Severe and unclassifiable tremor.

BACKGROUND: Patients often exhibit very severe or disabling forms of tremor that cannot be clearly characterized. OBJECTIVE: To present a series of 37 cases of tremor considered unclassifiable. Patients diagnosed with essential tremor according to criteria of the International Parkinson Disease and Movement Disorder Society (IPDMDS), who had been previously studied, were included as controls. All patients underwent a battery of tests between 2019 and 2022, which enabled us to compare them. METHODS: Relevant demographic and clinical information were collected. The following tools were applied: the Mini-Mental State Examination (MMSE); the Hospital Anxiety and Depression Scale (HADS); the Fahn-Tolosa-Marín Tremor Rating Scale (TRS); and the Quality of Life in Essential Tremor (QUEST). A simple brain magnetic resonance imaging (MRI) scan was performed for all patients. The categorical variables were compared using the Chi-squared test and the t-test with Fisher correction if appropriate, and the quantitative variables were compared through the two-tailed Student t-test. Values of p ≤ 0.01 were considered statistically significant. RESULTS: The cases presented higher scores on the anxiety and depression subscales of the HADS than the controls (p ≤ 0.006 and 0.000 respectively). In all domains of the TRS, the cases scored significantly higher, as well as in the QUEST. History of enolism was higher among the controls, and history of orthostasis and rest tremor was higher among the cases (p ≤ 0.000). Cerebellar atrophy was present in every patient in the case group, and in 24 subjects in the control group. Dystonia was observed in 7 subjects in the case group, and in none of the patients in the control group. CONCLUSION: There are patients with unclassifiable and extremely disabling tremors who respond poorly to the pharmacological therapy options.

ANTECEDENTES: Os pacientes muitas vezes apresentam formas muito graves ou incapacitantes de tremor que não podem ser claramente caracterizadas. OBJETIVO: O objetivo deste trabalho foi apresentar uma série de 37 casos de tremor considerados inclassificáveis. Pacientes diagnosticados com tremor essencial de acordo com os critérios da International Parkinson Disease and Movement Disorder Society (IPDMDS), já estudados anteriormente, foram incluídos como controles. Todos os pacientes foram submetidos a exames entre 2019 e 2022 para permitir sua comparaç ão. MéTODOS: As informaç ões demográficas e clínicas relevantes foram coletadas. As seguintes ferramentas foram aplicadas: o Miniexame do Estado Mental (MEEM), a Escala Hospitalar de Ansiedade e Depressão (HADS, do inglês Hospital Anxiety and Depression Scale), a Escala de Avaliaç ão de Tremor de Fahn-Tolosa-Marín (TRS, do inglês Fahn-Tolosa-Marín Tremor Rating Scale) e a Qualidade de Vida em Tremor Essencial (QUEST, do inglês Quality of Life in Essential Tremor). Uma ressonância magnética simples do cérebro foi realizada em todos os pacientes. As variáveis categóricas foram comparadas pelo teste qui-quadrado e pelo teste t com correç ão de Fisher, se apropriado, enquanto as variáveis quantitativas foram comparadas por meio do teste t de Student bicaudal. Valores de p ≤ 0,01 foram considerados estatisticamente significativos. RESULTADOS: Os casos apresentaram pontuaç ões maiores nas subescalas de ansiedade e depressão do HADS do que os controles (p ≤ 0,006 e 0,000, respectivamente). Em todos os domínios do TRS, a pontuaç ão dos casos foi significativamente maior, assim como no QUEST. O histórico de enolismo foi maior entre os controles e o histórico de ortostase e tremor em repouso foi maior entre os casos (p ≤ 0,000). A atrofia cerebelar foi apresentada por todos os pacientes do grupo de casos e em 24 indivíduos do grupo de controle. A distonia foi observada em sete indivíduos do grupo de casos e em nenhum dos pacientes do grupo controle. CONCLUSãO: Há pacientes com tremores inclassificáveis e extremamente incapacitantes que respondem mal às opç ões terapêuticas farmacológicas.

Abuse and other factors related to depression in older Ecuadorian adults.

Objective: To identify abuse and other risk factors associated with depression in older Ecuadorian adults using data from the 2012 Ecuador's Survey of Health, Welfare, and Aging (SABE). Methods: This cross-sectional study analyzed data from the 2012 SABE survey, which included 5235 adults aged 60 and above. The study evaluated residence, education level, ethnic self-identification, self-perceived health and memory, loneliness, cognitive status, and abuse. Depression was assessed using the Yesavage Depression Scale, short version (YDS-SV). Categorical variables were analyzed with the Chi-square test, differences between groups were calculated with the Kruskal-Wallis test, and multiple linear regression analysis was performed. A p-value of ≤0.05 was considered statistically significant. Results: The mean age was 71.39 ± 8.59 years and 55.10% of the sample were women. Abuse was absent in 72.1% (3.773) of the population. The Chi-square test indicated significant associations between depression and poor self-reported health (P = 0.000) and indigenous ethnicity (P = 0.000). Multiple linear regression analysis revealed that age (P < 0.001), abuse (p < 0.001), cognitive status (P = 0.002), and living alone (P = 0.034) significantly contributed to mood as assessed by the YDS-SV. No statistically significant association was found for perceived health status or place of residence (urban or rural). Conclusions: Risk factors associated with depression in older Ecuadorian adults include advanced age, living alone, cognitive decline, poor self-perception of health and cognition, and abuse.

Expanded and Independent Spanish Validation of the MDS-Non Motor Rating Scale.

Background: The Movement Disorder Society-sponsored Non-motor Rating Scale (MDS-NMS) assess the severity and disability caused by non-motor symptoms (NMS) in Parkinson's disease (PD). Objective: This article encapsulates the formal process for completing this program and the data on the first officially approved non-English version of the MDS-NMS (Spanish). Methods: The MDS-NMS translation program involves four steps: translation and back-translation; cognitive pre-testing to ensure that raters and patients understand the scale and are comfortable with its content; field testing of the finalized version; analysis of the factor structure of the tested version against the original English language version for the nine domains that could be analyzed in a confirmatory factor analysis. To be designated an "Official MDS translation," the confirmatory factor analysis Comparative Fit Index had to be ≥0.90. Results: The Spanish MDS-NMS was tested in 364 native-Spanish-speaking patients with PD from seven countries. For all subjects with fully computable data with all domains of the MDS-NMS (n = 349), the Comparative Fit Index was ≥0.90 for the nine eligible domains. Missing data were negligible and moderate floor effect (42.90%) was found for the Non-Motor Fluctuations subscale. Item homogeneity coefficient was adequate, and the correlation of the MDS-NMS domains with other measures for related constructs was acceptable (r s ≥ 0.50). Conclusions: The Spanish version of the MDS-NMS followed the IPMDS Translation Program protocol, reached the criterion to be designated as an Official Translation, and is now available on the MDS website.

A holistic approach to evaluating Parkinson's disease, using the Delphi method: a linear evaluation index / Un enfoque holístico para evaluar la enfermedad de Parkinson con el método Delphi: un índice evaluativo lineal

ABSTRACT Background: Parkinson's disease (PD) is a chronic disease that presents a multitude of symptoms, with symptoms of both motor and nonmotor nature. The Delphi method is widely used to create consensuses among experts in a field of knowledge. Objective: In order to reach a consensus on the values that should be assigned to the different motor and nonmotor manifestations of Parkinson's disease, a linear evaluation index (LEI) was created. Subsequently, the metric properties of this index were studied. Methods: 120 consecutive patients with a Parkinson's diagnosis were chosen in accordance with the UKPDSBB criteria. The Delphi method was used to reach a consensus among experts regarding the values of each of the manifestations included. Subsequently, the following attributes were analyzed: quality and acceptability of the data; reliability, in terms of internal consistency, reliability index, Cronbach's alpha and standard error of measurement; and validity, in terms of convergent validity and validity for known groups. Results: Twenty-five experts participated. The importance factor did not differ between the first round and the second round (chi-square test). We analyzed the responses that assigned percentage values to the 10 dimensions of the LEI. Both in the first and in the second round, the values of the scattering coefficient Vr were always close to 0. The homogeneity index was 0.36; the corrected-item total correlation values ranged from 0.02 to 0.7; Cronbach's α was 0.69; and the SEM was 4.23 (55.1%). Conclusions: The LEI was obtained through rigorous recommended methodology. The results showed adequate metric properties.

RESUMO Antecedentes: La enfermedad de Parkinson (EP) es una enfermedad crónica que presenta una multitud de síntomas, tanto de naturaleza motora cuanto no motora. El método Delphi se utiliza ampliamente para crear un consenso entre expertos de un campo del conocimiento. Objetivos: Con el fin de llegar a un consenso sobre los valores que deben asignarse a las diferentes manifestaciones motoras y no motoras de la enfermedad de Parkinson, se creó el "Índice de Evaluación Lineal" (linear evaluation index - LEI). Posteriormente, se estudiaron las propiedades métricas de este índice. Métodos: Se eligieron 120 pacientes consecutivos con diagnóstico de Parkinson según los criterios del UKPDSBB. Se utilizó el método Delfos para llegar a un consenso entre los expertos sobre los valores de cada una de las manifestaciones incluidas. Posteriormente, se analizaron los siguientes atributos: Calidad y aceptabilidad de los datos. Fiabilidad: consistencia interna, índice de fiabilidad, alfa de Cronbach y error estándar de medida. Finalmente, Validez: validez convergente y validez para grupos conocidos. Resultados: Participaron 25 expertos, el factor de importancia entre la primera y la segunda rondas (prueba chi-cuadrado), no fue diferente. Analizamos las respuestas que asignaron valores porcentuales a las 10 dimensiones del LEI; tanto en la primera como en la segunda rondas, los valores del coeficiente de dispersión Vr siempre estuvieron cerca de 0. El índice de homogeneidad fue de 0,36; los valores corregidos de correlación ítem-total variaron de 0,02 a 0,7; alpha de Cronbach fue de 0,69. El SEM fue 4,23 (55,1%). Conclusiones: El LEI se ha obtenido siguiendo una rigurosa metodología recomendada. Los resultados han mostrado propiedades métricas adecuadas.

Living with chronic illness scale in Parkinson's disease: Longitudinal metric properties and meaningful change.

AIM: To analyze the responsiveness and interpretability of the Living with Chronic Illness Scale in patients with Parkinson's disease (LW-CI-PD). METHODS: Longitudinal, international study, with a convenience sample of 153 PD Spanish and Latin-American patients assessed at baseline and one year later. The LW-CI-PD and other clinical measures were applied. For responsiveness, Wilcoxon-Mann-Whitney test of differences, correlation of change between rating scales, standard error of difference, relative change, Cohen's effect size and standardized response mean of LW-CI-PD were computed. The minimally clinical important difference was calculated using anchor- (applying the Patient Global Impression of Severity) and distribution-based methods. A triangulation of interpretability indexes was performed to determine the range of the minimally clinical important difference values. RESULTS: The LW-CI-PD scored 65.7 (11.7, range: 33-101) at baseline, and 68.6 (10.3, range: 33-102) one year later (p < 0.001). Change in LW-CI-PD correlated -0.26 with change in psychosocial status, 0.18 with change in motor function and -0.15 with change in social support. Responsiveness statistics were: relative change = 4.5%; effect size = 0.25; standardized response mean = 0.46. Using PGI-S as anchor, 29 patients worsened, and the value of minimally clinical important difference for worsening in LW-CI-PD total score was 4.7. Minimally clinical important difference values using distribution-based methods were between 4.5 (1 standard error of measurement) and 10.4 (10% of total score), with a mean of 6.9. CONCLUSIONS: Our study suggest the LW-CI-PD is responsive to changes over time. The use of different methods for calculating the minimally clinical important difference allows to determine a range of the real change for the LW-CI-PD.

A holistic approach to evaluating Parkinson's disease, using the Delphi method: a linear evaluation index.

BACKGROUND: Parkinson's disease (PD) is a chronic disease that presents a multitude of symptoms, with symptoms of both motor and nonmotor nature. The Delphi method is widely used to create consensuses among experts in a field of knowledge. OBJECTIVE: In order to reach a consensus on the values that should be assigned to the different motor and nonmotor manifestations of Parkinson's disease, a linear evaluation index (LEI) was created. Subsequently, the metric properties of this index were studied. METHODS: 120 consecutive patients with a Parkinson's diagnosis were chosen in accordance with the UKPDSBB criteria. The Delphi method was used to reach a consensus among experts regarding the values of each of the manifestations included. Subsequently, the following attributes were analyzed: quality and acceptability of the data; reliability, in terms of internal consistency, reliability index, Cronbach's alpha and standard error of measurement; and validity, in terms of convergent validity and validity for known groups. RESULTS: Twenty-five experts participated. The importance factor did not differ between the first round and the second round (chi-square test). We analyzed the responses that assigned percentage values to the 10 dimensions of the LEI. Both in the first and in the second round, the values of the scattering coefficient Vr were always close to 0. The homogeneity index was 0.36; the corrected-item total correlation values ranged from 0.02 to 0.7; Cronbach's α was 0.69; and the SEM was 4.23 (55.1%). CONCLUSIONS: The LEI was obtained through rigorous recommended methodology. The results showed adequate metric properties.

Adherence to treatment in Parkinson's disease: A multicenter exploratory study with patients from six Latin American countries.

BACKGROUND: Adherence to treatment in Parkinson's disease (PD) is compromised due to the need for multiple therapies, comorbidities related to aging, and the complexity of therapeutic schemes. In the present study, we aimed to explore adherence to treatment in groups of PD patients from six Latin-American (LA) countries and identify its associated demographic and clinical parameters. METHODS: A multicenter, cross-sectional, exploratory study was conducted from September 2016 to March 2017. Treatment adherence was assessed using the simplified medication adherence questionnaire (SMAQ), applied to patients and caregivers. Sociodemographic and clinical variables (MDS-UPDRS Part III-IV, MMSE, Beck Depression Inventory-II (BDI-II)) were recorded. RESULTS: Eight hundred patients from six LA countries were evaluated. Nonadherence was reported in 58.25% of the population, according to patients. The most frequent issues were forgetfulness and correct timing of doses. A high level of agreement in adherence prevalence and most SMAQ items were observed between patients and their caregivers. The nonadherent population had a significantly higher proportion of unemployment, free access to medication, troublesome dyskinesias and off-periods, lesser years of education, and worse motor, cognitive, and mood scores. In multiple logistic and linear regression analyses, MDS-UPDRS Part III, BDI-II, gender, free access to medication, treatment with dopamine agonists alone, years of education, excessive concerns about adverse effects, and beliefs about being well-treated remained significant contributors to adherence measures. CONCLUSION: Educational strategies, greater involvement of PD patients in decision-making, and consideration of their beliefs and values might be of great need to improve medication adherence in this PD population.

Parkinson's Disease Gravity Index: A Method by means of Optimal Scaling.

OBJECTIVE: This study has been designed with the aim of using optimal scaling to perform the allocation of scores and to be able to construct an indicator of the Parkinson's Disease Gravity Index. Scores were assigned to interrelated dimensions that share information about the patient's situation, to have an objective, holistic tool which integrates scores so that doctors can have a comprehensive idea of the patient's situation. Patients and Methods. 120 consecutive patients with Parkinson's diagnosis were chosen according to the United Kingdom Parkinson's Disease Society Brain Bank criteria. Subsequently, all the chosen dimensions were transformed into interval variables for which the formula proposed by Sturges was used. Once the dimensions were transformed into interval variables, optimal scaling was carried out. Subsequently, the following attributes were analyzed: quality and acceptability of the data; reliability: internal consistency, reliability index, Cronbach's alpha, and standard error of measurement; finally, validity: convergent validity and validity for known groups. RESULTS: There were no missing data. An appropriate Cronbach's alpha value of 0.71 was gathered, and all items were found to be pertinent to the scale. The item homogeneity index was 0.36. Precision evaluated with the standard error of measurement was 7.8. The Parkinson's Disease Gravity Index discriminant validity (validity for known groups), assessed among the different stages of Hoehn and Yahr scale by the Kruskal-Wallis test, showed major significance (X 2 = 32.7, p ≤ 0.001). CONCLUSIONS: The Parkinson's Disease Gravity Index has shown adequate metric properties.

Evaluation of the metric properties of the WHODAS 2.0, WHODAS-S, and RADS in the assessment of disability in Parkinsonian patients.

OBJECTIVES: Parkinson's disease is the second most prevalent progressive neurodegenerative disease and causes considerable disability in patients. We conducted a cross-sectional analytical study to examine the metric properties of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS-2); the 12-item World Health Organization Disability Assessment Schedule (WHODAS-S) and the Rapid Assessment of Disability Scale (RADS) in assessing disability in Parkinsonian patients. PATIENTS AND METHODS: Patients with cognitive impairment, neurological disorder, or disability due to any condition other than PD were excluded. One hundred sixty-eight consecutive patients were assessed in ON state. The following attributes were evaluated: data quality and acceptability, reliability, and construct (convergent and known-groups) validity. Testretest reliability was analyzed in fifty-six patients. RESULTS: Out of 168 patients, 65.4% were men's, 96 (57.1%) at stage III of Hoehn and Yahr. One hundred fifty-one patients lived independently in the community, 102 lived with their spouses, 108 were retired, and 48 were still working. Cronbach's alpha exceeded the minimum requirement of 0.70 for the three scales. The SEM obtained was, also for the three scales, higher than the ½ of the standard deviation value. The validity for known groups showed that all domains were significantly different in both WHODAS-S and RADS. The stability of the scale was evaluated with the test-retest (ICC). The results for the WHODAS-2 ≤ 0.002; for the WHODAS-S were p ≤ 0.000]; and for the RADS were p ≤ 0.000]. CONCLUSION: The RADS is by far the fastest scale to use. All three scales showed suitable metric properties.

The Parkinson's Disease Sleep Scale-2 (PDSS-2): Validation of the Spanish Version and Its Relationship With a Roommate-Based Version.

BACKGROUND: Because of the prevalence and impact of sleep disorders in Parkinson's disease (PD), valid instruments for their evaluation and monitoring are necessary. However, some nocturnal sleep disorders may go unnoticed by patients themselves. OBJECTIVES: To validate a pan-Spanish version of the Parkinson's Disease Sleep Scale Version 2 (PDSS-2) and to test the relationships between the PDSS-2 and a PDSS-2 roommate version. METHODS: PD patients (n = 399) from seven Spanish-speaking countries were included. In addition to the tested PDSS-2 scales, valid measures for sleep disorders and both motor and nonmotor manifestations were applied. Acceptability, dimensionality, reliability, precision, and construct validity were explored, as well as discrepancies and agreement between the PDSS-2 and the roommate version. RESULTS: PDSS-2 showed negligible floor and ceiling effects. Four factors (57% of the variance) were identified. Reliability parameters were satisfactory: alpha = 0.84; item homogeneity coefficient = 0.27; corrected item total correlation = 0.28 to 0.61; and test-retest reliability (average kappa = 0.70; intraclass correlation coefficient [ICC] = 0.83). The standard error of measurement was 5.84, and correlations with other scales assessing nocturnal sleep were high (rS = 0.62-0.56). In comparison to the patient-based total score, the by proxy total score showed no significant difference, high correlation (rS = 0.70), and acceptable agreement (ICC = 0.69), but there were discrepancies in two or more points in 18% of item scores. CONCLUSIONS: The Spanish version of the PDSS-2 has shown satisfactory clinimetric attributes. Acceptability and precision data are presented for the first time. The PDSS-2 roommate version could be useful to complement the patient-based evaluation, but additional studies are needed.

Association between Blood Viscosity and Cardiovascular Risk Factors in Patients with Arterial Hypertension in a High Altitude Setting.

Background  Blood viscosity is a determinant of vascular resistance, and it is expected to contribute to blood pressure. Arterial hypertension (HTN), in addition to other cardiovascular risk factors, contribute to cardiac morbidity. Our study aimed to establish the association between cardiovascular risk factors including HTN and whole blood viscosity in Ecuadorian patients. Material and methods We studied 132 patients with the diagnosis of HTN. Fifteen cardiovascular risk factors were analyzed. The association between whole blood viscosity (WBV) and the number of cardiovascular risk factors was studied. The association between blood viscosity and risk factors was analyzed. Results  One hundred and thirty-two patients were analyzed. Blood viscosity was associated with a number of cardiovascular risk factors. Creatinine, uric acid, total cholesterol, and low-density lipoprotein (LDL) values were significantly higher in patients with high blood viscosity. Conclusion  Blood viscosity is a physiological variable associated with a number of cardiovascular risk factors in hypertensive patients. Such risk factors are related to renal function and lipid profiles. In high-altitude residents, polycythemia is common, and the consequences of high hematocrit on cardiovascular morbidity in this setting deserve special attention and warrant further research.

Correction to: Case series of Creutzfeldt-Jakob disease in a third-level hospital in Quito.

Following publication of the original article [1], Andrés Damián Ortega Heredia requested that his name be corrected from.

Case series of Creutzfeldt-Jakob disease in a third-level hospital in Quito.

BACKGROUND: Creutzfeldt-Jakob disease is a rare and fatal neurodegenerative disorder that affects mammals and humans. The prevalence of this disease in the United States is 0.5 to 1 per million inhabitants. So far in Ecuador, we do not know what the prevalence or incidence is, and only one case report has been written. CASE PRESENTATION: We present a case series of Creutzfeldt-Jakob disease in a third-level hospital in Quito. The average age of symptom onset in our patients was 58.8 years. The male to female ratio was 1:1. Two patients began with cognitive/behavioral symptoms, while 4 patients began with focal neurological signs; 1 case with ataxia, 2 with gait disorders and 1 with vertigo and headache. All of the patients had the clinical features established by the World Health Organization. In addition, the entire cohort was positive for the 14-3-3 protein in cerebrospinal fluid, and had high signal abnormalities in caudate and putamen nucleus in DWI and FLAIR IRM. Only in one case, did we reach a definitive diagnosis through a pathological study. All other cases had a probable diagnosis. In this series of cases, 6 out of 6 patients died. The average time from the onset of the symptoms to death in this cohort was 13 months. CONCLUSION: This is the first report of a series of cases of Creutzfeldt-Jakob disease in Quito. Although definitive diagnosis must be histopathological, there are ancillary tests currently available that have allowed us to obtain a diagnosis of the disease.

Fatigue in Parkinson's disease: Metric properties of the fatigue impact scale for daily use (D-FIS), and its impact on quality of life.

OBJECTIVE: In Parkinson's disease patients, fatigue is a disabling non-motor symptom whose prevalence ranges from 28% to 58%. The Fatigue Impact Scale for Daily Use (D-FIS), one of the various scales for quantifying fatigue. The aim of our study was to analyze the metric properties of the D-FIS in PD subjects and assess the impact of fatigue on their quality of life. PATIENTS AND METHODS: The cohort in this study was comprised of 211 consecutive patients with a PD diagnosis regularly followed up at the Movement Disorders Unit of the Neurology Department at Carlos Andrade Marín Hospital (HCAM) in Quito, Ecuador, according to the United Kingdom PD Society Brain Bank criteria. Data Quality, Acceptability, Reliability, Stability (test-retest), Validity and Multiple linear regression analysis were determined. RESULTS: The final sample consisted of 138 men (65.4%) and 73 women. Forty-six percent of these (98 patients) were in stage II of H&Y. We obtained a Cronbach's α value of 0.912 and an ICC value of 0.79. D-FIS was strongly correlated with depression (Spearman rho [Srho] 0.60), anxiety (Srho 0.59), quality of life (Srho 0.67), and non-motor symptoms (Srho 0.66). The scale's discriminant validity, assessed among the different stages of H&Y by the Kruskal-Wallis test, showed major significance (X2 = 23.183, p ≤ 0.001). In the Multiple linear regression study, the resulting model proves that fatigue has a determining effect on quality of life. CONCLUSIONS: The D-FIS has good metric properties and demonstrates that fatigue significantly affects PD patients' quality of life and that its impact is independent from that of anxiety, depression, and sleep disorders.

A Multicenter Comparative Study of Impulse Control Disorder in Latin American Patients With Parkinson Disease.

OBJECTIVES: Impulse control disorder (ICD) is a common adverse effect in patients with Parkinson disease who receive dopamine agonists; however, other factors are involved in its manifestations. To study the frequency and factors involved in the development of this adverse effect in a Latin American population, we conducted a cross-sectional multicenter study. METHODS: Two hundred fifty-five patients in 3 Latin American centers were evaluated by examination and application of scales (Unified Parkinson's Disease Rating Scale, Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease-Rating Scale, Hoehn and Yahr, Clinical Impression of Severity Index for Parkinson's Disease). RESULTS: Of the patients, 27.4% had ICD, most of whom were on dopamine agonists. Other associated risk factors included a younger age at onset of Parkinson disease, moderate symptoms, a shorter evolution of the clinical manifestations, rapid eye movement (REM) sleep disorder behavior, and the consumption of tea, mate, and alcohol. CONCLUSIONS: The frequency of ICD is higher in Latin America than in Anglo-Saxon populations. Consuming tea and mate, in addition to the use of dopamine agonists, is a factor that may demonstrate a genetic link that predisposes patients to the establishment of an ICD.

Validation of the Parkinson's Disease-Cognitive Rating Scale Applying the Movement Disorder Society Task Force Criteria for Dementia Associated with Parkinson's Disease.

BACKGROUND: The authors studied the measurement properties of the Parkinson's Disease-Cognitive Rating Scale (PD-CRS) compared with Movement Disorders Society Task Force (MDS-TF) criteria for the diagnosis of dementia in patients with Parkinson's disease. METHODS: The sample consisted of 223 patients who were diagnosed in accordance with the United Kingdom Parkinson's Disease Society Brain Bank who were assessed with both the MDS-TF and the PD-CRS criteria (in addition to other instruments) without the assessors' knowledge of previous results. Internal consistency was studied (homogeneity of the items and Guttmann's λ values were obtained) in addition to convergent, divergent, and discriminative validity. The receiver operating characteristic curve was obtained, and the cutoff point at which the PD-CRS had the greatest efficiency was analyzed. RESULTS: The internal consistency was shown to be adequate, with a λ value of 0.821. A floor effect was observed in 4 of the items (Sustained Attention, Working Memory, Immediate Verbal Memory, and Alternating Verbal Fluency), and 1 item showed a ceiling effect (Clock Copying). The scale adequately discriminated patients with and without dementia (Kruskal-Wallis; P ≤ 0.000). The area under the curve was 0.899. With a cutoff score of 62 (from a possible score of 134), the scale achieved 94% sensitivity and 99% specificity. CONCLUSIONS: The PD-CRS has adequate measurement properties and is a valid tool for studying the presence of dementia in patients with Parkinson's disease.

Self-Assessment of Disability in Parkinson's Disease: The MDS-UPDRS Part II Versus Clinician-Based Ratings.

BACKGROUND: Parkinson's disease (PD) is characterized by motor and nonmotor symptoms that progress with time, causing disability. The performance of a disease-specific, self-applied tool for assessing disability, the MDS-UPDRS Part II, is tested against generic and rater-based rating scales. METHODS: An international, cross-sectional, observational study was performed. Patients were assessed with the Hoehn and Yahr (HY) and five disability measures: MDS-UPDRS Part II, Schwab and England Scale (S&E), Clinical Impression of Severity Index-PD (CISI-PD) Disability item, Barthel Index (BI), and Rapid Assessment of Disability Scale (RADS). Data analysis included correlation coefficients, Mann-Whitney and Kruskal-Wallis tests, and intraclass-correlation coefficient for concordance. RESULTS: The sample was composed of 451 patients, 55.2% men, with a mean age of 65.06 years (SD = 10.71). Disability rating scales correlated from |0.75| (CISI-PD Disability with BI) to 0.87 (MDS-UPDRS Part II with RADS). In general, MDS-UPDRS Part II showed high correlation coefficients with clinical variables and satisfactory concordance with the rest of disability measures, with ICC ranging from 0.83 (with BI) to 0.93 (with RADS). All disability rating scales showed statistical significant differences in the sample grouped by sex, age, disease duration, and severity level. CONCLUSIONS: The MDS-UPDRS Part II showed an appropriate performance to assess disability in PD, even better than some rater-based, generic or specific, scales applied in this study.

New diagnostic criteria for neurocysticercosis: Reliability and validity.

OBJECTIVE: The diagnosis of neurocysticercosis (NCC) remains problematic because of the heterogeneity of its clinical, immunological, and imaging characteristics. Our aim was to develop and assess a new set of diagnostic criteria for NCC, which might allow for the accurate detection of, and differentiation between, parenchymal and extraparenchymal disease. METHODS: A group of Latin American NCC experts developed by consensus a new set of diagnostic criteria for NCC. A multicenter, retrospective study was then conducted to validate it. The reference standard for diagnosis of active NCC was the disappearance or reduction of cysts after anthelmintic treatment. In total, three pairs of independent neurologists blinded to the diagnosis evaluated 93 cases (with NCC) and 93 controls (without NCC) using the new diagnostic criteria. Mixed-effects logistic regression models were used to estimate sensitivity and specificity. RESULTS: Inter-rater reliability (kappa) of diagnosis among evaluators was 0.60. For diagnosis of NCC versus no NCC, the new criteria had a sensitivity of 93.2% and specificity of 81.4%. For parenchymal NCC, the new criteria had a sensitivity of 89.8% and specificity of 80.7% and for extraparenchymal NCC, the new criteria had a sensitivity of 65.9% and specificity of 94.9%. INTERPRETATION: These criteria have acceptable reliability and validity and could be a new tool for clinicians and researchers. An advantage of the new criteria is that they consider parasite location (ie, parenchymal or extraparenchymal), which is an important factor determining the clinical, immunological, and radiological presentation of the disease, and importantly, its treatment and prognosis. Ann Neurol 2016;80:434-442.

Satisfaction with Life Scale (SLS-6): First validation study in Parkinson's disease population.

INTRODUCTION: To explore the psychometric attributes of a new Satisfaction with Life Scale (SLS-6) in a wide Spanish-speaking population with Parkinson's disease (PD). METHODS: This was an international, cross-sectional study. Several rater-based and patient-reported outcomes measures for evaluation of PD (e.g., Scales for Outcomes in Parkinson's Disease-Motor) and other constructs (e.g., Duke-UNC Functional Social Support Questionnaire, Scale for Living with Chronic Illness) were applied together with the SLS-6. Acceptability, scaling assumptions, reliability, precision, and construct validity were tested. RESULTS: The study included 324 patients from five countries, with age (mean ± standard deviation) 66.67 ± 10.68 years. None of the SLS-6 items had missing values and all acceptability parameters fulfilled the standard criteria. Scaling assumptions allowed the calculation of a summary index from items 2 to 6, complementary to the global evaluation (item 1). For these five items, Cronbach's alpha was 0.85; the corrected item-total correlation 0.53-0.73; inter-item correlation, 0.45-0.70, with an item homogeneity index of 0.55. The standard error of measurement, based on Cronbach's alpha for a single observation, was 3.48. SLS-6 correlations were moderate to strong (rs ≥ 0.35) with the patient-reported outcomes and weak to moderate with the rater-based assessments used in the study. The SLS-6 total score was significantly different according to PD severity levels established according to Hoehn and Yahr staging, Clinical Impression of Severity Index, and Patient-Based Global Impression of Severity scale. CONCLUSION: The results suggest that SLS-6 is an easy, feasible, acceptable, consistent, precise and valid measure to evaluate satisfaction with life in PD patients.