Pulmonary paracoccidioidomycosis associated with the use of natalizumab in multiple sclerosis.

BACKGROUND: Natalizumab (NTZ) is a monoclonal antibody with an immunosuppressive effect that reduces the inflammation of the central nervous system, and it has been used for the treatment of relapsing-remitting multiple sclerosis (RRMS). In patients with low cellular immune response, systemic mycosis arising from endemic areas may occur. RESULTS AND CONCLUSION: In this article, we will describe a case of paracoccidioidomycosis as a complication to treatment with NTZ in an RRMS patient.

Modified Pfeffer Questionnaire for Functional Assessment in Parkinson Disease.

INTRODUCTION: It was proposed to modify the Pfeffer questionnaire (PQ) for functional assessment in patients with Parkinson disease (PD). AIM: To determine the cutoff score for diagnosis of functional impairment in patients with PD by modified PQ (mPQ). METHODS: A total of 110 patients with PD were enrolled into the study, and a neuropsychological test battery was performed to assess their cognitive status. Regarding functional assessment, the mPQ has been applied, and their results were compared to the functional assessment by Informant Questionnaire on Cognitive Decline in the Elderly adapted for use in Brazil (IQCODE-BR). The statistical analysis was accomplished through receiver operating characteristic (ROC) curve with evaluation of the area under the curve, sensitivity, and specificity of the new cutoff point. RESULTS: Eighty-nine patients with PD were evaluated with a mean age of 63.69 ± 9.14 years. Cognitive status categorization was 28.10% as normal, 44.94% as mild cognitive impairment, and 26.96% of patients as dementia associated with PD. The average score on PQ was 3.49 ± 4.79 and on the mPQ 2.56 ± 3.49. In IQCODE-BR, the average score was 6.75 ± 32.72. The ROC curve for the new cutoff point presented 47.4% sensitivity, 88.10% specificity, and 0.757 of area under the curve, with a standard deviation of 0.055 (95% confidence interval: 0.650-0.864). CONCLUSION: 3.5 is proposed as the cutoff point to define functional impairment in patients with PD by mPQ.

Longitudinal analysis of functional disabilities, cognitive decline and risk of dementia in women with Parkinson's disease and detrusor overactivity.

OBJECTIVES: This long-term study exclusively in women with Parkinson's disease and urinary symptoms aimed to verify the correlation of urinary symptoms with motor severity of the disease and cognitive functions as well as analyze the functional abilities, mental functions and risk of dementia in patients with detrusor overactivity. SUBJECTS AND METHODS: At baseline a cohort of 63 ambulatory patients with Parkinson's disease were evaluated for global disease severity, functional abilities and mental function using the Unified Parkinson's Disease Rating Scale (UPDRS) and Schwab & England scale (SES). Urologic function was assessed by International Prostatic Symptom Scale (IPSS) and urodynamic study. Two groups were then categorized at baseline: patients with and without detrusor overactivity. After seven years the same parameters were evaluated and the cognitive functions were assessed with the Montreal Cognitive Assessment (MoCA). RESULTS: At baseline the lower urinary tract symptoms were correlated with the severity of the disease and the functional disabilities were significant in patients with detrusor overactivity. In the follow-up functional disabilities did not have different progression between the groups. There was a clear progression of mental scores, increased cognitive decline and risk of dementia in the group with detrusor overactivity. CONCLUSION: Detrusor overactivity is a prevalent urodynamic finding correlated with motor severity of the disease and associated with functional disabilities in women with Parkinson's disease. Patients with detrusor overactivity had in the long-term progression, a clear cognitive and mental function decline and increased risk of dementia.

Cut-off points of the Portuguese version of the Montreal Cognitive Assessment for cognitive evaluation in Parkinson's disease.

The Movement Disorder Society has published some recommendations for dementia diagnosis in Parkinson disease (PD), proposing the Montreal Cognitive Assessment (MOCA) as a cognitive screening tool in these patients. However, few studies have been conducted assessing the Portuguese version of this test in Brazil (MOCA-BR). OBJECTIVE: the aim of the present study was to define the cut-off points of the MOCA-BR scale for diagnosing Mild Cognitive Impairment (PD-MCI) and Dementia (PD-D) in patients with PD. METHODS: this was a cross-sectional, analytic field study based on a quantitative approach. Patients were selected after a consecutive assessment by a neurologist, after an extensive cognitive evaluation, and were classified as having normal cognition (PD-N), PD-MCI or PD-D. The MOCA-BR was then applied and 89 patients selected. RESULTS: on the cognitive assessment, 30.3% were PD-N, 41.6% PD-MCI and 28.1% PD-D. The cut-off score on the MOCA-Br to distinguish PD-N from PD-D was 22.50 (95% CI 0.748-0.943) for sensitivity of 85.5% and specificity of 71.1%. The cut-off for distinguishing PD-D from MCI was 17.50 (95% CI 0.758-0.951) for sensitivity of 81.6% and specificity of 76%.

A Movement Disorder Society publicou algumas recomendações para o diagnóstico de demência na doença de Parkinson (DP), propondo o Montreal Cognitive Assessment (MOCA) como ferramenta de triagem cognitiva nesses pacientes. Entretanto, poucos estudos foram aplicados à versão em português (MOCA-BR). OBJETIVO: o presente estudo tem o objetivo de definir os valores de corte na escala de MOCA-BR para diagnosticar o Comprometimento Cognitivo Leve (DP-CCL) e Demência (DP-D) em pacientes com DP. MÉTODOS: trata-se de um estudo transversal, analítico, com uma abordagem quantitativa. Os pacientes foram selecionados depois de avaliações consecutivas por um neurologista, após avaliação cognitiva extensa, e foram classificados como cognição normal (DP-N), DP-CCL e DP-D e então o MOCA-BR foi aplicado, sendo selecionados 89 pacientes. RESULTADOS: na avaliação cognitiva, foram encontrados 30.3% de DP-N, 41.6% de DP-CCL e 28.1% DP-D. O valor de corte no MOCA-BR para distinguir entre DP-N de DP-D foi 22.5 (IC 95%; 0.748-0.943), sensibilidade de 85.5% e especificidade de 71.1%. Para distinguir DP-P de CCL, o ponto de corte foi de 17.5 (IC 95%; 0.758-0.951), sensibilidade de 81.6% e especificidade de 76%.

Knowledge of stroke among a Brazilian urban population.

Knowledge of the population in regards to stroke has clinical and epidemiological importance. Prompt identification of the symptoms means efficient medical attendance within the window of therapeutic opportunities reducing significantly the morbidity-mortality. Our aim was to evaluate the level of knowledge of the population of Teresina (PI) concerning factors of risk, symptoms and treatment of stroke. The door-to-door study was carried out by means of a standardized application of questionnaire on risk factors, symptoms and attitude when faced with a stroke victim. 991 forms were selected. Factors of risk more cited were hypertension identified by 416 [42.0%] and hyperlipidemia 284 [28.7%]. The most remembered symptoms were headache 277 [28.0%] and hemiplegia 219 [22.1%]. 375 (37.8%) respondents were unable to identify any risk factors and and 410 (41.4%) any symptom. The lack of knowledge of the population of Teresina in relation to stroke reflects the need for intervention through public and professional educational campaigns.

[Herpes zoster and polyradiculopathy: report of a case]. / Herpes zoster e polineuropatiaperiférica: Relato de um caso.

Polyradiculopathy that develops as a result of herpes zoster is rare. When it does occur, it usually follows the cutaneous eruption. However, we present a case of nerve impairment (motor, sensatory, and autonomic) that occurred prior to the cutaneous herpes zoster eruption.

Urinary symptoms in Parkinson's disease: prevalence and associated factors.

The authors present a cross-sectional study involving 61 patients with idiopathic Parkinson's disease (PD) who were consecutively examined and compared to a control group with 74 subjects. Only patients who fulfilled the standard diagnostic criteria for PD and whose brain magnetic resonance imaging was normal were included. The objective of the study was to evaluate the prevalence of inferior urinary tract symptoms in PD and to study the possible association between clinical factors to urinary dysfunction. ln the patient group, 39.3% presented urinary symptoms when compared to 10.8% in the control group. All symptomatic patients presented irritative symptoms. The most common irritative symptom PD was nocturia, followed by frequency and urinary incontinence. Around 25% of the patients presented functional obstructive symptoms determined by the disease. The most frequent obstructive symptom was incomplete emptying of the bladder. Only the age of the patients and control group were correlated with urinary dysfunction.

Cut-off points of the Portuguese version of the Montreal Cognitive Assessment for cognitive evaluation in Parkinson's disease / Valores de corte da versão em português do "montreal cognitive assessment" para avaliação cognitiva na doença de parkinson

ABSTRACT. The Movement Disorder Society has published some recommendations for dementia diagnosis in Parkinson disease (PD), proposing the Montreal Cognitive Assessment (MOCA) as a cognitive screening tool in these patients. However, few studies have been conducted assessing the Portuguese version of this test in Brazil (MOCA-BR). Objective: the aim of the present study was to define the cut-off points of the MOCA-BR scale for diagnosing Mild Cognitive Impairment (PD-MCI) and Dementia (PD-D) in patients with PD. Methods: this was a cross-sectional, analytic field study based on a quantitative approach. Patients were selected after a consecutive assessment by a neurologist, after an extensive cognitive evaluation, and were classified as having normal cognition (PD-N), PD-MCI or PD-D. The MOCA-BR was then applied and 89 patients selected. Results: on the cognitive assessment, 30.3% were PD-N, 41.6% PD-MCI and 28.1% PD-D. The cut-off score on the MOCA-Br to distinguish PD-N from PD-D was 22.50 (95% CI 0.748-0.943) for sensitivity of 85.5% and specificity of 71.1%. The cut-off for distinguishing PD-D from MCI was 17.50 (95% CI 0.758-0.951) for sensitivity of 81.6% and specificity of 76%.

RESUMO. A Movement Disorder Society publicou algumas recomendações para o diagnóstico de demência na doença de Parkinson (DP), propondo o Montreal Cognitive Assessment (MOCA) como ferramenta de triagem cognitiva nesses pacientes. Entretanto, poucos estudos foram aplicados à versão em português (MOCA-BR). Objetivo: o presente estudo tem o objetivo de definir os valores de corte na escala de MOCA-BR para diagnosticar o Comprometimento Cognitivo Leve (DP-CCL) e Demência (DP-D) em pacientes com DP. Métodos: trata-se de um estudo transversal, analítico, com uma abordagem quantitativa. Os pacientes foram selecionados depois de avaliações consecutivas por um neurologista, após avaliação cognitiva extensa, e foram classificados como cognição normal (DP-N), DP-CCL e DP-D e então o MOCA-BR foi aplicado, sendo selecionados 89 pacientes. Resultados: na avaliação cognitiva, foram encontrados 30.3% de DP-N, 41.6% de DP-CCL e 28.1% DP-D. O valor de corte no MOCA-BR para distinguir entre DP-N de DP-D foi 22.5 (IC 95%; 0.748-0.943), sensibilidade de 85.5% e especificidade de 71.1%. Para distinguir DP-P de CCL, o ponto de corte foi de 17.5 (IC 95%; 0.758-0.951), sensibilidade de 81.6% e especificidade de 76%.

Urinary dysfunction with detrusor hyperactivity in women with Parkinson's disease cannot be blamed as a factor of worsening motor performance.

INTRODUCTION: Detrusor hyperactivity is the leading cause of urinary dysfunction in Parkinson's disease (PD). There are few studies correlating PD clinical aspects with this autonomic feature. METHODS: A cohort of 63 women with PD were prospectively examined for assessment of clinical aspects and disease severity using unified Parkinson's disease rating scale and Hoehn-Yahr scale, respectively. The urologic function was evaluated by the urodynamic study. Two groups were categorized at this time - groups with and without detrusor hyperactivity. After seven years, the same parameters were re-evaluated. RESULTS: Progression of the disease on mental scores was found in the group with detrusor hyperactivity. On follow-up, clinical symptoms and severity did not show significant worsening between the groups. CONCLUSION: Detrusor hyperactivity is a frequent urodynamic finding in PD, and even though it is associated with dopaminergic dysfunction, it cannot be blamed as a factor of worsening motor performance, but is probably associated with poor cognitive and mental prognosis.

Executive dysfunction and motor symptoms in Parkinson's disease.

The aim of this study is to analyze executive function and motor symptoms in patients with idiopathic Parkinson's disease (PD). The sample consisted of 44 subjects with PD between the ages of 45 to 75, who were examined consecutively. The subjects were divided into two groups according to the duration of the disease. The control group was composed of spouses, family and accompanying members. Patients included were submitted to motor dysfunction evaluation using the UPDRS. The executive functions modalities analyzed included: operational memory, inhibitory control, planning, cognitive flexibility and inductive reasoning. Significant differences between the experimental and control groups were found in all the executive domains studied. Evidence of tremor, rigidity and bradykinesia correlation with executive dysfunction were not observed. Patients with PD, even in the initial phase of the disease, presented executive dysfunction. The cardinal motor signs of the disease were not correlated with the cognitive dysfunction found.

Multiparity after an initial diagnosis of Parkinson's disease: a report on a rare case.

OBJECTIVE: To report a very rare case of multiparity after a diagnosis of Parkinson's disease (PD). DESIGN: Case report. SETTING: Department of neurology and gynecology of a university teaching hospital. PATIENT(S): A 36-year-old multiparous woman. INTERVENTION(S): Treatment of PD during pregnancy. MAIN OUTCOME MEASURE(S): The effect of multiparity on PD. RESULT(S): Multiparity had no effect on the progression of PD, and treatment of the disease during pregnancy appears to have been safe. CONCLUSION(S): Multiparity after a diagnosis of PD is extremely rare and, in the present case, had no effect on the progression of the disease.

Urinary dysfunction with detrusor hyperactivity in women with Parkinson's disease cannot be blamed as a factor of worsening motor performance / Disfuncao urinaria com hiperatividade detrusora nao e fator de risco para progressao do desempenho motor em mulheres com doenca de Parkinson

Introduction Detrusor hyperactivity is the leading cause of urinary dysfunction in Parkinson's disease (PD). There are few studies correlating PD clinical aspects with this autonomic feature. Methods A cohort of 63 women with PD were prospectively examined for assessment of clinical aspects and disease severity using unified Parkinson's disease rating scale and Hoehn-Yahr scale, respectively. The urologic function was evaluated by the urodynamic study. Two groups were categorized at this time - groups with and without detrusor hyperactivity. After seven years, the same parameters were re-evaluated. Results Progression of the disease on mental scores was found in the group with detrusor hyperactivity. On follow-up, clinical symptoms and severity did not show significant worsening between the groups. Conclusion Detrusor hyperactivity is a frequent urodynamic finding in PD, and even though it is associated with dopaminergic dysfunction, it cannot be blamed as a factor of worsening motor performance, but is probably associated with poor cognitive and mental prognosis. .

Introdução Hiperatividade detrusora (HD) é a principal causa de disfunção urinária na doença de Parkinson e poucos estudos correlacionam aspectos clínicos da doença com este componente autonômico. Métodos Foi avaliada uma coorte de 63 pacientes com DP quanto aos aspectos clínicos e gravidade global da doença utilizando as escalas UPDRS e Hoehn-Yahr. A função urológica foi avaliada através de estudo urodinâmico. Foram então categorizados dois grupos: pacientes com e sem HD. Após sete anos os mesmos parâmetros foram reavaliados. Resultados Houve progressão da doença quanto aos escores mentais no grupo com HD. Na reavaliação dos grupos os sintomas motores não evidenciaram piora significante. Conclusão HD é um achado urodinâmico frequente em pacientes com DP. Embora associada à disfunção dopaminérgica, HD não pode ser considerada fator de risco para piora do desempenho motor, mas provavelmente está associada com pior prognóstico mental e cognitivo. .

Executive dysfunction and motor symptoms in Parkinson's disease / Disfunções executivas e sintomas motores na doença de Parkinson

The aim of this study is to analyze executive function and motor symptoms in patients with idiopathic Parkinson's disease (PD). The sample consisted of 44 subjects with PD between the ages of 45 to 75, who were examined consecutively. The subjects were divided into two groups according to the duration of the disease. The control group was composed of spouses, family and accompanying members. Patients included were submitted to motor dysfunction evaluation using the UPDRS. The executive functions modalities analyzed included: operational memory, inhibitory control, planning, cognitive flexibility and inductive reasoning. Significant differences between the experimental and control groups were found in all the executive domains studied. Evidence of tremor, rigidity and bradykinesia correlation with executive dysfunction were not observed. Patients with PD, even in the initial phase of the disease, presented executive dysfunction. The cardinal motor signs of the disease were not correlated with the cognitive dysfunction found.

O objetivo do estudo é avaliar as funções executivas e sintomas motores em pacientes portadores de doença de Parkinson. A amostra se constituiu de 44 portadores de doença de Parkinson com idade entre 45 e 75 anos, examinados consecutivamente, os quais foram divididos em dois grupos de acordo com o tempo de duração da doença. O grupo controle foi composto de acompanhantes ou cônjuges. Os sujeitos selecionados foram submetidos à avaliação motora utilizando-se a escala UPDRS e à avaliação das funções executivas nas modalidades: raciocínio indutivo, memória operacional, controle inibitório, planejamento e flexibilidade cognitiva. Os resultados apontaram diferenças significantes entre os grupos experimentais e controle nas modalidades analisadas. Não encontramos evidência de associação entre tremor, rigidez e bradicinesia com as funções executivas. Conclui-se que os pacientes com doença de Parkinson, mesmo nas fases iniciais da doença, apresentam comprometimento cognitivo executivo. Os sintomas motores da doença não estavam correlacionados às disfunções executivas.

Knowledge of stroke among a brazilian urban population

Knowledge of the population in regards to stroke has clinical and epidemiological importance. Prompt identification of the symptoms means efficient medical attendance within the window of therapeutic opportunities reducing significantly the morbi-mortality. Our aim was to evaluate the level of knowledge of the population of Teresina (PI) concerning factors of risk, symptoms and treatment of stroke. The door-to-door study was carried out by means of a standardized application of questionnaire on risk factors, symptoms and attitude when faced with a stroke victim. 991 forms were selected. Factors of risk more cited were hypertension identified by 416 [42.0 percent] and hyperlipidemia 284 [28.7 percent]. The most remembered symptoms were headache 277 [28.0 percent] and hemiplegia 219 [22.1 percent]. 375 (37.8 percent) respondents were unable to identify any risk factors and and 410 (41.4 percent) any symptom. The lack of knowledge of the population of Teresina in relation to stroke reflects the need for intervention through public and professional educational campaigns.

O conhecimento da população sobre doenças cerebrovasculares (DCV) possui importância clínica e epidemiológica. A rápida identificação dos sintomas significará atendimento médico eficiente dentro das janelas de oportunidades terapêuticas reduzindo significativamente a morbimortalidade. Objetivou-se avaliar o nível de conhecimento da população de Teresina (PI) acerca dos fatores de risco, sintomas e tratamento das DCV. O estudo populacional, porta-a-porta, foi conduzido mediante aplicação padronizada de um questionário sobre fatores de risco, sintomas e atitude diante de um caso de DCV. Foram eleitos 991 formulários preenchidos. Os fatores de risco mais citados foram hipertensão arterial identificada por 416 [42,0 por cento] e hiperlipidemia 284 [28,7 por cento]. Os sintomas mais lembrados foram cefaléia 277 [28,0 por cento] e hemiplegia 219 [22,1 por cento]. Não identificaram nenhum fator de risco 375 (37,8 por cento) respondedores e 410 (41,4 por cento), nenhum sintoma. O reduzido conhecimento da população de Teresina com relação às DCV reflete a necessidade de intervenção com campanhas educativas públicas e profissionais nesta população.

Urinary symptoms in Parkinson's disease: prevalence and associated factors

The authors present a cross-sectional study involving 61 patients with idiopathic Parkinson's disease (PD) who were consecutively examined and compared to a control group with 74 subjects. Only patients who fulfilled the standard diagnostic criteria for PD and whose brain magnetic resonance imaging was normal were included. The objective of the study was to evaluate the prevalence of inferior urinary tract symptoms in PD and to study the possible association between clinical factors to urinary dysfunction. ln the patient group, 39.3 percent presented urinary symptoms when compared to 10.8 percent in the control group. All symptomatic patients presented irritative symptoms. The most common irritative symptom PD was nocturia, followed by frequency and urinary incontinence. Around 25 percent of the patients presented functional obstructive symptoms determined by the disease. The most frequent obstructive symptom was incomplete emptying of the bladder. Only the age of the patients and control group were correlated with urinary dysfunction