Osteoporosis in Parkinson's disease and the role of lean body mass: a cross-sectional study in a Brazilian tertiary center.

Background: Parkinson's disease (PD) is the second most common neurodegenerative illness and has the highest increase rate in recent years. There is growing evidence to suggest that PD is linked to higher osteoporosis rates and risk of fractures. Objective: This study aims to estimate the prevalence and factors associated with osteoporosis as defined by the National Osteoporosis Foundation (NOF) and World Health Organization in patients with mild to moderate PD. Methods: We performed a cross-sectional study at a tertiary public hospital in Fortaleza, Brazil, dating from May 2021 until April 2022. The study sample was comprised of patients with mild to moderate PD who were at least 40 years old and who had the ability to walk and stand unassisted. Bone Mineral Density (BMD) of both the hip (neck of the femur) and the lumbar spine were obtained via properly calibrated Dual Energy X-ray Absorptiometry (DXA) scanning. The FRAX (Fracture Risk Assessment Tool) score was used to determine a person's 10-year risk of major osteoporotic fracture. The Revised European Working Group on Sarcopenia in Older People (EWGSOP 2) was used as a basis to confirm a sarcopenia diagnosis with the following parameters: low muscle strength gauged by handgrip strength and low muscle quantity by DXA. Physical performance was carefully evaluated by using the Short Physical Performance Battery test. Osteoporosis and osteopenia were diagnosed following the NOF guidelines and WHO recommendations. Results: We evaluated 107 patients in total, of whom 45 (42%) were women. The group's mean age was 68 ± 9 years, and the mean disease time span was 9.9 ± 6.0 years and mean motor UPDRS was 43 ± 15. We found that 42.1% and 34.6% of the sample had osteopenia and osteoporosis following NOF criteria, respectively, and 43% and 33.6% following the WHO recommendations. Lower lean appendicular mass was associated to osteopenia and osteoporosis in multinomial logistic regression analysis in both diagnostic criteria. Conclusion: Our findings provide additional evidence for the protective role of lean mass against osteoporosis in patients with PD.

Effectiveness of vestibular rehabilitation on postural balance in Parkinson's disease: a systematic review and meta-analysis of randomized controlled trials.

INTRODUCTION: Postural balance impairment can affect the quality of life of patients with Parkinson's disease. Previous studies have described connections of the vestibular system with postural functions, suggesting a potential participation of the basal ganglia in receiving vestibular stimuli. This systematic review aims to summarize the evidence on the effectiveness of vestibular rehabilitation on postural balance in patients with Parkinson's disease. METHODS: A systematic review was conducted using the electronic databases: PubMed, Embase, Scopus and PEDro. The study selection was independently conducted by two reviewers, and disagreements were evaluated by a third reviewer. The included studies had no restrictions on publication dates or languages and the last update occurred in July 2023. RESULTS: From the 485 studies found in the searches, only 3 studies were deemed eligible for the systematic review involving a total of 130 participants. The Berg Balance Scale was described as the tool for evaluation of postural balance in all studies. The meta-analysis showed statistically significant results in favor of vestibular rehabilitation (MD = 5.35; 95% CI = 2.39, 8.31; P < 0.001), regardless of the stage of Parkinson's disease. Although the effect size was suggested as a useful functional gain, the analysis was done with caution, as it only included 3 randomized controlled trials. The risk of bias using the RoB-2 was considered as being of "some concern" in all studies. Furthermore, the quality of the evidence based on the Grading of Recommendations Assessment Development and Evaluation system, produced by pooling the included studies was considered very low. CONCLUSION: Compared to other interventions, vestibular rehabilitation has potential to assist the postural balance of patients with Parkinson's disease. However, the very low quality of the evidence demonstrates uncertainty about the impact of this clinical practice. More robust studies are needed to confirm the benefits of this therapy in patients with Parkinson's disease. This study was prospectively registered in PROSPERO: CRD42020210185.

Educational disparities in Brazil may interfere with the cognitive performance of Parkinson's disease patients.

The prevalence of cognitive impairment in Parkinson's disease (PD) is about 20% to 60%. The Mini-Mental Status Examination (MMSE) is the most used cognitive screening test. Objective: To evaluate the influence of clinical and demographic characteristics, specifically the education level, on the MMSE score in PD patients of a northeast Brazilian sample. Methods: We performed a cross-sectional study of 198 PD patients at a Movement Disorders outpatient clinic in Fortaleza, CE, Brazil. Participants were assessed by detailed clinical history, modified Hoehn and Yahr staging (HY), geriatric depression scale (GDS) and MMSE. Results: We found that 68% of patients had MMSE scores below the Brazilian thresholds, which were based in Brucki et al. study (2003). There was a statistically significant difference in the bivariate analysis between educational level and cut-off classification for MMSE. More years of formal schooling were associated with more patients scoring below threshold. We found that 75%, 68.8%, and 79.7% of individuals with more than 11, 9 to 11, and 4 to 8 years of formal schooling, respectively, were below the suggested Brazilian Brucki's threshold. GDS and age were negatively correlated with total MMSE and all its domains. There was no correlation between disease duration and MMSE. Subjects with hallucinations had lower scores. Conclusion: Most of the sample had lower performance according to Brazilian thresholds, but there was no control group and no neuropsychological test in this study. Further studies in northeast Brazil are needed to review MMSE cut-off values.

A prevalência de comprometimento cognitivo na doença de Parkinson (DP) é de cerca de 20 a 60%. O Miniexame do Estado Mental (MEEM) é o teste de rastreio cognitivo mais utilizado. Objetivo: Avaliar a influência de características clínicas e demográficas, especificamente a escolaridade, no escore do MEEM em pacientes com DP de uma amostra do nordeste brasileiro. Métodos: Realizamos um estudo transversal com 198 pacientes com DP em um ambulatório de Distúrbios do Movimento em Fortaleza. Os participantes foram avaliados por história clínica detalhada, estadiamento modificado de Hoehn e Yahr (HY), escala de depressão geriátrica (EDG) e MEEM. Resultados: Encontramos 68% dos pacientes com escores do MEEM abaixo dos limiares brasileiros baseados em estudo de Brucki et al. (2003). Houve diferença estatisticamente significativa na análise bivariada entre a escolaridade e a classificação de corte para o MEEM. Mais anos de escolaridade foram associados a mais pacientes com pontuação abaixo do limiar. Constatamos que 75, 68,8 e 79,7% dos indivíduos com mais de 11, nove a 11 e quatro a oito anos de escolaridade, respectivamente, estavam abaixo dos limiares sugeridos pelo estudo brasileiro de Brucki et al. (2003). A EDG e a idade correlacionaram-se negativamente com o MEEM total e todos os seus domínios. Não houve correlação entre a duração da doença e o MEEM. Indivíduos com alucinações tiveram pontuações mais baixas. Conclusão: A maioria da amostra apresentou desempenho inferior aos limiares, mas não houve grupo controle e nem teste neuropsicológico neste estudo. Mais estudos no nordeste do Brasil são necessários para revisar os valores de corte do MEEM.

Screening Tools for Sarcopenia in Mild to Moderate Parkinson's Disease: Assessing the Accuracy of SARC-F and Calf Circumference.

BACKGROUND: Parkinson's disease (PD) and sarcopenia share similar pathophysiological mechanisms. OBJECTIVE: Estimate the prevalence of sarcopenia in PD patients and describe clinical and demographic features associated with sarcopenia. METHODS: A cross-sectional study was carried out at a tertiary public hospital in Brazil. A modified HY scale of stage 1 to 3, being at least 40 years old and having the ability to stand and walk unassisted were required for eligibility. We evaluated physical performance and muscle mass using DEXA. RESULTS: The study population comprised 124 patients, of which 53 (42.7%) were women. The mean age and mean disease duration were 65.8±10.5 and 10.1±5.8 years, respectively. The mean handgrip strength of 20.4±6.9 in woman and 34.6±8.4 kg in men. Moreover, 50.8% patients had positive SARC-F, 20% patients had probable sarcopenia, 9.6% confirmed sarcopenia, and 16.8% patients showed low muscle mass quantity measured by DEXA. Lower Levodopa Equivalent Dosage (LED) and calf circumference (CC) were independently associated with confirmed sarcopenia. LLED, higher MDS-UPDRS Part III, and lower MMSE scores were independently associated with probable sarcopenia. The CC demonstrated accuracy to identify PD patients with confirmed sarcopenia with a cut-off of <31 cm in women and <34 cm in men. CONCLUSION: We found low prevalence of confirmed sarcopenia among PD patients. We propose that healthcare providers introduce measuring CC, which is a quick and inexpensive method to assess for sarcopenia in PD patients.

Muscle Quality in Older Adults: A Scoping Review.

OBJECTIVE: This scoping review aimed to map out currently available definitions and assessment methods of muscle quality in older adults. DESIGN: Scoping review. SETTING AND PARTICIPANTS: All available studies. METHODS: Four databases (PubMed, EMBASE, Web of Science, and Cochrane Library) were searched from inception to May 2022. Title, abstract, and full-text screening were undertaken by 2 reviewers independently. Observational and experimental studies were eligible for inclusion if there was a clear description of muscle quality assessment in individuals aged 60+ years. RESULTS: A total of 96 articles were included. Several definitions and assessment methods of muscle quality were identified and divided into 2 main domains: (1) functional domain, and (2) morphological domain. A total of 70% and 30% of the included studies assessed muscle quality in the functional and morphological domains, respectively. In the functional domain, most studies defined muscle quality as the ratio of knee extension strength by leg lean mass (45.9%). In the morphological domain, most studies defined muscle quality as the echo intensity of quadriceps femoris by ultrasound (50.0%). CONCLUSIONS AND IMPLICATIONS: There is a substantial heterogeneity of definitions and assessment methods of muscle quality in older adults. Herein, we propose a standardized definition of muscle quality to include terminology, domain, and assessment methods (tests, tools, and body sites). Such standardization may help researchers, clinicians, and decision makers use muscle quality as a potential marker of "skeletal muscle health" in older adults.

Cognitive Dysfunction Biomarkers in Patients With Rheumatoid Arthritis: A Systematic Review.

BACKGROUND/OBJECTIVES: During the last years, a growing number of studies have investigated the link between cognitive dysfunction and rheumatoid arthritis (RA), highlighting the potential pathogenic role of several clinical, psychological, and biological factors. We aimed to investigate serological and cerebrospinal fluid biomarkers in humans and its association with cognitive dysfunction in patients with RA. METHODS: We performed a systematic review using PRISMA (Preferred Reported Items for Systematic Reviews and Meta-analysis) protocol. A systematic search was conducted in the PubMed/MEDLINE, EMBASE, LILACS, Scopus, and Google Scholar databases from inception up to November 2021. The inclusion criteria for studies were defined based on the participants involved, type of exposure, type of comparison group, outcome of interest, and study design. RESULTS: Five original studies were included, which provided data from 428 participants. Among plasma proteins, SHH was increased and TTR was reduced in patients with mild cognitive impairment; anti-myelin basic protein and anti-myelin oligodendrocyte glycoprotein negatively correlated with memory, executive function, and attention. S100ß negatively correlated with memory and executive functions; some lymphocyte subpopulations positively correlated with attention, memory, and executive functions. Interleukin 2 [IL-2], IL-4, IL-6, and tumor necrosis factor α negatively correlated with memory and positively correlated with executive functions. Interleukin 1ß negatively correlated with global cognitive dysfunction and positively correlated with logical thinking. Interleukin 10 and brain-derived neurotrophic factor negatively correlated with memory. CONCLUSION: Despite the relative scarcity of studies on this subject and the heterogeneity of results, we identified possible biomarkers for cognitive deficits in the RA population. Further longitudinal studies are warranted to clarify these associations and the establishment of possible biomarkers for cognitive deficits in RA.

Falls in Parkinson's disease: the impact of disease progression, treatment, and motor complications.

The prevalence of Parkinson's disease (PD) tends to increase worldwide in the coming decades. Thus, the incidence of falls is likely to increase, with a relevant burden on the health care system. Objective: The objective of this study was to evaluate clinical factors and drug use associated with falls in PD patients. Methods: We conducted a cross-sectional study at the Movement Disorders outpatient clinic of a tertiary hospital in Northeast Brazil. We performed structured interviews to collect sociodemographic and clinical data. Functional capacity was assessed using the Schwab and England Activities of Daily Living Scale and the modified Hoehn and Yahr Staging Scale. We divided the study sample into non-fallers (no falls) and fallers (≥1 fall), and non-recurrent (≤1 fall) and recurrent fallers (>1 fall). Results: The study population comprised 327 PD patients (48% women), with a mean age of 70 years. The mean disease duration was 9.9±6.9 years. The most prevalent comorbidities were depression (47.2%), hypertension (44.0%), and type 2 diabetes mellitus (21.5%). The logistic regression analysis revealed that hallucinations, amantadine, and catechol-O-methyltransferase inhibitors (entacapone) were independently associated with falls in PD patients. Also, hallucinations, dyskinesia, and the use of amantadine were independently associated with recurrent falls. Conclusions: Health care providers play an essential role in fall prevention in PD patients, particularly by identifying older adults experiencing dyskinesia and visual hallucinations. Prospective studies should investigate the use of amantadine as a risk factor for falls in PD patients.

Estima-se aumento na prevalência da doença de Parkinson (DP) em todo o mundo nas próximas décadas. Dessa forma, espera-se também aumento na incidência de quedas e seu impacto no sistema de saúde. Objetivo: O objetivo deste estudo foi avaliar fatores clínicos e medicamentos associados a quedas em pacientes com DP. Métodos: Trata-se de um estudo observacional transversal, realizado no ambulatório de Distúrbios do Movimento de hospital terciário no Brasil. Os dados sociodemográficos e clínicos foram coletados por meio de entrevista estruturada. A capacidade funcional foi avaliada pela Escala de Atividades de Vida Diária de Schwab e England e o estadiamento por Hoehn e Yahr modificado. A amostra foi dividida em não caidores (0 quedas) e caidores (≥1 queda) e não caidores recorrentes (≤1 queda) e caidores recorrentes (>1 queda). A informação sobre o número de quedas nos últimos seis meses foi confirmada com familiares e cuidadores. Resultados: A população do estudo foi de 327 pacientes (48% mulheres), com idade média de 70 anos e duração média da doença de 9,9±6,9 anos. As comorbidades mais prevalentes foram depressão (47,2%), hipertensão (44%) e diabetes mellitus tipo 2 (21,5%). A análise de regressão logística revelou que alucinações visuais, uso de amantadina e uso de entacapona foram independentemente associadas a quedas. Alucinações visuais, discinesia e uso de amantadina foram independentemente associados a quedas recorrentes neste estudo. Conclusões: Os profissionais de saúde desempenham um papel importante na prevenção de quedas em pacientes com DP, principalmente idosos que apresentam discinesia e alucinações visuais. Estudos prospectivos da amantadina devem ser realizados para investigar sua associação com quedas em pacientes com DP.

Effects of a power strength training using elastic resistance exercises on the motor and non-motor symptoms in patients with Parkinson's disease H&Y 1-3: study protocol for a randomised controlled trial (PARK-BAND Study).

INTRODUCTION: Parkinson's disease (PD) is the second most common neurodegenerative disorder in Brazil. Physical activity is a complementary intervention in managing inherent declines associated with the disease like strength, balance, gait, and functionality and benefit health-related outcomes. Here, we report the PARK-BAND Study protocol, which aims to investigate potential benefits of power training using elastic devices in participants with PD. Our intervention will be provided in patients with PD using elastic devices like elastic bands and tubes. Therefore, we used the term Park from Parkinson's disease and band from elastic bands. METHODS AND ANALYSIS: This randomised single-blind single-centre two-arm parallel, superiority trial will include 50 participants with PD attending the clinical setting. Those who meet the eligibility criteria and provide consent to participate will be randomised in a 1:1 ratio to either the exercise group, which will receive power training programme or the health education group, which will receive the education programme. Randomisation will be performed by permuted block randomisation with a block size of eight. Both groups will receive a 12-week intervention. The exercise group will have two sessions per week and the health education group will have one session per week. Changes from baseline in bradykinesia, as assessed by the Unified Parkinson's Disease Rating Scale motor examination subscore and physical functional performance, will be the primary outcomes. Secondary outcomes include other neurological, neurophysiological and physical variables, as well as the quality of life, depression, cognition, sleep quality and disturbances, assessed before and after interventions. We hypothesise that the exercise group will have greater improvement in primary and secondary outcomes than the health education group. ETHICS AND DISSEMINATION: The study is approved by the Research Ethics Committee of Hospital Universitário Walter Cantidio and all participants will provide their written informed consent (register number 91075318.1.0000.5045).Trial results will be disseminated via peer reviewed journal articles and conference presentations, reports for organisations involved with PD and for participants. TRIAL REGISTRATION NUMBER: Registro Brasileiro de Ensaios Clínicos Registry (RBR-5w2sqt); Pre-results.

Clinical correlates of sarcopenia and falls in Parkinson's disease.

BACKGROUND: Sarcopenia is a complex and multifactorial geriatric condition seen in several chronic degenerative diseases. This study aimed to screen for sarcopenia and fall risk in a sample of Parkinson's disease (PD) patients and to investigate demographic and clinical factors associated. METHODS: This is a cross-sectional study. We evaluated 218 PD patients at the Movement Disorders Clinic in Fortaleza, Brazil, and collected clinical data including experiencing falls in the six months prior to their medical visit. Probable sarcopenia diagnosis was confirmed by using a sarcopenia screening tool (SARC-F questionnaire) and the presence of low muscle strength. RESULTS: One hundred and twenty-one patients (55.5%) were screened positive for sarcopenia using the SARC-F and 103 (47.4%) met the criteria for probable sarcopenia. Disease duration, modified Hoehn and Yahr stage, Schwab and England Activities of Daily Living Scale score, levodopa equivalent dose, probable sarcopenia and positive SARC-F screening were all associated with experiencing falls. Disease duration, lower quality of life and female gender were independently associated with sarcopenia. Experiencing falls was significantly more frequent among patients screened positive in the SARC-F compared to those screened negative. CONCLUSIONS: Sarcopenia and PD share common pathways and may affect each other's prognosis and patients' quality of life. Since sarcopenia is associated with lower quality of life and increased risk of falls, active case finding, diagnosis and proper management of sarcopenia in PD patients is essential.