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.

Brazilian Portuguese validation of Mood Disorder Questionnaire.

BACKGROUND: The Mood Disorder Questionnaire (MDQ) is a screening instrument for bipolar spectrum disorders already validated in many languages. METHODS: Patients from 2 psychiatric outpatient facilities were diagnosed with bipolar disorder (BD) type I and II and major depression according to the mood module of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (SCID), Axis I Disorders--Clinician Version. In addition, a control group of healthy subjects was selected. The diagnostic interviews were used as the gold standard against which to investigate the performance of the MDQ. The MDQ was administered to 153 subjects, distributed among 4 groups. We analyzed the test reliability and discriminative capacity of the MDQ for the detection of patients with BD. RESULTS: Based on the SCID, Axis I Disorders--Clinician Version, 52 subjects (33.3%) presented a bipolar spectrum disorder (type I, II, or not otherwise specified), 48 (32.4%) were diagnosed as having unipolar depressive disorder, whereas 54 (35.3%) were unaffected by any type of psychiatric disorder (had no psychiatric disorder according to SCID results). The sensitivity for bipolar disorder was 0.72 (bipolar I disorder, 0.81; bipolar II disorder, 0.58; and bipolar disorder not otherwise specified, 0.69), with specificity of 0.95. The Brazilian Portuguese MDQ demonstrated adequate internal consistency (Cronbach α = .87). LIMITATIONS: Recruiting patients attending tertiary services may inflate the performance of the MDQ. CONCLUSIONS: The performance of the Brazilian Portuguese MDQ is comparable with other language validations. In a psychiatric outpatient sample, the Brazilian Portuguese MDQ proves to be a feasible and reliable screening instrument.

Feasibility indicators of telemedicine for patients with dementia in a public hospital in Northeast Brazil during the COVID-19 pandemic.

BACKGROUND: The use of telemedicine has become a fundamental tool in healthcare in recent years, especially at times of Covid-19 pandemic. Currently, there are several telemedicine tools that are simple, inexpensive, and effective means of communication. This article aims to describe indicators of feasibility including patient recruitment, attendance, discomfort (internet connection issues and/or noncompliant patient behavior), satisfaction, and travel time and cost savings of virtual telemedicine consultations for patients with dementia. METHODS: The study was conducted at the Geriatrics Department of Hospital Universitário Walter Cantídio (HUWC) in Fortaleza, Brazil, between May 1st and December 31, 2020. The eligibility criteria included previous diagnosis of dementia syndrome and receiving care at the hospital's dementia outpatient clinic in face-to-face consultations in the preceding 12 months. Patients were excluded if they did not feel comfortable with virtual consultations, did not have the required communication technology available or their caregiver was not available to attend the remote consultation. The patients were recruited from the outpatient dementia clinic's medical appointment scheduling list. The intervention was designed as a one-time consultation and it included treatment approaches and health promotion recommendations. RESULTS: Patient recruitment, attendance and discomfort rates were 85.5%, 97.7% and 9.4%, respectively. To attend face-to-face visits, they reported an average travel time (including the consultation) of 233.21 minutes and average total cost of 60.61 reais (around USD 11). The study intervention was well accepted among the patients and their caregivers with 97.6% being satisfied. Many were happy to avoid long waits in crowded medical waiting rooms and the risk of covid-19 contagion. CONCLUSIONS: We found good recruitment, attendance, and acceptance rates of remote care for the follow-up of dementia patients as well as low discomfort rates. TRIAL REGISTRATION: Brazilian Trial Registry (REBEC) RBR-9xs978.

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.

Educational disparities in Brazil may interfere with the cognitive performance of Parkinson's disease patients / As disparidades educacionais brasileiras podem interferir na performance cognitiva de pacientes com doença de Parkinson

ABSTRACT. 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.

RESUMO. 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.

Falls in Parkinson's disease: the impact of disease progression, treatment, and motor complications / Quedas na doença de parkinson: impacto da progressão da doença, do tratamento e das complicações motoras

ABSTRACT. 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.

RESUMO. 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.