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OBJECTIVE: Childhood maltreatment is associated with late-life depression. Preliminary evidence indicates that personality characteristics, in particular neuroticism and extroversion, and an anxious attachment style mediate this association. The objective is to evaluate 3 models, in which personality and attachment are considered mediators between childhood maltreatment and late-life depression in a socioeconomically disadvantaged Brazilian population. METHODS: This study included participants (n = 260) from socioeconomically disadvantaged neighborhoods of Porto Alegre, Brazil, who completed measures of childhood maltreatment (Childhood Trauma Questionnaire - CTQ), personality characteristics (NEO-Five Factor Inventory), attachment styles (Relationship Scales Questionnaire), and geriatric depression (Mini-International Neuropsychiatric Interview-Plus). General multiple and sequential mediation analyses were used to test for possible associations. RESULTS: Attachment anxiety but not attachment avoidance is a mediator between childhood maltreatment and geriatric depression. Neuroticism is a full mediator. At that, attachment anxiety was found to be a predictor of neuroticism. Finally, sequential mediation analysis shows a path from childhood maltreatment to geriatric depression through attachment anxiety and neuroticism. CONCLUSIONS: The results suggest a pathway from childhood maltreatment to anxious attachment, which in turn predicts higher neuroticism that itself may favor late-life depression. This hypothesis could have implications for older adults living in low socioeconomic settings in that treating the high-risk group of maltreated children may help prevent late-life depression.
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Maus-Tratos Infantis , Depressão , Humanos , Idoso , Criança , Depressão/psicologia , Personalidade , Transtornos de Ansiedade/psicologia , Ansiedade , Maus-Tratos Infantis/psicologiaRESUMO
OBJECTIVE: To evaluate perceived coercion (PC) of noninstitutionalized elderly patients undergoing research for the diagnosis of temporomandibular joint dysfunction. METHOD: A cross-sectional study conducted with 1,112 elderly individuals aged 60 or older, enrolled in the Family Health Programme of the municipality of Areia, State of Paraíba, Brazil, from January to June 2013. The data collection tool was the Perceived Coercion Scale (PSC). RESULTS: The participants were predominantly women (62.5%) in the 60 to 69 age group (45.9%), illiterate (57.9% percent), married or in a common law marriage (54.1%), retired (83.6%), and receiving a monthly income under the minimum wage (72.0%). The average overall PC was 1.25+ 1.15 and Trend 1 (41,4%). There was a difference between the group of individuals who were literate, married and in a common law marriage and the members of the other groups. CONCLUSION: Results showed that the elderly patients were minimally coerced when deciding whether to participate in research for diagnosing temporomandibular joint dysfunction. They also revealed a significant association of PC with literacy and marital status.
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Idoso/psicologia , Coerção , Experimentação Humana , Sujeitos da Pesquisa/psicologia , Transtornos da Articulação Temporomandibular/diagnóstico , Idoso de 80 Anos ou mais , Brasil , Estudos Transversais , Tomada de Decisões , Escolaridade , Emprego , Feminino , Humanos , Renda , Consentimento Livre e Esclarecido , Masculino , Estado Civil , Inquéritos e Questionários , Transtornos da Articulação Temporomandibular/psicologia , VoliçãoRESUMO
The purpose of this study was to define the Healthy Eating Index (HEI) of the elderly of Southern Brazil and its association with energy, macronutrients and micronutrients intake. A cross-sectional study was conducted with 186 elderly aged 60 and older of the Geriatric Service of São Lucas Hospital, Porto Alegre, Brazil. Dietary data were collected by two 24-hour recalls, and diet quality was assessed by HEI adapted to the Brazilian population. The HEI total score was divided into three categories: inadequate diet (below 51 points), diet needs improvement (between 51 and 80 points), and healthy diet (over 80 points). The results showed that the mean HEI score was 58.8±10.5 points (ranging from 31.4 to 79.8). Most elderly (74.2%) showed a diet that needed modification and no elderly individual had a healthy diet. The quality of the diet was associated with greater intake of carbohydrates, and lower intake of total lipids, saturated fatty acids, cholesterol, and sodium. Consumption of vitamins C and D and calcium was shown to be positively correlated with the quality of the diet. Less than 1.1% of the elderly consumed a varied diet. The findings suggest that the diet of the majority of the elderly needs improvement, reinforcing the importance of care in relation to adequate nutrition in this population, and can help in guiding the activities and programs of nutritional education and public policies that stimulate increasingly healthy eating.
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Dieta/normas , Carboidratos da Dieta/administração & dosagem , Gorduras na Dieta/administração & dosagem , Proteínas Alimentares/administração & dosagem , Micronutrientes/administração & dosagem , Idoso , Idoso de 80 Anos ou mais , Brasil , Estudos Transversais , Dieta/estatística & dados numéricos , Inquéritos sobre Dietas , Ingestão de Energia , Comportamento Alimentar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores SocioeconômicosRESUMO
INTRODUCTION: The influence of cold temperatures on neuropathies has been reported previously, but its impact on carpal tunnel syndrome (CTS) is not well analyzed. METHODS: We analyzed the frequency of CTS among neurophysiological evaluations according to seasonal variation in 9574 consecutive patients (4260 with CTS). RESULTS: A higher frequency of CTS was found in the winter (50.8%), and the lowest number for CTS diagnosis was found in the summer (38.9%). In both autumn and spring the prevalence remained stable at an intermediate level between summer and winter at 42.8% and 43.5%, respectively. CONCLUSION: CTS frequency was much higher in winter in this center.
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Síndrome do Túnel Carpal/epidemiologia , Temperatura Baixa , Estações do Ano , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Adulto JovemRESUMO
BACKGROUND: The aging process causes physiological changes on its own. The combination of an unhealthy lifestyle with the presence of genetic polymorphisms, such as the Val16Ala of the antioxidant enzyme manganese-dependent superoxide dismutase (MnSOD) may contribute to a greater occurrence of cardiometabolic risk factors. OBJECTIVE: This study aimed to verify the association of Val16Ala-MnSOD polymorphism with food intake, caloric expenditure, and cardiometabolic risk factors in the elderly. METHODS: A cross-sectional study with a sample size of 270 elderly individuals assisted in primary health care in the city of Porto Alegre, RS, Brazil. Val16Ala polymorphism, glucose, lipid profile, insulin, HOMA-IR, blood pressure, waist circumference, PCR-us, IL-6, food consumption, and caloric expenditure were evaluated. RESULTS: The average age of the elderly was 68.6 ± 7.6 years. There were statistically significant differences regarding the consumption of two or more servings of fruits and vegetables daily between the elderly VV versus AV (P=0.017). There were also statistically significant differences regarding the consumption of two or more daily servings of legumes and eggs between the elderly AA versus VV (P=0.002). The median of insulin was higher in the elderly AA versus AV (P=0.025) and the median of HOMA-IR was higher in the elderly VV versus AV (P=0.029). AA elderly individuals had higher means of high-density lipoprotein (HDL-c), compared to AV (P=0.029). CONCLUSION: The results suggest that Val16Ala -MnSOD polymorphism is associated with the consumption of fruits, vegetables, legumes, and eggs, as well as with cardiometabolic risk factors in the elderly.
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Fatores de Risco Cardiometabólico , Insulinas , Idoso , Estudos Transversais , Ingestão de Alimentos , Humanos , Insulinas/genética , Polimorfismo Genético , Atenção Primária à Saúde , Superóxido DismutaseRESUMO
Temporomandibular disorders (TMD) can have multiple etiologies, including oromandibular dystonia (OMD). However, in a few cases, the OMD can evolve from cervical dystonia (CD), leading to severe bone degeneration. The purpose of this case report of a 64-year-old woman presenting to the Outpatient Neurology Clinic of the Federal University of Bahia is to illustrate the development of oromandibular dystonia with temporomandibular joint (TMJ) dysfunction after 10 years of cervical dystonia. Clinical examination showed bone degeneration of the mandibular ramus and right TMJ click, a prevalent sound in patients with temporomandibular disorders when they open their mouths or chew. After onabotulinum toxin type A injections in the right lateral pterygoid muscle, the patient improved in swallowing and pain. This case highlights the importance of close follow-up of cervical dystonia patients to identify new dystonic muscles. In our patient, lateral pterygoid muscle involvement was followed by several comorbidities, such as dysphagia and jawbone abnormalities.
Os distúrbios temporomandibulares (DTM) podem ter múltiplas etiologias, incluindo a distonia oromandibular (DO). No entanto, em raros casos, a DO pode evoluir a partir da distonia cervical (DC) e raramente pode levar a degeneração óssea. O objetivo deste relato de caso de uma mulher de 64 anos atendida no Ambulatório de Neurologia da universidade Federal da Bahia é ilustrar o desenvolvimento de distonia oromandibular com disfunção da articulação temporomandibular (ATM) após 10 anos de distonia cervical. O exame clínico mostrou degeneração óssea do ramo mandibular e clique na ATM direita, um som prevalente em pacientes com distúrbios temporomandibulares quando abrem a boca ou mastigam. Após injeções de toxina botulínica tipo A no músculo pterigoideo lateral direito, a paciente apresentou melhora na deglutição e na dor. Este caso destaca a importância do acompanhamento próximo de pacientes com distonia cervical para identificar novos músculos distônicos. Em nossa paciente, o envolvimento do músculo pterigoide lateral foi seguido por várias comorbidades, como disfagia e anormalidades ósseas da mandíbula.
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BACKGROUND: Dysphagia is a predictor of mortality in Parkinson's disease (PD). Developing alternative methods to videofluoroscopy swallowing study (VFSS) for the evaluation of dysphagia is a public health necessity. The Swallowing Clinical Assessment Score in Parkinson's Disease (SCAS-PD) is an alternative and low-cost tool for diagnosis of dysphagia, but had not been properly validated in comparison to the gold-standard method. The objective of this study was to assess the validity and reliability of the SCAS-PD. METHODS: SCAS-PD was applied to 31 patients with PD, and VFSS was conducted concurrently. This clinical assessment uses different volumes and viscosities to identify signs of swallowing impairments. For validation purposes, the interclass correlation coefficient and the weighted kappa were calculated. The AUC of the ROC curve, sensitivity, and specificity values for detection of penetration/aspiration (PA) were assessed. Internal consistency was calculated by Cronbach's alpha. RESULTS: Fifty-one percent of patients were classified with dysphagia. SCAS-PD was differentiated between normal/functional deglutition and dysphagia with AUC 0.97, 95% CI 0.92-1.00, and an optimal cutoff at 19 (sensitivity 100% and specificity 87.5%). The internal consistency was α = 0.91 for the total score. The internal consistency of the SCAS-PD domains was oral phase (α = 0.73), pharyngeal phase (α = 0.86), and signs of PA (α = 0.95). The weighted kappa analysis demonstrated a high rate of concordance at 0.71 (p < 0.001) between SCAS-PD and VFSS. CONCLUSIONS: SCAS-PD has been shown to have a good concordance with the VFSS. Considering this, SCAS-PD is highly applicable in clinical settings, since it is a simple and low-cost diagnostic tool for detecting dysphagia in PD patients.
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OBJECTIVE: To identify risk factors for dementia among the elderly in a rural area of Northeastern Brazil. METHOD: The subjects assessed were all 60 years old or older, and lived in a rural region of Bahia, a Northeastern State of Brazil. CAMDEX, a structured clinical evaluation protocol, was used for diagnosis, and applied at the home of the subjects. RESULTS: The risk factors identified were divided in accordance with socio-demographic characteristics, the presence of co-morbid conditions, and the use of medications. The variables with strong association with dementia were age, history of stroke, arterial hypertension, and sight impairment. CONCLUSION: Advanced age, arterial hypertension, and vascular brain injury were the main risk factors associated with dementia, which suggests that public health measures adopted to prevent and control modifiable risk factors can mitigate the prevalence of high rates of dementia.
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Demência/etiologia , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Demência/diagnóstico , Demência/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , População Rural , Fatores SocioeconômicosRESUMO
Language assessment seems to be an effective tool to differentiate healthy and cognitively impaired aging groups. This article discusses the impact of educational level on a naming task, on a verbal learning with semantic cues task and on the MMSE in healthy aging adults at three educational levels (very low, low and high) as well as comparing two clinical groups of very low (0-3 years) and low education (4-7 years) patients with Alzheimer's disease (AD) and mild cognitive impairment (MCI) with healthy controls. The participants comprised 101 healthy controls, 17 patients with MCI and 19 with AD. Comparisons between the healthy groups showed an education effect on the MMSE, but not on naming and verbal learning. However, the clinical groups were differentiated in both the naming and verbal learning assessment. The results support the assumption that the verbal learning with semantic cues task is a valid tool to diagnose MCI and AD patients, with no influence from education.
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Envelhecimento/fisiologia , Doença de Alzheimer/fisiopatologia , Disfunção Cognitiva/fisiopatologia , Escolaridade , Aprendizagem Verbal/fisiologia , Adulto , Envelhecimento/psicologia , Doença de Alzheimer/psicologia , Análise de Variância , Brasil , Estudos de Casos e Controles , Disfunção Cognitiva/psicologia , Feminino , Envelhecimento Saudável/fisiologia , Envelhecimento Saudável/psicologia , Humanos , Testes de Linguagem , Masculino , Memória Episódica , Testes Neuropsicológicos , Escalas de Graduação Psiquiátrica , Valores de Referência , Semântica , Análise e Desempenho de TarefasRESUMO
BACKGROUND: The corpus callosum index (CCI) can be easily and reliably obtained from conventional magnetic resonance imaging (MRI) and has been proposed as a possible marker of brain atrophy in MS. However, further validation of its correlation with volumetric measurements is still warranted. OBJECTIVE: To assess the correlation of the CCI with the corpus callosum volume (CCV), brain and lesion volumes, and level of disability in MS. METHODS: Cross-sectional, exploratory study including patients with relapsing-remitting MS. Clinical assessment comprised of physical and cognitive disability scales. MRI parameters included conventional volumetric measurements, the CCI (manual), and the CCV (automated). RESULTS: Twenty-four patients were included. There was a strong correlation between the CCI and CCV. The CCI correlated strongly with the white matter and lesion volumes, and moderately with the whole brain volume and scores on the Paced Auditory Serial Addition Test and MS Functional Composite. There were no correlations between the CCI and either gray matter volume or scores on the Expanded Disability Status Scale, the 9-Hole Peg Test, or the Timed 25-Foot Walk test. CONCLUSION: The findings support the validity of the CCI as an easy-to-obtain marker of brain atrophy, lesion load, and cognitive dysfunction in patients with MS.
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Encéfalo/diagnóstico por imagem , Disfunção Cognitiva/diagnóstico por imagem , Esclerose Múltipla Recidivante-Remitente/diagnóstico por imagem , Esclerose Múltipla Recidivante-Remitente/psicologia , Adulto , Encéfalo/patologia , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/patologia , Estudos Transversais , Avaliação da Deficiência , Feminino , Substância Cinzenta/diagnóstico por imagem , Substância Cinzenta/patologia , Humanos , Interpretação de Imagem Assistida por Computador , Imageamento por Ressonância Magnética , Masculino , Esclerose Múltipla Recidivante-Remitente/patologia , Substância Branca/diagnóstico por imagem , Substância Branca/patologiaRESUMO
PURPOSE: Anthropometry is a useful tool for assessing some risk factors for frailty. Thus, the aim of this study was to verify the discriminatory performance of anthropometric measures in identifying frailty in the elderly and to create an easy-to-use tool. METHODS: Cross-sectional study: a subset from the Multidimensional Study of the Elderly in the Family Health Strategy (EMI-SUS) evaluating 538 older adults. Individuals were classified using the Fried Phenotype criteria, and 26 anthropometric measures were obtained. The predictive ability of anthropometric measures in identifying frailty was identified through logistic regression and an artificial neural network. The accuracy of the final models was assessed with an ROC curve. RESULTS: The final model comprised the following predictors: weight, waist circumference, bicipital skinfold, sagittal abdominal diameter, and age. The final neural network models presented a higher ROC curve of 0.78 (CI 95% 0.74-0.82) (P < 0.001) than the logistic regression model, with an ROC curve of 0.71 (CI 95% 0.66-0.77) (P < 0.001). CONCLUSION: The neural network model provides a reliable tool for identifying prefrailty/frailty in the elderly, with the advantage of being easy to apply in the primary health care. It may help to provide timely interventions to ameliorate the risk of adverse events.
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BACKGROUND & AIMS: The ingestion of small to moderate alcohol consumption amounts has been associated to cardiovascular protection. This study aimed to evaluate the association between alcohol consumption and coronary artery disease severity. MATERIAL AND METHODS: Cross-sectional Study with patients undergoing coronary angiography. Age, cardiovascular risk factors (smoking, systemic arterial hypertension, dyslipidemia and diabetes) and alcohol drinking habit were investigated. Alcohol consumption was divided in three categories: nondrinker, moderate alcohol consumption (less than 15 g ethanol/day for women or 30 g ethanol/day for men) and heavy alcohol consumption. Coronary artery disease severity was assessed through the Friesinger Score (FS) in the coronary angiography, by interventional cardiologists blinded to alcohol consumption. RESULTS: The final sample included 363 adults; of those, 228 were men (62.81%). Mean age was 60.5 ± 10.9 y. Unadjusted analyses identified sex, age, hypertension, diabetes, dyslipidemia and alcohol consumption as the main covariates associated with the Friesinger score. Lower Friesinger scores were also observed in moderate alcohol consumption when comparing to those who do not drink (RR 0.86; 95% CI 0.79-0.95). CONCLUSION: Among patients with suspected coronary artery disease undergoing coronary angiography, moderate alcohol consumption is associated to a lower coronary artery disease severity than heavy drinking.
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Abstinência de Álcool , Consumo de Bebidas Alcoólicas/efeitos adversos , Alcoolismo/fisiopatologia , Doença da Artéria Coronariana/etiologia , Vasos Coronários/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/epidemiologia , Doença da Artéria Coronariana/fisiopatologia , Estudos Transversais , Feminino , Hospitais Urbanos , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Autorrelato , Índice de Gravidade de Doença , Adulto JovemRESUMO
OBJECTIVE: Spasticity poststroke leads to muscle weakness and soft tissue contracture, however, it is not clear how muscle properties change due this motor neural disorder. The purpose was to compare medial gastrocnemius muscle architecture and mechanical properties of the plantarflexor muscles between stroke survivors with spasticity and healthy subjects. METHODS: The study included 15 stroke survivors with ankle spasticity and 15 healthy subjects. An isokinetic dynamometer was used for the evaluation of maximal isometric plantarflexor torque and images of the medial gastrocnemius muscle were obtained using ultrasonography. Images were collected at rest and during a maximum voluntary contraction. RESULTS: The affected limb showed reduced fascicle excursion (0.9 ± 0.7 cm), shorter fascicle length, and reduced muscle thickness (0.095 ± 0.010% of leg length and 1.18 ± 0.20 cm, at rest) compared to contralateral (1.6 ± 0.4 cm, 0.106 ± 0.015% of leg length and 1.29 ± 0.24 cm, respectively) and to healthy participants (1.8 ± 0.7 cm, 0.121 ± 0.019% of leg length and 1.43 ± 0.22 cm, respectively). The contralateral limb showed lower force (between 32 and 40%) and similar architecture parameters compared to healthy participants. CONCLUSION: The affected limb had a different muscle architecture that appears to result in lower force production. The contralateral limb showed a decrease in force compared to healthy participants due to the other neural impairments than muscle morphology. Spasticity likely leds to adaptations of muscle architecture in the affected limb and in force reductions in both limbs of stroke survivors.
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Tornozelo/fisiopatologia , Hemiplegia/fisiopatologia , Espasticidade Muscular/fisiopatologia , Músculo Esquelético/patologia , Músculo Esquelético/fisiopatologia , Acidente Vascular Cerebral/fisiopatologia , Idoso , Feminino , Hemiplegia/etiologia , Humanos , Masculino , Microscopia Acústica , Pessoa de Meia-Idade , Espasticidade Muscular/diagnóstico por imagem , Espasticidade Muscular/etiologia , Músculo Esquelético/diagnóstico por imagem , Acidente Vascular Cerebral/complicações , Sobreviventes , TorqueRESUMO
BACKGROUND: The present study compared the Achilles tendon morphological characteristics, plantar flexor toque and passive ankle stiffness between hemiparetic spastic stroke survivors and healthy subjects. METHODS: The Achilles tendon length was measured at the affected and contralateral limbs of twelve hemiparetic stroke survivors with ankle spasticity and twelve healthy subjects. The ankle was held at three different angles (20° plantar flexion, 0° and maximum dorsiflexion) while an ultrasound system was used to capture images from the Achilles tendon. Active and passive plantar flexor torque production was measured using an isokinetic dynamometer. FINDINGS: There was no significant difference in tendon length and Achilles tendon complacency between stroke survivors [affected limb: 20.8 (1.59) cm at 0° and 0.11 (0.09) cm/N; contralateral limb: 20.8 (1.7) cm at 0° and 0.12 (0.08) cm/N] and healthy subjects [20 (2.78) cm at 0° and 0.15 (0.1) cm/N]. The contralateral limb was stronger than the affected limb, while healthy participants presented larger active torque in relation to stroke survivors. There was no significant difference in passive ankle stiffness between the affected [0.43 (0.08) N/°] and the contralateral limb [0.40 (0.11) N/°], but affected limb was significantly stiffer than the healthy subjects [0.32 (0.07) N/°]. INTERPRETATION: The larger passive torque and ankle joint stiffness from stroke survivors with similar Achilles tendon length compared to healthy subjects seem to be unrelated to tendon extensibility.
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Tendão do Calcâneo/anatomia & histologia , Tendão do Calcâneo/fisiopatologia , Tornozelo/fisiopatologia , Espasticidade Muscular/fisiopatologia , Paresia/fisiopatologia , Acidente Vascular Cerebral/complicações , Tendão do Calcâneo/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paresia/diagnóstico por imagem , Paresia/etiologia , Sobreviventes , Torque , UltrassonografiaRESUMO
OBJECTIVE: To use demographic and clinical data to identify the clinical pattern that best predicts the diagnosis of carpal tunnel syndrome (CTS), as defined by neurophysiologic studies. METHODS: A diagnostic cross-sectional study in 2535 consecutive patients (3907 upper limbs) older than 12 years old who were referred for nerve conduction studies in the upper limbs between August 2001 and January 2003 in 3 university hospitals and 2 private neurophysiology services in the state of Rio Grande do Sul, Brazil. RESULTS: A neurophysiologic diagnosis of CTS was established in 39.1% of these upper limbs. The presence of paresthesias or pain at least 2 of the first 4 digits in association with one of the following: female gender, symptoms worsening at night or on awakening, an BMI > or =30, thenar atrophy, or other sign (Tinel's, Phalen's, or Reversed Phalen's signs); were the best pattern associated with the diagnosis. CONCLUSIONS: We have found that the clinical picture alone does not seem sufficient, in majority of the population, to correctly predict the diagnosis of CTS, as defined by median nerve neuropathy at the carpal tunnel. We believe that a compressive lesion of the median nerve at the carpal tunnel can be present both in patients with no typical symptoms of CTS (including asymptomatic individuals) and in patients in which neurophysiologic studies are negative. SIGNIFICANCE: Further studies separating patients into these groups will allow us to identify the long-term prognosis as well as the ideal therapeutic approach for each of these clinical situations.
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Síndrome do Túnel Carpal/diagnóstico , Síndrome do Túnel Carpal/fisiopatologia , Demografia , Eletrodiagnóstico/métodos , Condução Nervosa/fisiologia , Adulto , Síndrome do Túnel Carpal/complicações , Intervalos de Confiança , Estudos Transversais , Diagnóstico Diferencial , Feminino , Humanos , Funções Verossimilhança , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Valor Preditivo dos Testes , Estudos Prospectivos , Estudos Retrospectivos , Sensibilidade e EspecificidadeRESUMO
There is no clear definition on the role of sympathetic skin response (SSR) in the evaluation of patients with Parkinson's disease (PD). We recorded the SSR of the palms of 64 controls and 46 patients with PD to electrical stimulation of the median nerve at the wrist. We analyzed onset latency and peak-to-peak amplitude. A study of parasympathetic function (R-R interval analysis) was also undertaken. We found that patients with PD had more absent SSRs than controls. The mean amplitude of the SSR was significantly reduced in both lower and upper limbs of PD patients in comparison with control subjects (p<0.001). The onset latency was longer in the lower limbs of these patients in respect to the control group (p<0.003). There was a significant inverse correlation between SSR amplitudes and age, severity and late onset of the disease. There was no association of these parameters with dysautonomic symptoms or R-R interval variation. In conclusion, there is a significant association between altered SSR and PD and an inverse correlation in this group of patients between SSR values and older age, greater severity and later onset of disease. Therefore, the study of SSR may provide valuable information on cholinergic sympathetic function in patients with PD.
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Resposta Galvânica da Pele/fisiologia , Doença de Parkinson/fisiopatologia , Pele/inervação , Sistema Nervoso Simpático/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Estimulação Elétrica/métodos , Extremidades/inervação , Extremidades/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tempo de Reação/fisiologia , Tempo de Reação/efeitos da radiação , Estudos Retrospectivos , Pele/efeitos da radiação , Estatísticas não Paramétricas , Sistema Nervoso Simpático/efeitos da radiaçãoRESUMO
INTRODUCTION: Hepatitis virus C (HCV) infection is considered a health problem in the State of Acre localized in the Brazilian Amazon which has a prevalence rate of 5.9%. Peripheral neuropathy is a common extra-hepatic manifestation in patients with HCV. OBJECTIVE: To determine the prevalence of peripheral neuropathies using clinical and neurophysiological parameters. METHOD: A cross sectional study was performed in patients assisted by a specialized center of infectious diseases in the State of Acre. All patients completed a clinicoepidemiological questionnaire, physical examination and nerve conduction studies (NCS). RESULTS: We studied 78 patients with mean age 45.5 years (range from 10 to 76 years), two thirds were male, 51% had at least 8 years of formal education and 96% lived in the capital city of Acre State. Roughly 34% of patients complained about paresthesias mainly in upper limbs. The NCS diagnosed multiple mononeuropathy in 11 (14.1%; IC95% 7.6-23.2) patients and carpal tunnel syndrome in 4 (5.1%) patients. CONCLUSION: Subclinical involvement of peripheral nerves seems common in patients with HCV, with multiple mononeuropathy the main manifestation of nerve injury in this region as suggested by electrophysiological studies.
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Hepatite C/epidemiologia , Doenças do Sistema Nervoso Periférico/epidemiologia , Adolescente , Adulto , Idoso , Brasil/epidemiologia , Criança , Estudos Transversais , Eletromiografia , Feminino , Hepatite C/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso Periférico/virologia , Prevalência , Fatores de RiscoRESUMO
The purpose of this study was to evaluate, through a series of cases, the relationship between the adverse neural tension of median nerve (ANTm) and the electrophysiological involvement in 38 patients with symptoms of the carpal tunnel syndrome (CTS), submitted to nerve conduction studies (NCS). The main measures had been ANTm (in degrees) obtained through the test of neural tension provocation (TNTP) and parameters of the NCS, divided into three groups: normal, without severe electrophysiological alteration and with severe electrophysiological alteration. Significant correlations were found between ANTm and parameters of the NCS (p<0.05), as well as between ANTm and the three groups defined by the electrophysiologic alteration (rs=+0.437, p=0.002). The TNAm values were significantly higher in the arms with electrophysiologic diagnoses (p=0.007). It is suggested that the ANTm does have a participation in the physiopathology of the CTS, and the use of therapeutical procedures that diminish the development of neural tension.
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Braço/inervação , Síndrome do Túnel Carpal/fisiopatologia , Nervo Mediano/fisiopatologia , Condução Nervosa/fisiologia , Tempo de Reação/fisiologia , Estudos de Casos e Controles , Estimulação Elétrica , Eletromiografia , Eletrofisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Exame Neurológico , Índice de Gravidade de DoençaRESUMO
Along with cognitive disorders, depression has been a concern for mental health services due to its highly debilitating effect on the functioning and quality of life of the elderly. However, there is still little understanding of the cognitive alterations resulting from depression or of the difficult differential diagnosis with mild cognitive impairment (MCI). It is known that performance on cognitive tests is strongly influenced by education but few studies have been conducted involving low-educated populations. OBJECTIVE: To evaluate the performance of elders with low education and no dementia on Addenbrooke's Cognitive Examination-Revised (ACE-R) test and its cognitive domains, and compare patients with Current Major Depressive Episode (CMDE) against those without depressive symptoms. METHODS: A retrospective, cross-sectional analytical study was conducted based on medical files of patients treated at the Cerebral Aging Clinic of the Hospital São Lucas of the PUCRS. The study included 116 individuals with low education (< 8 years of education) aged between 60 and 84 (69.6 ± 6.4) years, with MCDE (N = 41) and controls (N = 75). RESULTS: No significant difference was observed between control and MCDE groups in median scores on the ACE-R, Mini-Mental State Examination, and the five cognitive domains. There was also no difference between the groups on separate analyses of results on the clock drawing test, the categorical verbal and phonological fluency test, and the naming test. CONCLUSION: The results of this study showed that depressive symptoms did not influence scores on the ACE-R tests conducted in elders with low education.
Depressão, juntamente com os transtornos cognitivos, tem sido uma preocupação entre os serviços de saúde mental, devido ao alto índice de prejuízo na funcionalidade e qualidade de vida desta população. Contudo, ainda permanece em aberto a compreensão das alterações cognitivas decorrentes da depressão e de difícil diagnóstico diferencial com o comprometimento cognitivo leve (CCL). Sabe-se que o desempenho nos testes cognitivos é fortemente influenciados pela escolaridade, no entanto, poucos estudos tem sido realizados em populações de muito baixa escolaridade. OBJETIVO: Avaliar o desempenho no Addenbrooke's Cognitive Examination-Revised (ACE-R) e seus domínios cognitivos em idosos de baixa escolaridade, sem demência, e comparar aqueles que tem diagnóstico de Episódio de Depressão Maior Atual (EDMA), com os que não têm quadro depressivo. MÉTODOS: Estudo transversal analítico, retrospectivo, através dos prontuários dos pacientes atendidos no Ambulatório de Envelhecimento Cerebral (AMBEC) do Hospital São Lucas da PUCRS. Foram incluídos 116 indivíduos com baixa escolaridade (< 8 anos de estudo) e idade entre 60 e 84 anos (69,6 ± 6,7), com EDMA (N = 41) e controles (N = 75). RESULTADOS: Na comparação das médias do ACE-R e os cinco domínios cognitivos, entre o grupo controle e o grupo com EDMA, não foi observada diferença significativa. Também não houve diferença entre os grupos quando analisado separadamente os resultados do teste do relógio, da fluência verbal categórica e fonológica e do teste de nomeação. CONCLUSÃO: Como observado neste estudo, os sintomas depressivos não modificam os valores dos testes realizados no ACE-R de idosos com baixa escolaridade.
RESUMO
Memory is a cognitive domain extensively evaluated in the neuropsychiatric setting. Assessment tools with appropriate norms for age and educational level are necessary for the proper interpretation of results. OBJECTIVE: To present normative data for older adults stratified by age and education for the Rivermead Behavioral Memory Test (RBMT). The effect of age and education on the total and sub-test scores was also analyzed. METHODS: A cross-sectional study involving a sample of 233 healthy elderly from a third-age group in Porto Alegre with an average age of 70 (SD 7.9) years and 10.7 (SD 4.8) years of education was carried out. The RBMT is considered an ecologically valid memory test, since it includes tasks similar to everyday situations. The sample was stratified into the following age groups: 60-69 years, 70-79 years and > 80 years. The sample was also divided into individuals with < 8 years and ≥ 8 years of education. Pearson's Chi-squared test and Spearman correlations were used. RESULTS: The elderly participants with low educational level had worse performance on all sub-tests, except the Pictures, Messages, Belongings and Orientation. Older elderly performed worse for total RBMT score and on the Face Recognition, Immediate and Delayed Route, Messages and Belongings subtests (p ≤ 0.005). CONCLUSION: Education and age significantly influenced RBMT scores. Therefore, norms for this test should be stratified according to these factors.
A memória é um domínio cognitivo amplamente avaliado no contexto neuropsiquiátrico. Instrumentos de avaliação adequados com normas por idade e escolaridade são necessárias para interpretação correta dos resultados. OBJETIVO: Apresentar dados normativos para idosos estratificados por idade e escolaridade para o Teste de Comportamental de Memória Rivermead (RBMT). O efeito da idade e da escolaridade também foi analisado. MÉTODOS: Estudo transversal com uma amostra de 233 idosos saudáveis, provenientes de um grupo de terceira idade do Município de Porto alegre, com média de idade de 70 anos (7,9 DP) e 10,7 (4,8 DP) anos de escolaridade. O RBMT é considerado um teste ecológico de memória, pois inclui tarefas semelhantes a situações cotidianas. A amostra foi dividida em idosos entre 60-69 anos, 70-79 anos e acima de 80 anos. A escolaridade foi dividida entre idosos abaixo de 8 anos e maior ou igual a 8 anos de estudo. Foram utilizados os testes Qui-Quadrado de Pearson e teste de correlação de Spearman. RESULTADOS: Os idosos com baixa escolaridade apresentaram pior desempenho em todas as tarefas, exceto no reconhecimento de figuras, envelope, pertence e na orientação. Idosos mais velhos tiveram desempenho inferior no escore total do RBMT e nas tarefas de reconhecimento de faces, no caminho imediato e recente, no recado e pertence (p ≤ 0,005). CONCLUSÃO: A escolaridade e a idade influenciam significativamente nos escores do RBMT e as normas para este teste devem ser estratificadas de acordo com estes fatores.