEEM foram preditores de pior QV no PDQ-39 "total", "mobilidade" e "atividades da vida diária". A fluência verbal foi fator de "bem estar emocional" do PDQ-39, enquanto maiores escores na EDH e desempenho inferior no item "atenção e calculo" do MEEM estiveram associados a pior QV em "apoio social". O escore total do MEEM e o nivel de escolaridade foram fatores de QV em "cognição". CONCLUSÕES: Nossos achados sugerem que diferentes fatores clínicos, cognitivos, da motricidade ou ligados a depressão contribuem de modo diferenciado para os diversos domínios da QV.

Factors associated with the employment situation and driving license of patients with epilepsy / Fatores associados a situação laboral e licença para dirigir em pacientes com epilepsia

INTRODUCTION: It is estimated that approximately 50 percent of patients with epilepsy have difficulty finding employment. OBJECTIVE: Evaluate the employment situation and driving license of patients with symptomatic or probably symptomatic focal epilepsy and correlate it with clinical and socio-demographic aspects. METHODS: Ninety-two patients were classified into 3 groups: "employed", "unemployed" and "retired/on leave". The relationship between employment and socio-demographic aspects and those of epilepsy was studied, and also whether the patients were holders of national driving licenses. RESULTS: Thirty-one (33.7 percent) of the patients were employed, 19 (20.7 percent) unemployed and 33 (35.9 percent) retired/on leave. Patients with formal education of less than 9 years predominated (p<0.05) in the "retired/on leave" group and non-white patients were more frequently unemployed. Of 58 patients who lost their jobs, 27 (46.6 percent) reported that epilepsy was the main reason (p<0.05). There was a significant relationship between the occurrence of ES at work and unemployment and "leave/retirement" (p<0.05). There was no relationship between clinical aspects and the employment situation. Nineteen (33.9 percent) of the 56 surveyed reported being holders of driving licenses. DISCUSSION: There was a high index of unemployment and retired/on leave individuals. There was a relationship between unemployment and the occurrence of ES at work and with a low scholastic level. CONCLUSION: The low scholastic level/professional qualifications and the stigma aggravated the employment perspectives of these individuals, contributing to their social exclusion.

INTRODUÇÃO: Estima-se que aproximadamente 50 por cento dos pacientes com epilepsia têm problemas para encontrar emprego. OBJETIVO: O objetivo desta pesquisa foi avaliar a situação laboral e a licença para dirigir de 92 pacientes com epilepsia focal sintomática ou provavelmente sintomática e, correlaciona-la a aspectos clínicos e sociodemográficos. RESULTADOS: 31 (33,7 por cento) pacientes estavam empregados, 19 (20,7 por cento) desempregados, 33 (35,9 por cento) afastados/aposentados. Os pacientes com maior escolaridade formal, da cor branca, e do gênero masculino estavam mais empregados (ANOVA; p<0,05). 30 (46,1 por cento) pacientes referiram que a epilepsia motivou a demissão. Houve relação significativa entre ocorrência de CE no trabalho com desemprego e afastamento/aposentadoria (χ2; p=0,03). Não houve relação entre aspectos clínicos da epilepsia e situação ocupacional. DISCUSSÃO: Foram observados índices elevados de desemprego e afastamentos/aposentadoria. Houve relação entre desemprego e ocorrência de CE no trabalho, e baixa escolaridade e qualificação profissional. CONCLUSÃO: A baixa escolaridade/qualificação profissional e o estigma agravaram a perspectiva de empregabilidade dos indivíduos, contribuindo para a exclusão social.

Dementia and mild cognitive impairment in patients with Parkinson's disease.

UNLABELLED: The objective of this research was to assess the occurrence of cognitive impairment in 32 individuals (average age: 67.2 years old) with Parkinson' disease (PD). PROCEDURES: clinical-neurological assessment; modified Hoehn and Yahr staging scale (HYS); standard neuropsychological battery of CERAD (Consortium to Establish a Registry for Alzheimer' Disease); Pfeffer questionnaire; and Clinical Dementia Rating. A comparison was made with a control group (CG), consisting of 26 individuals with similar age and educational level but without cognitive impairment. The PD patients showed an inferior performance in the CERAD battery when compared to the CG. Three PD sub-groups were characterised according to cognition: no cognitive impairment--15 cases; mild cognitive impairment--10; dementia--7 cases. There was a significant association between motor disability (HYS) and the occurrence of dementia. Dementia and mild cognitive impairment frequently occur in PD patients and should be investigated in a routine way.