Validation of the Brazilian Portuguese version of the Rapid Eye Movement Sleep Behavior Disorder Screening Questionnaire (RBDSQ-BR).

INTRODUCTION: A diagnosis of rapid eye movement sleep behavior disorder (RBD) currently requires confirmation with polysomnography (PSG). However, PSG may not be sufficiently available. In these situations, a clinical diagnostic measure might be useful. OBJECTIVE: To validate the Brazilian Portuguese version of RBD screening questionnaire (RBDSQ) for patients with Parkinson's disease (PD). METHODS: Using detailed clinical interviews and PSG analysis (diagnostic gold standard), a convenience sample of 69 subjects was divided into the following subgroups: patients with PD and RBD (PD+RBD; n=50) and patients with PD alone (PD-RBD; n=19). RESULTS: RBDSQ-BR showed adequate internal consistency (Cronbach's α=0.809) and, except for item 8, adequate item-test correlation. The retest performed in a second sample (n=13, consecutive) showed high agreement for total score (intraclass correlation coefficient, ICC=0.863) and acceptable agreement for items 2, 3, 6.2, 6.3, 7, and 8 (K>0.60). The receiver operating characteristic (ROC) curve analysis had an area under the curve (AUC) of 0.728. A cut-off score of 4 enabled the correct diagnosis of 76.8% subjects and provided the best balance between sensitivity (84%) and specificity (57.9%), with a 2.0 likelihood ratio of a positive result (LR+) and a 0.3 likelihood ratio of a negative result (LR-). Items 2 and 6.2 had 84.2% specificity and 3.2 LR+. Combined items 1+2+6.2, 2+6.1, and 6.1+6.2 increased the specificity to 94.7%, with LR+ ranging from 6.1 to 7.6. CONCLUSIONS: RBDSQ-BR is a reliable instrument, which may be useful for RBD diagnosis of Brazilian patients with PD. The instrument is also valid and may help in a better selection of cases for a more detailed clinical evaluation or even PSG analysis.

Validation of the Brazilian Portuguese version of the Rapid Eye Movement Sleep Behavior Disorder Screening Questionnaire (RBDSQ-BR) / Validação da Versão Brasileira do Questionário de Triagem do Transtorno Comportamental do Sono REM (QT-TCSREM-BR)

ABSTRACT Introduction: A diagnosis of rapid eye movement sleep behavior disorder (RBD) currently requires confirmation with polysomnography (PSG). However, PSG may not be sufficiently available. In these situations, a clinical diagnostic measure might be useful. Objective: To validate the Brazilian Portuguese version of RBD screening questionnaire (RBDSQ) for patients with Parkinson's disease (PD). Methods: Using detailed clinical interviews and PSG analysis (diagnostic gold standard), a convenience sample of 69 subjects was divided into the following subgroups: patients with PD and RBD (PD+RBD; n=50) and patients with PD alone (PD-RBD; n=19). Results: RBDSQ-BR showed adequate internal consistency (Cronbach's α=0.809) and, except for item 8, adequate item-test correlation. The retest performed in a second sample (n=13, consecutive) showed high agreement for total score (intraclass correlation coefficient, ICC=0.863) and acceptable agreement for items 2, 3, 6.2, 6.3, 7, and 8 (K>0.60). The receiver operating characteristic (ROC) curve analysis had an area under the curve (AUC) of 0.728. A cut-off score of 4 enabled the correct diagnosis of 76.8% subjects and provided the best balance between sensitivity (84%) and specificity (57.9%), with a 2.0 likelihood ratio of a positive result (LR+) and a 0.3 likelihood ratio of a negative result (LR-). Items 2 and 6.2 had 84.2% specificity and 3.2 LR+. Combined items 1+2+6.2, 2+6.1, and 6.1+6.2 increased the specificity to 94.7%, with LR+ ranging from 6.1 to 7.6. Conclusions: RBDSQ-BR is a reliable instrument, which may be useful for RBD diagnosis of Brazilian patients with PD. The instrument is also valid and may help in a better selection of cases for a more detailed clinical evaluation or even PSG analysis.

RESUMO Introdução: O diagnóstico do transtorno comportamental do sono REM (TCSREM) implica na realização da polissonografia (PSG), mas sua disponibilidade pode não ser suficiente. Portanto, meios clínicos para o diagnóstico podem ser úteis. Objetivo: Validar para a língua portuguesa falada no Brasil o questionário de triagem do TCSREM (QT-TCSREM) em pacientes portadores de doença de Parkinson (DP). Métodos: Uma amostra por conveniência composta de 69 indivíduos foi dividida em portadores de DP com TCSREM (n=50) e DP sem TCSREM (n=19) através de entrevista clínica detalhada e análise da PSG. Resultados: QT-TCSREM-BR apresentou consistência interna adequada (α de Cronbach=0,809) e, exceto pelo item 8, correlação item-total adequada. Reteste feito em uma segunda amostra (n=13, consecutivos) evidenciou concordância elevada para o escore total (coeficiente de correlação intraclasse, CCI=0,863) e aceitável para os itens 2, 3, 6.2, 6.3, 7 e 8 (K>0,60). Análise da curva característica de operação do receptor (COR) obteve uma área sob a curva de 0,728. O corte 4 permitiu o diagnóstico correto de 76,8% dos indivíduos e apresentou o melhor equilíbrio entre sensibilidade (84%) e especificidade (57,9%), com uma razão de verossimilhança de um resultado positivo (RV+) 2,0 e de um resultado negativo (RV-) 0,3. Os itens 2 e 6.2 obtiveram especificidade 84,2% e RV+ 3,2. Itens combinados 1+2+6,2, 2+6,1 e 6,1+6,2 aumentaram a especificidade para 94,7%, com RV+ variando de 6,1 até 7,6. Conclusões: O QT-TCSREM-BR é um instrumento confiável que pode ser útil para o diagnóstico do TCSREM em pacientes com DP no Brasil. O instrumento também é válido e pode auxiliar numa melhor seleção de casos a serem submetidos a uma avaliação mais detalhada ou até mesmo a uma análise de PSG.

Effects of spinal cord stimulation on postural control in Parkinson's disease patients with freezing of gait.

Freezing of gait (FoG) in Parkinson's disease (PD) is an incapacitating transient phenomenon, followed by continuous postural disorders. Spinal cord stimulation (SCS) is a promising intervention for FoG in patients with PD, however, its effects on distinct domains of postural control is not well known. The aim of this study is to assess the effects of SCS on FoG and distinct domains of postural control. Four patients with FoG were implanted with SCS systems in the upper thoracic spine. Anticipatory postural adjustment (APA), reactive postural responses, gait and FoG were biomechanically assessed. In general, the results showed that SCS improved FoG and APA. However, SCS failed to improve reactive postural responses. SCS seems to influence cortical motor circuits, involving the supplementary motor area. On the other hand, reactive posture control to external perturbation that mainly relies on neuronal circuitries involving the brainstem and spinal cord, is less influenced by SCS.

Cluster analysis of cognitive performance in a sample of patients with Parkinson's disease / "Análise de Cluster" do desempenho cognitivo em uma amostra de pacientes com doença de Parkinson

ABSTRACT Background: Cognitive impairment is a common feature of Parkinson's disease (PD). The diagnoses of mild cognitive impairment (MCI) in patients with PD implies an increased risk for later development of dementia, however, it is unclear whether a specific type of cognitive loss confers increased risk for faster cognitive decline. Objective: Determine whether it was possible to identify distinct cognitive phenotypes in a sample of patients with PD. Methods: A cross-sectional evaluation of 100 patients with PD recruited from a movement disorders clinic was conducted. The patients were evaluated using the simplified motor score of the UPDRS, the Hoehn and Yahr, Schwab and England, Geriatric Depression Scale, Pfeffer Functional Activities Questionnaire, Clinical Dementia Rating Scale, Mini-Mental State Examination, clock drawing test, digit span, word list battery of CERAD, Frontal Assessment Battery and verbal fluency test. We classified the patients as having normal cognition (PDNC), MCI (PDMCI) or dementia (PDD). Data were analyzed using the chi-square test, non-parametric statistics and cluster analysis. Results: There were 40 patients with PDD, 39 with PDMCI and 21 with PDNC. Patients with PDD were older, had longer disease duration, lower education and lower MMSE scores. Cluster analysis showed 3 general distinct cognitive profiles that represented a continuum from mild to severe impairment of cognition, without distinguishing specific cognitive profiles. Conclusion: Cognitive impairment in PD occurs progressively and heterogeneously in most patients. It is unclear whether the definition of the initial phenotype of cognitive loss can be used to establish the cognitive prognosis of patients.

RESUMO Embasamento: O comprometimento cognitivo é um problema comum da doença de Parkinson (DP). O diagnóstico de comprometimento cognitivo leve (CCL) em pacientes com DP implica em risco aumentado para o desenvolvimento posterior de demência, no entanto, não é claro se algum tipo específico de perda cognitiva confere risco para um declínio cognitivo mais rápido. Objetivo: Determinar se seria possível identificar fenótipos cognitivos em uma amostra de pacientes com DP. Métodos: Foi uma avaliação transversal de 100 pacientes com DP recrutados de uma clínica de distúrbios de movimento. Eles foram avaliados utilizando um escore motor simplificado da UPDRS, Hoehn e Yahr, Schwab e England, Escala de Depressão Geriátrica, Questionário de Atividades Funcionais de Pfeffer, Escala CDR, Mini-Exame do Estado Mental, desenho do relógio, extensão de dígitos, lista de palavras da bateria do CERAD, bateria de avaliação frontal e teste de fluência verbal. Nós classificamos os pacientes como tendo cognição normal (PDCN), CCL (PDCCL) ou demência (PDD). Os dados foram analisados por meio do teste do qui-quadrado, estatística não-paramétrica e análise de cluster. Resultados: Havia 40 pacientes com PDD, 39 com PDCCL e 21 com PDCN. Pacientes com PDD eram mais velhos, tinham maior tempo de doença, menor escolaridade e desempenho inferior no MEEM. A análise de cluster mostrou 3 perfis cognitivos distintos que representariam um continuo entre discreto a grave comprometimento da cognição, sem distinguir perfis cognitivos específicos. Conclusão: O comprometimento cognitivo na DP ocorre de forma progressiva e heterogênea na maioria dos pacientes. Não é claro se a definição do fenótipo inicial de perda cognitiva poderia ser utilizado para estabelecer o prognóstico cognitivo para o paciente.

The interlocking finger test in patients with Parkinson's disease and healthy subjects.

The interlocking finger test (ILFT) is a bedside screening test in which the subject must imitate four bimanual finger gestures without symbolic meaning. We assessed the utility of the test in the cognitive evaluation of patients with Parkinson's disease (PD). We evaluated 88 healthy subjects and 101 patients with PD using a simplified motor score of the Unified Parkinson's Disease Rating Scale (UPDRS), Hoehn and Yahr and Schwab and England scales, Geriatric Depression Scale, Pfeffer Functional Activities Questionnaire, Clinical Dementia Rating, Mini-Mental State Examination, clock drawing test, digit span, word list battery of the Consortium to Establish a Registry for Alzheimer's Disease assessment, Frontal Assessment Battery, semantic verbal fluency test, and the ILFT. Diagnoses of mild cognitive impairment and dementia were made using the Movement Disorder Society diagnostic criteria. ILFT scores in healthy subjects correlated significantly with age (p=0.001) and only one healthy subject scored 2 in the test. ILFT scores were significantly lower in patients with PD and dementia (p=0.001) and significantly correlated with cognitive and functional tests, but not with depressive symptoms (p=0.607), Hoehn and Yahr scores (p=0.907), or Schwab and England scores (p=0.701). Twenty-five patients with dementia, three patients with mild cognitive impairment, and six patients with apparently normal cognition scored less than 3 in the ILFT. The area under the receiver operating characteristic curve for the ILFT to discriminate patients with dementia from those without it was 0.76 (cut-off score of 3/2: sensitivity of 61%, specificity of 0.85). In conclusion, the ILFT seems to be a useful bedside test to assess cognitive impairment in patients with PD.

Cluster analysis of cognitive performance in a sample of patients with Parkinson's disease.

BACKGROUND: Cognitive impairment is a common feature of Parkinson's disease (PD). The diagnoses of mild cognitive impairment (MCI) in patients with PD implies an increased risk for later development of dementia, however, it is unclear whether a specific type of cognitive loss confers increased risk for faster cognitive decline. OBJECTIVE: Determine whether it was possible to identify distinct cognitive phenotypes in a sample of patients with PD. METHODS: A cross-sectional evaluation of 100 patients with PD recruited from a movement disorders clinic was conducted. The patients were evaluated using the simplified motor score of the UPDRS, the Hoehn and Yahr, Schwab and England, Geriatric Depression Scale, Pfeffer Functional Activities Questionnaire, Clinical Dementia Rating Scale, Mini-Mental State Examination, clock drawing test, digit span, word list battery of CERAD, Frontal Assessment Battery and verbal fluency test. We classified the patients as having normal cognition (PDNC), MCI (PDMCI) or dementia (PDD). Data were analyzed using the chi-square test, non-parametric statistics and cluster analysis. RESULTS: There were 40 patients with PDD, 39 with PDMCI and 21 with PDNC. Patients with PDD were older, had longer disease duration, lower education and lower MMSE scores. Cluster analysis showed 3 general distinct cognitive profiles that represented a continuum from mild to severe impairment of cognition, without distinguishing specific cognitive profiles. CONCLUSION: Cognitive impairment in PD occurs progressively and heterogeneously in most patients. It is unclear whether the definition of the initial phenotype of cognitive loss can be used to establish the cognitive prognosis of patients.

EMBASAMENTO: O comprometimento cognitivo é um problema comum da doença de Parkinson (DP). O diagnóstico de comprometimento cognitivo leve (CCL) em pacientes com DP implica em risco aumentado para o desenvolvimento posterior de demência, no entanto, não é claro se algum tipo específico de perda cognitiva confere risco para um declínio cognitivo mais rápido. OBJETIVO: Determinar se seria possível identificar fenótipos cognitivos em uma amostra de pacientes com DP. MÉTODOS: Foi uma avaliação transversal de 100 pacientes com DP recrutados de uma clínica de distúrbios de movimento. Eles foram avaliados utilizando um escore motor simplificado da UPDRS, Hoehn e Yahr, Schwab e England, Escala de Depressão Geriátrica, Questionário de Atividades Funcionais de Pfeffer, Escala CDR, Mini-Exame do Estado Mental, desenho do relógio, extensão de dígitos, lista de palavras da bateria do CERAD, bateria de avaliação frontal e teste de fluência verbal. Nós classificamos os pacientes como tendo cognição normal (PDCN), CCL (PDCCL) ou demência (PDD). Os dados foram analisados por meio do teste do qui-quadrado, estatística não-paramétrica e análise de cluster. RESULTADOS: Havia 40 pacientes com PDD, 39 com PDCCL e 21 com PDCN. Pacientes com PDD eram mais velhos, tinham maior tempo de doença, menor escolaridade e desempenho inferior no MEEM. A análise de cluster mostrou 3 perfis cognitivos distintos que representariam um continuo entre discreto a grave comprometimento da cognição, sem distinguir perfis cognitivos específicos. CONCLUSÃO: O comprometimento cognitivo na DP ocorre de forma progressiva e heterogênea na maioria dos pacientes. Não é claro se a definição do fenótipo inicial de perda cognitiva poderia ser utilizado para estabelecer o prognóstico cognitivo para o paciente.

Comparison Between Dysport and Prosigne in the Treatment of Cervical Dystonia.

UNLABELLED: Cervical dystonia is the most frequent type of primary focal dystonia and treatment with botulinum toxin (BTX) is currently the criterion standard. OBJECTIVE: In this study, we compared the safety and efficacy of the following 2 formulations of BTXs available in Brazil: abobotulinumtoxin A (Dysport) and Lanzhou BTX type A (Prosigne), during a follow-up of 13 months. METHODS: We conducted a prospective, randomized, double blind trial with 1 group being treated with Dysport and the other with Prosigne. RESULTS: Fourteen patients were randomized to receive Dysport and 20 patients to receive Prosigne, each patient was followed during 13 months and received 5 injections of BTX in this period. The dose equivalency used was 3 U of Dysport for 1 U of Prosigne. After each treatment session, we assessed improvement with the Clinician Interview-Based Impression of Change scale and asked about adverse effects and duration of improvement. We also used the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) before and after the first and fifth treatment sessions. After the first injection, mean TWSTRS values reduced 12.78 points in the Dysport group and 9.98 in the Prosigne group (P = 0.38). After the last injection, the reduction in TWSTRS values was 11.87 points for Dysport and 11.35 points for Prosigne (P = 0.86). CONCLUSIONS: Our data showed similar efficacy and safety profiles when comparing both toxins in the treatment of cervical dystonia.

An analysis of the cognitive items of the movement disorders society checklist for the diagnosis of dementia in patients with Parkinson's disease.

OBJECTIVE: Some studies about the Movement Disorders Society checklist for the diagnosis of Parkinson's disease (PD) dementia (PDD) suggested that its accuracy was not totally satisfactory. Our study focused to evaluate the two items of the checklist related to the cognitive assessment. METHODS: We assessed 95 consecutive patients with a diagnosis of PD using the UPDRS, Hoehn and Yahr, Schwab and England scales, Pfeffer Functional Activities Questionnaire, MMSE, Clinical Dementia Rating, clock drawing test, verbal fluency test (animals), digit span, word list battery of CERAD, Frontal Assessment Battery and the 15-item Geriatric Depression Scale The cognitive diagnosis was based on the MDS diagnostic criteria for PDD. The checklist was completed later by a blinded investigator. The data were evaluated using descriptive analysis and calculation of sensitivity, and specificity of the checklist for the diagnosis of PDD. RESULTS: 33 patients (35%) were diagnosed with PDD. The ROC curve showed that the MMSE cut-off score < 26 had the highest accuracy (sensitivity: 94%, specificity: 55%) for the diagnosis of PDD. Using the checklist with original cut-off scores we found sensitivity of 97% and specificity of 58%. Using an alternative way to interpret the cognitive assessment of the checklist we found sensitivity of 94% and specificity of 89% for the diagnosis of PDD. CONCLUSIONS: Our findings suggest that to improve the accuracy of the checklist, it would be necessary to adjust the way we use and interpret the cut-off scores of the MMSE and of the subtests, without the need to eliminate their use.

Frontal assessment battery in a Brazilian sample of healthy controls: normative data / Bateria de avaliação frontal em uma amostra brasileira de controles saudáveis: dados normativos

OBJECTIVE: To show data on the performance of healthy subjects in the Frontal Assessment Battery (FAB), correlating with gender, age, education, and scores in the Mini-Mental State Examination (MMSE). METHODS: Two hundred and seventy-five healthy individuals with mean age of 66.4±10.6 years-old were evaluated. Mean total FAB scores were established according to the educational level. RESULTS: Mean total FAB scores according to the educational level were 10.9±2.3, for one to three years; 12.8±2.7, for four to seven years; 13.8±2.2, for eight to 11 years; and 15.3±2.3, for 12 or more years. Total FAB scores correlated significantly with education (r=0.47; p<0.0001) and MMSE scores (r=0.39; p<0.0001). No correlation emerged between FAB scores, age, and gender. CONCLUSION: In this group of healthy subjects, the Brazilian version of the FAB proved to be influenced by the education level, but not by age and gender.

OBJETIVO: Avaliar o desempenho de indivíduos brasileiros saudáveis na Bateria de Avaliação Frontal (FAB) correlacionado com gênero, idade, educação e escores do Exame do Mini-Mental (MMSE). MÉTODOS: Foram avaliados 275 controles saudáveis com média de idade de 66,4±10,6 anos. Os escores médios foram estabelecidos de acordo com o nível educacional. RESULTADOS: Os escores médios da FAB em relação ao nível educacional foram 10,9±2,3 para um a três anos; 12,8±2,7 para quatro a sete anos; 13,8±2,2 para oito a 11 anos e 15,3±2,3 para 12 ou mais anos. Os escores totais da FAB se correlacionaram significativamente com o nível educacional (r=0,47; p<0,0001) e com os escores do MMSE (r=0,39; p<0,0001). Não foram observadas correlações significativas entre os escores da FA, o gênero e a idade. CONCLUSÃO: Na presente amostra, a versão brasileira da FAB sofreu influência do nível de escolaridade, mas não da idade e do gênero.

Frontal assessment battery in a Brazilian sample of healthy controls: normative data.

OBJECTIVE: To show data on the performance of healthy subjects in the Frontal Assessment Battery (FAB), correlating with gender, age, education, and scores in the Mini-Mental State Examination (MMSE). METHODS: Two hundred and seventy-five healthy individuals with mean age of 66.4 ± 10.6 years-old were evaluated. Mean total FAB scores were established according to the educational level. RESULTS: Mean total FAB scores according to the educational level were 10.9 ± 2.3, for one to three years; 12.8 ± 2.7, for four to seven years; 13.8 ± 2.2, for eight to 11 years; and 15.3 ± 2.3, for 12 or more years. Total FAB scores correlated significantly with education (r=0.47; p<0.0001) and MMSE scores (r=0.39; p<0.0001). No correlation emerged between FAB scores, age, and gender. CONCLUSION: In this group of healthy subjects, the Brazilian version of the FAB proved to be influenced by the education level, but not by age and gender.

Use of the frontal assessment battery in evaluating executive dysfunction in patients with Huntington's disease.

The frontal assessment battery (FAB) is a bedside cognitive scale designed to measure executive functions. Huntington's disease (HD) is a neurodegenerative disorder characterized by motor, behavioral, and cognitive dysfunction. The aim of this study was to check the validity of the FAB for the evaluation of cognitive impairment in patients with HD. Forty-one patients diagnosed with HD and 53 healthy controls matched by education, sex and age were evaluated with a validated Brazilian version of the UHDRS, the VFT, the SDMT, the SIT, the MMSE, and the FAB. The diagnosis of HD was made by DNA analysis. FAB scores were lower in patients than in the controls (p < 0.001) and had significant correlations with the VFT (r = 0.79; p < 0.05), the SDMT (r = 0.80; p < 0.05), the SIT (r = 0.72; p < 0.05), the MMSE (r = 0.83; p < 0.05), the FCS (r = 0.79; p < 0.05) and the motor section of the UHDRS (r = -0.80; p < 0.05). The FAB differentiated between HD patients in the initial and later stages of the disease. The one-year longitudinal evaluation revealed a global trend toward a worsening in the second score of the FAB. The results demonstrate that the FAB presents good internal consistency and also convergent and discriminative validity; therefore it is a useful scale to assess executive functions and to evaluate cognitive impairment in patients with HD.

Visuospatial cognitive tests for the evaluation of patients with Parkinson's disease.

Parkinson's disease (PD) is a neurological disorder characterized by motor disturbances, neuropsychological symptoms and cognitive changes, including cases of dementia. The most frequently described cognitive changes in these patients involve executive and visuospatial functions, which are very important for the execution of daily life activities. OBJECTIVE: To compare different tests used to examine visuospatial functions in patients with PD. METHODS: Thirty-five patients (21 women) with PD symptoms (medicated and "on") and mean schooling of 5.5±4.2 years were examined using the following tests: Mini-Mental State Examination (MMSE), Dementia Rating Scale (DRS), Scales of Outcomes of Parkinson's Disease (SCOPA-COG), Hooper Visual Organization Test (HVOT), Judgment of Line Orientation, Form V (JLO), and Clock drawing task - CLOX (1 and 2). RESULTS: The mean MMSE score was 24.8±3.03and 54.8% of the patients performed correctly in the copy of a pentagon drawing, with a medium-level performance in most tests. Good correlations were detected between JLO versus SCOPA Assembling patterns (0.67), JLO versus HVOT (0.56), JLO versus CLOX2 (0.64), SCOPA Figure Composition versus HVOT (0.54), CLOX1 versus CLOX2 (0.43), and DRS Construction versus CLOX2 (0.42). DISCUSSION: Although correlations were detected, not all were strong, probably because the tests employed do not measure solely visuospatial functions, but also other skills such as attention, motor ability and executive functions. A limitation of the present study was the lack of a control group for the establishment of adequate standards for this population.

A doença de Parkinson (PD) é um transtorno neurológico caracterizado por distúrbios motores, sintomas neuropsicológicos e por alterações cognitivas, inclusive casos de demência. As alterações cognitivas mais descritas nesses pacientes são as funções executivas e as visuais-espaciais, funções importantíssimas para a realização de atividades da vida diária. OBJETIVO: Comparar diferentes testes que examinam funções visuais-espaciais em pacientes com DP. MÉTODOS: Foram avaliados 35 pacientes (21 mulheres) sintomáticos para DP (medicados e em "on") e escolaridade média de 5,5±4,2 com os seguintes testes: Mini-Exame do Estado Mental (MEEM), Escala de Avaliação de Demência de Mattis (EADM), Escala de Conseqüências da Doença de Parkinson (SCOPA-COG), Teste de Organização Visual de Hooper (TOVH), Julgamento de Orientação de Linhas ­ Forma V (JOL), e Teste do Desenho do Relógio ­ CLOX (1 e 2). RESULTADOS: Os pacientes obtiveram média 24,8±3,03 no MMSE e 54,8% acertou o de cópia do desenho do pentágono e desempenho mediano na maioria dos testes. Foram encontradas boas correlações entre JOL versus SCOPA Composição de Figuras (0.67), JLO versus TOVH (0.56), JOL versus CLOX2 (0.64), SCOPA Composição de Figuras versus TOVH (0.54), CLOX1 versus CLOX2 (0.43) e EADM Construção versus CLOX2 (0.42). DISCUSSÃO: Mesmo tendo sido verificadas correlações, nem todas foram "fortes", o que pode ser explicado pelo fato de que os testes não medem somente funções visuais-espaciais, mas outras habilidades como atenção, habilidade motora e funções executivas. Uma dificuldade do presente estudo diz respeito à falta de grupo controle para estabelecer padrões adequados à essa população.

Executive cognitive tests for the evaluation of patients with Parkinson's disease.

Parkinson's disease (PD) is characterized by changes in movement, which are later followed by cognitive, behavioral and psychological changes. The objective of the present study was to correlate different tests used to examine executive functions in PD patients followed at a specialized outpatient clinic. METHODS: Thirty-five patients with idiopathic PD aged 63.0 years on average and with mean schooling of 5.5±4.2 years, were examined using the following tests: Mattis Dementia Rating Scale (MDRS), Scales for Outcomes of Parkinson's Disease-Cognition (SCOPA-COG), Wisconsin Card Sorting Test (WCST), Frontal Assessment Battery (FAB), Digit Span - Inverse Order (IO) (a subtest of the WAIS III) and Verbal Fluency Test (category animals). RESULTS: Significant correlations were detected between FAB and MDRS Conceptualization (0.814), MDRS Initiation/Perseveration (I/P) and SCOPA-COG Executive Function (0.643), FAB and MDRS I/P (0.601), FAB and Verbal Fluency (0.602), MDRS I/P and MDRS Conceptualization (0.558), Verbal Fluency and MDRS I/P (0.529), MDRS Attention and SCOPA-COG Executive Function (0.495), MDRS Conceptualization and SCOPA-COG Executive Function (0.520), FAB and Digit Span (OI) (0.503), Verbal Fluency and MDRS Conceptualization (0.501), and WCST perseverative errors and FAB (-0.379), WCST perseverative errors and MDRS Conceptualization (0.445), WCST perseverative errors and MDRS I/P (-0.407) and WCST categories completed and MDRS Conceptualization (0.382). DISCUSSION: The results demonstrated strong correlations between most of the tests applied, but no associations were detected between the WCST and the other tests, a fact that may be explained by the heterogeneity of scores obtained in the tests by the patients evaluated. A difficulty of the present study was the lack of a control groups for the establishment of adequate standards for this population.

A doença de Parkinson (DP) caracteriza-se por alterações do movimento, cognitivas, comportamentais e psicológicas. O objetivo do presente estudo foi correlacionar diferentes testes que examinam funções executivas em pacientes com DP acompanhados em um ambulatório especializado. MÉTODOS: Foram avaliados 35 pacientes com DP idiopática com idade média de 63,0 anos e escolaridade média de 5,5±4,2 utilizando os seguintes testes: Escala de Avaliação de demência de Mattis (EADM), Escala de Desfechos da Doença de Parkinson (SCOPA-COG), Teste Wisconsin de Classificação de Cartas (WCST), Bateria de Avaliação Frontal (BAF), Amplitude de Dígitos-Ordem Inversa (OI) (subteste do WAIS III) e Teste de Fluência Verbal (categoria animais). RESULTADOS: Foram encontradas correlações significativas entre BAF e EADM Conceituação (0,814), EADM Iniciativa/Perseveração (I/P) e SCOPA-COG Funções Executivas (0,643), BAF e EADM I/P (0,601), BAF e Fluência Verbal (0,602) e EADM I/P e EADM Conceituação (0,558), Fluência Verbal e EADM I/P (0,529), EADM Atenção e SCOPA-COG Funções Executivas (0,49), EADM Conceituação e SCOPA-COG Funções Executivas (0,495), BAF e Amplitude de dígitos (OI) (0,503), Fluência Verbal e EADM Conceituação (0,501), WCST Erros Perseverativos e BAF (­0,379), WCST erros perseverativos e MDRS Conceptualization (­0,445), WCST erros perseverativos e EADM I/P (­0,407) e WCST categorias completas e EADM Conceituação (0,382). DISCUSSÃO: Os resultados evidenciaram fortes correlações entre a maioria dos testes aplicados. Uma dificuldade do estudo presente diz respeito à falta de grupo controle para estabelecer padrões adequados a essa população.