Determinant factors of sarcopenia in individuals with Parkinson's disease.

OBJECTIVE: Evaluate the occurrence of sarcopenia and determinant factors in individuals with Parkinson's disease (PD) in a city in northeastern Brazil. METHODS: Case series with 77 men and women (adults and older adults) with PD. The risk of sarcopenia was determined using the SARC-F and SARC-CalF screening tools. The diagnosis of sarcopenia was based on the new consensus published by the European Working Group on Sarcopenia in Older People (EWGSOP2). Sarcopenic obesity was diagnosed based on the criteria proposed by Stenholm. Disease stage and severity were determined using the Hoehn and Yahr scale and the Unified Parkinson Disease Rating Scale, respectively. RESULTS: The prevalence of sarcopenia was 19.5% and was associated with age, poor performance on activities of daily living and poor nutritional status. No significant association was found between the SARC-F score and the diagnosis of sarcopenia. The main factors that determined the variation in the parameters for the diagnosis of sarcopenia in the present sample were age, disease severity, body weight, and SARCF score. CONCLUSION: Despite the low prevalence in the present study, sarcopenia progresses with the worsening of the nutritional status and functional capacity of individuals with PD. Further studies are needed on the factors involved in the genesis of sarcopenia. The SARC-F questionnaire is related to parameters for the diagnosis and severity of sarcopenia as well as the severity of PD.

Pharmacogenetic profile and the development of the dyskinesia induced by levodopa-therapy in Parkinson's disease patients: a population-based cohort study.

Levodopa-induced dyskinesia (LID) is an adverse effect that negatively impacts the quality of life of patients with Parkinson's disease (PD). Studies report that genetic variations in the genes of the pharmacogenetic pathway of the levodopa (L-DOPA) might be associated with LID development. The goal of the present study was to investigate a possible influence of functional genetic variants in the DRD1 (rs4532), DRD2 (rs1800497), DAT1 (rs28363170), and COMT (rs4680) genes with LID development. A total of 220 patients with idiopathic PD were enrolled. The genotyping for DRD1 (rs4532), DRD2 (rs1800497), DAT1 (rs28363170), and COMT (rs4680) polymorphisms were performed using Restriction Fragment Length Polymorphism (PCR-RFLP). Univariate and multivariate analyses were performed to assess the association of these polymorphisms and risk factors with LID development. Multivariate Cox regression analysis showed increased risk to LID development for both Levodopa Dose Equivalency (LED) (Hazard ratios (HR) = 1.001; 95% CI 1.00-1.01; p = 0.009) and individuals carrying the COMT L/L genotype (HR = 2.974; 95% CI 1.12-7.83; p = 0.010). Furthermore, when performed a Cox regression analysis adjusted for a total LED, we observed that the genotype COMT L/L had a 3.84-fold increased risk for LID development (HR = 3.841; 95% CI 1.29-11.37; p = 0.012). Our results suggest that before treating LID in PD patients, it is important to take into consideration genetic variant in the COMT gene, since COMT LL genotype may increase the risk for LID development.

Chronic pain and depression as factors associated with temporomandibular dysfunction in older adults with Parkinsons disease / Dor crônica e depressão como fatores associados à disfunção temporomandibular em pessoas idosas com doença de Parkinson

ABSTRACT Purpose: to investigate whether chronic pain and depression are factors associated with temporomandibular dysfunction (TMD) in older adults with Parkinson's disease. Methods: a cross-sectional study using the Research Diagnostic Criteria for Temporomandibular Disorders questionnaire. The clinical variables studied were chronic pain, depression, nonspecific physical symptoms including and excluding items of pain, and dentures use. The associations between the dependent and independent variables were evaluated by the chi-square odds ratio, with a 95% confidence interval. Results: a total of 81 older adults met the eligibility criteria - 67% were males, 74% were married or had a partner, 43% reported earning 1 to 2 minimum wages, and 47% were in the moderate stage of Parkinson's disease. TMD was identified in 22% of the sample, 12% reporting chronic pain. The statistical analysis showed an association between TMD and chronic pain (p = 0.001, OR = inf, 95% CI = 12.13 - inf) and between TMD and moderate-to-severe depression (p = 0.014, OR = 4.8, 95% CI = 1.14 - 23.51). Conclusion: it was verified that chronic pain and moderate-to-severe depression were the factors associated with TMD in older adults presented with Parkinson's disease.

RESUMO Objetivo: investigar se a dor crônica e a depressão representam fatores associados à disfunção temporomandibular (DTM) em idosos com doença de Parkinson. Métodos: estudo de corte transversal realizado no Hospital das Clínicas da Universidade Federal de Pernambuco, em 2018. Utilizou-se o questionário Critério de Diagnóstico de Pesquisa para Disfunções Temporomandibulares. As variáveis clínicas estudadas foram: dor crônica, depressão, sintomas físicos não específicos, incluindo e excluindo itens de dor e uso de prótese dentária. As associações entre as variáveis dependente e independentes foram avaliadas pelo teste do Odds Ratio do Qui-quadrado, com intervalo de confiança de 95%. Resultados: encontraram-se dentro dos critérios de elegibilidade 81 idosos, 67% eram do sexo masculino, 74% eram casados ou tinham companheiro, 43% declararam receber de 1-2 salários mínimos e 47% apresentavam-se no estágio moderado da doença de Parkinson. A DTM foi identificada em 22% da amostra e 12% dos participantes referiram presença de dor crônica. A análise estatística demonstrou associação entre DTM e dor crônica (p=0,001, OR=inf, IC95%=12,13-inf), bem como entre DTM e depressão moderada-severa (p=0,014, OR=4,8, IC95%=1,14 - 23,51). Conclusão: verificou-se que os fatores que estavam associados à DTM em idosos com doença de Parkinson foram dor crônica e depressão moderada-severa.

Pharmacogenetic Profile and the Occurrence of Visual Hallucinations in Patients With Sporadic Parkinson's Disease.

Visual hallucinations are significant nonmotor symptoms in the course of treatment of Parkinson's disease. Previous studies have shown that the interindividual variability and pharmacogenetic profile of Parkinson's disease patients seem to influence the occurrence of visual hallucinations. In our study, we investigated a possible relationship of sequence variants in DRD1, DRD2, DRD3, DAT1, and COMT genes with the presence of visual hallucinations in Parkinson's disease patients. A total of 224 Brazilian patients from the Pro-Parkinson service at the Clinical Hospital of the University of Pernambuco, diagnosed with sporadic Parkinson's disease, were enrolled. Parkinson's disease patients were divided into 2 groups based on the presence or absence of visual hallucinations. The sequence variants for DRD1, DRD2, DRD3, DAT1, and COMT were determined through the polymerase chain reaction-restriction fragment length polymorphism technique. Multiple Poisson regression analyses showed that individuals carrying the DRD3 Ser/Ser and Ser/Gly genotypes presented increased prevalence ratios of visual hallucinations (9.7-fold and 4.4-fold, respectively; P < .001). Regarding DAT1 rs28363170, there was a 9.82-fold increase in the prevalence ratio in patients with the 10/11 genotype, 8.78-fold for the 10/8 genotype, and 2.44-fold for the 9/8 genotypes (P < .001, for all). In addition, visual hallucinations were also associated with use of transdermal patches with rotigotine (PR, 3.7; 95%CI, 1.2-10.9; P = .017) and rasagiline (PR, 2.8; 95%CI, 1.3-6.0; P = .006). Our results suggest that the genetic variants DRD3 and DAT1, along with other therapeutic confounders, may influence the prevalence ratio of visual hallucinations.

The influence of SLC6A3 and DRD2 polymorphisms on levodopa-therapy in patients with sporadic Parkinson's disease.

OBJECTIVES: The aim of this study was to evaluate a possible relationship between DRD2/ANKK1 (rs1800497) and SLC6A3/DAT1 (rs28363170) gene polymorphisms with the response to levodopa (L-DOPA)-therapy in patients with Parkinson's disease (PD). METHODS: One hundred and ninety-five patients with idiopathic PD were investigated. Patients were genotyped for rs1800497 and rs28363170 polymorphisms using PCR-RFLP. Logistic regression was performed to assess the association of polymorphisms with the occurrence of the chronic complications of L-DOPA therapy. KEY FINDINGS: Our results showed association between the occurrence of dyskinesia with an increased greater disease severity (P = 0.007), higher L-DOPA dose (P = 0.007) and use of dopamine agonist (P = 0.020). Moreover, there were significant protective effects for age (P = 0.004) and male subjects (P = 0.006). CONCLUSIONS: Clinical and demographic characteristics of Brazilian PD patients and differences in DRD2 and DAT1 genes may to determine individual variations in the therapeutic response to L-DOPA in the Brazilian PD patients.

MAO-B and COMT Genetic Variations Associated With Levodopa Treatment Response in Patients With Parkinson's Disease.

The most commonly used Parkinson's disease (PD) treatment is the replacement of dopamine by its levodopa precursor (l-dopa). Monoamine oxidase-B (MAO-B) and catechol-o-methyl transferase (COMT) are enzymes involved in the metabolism and regulation of dopamine availability. In our study we investigated the possible relation among selected single-nucleotide polymorphisms (SNPs) in the MAO-B (rs1799836) and COMT (rs4680) genes and the therapeutic response to levodopa (l-dopa). A total of 162 Brazilian patients from the Pro-Parkinson service of Clinics Hospital of Pernambuco diagnosed with sporadic PD and treated with levodopa were enrolled. PD patients were stratified into 2 groups according to the daily levodopa dose. MAO-B and COMT SNP genotyping was conducted by polymerase chain reaction-restriction fragment length polymorphism. After multivariate analysis, we observed a significant difference between PD groups for the following variables: sex (P = .02), longer duration of disease (P = .02), longer levodopa therapy duration (P = .01), younger onset of PD (P = .01), and use of COMT inhibitor (P = .02). We observed that patients carrying MAO-B (rs1799836) A and AA genotypes and COMT (rs4680) LL genotype suffered more frequently from levodopa-induced-dyskinesia. In addition, we found an increased risk of 2.84-fold for male individuals carrying the MAO-B G allele to be treated with higher doses of levodopa (P = .04). We concluded that before beginning PD pharmacological treatment, it is important to consider the genetic variants of the MAO-B and COMT genes and the sex, reinforcing the evidence that sexual dimorphism in the genes related to dopamine metabolism might affect PD treatment.

Individualized guidance and telephone monitoring in a self-supervised home-based physiotherapeutic program in Parkinson / Orientação individualizada e monitoramento telefônico em programa domiciliar fisioterapêutico autossupervisionado no Parkinson

Abstract Introduction: Home therapeutic exercises have been a target of interest in the treatment of the Parkinson's disease (PD). The way that the physical therapist guides and monitors these exercises can impact the success of therapy. Objective: To evaluate the effects of individualized orientation and monitoring by telephone in a self-supervised home therapeutic exercise program on signs and symptoms of PD and quality of life (QoL). Methods: Single-blind randomized clinical trials with 28 people with PD (Hoehn and Yahr 1 to 3). Patients were randomized into two groups: experimental and control. The experimental group had a meeting with individualized guidance about physiotherapy exercises present in a manual, received the manual to guide their activities at home and obtained subsequent weekly monitoring by telephone. The control group received the usual cares by the service. Both were orientated to carry out exercises three times a week during 12 weeks. Was evaluated: (1) activities of daily living (ADL) and motor examination sections of the Unified Parkinson's Disease Rating Scale (UPDRS) and QoL by the Parkinson Disease Questionnaire 39 (PDQ-39). The analysis between groups was performed by the Mann-Whitney test and intragroup through the Wilcoxon (p < 0.05). Results: Significant improvement in ADL (p= 0.001) and motor examination (p= 0.0008) of the UPDRS, PDQ-39 total (p = 0.027) and dimensions mobility (p = 0.027), emotional well-being (p= 0.021) and bodily discomfort (p = 0.027) in the experimental group compared to the control group. Conclusion: The individualized guidance and weekly monitoring by telephone in a self-supervised home therapeutic exercises program promoted positive effects on ADL, motor examination and QoL of people in early stages of PD.

Resumo Introdução: Exercícios terapêuticos domiciliares vêm sendo alvo de interesse no tratamento da doença de Parkinson (DP). A forma como o fisioterapeuta orienta e monitora estes exercícios pode impactar no sucesso da terapêutica. Objetivo: Avaliar os efeitos da orientação individualizada e do monitoramento por telefone em um programa de exercícios terapêuticos domiciliares autossupervisionados sobre os sinais e sintomas da DP e a qualidade de vida (QV). Métodos: Ensaio clínico randomizado simples-cego com 28 pessoas com DP (Hoehn e Yahr 1 a 3). Pacientes foram randomizados em dois grupos: experimental e controle. O grupo experimental teve um encontro com orientação individualizada sobre os exercícios de fisioterapia de um manual, recebeu o manual para orientar atividades em domicílio e obteve posterior monitoramento semanal por telefone. O grupo controle recebeu cuidados usuais do serviço. Ambos foram orientados a realizar exercícios três vezes por semana durante 12 semanas. Foram avaliadas: seções atividades da vida diária (AVD) e exame motor da Escala Unificada de Avaliação da Doença de Parkinson (UPDRS) e QV mediante Questionário de Doença de Parkinson 39 (PDQ-39). Foi realizada análise intergrupos (Mann-Whitney) e intragrupos (Wilcoxon) com p < 0.05. Resultados: Melhora significativa nas seções AVD (p = 0.001) e exame motor (p = 0.0008) da UPDRS, PDQ-39 total (p = 0.027) e dimensões mobilidade (p=0.027), bem-estar emocional (p = 0.021) e desconforto corporal (p=0.027) no grupo experimental quando comparado ao controle. Conclusão: A orientação individualizada e o monitoramento semanal por telefone em um programa de exercícios terapêuticos domiciliares autossupervisionados apresentaram efeitos positivos sobre AVD, exame motor e QV em estágios iniciais da DP.

Acupuncture as Adjuvant Therapy for Sleep Disorders in Parkinson's Disease.

There are few studies which attest the efficacy of acupuncture on treatment of sleep disturbs in Parkinson disease. The aimed of this randomized clinical trial was to evaluate the effects of acupuncture on sleep disturbs of 22 patients with diagnosis of idiopathic Parkinson disease (Hoehn-Yahr 1 to 3) who have assistance on the Pro-Parkinson Program of Clinical Hospital at Federal University of Pernambuco in Brazil. All participants were evaluated by Parkinson Disease Sleep Scale (PDSS) before and after 8 weeks. The experimental group was submitted to 8 sections (once a week) which had duration of 30 minutes. The control group had no intervention. The intervention was executed using the acupuncture points LR3 (Taichong), SP6 (Sanyinjiao), LI4 (Hegu), TE5 (Wai-Guan), HT7 (Shenmen), PC6 (Neiguan), LI11 (Quchi), GB20 (Fengchi). Paired analyses were obtained by Wilcoxon test and independent analyses were made according to Mann-Whitney test. This study presented a potential therapeutic benefit of acupuncture on sleep disturbs of Parkinson's disease patients. This study showed a possible therapeutic benefit through acupuncture in sleep disorders in patients with PD. However, we propose new studies related to the effects of acupuncture on the clinical symptoms and evolution of the disease.