Predictors of freezing of gait in Chinese patients with Parkinson's disease.

Objective: To explore the clinical predictors of freezing of gait (FOG) in Chinese patients with Parkinson's disease (PD). Methods: This study included 225 patients with PD who completed a three-year follow-up visit. The end-point was the presence of FOG (freezers), which was assessed during the follow-up visit. Group comparisons were conducted, followed by a further forward binary logistic regression analysis. Results: Eighty-five patients with PD (38%) had developed FOG at the end of study. At baseline, freezers exhibited higher age, longer disease duration, higher scores in Unified PD Rating Scale (UPDRS) III and Hamilton Depression/Anxiety Rating Scale, lower Frontal Assessment Battery (FAB) score, higher subscores (e.g., "urgency") and frequencies (e.g., "hallucinations") in Non-Motor Symptoms Scale, higher annual changes in MoCA, UPDRS III and FAB scores, and higher incidences of festination and falls than nonfreezers (p < .05). The forward binary logistic regression model indicated that a longer disease duration, a higher UPDRS III score, higher annual changes in UPDRS III score and "visuospatial/executive abilities" subscore, onset in lower limbs, and the presence of festination, falls, and hallucinations were associated with the development of FOG. Conclusions: Patients with onset in the lower limbs and the presence of festination, falls, and hallucinations may be prone to develop FOG episodes. FOG also likely occurs with the deterioration of PD severity and visuospatial function.

Locomotive syndrome in the elderly: translation, cultural adaptation, and Brazilian validation of the tool 25-Question Geriatric Locomotive Function Scale.

OBJECTIVE: The term Locomotive Syndrome refers to conditions in which the elderly are at high risk of inability to ambulate due to problems in locomotor system. For Locomotive Syndrome screening, the 25-Question Geriatric Locomotive Function Scale was created. The objective here was to translate, adapt culturally to Brazil, and study the psychometric properties of 25-Question Geriatric Locomotive Function Scale. METHOD: The translation and cultural adaptation of 25-Question Geriatric Locomotive Function Scale were carried out, thus resulting in GLFS 25-P, whose psychometric properties were analyzed in a sample of 100 elderly subjects. Sociodemographic data on pain, falls, self-perceived health and basic and instrumental functionalities were determined. GLFS 25-P was applied three times: in one same day by two interviewers, and after 15 days, again by the first interviewer. RESULT: GLFS 25-P showed a high internal consistency value according to Cronbach's alpha coefficient (0.942), and excellent reproducibility, according to intraclass correlation, with interobserver and intraobserver values of 97.6% and 98.4%, respectively (p<0.01). Agreements for each item of the instrument were considerable (between 0.248 and 0.673), according to Kappa statistic. In its validation, according to the Pearson's coefficient, regular and good correlations were obtained for the basic (BADL) and instrumental (IADL) activities of daily living, respectively (p<0.01). Statistically significant associations with chronic pain (p<0.001), falls (p=0.02) and self-perceived health (p<0.001) were found. A multivariate analysis showed a significantly higher risk of Locomotive Syndrome in the presence of chronic pain (OR 15.92, 95% CI 3.08-82.27) and with a worse self-perceived health (OR 0.23, 95% CI 0.07-0.79). CONCLUSION: GLFS 25-P proved to be a reliable and valid tool in Locomotive Syndrome screening for the elderly population.

Locomotive syndrome in the elderly: translation, cultural adaptation, and Brazilian validation of the tool 25-Question Geriatric Locomotive Function Scale / Síndrome locomotora em idosos: tradução, adaptação cultural e validação brasileira do instrumento 25-Question Geriatric Locomotive Function Scale

ABSTRACT Objective: The term Locomotive Syndrome refers to conditions in which the elderly are at high risk of inability to ambulate due to problems in locomotor system. For Locomotive Syndrome screening, the 25-Question Geriatric Locomotive Function Scale was created. The objective here was to translate, adapt culturally to Brazil, and study the psychometric properties of 25-Question Geriatric Locomotive Function Scale. Method: The translation and cultural adaptation of 25-Question Geriatric Locomotive Function Scale were carried out, thus resulting in GLFS 25-P, whose psychometric properties were analyzed in a sample of 100 elderly subjects. Sociodemographic data on pain, falls, self-perceived health and basic and instrumental functionalities were determined. GLFS 25-P was applied three times: in one same day by two interviewers, and after 15 days, again by the first interviewer. Result: GLFS 25-P showed a high internal consistency value according to Cronbach's alpha coefficient (0.942), and excellent reproducibility, according to intraclass correlation, with interobserver and intraobserver values of 97.6% and 98.4%, respectively (p < 0.01). Agreements for each item of the instrument were considerable (between 0.248 and 0.673), according to Kappa statistic. In its validation, according to the Pearson's coefficient, regular and good correlations were obtained for the basic (BADL) and instrumental (IADL) activities of daily living, respectively (p < 0.01). Statistically significant associations with chronic pain (p < 0.001), falls (p = 0.02) and self-perceived health (p < 0.001) were found. A multivariate analysis showed a significantly higher risk of Locomotive Syndrome in the presence of chronic pain (OR 15.92, 95% CI 3.08–82.27) and with a worse self-perceived health (OR 0.23, 95% CI 0.07–0.79). Conclusion: GLFS 25-P proved to be a reliable and valid tool in Locomotive Syndrome screening for the elderly population.

RESUMO Objetivo: O termo síndrome locomotora (SL) designa condições nas quais os idosos apresentam alto risco de incapacidade para deambulação em decorrência de problemas em órgãos locomotores. Para seu rastreio foi criado o 25-Question Geriatric Locomotive Function Scale (GLFS-25). Objetivou-se aqui, traduzir, adaptar transculturalmente para o Brasil e estudar as propriedades psicométricas do GLFS-25. Método: Feitas tradução e adaptação transcultural do GLFS-25 que originaram o GLFS 25-P, cujas propriedades psicométricas foram analisadas numa amostra de 100 idosos. Apurados dados sociodemográficos relativos a dor, queda, autopercepção da saúde e funcionalidades básica e instrumental. O GLFS 25-P foi aplicado em três momentos: num mesmo dia por dois entrevistadores e após 15 dias novamente pelo primeiro entrevistador. Resultado: O GLFS 25-P apresentou alto valor de consistência interna, segundo o coeficiente Alfa de Cronbach (0,942); e reprodutibilidade ótima, segundo a correlação intraclasses: valores de 97,6% e 98,4%, interobservador e intraobservador, respectivamente (p < 0,01). As concordâncias para cada item do instrumento foram consideráveis (entre 0,248 e 0,673), segundo a estatística Kappa. Na validação, segundo o coeficiente de Pearson, foram obtidas correlações regular e boa para as atividades de vida diária básicas (AVDB) e instrumentais (AIVD), respectivamente (p < 0,01). Encontradas associações estatisticamente significantes com dor crônica (p < 0,001), queda (p = 0,02) e autopercepção de saúde (p < 0,001). A análise multivariada evidenciou risco de SL significativamente maior na presença de dor crônica (OR 15,92, IC 95% 3,08-82,27) e pior autopercepção de saúde (OR 0,23, IC 95% 0,07-0,79). Conclusão: O GLFS 25-P demonstrou ser confiável e válido no rastreio da SL em idosos.

Cerebellar ataxia in the eastern and southern parts of Norway.

INTRODUCTION: The relative frequencies of different ataxias vary among different ethnic and geographic groups. The aim of this study was to examine patients with cerebellar ataxia and find the occurrence of autosomal dominant and recessive cerebellar ataxias in the population of the southern and eastern parts of Norway and estimate its prevalence. MATERIALS AND METHODS: Probands were systematically tested for spinocerebellar ataxia 1, 2, 3, 6 and Friedreich's ataxia. A total of 94 patients with ataxia were assessed. RESULTS: We registered 60 patients from 39 unrelated families with hereditary ataxias. One family with SCA2 (two patients), one family with Friedreich's ataxia (two patients), two patients heterozygote for Friedreich's ataxia and one metabolic ataxia were identified. CONCLUSIONS: We have few Friedreich's ataxia and SCA 1,2,3 and 6 in our population. Prevalence in Oslo County was estimated at 2.2/100,000 for autosomal recessive and 3.0/100,000 for autosomal dominant ataxia, respectively.

Clinical characteristics of African Americans vs Caucasian Americans with multiple sclerosis.

BACKGROUND: African American (AA) individuals are thought to develop multiple sclerosis (MS) less frequently than Caucasian American (CA) individuals. OBJECTIVE: To compare the clinical characteristics of AA and CA patients with MS. METHODS: The clinical features of MS were compared in a large retrospective cohort of AA (n = 375) and CA (n = 427) subjects. RESULTS: The proportion of women to men was similar in AA and CA subjects (81% [AA] vs 77% [CA]; p = 0.122). There were no differences in the proportions of subjects with relapsing-remitting, secondary progressive, primary progressive, and progressive relapsing MS. The median time to diagnosis was 1 year after symptom onset in AA subjects and 2 years after symptom onset in CA subjects (p = 0.0013). The age at onset was approximately 2.5 years later in AA than CA subjects (33.7 vs 31.1 years; p = 0.0001). AA subjects presented with multisite signs and symptoms at disease onset more often than CA subjects (p = 0.018). Clinical involvement restricted to the optic nerves and spinal cord (opticospinal MS) occurred in 16.8% of AA patients compared with 7.9% of CA patients (p < 0.001). Transverse myelitis also occurred more frequently in AA subjects (28 vs 18%; p = 0.001). Survival analysis revealed that AA subjects were at higher risk for development of ambulatory disability than CA subjects. After adjusting for baseline variations and differences in therapeutic interventions, AAs were at 1.67-fold greater risk for requiring a cane to ambulate than CA patients (p < 0.001). There was a trend suggesting that AAs were also at greater risk for development of wheelchair dependency (p = 0.099). Adjusted Cox proportional hazard models showed that this effect was in part attributable to the older age at onset in AAs (p < 0.001). CONCLUSIONS: Compared with multiple sclerosis (MS) in Caucasian Americans, African American patients with MS have a greater likelihood of developing opticospinal MS and transverse myelitis and have a more aggressive disease course.