Is white matter hyperintensity burden associated with cognitive and motor impairment in patients with parkinson's disease? A systematic review and meta-analysis.

White matter damage quantified as white matter hyperintensities (WMH) may aggravate cognitive and motor impairments, but whether and how WMH burden impacts these problems in Parkinson's disease (PD) is not fully understood. This study aimed to examine the association between WMH and cognitive and motor performance in PD through a systematic review and meta-analysis. We compared the WMH burden across the cognitive spectrum (cognitively normal, mild cognitive impairment, dementia) in PD including controls. Motor signs were compared in PD with low/negative and high/positive WMH burden. We compared baseline WMH burden of PD who did and did not convert to MCI or dementia. MEDLINE and EMBASE databases were used to conduct the literature search resulting in 50 studies included for data extraction. Increased WMH burden was found in individuals with PD compared with individuals without PD (i.e. control) and across the cognitive spectrum in PD (i.e. PD, PD-MCI, PDD). Individuals with PD with high/positive WMH burden had worse global cognition, executive function, and attention. Similarly, PD with high/positive WMH presented worse motor signs compared with individuals presenting low/negative WMH burden. Only three longitudinal studies were retrieved from our search and they showed that PD who converted to MCI or dementia, did not have significantly higher WMH burden at baseline, although no data was provided on WMH burden changes during the follow up. We conclude, based on cross-sectional studies, that WMH burden appears to increase with PD worse cognitive and motor status in PD.

White matter hyperintensity burden predicts cognitive but not motor decline in Parkinson's disease: results from the Ontario Neurodegenerative Diseases Research Initiative.

BACKGROUND AND PURPOSE: The pathophysiology of Parkinson's disease (PD) negatively affects brain network connectivity, and in the presence of brain white matter hyperintensities (WMHs) cognitive and motor impairments seem to be aggravated. However, the role of WMHs in predicting accelerating symptom worsening remains controversial. The objective was to investigate whether location and segmental brain WMH burden at baseline predict cognitive and motor declines in PD after 2 years. METHODS: Ninety-eight older adults followed longitudinally from Ontario Neurodegenerative Diseases Research Initiative with PD of 3-8 years in duration were included. Percentages of WMH volumes at baseline were calculated by location (deep and periventricular) and by brain region (frontal, temporal, parietal, occipital lobes and basal ganglia + thalamus). Cognitive and motor changes were assessed from baseline to 2-year follow-up. Specifically, global cognition, attention, executive function, memory, visuospatial abilities and language were assessed as were motor symptoms evaluated using the Movement Disorder Society Unified Parkinson's Disease Rating Scale Part III, spatial-temporal gait variables, Freezing of Gait Questionnaire and Activities Specific Balance Confidence Scale. RESULTS: Regression analysis adjusted for potential confounders showed that total and periventricular WMHs at baseline predicted decline in global cognition (p < 0.05). Also, total WMH burden predicted the decline of executive function (p < 0.05). Occipital WMH volumes also predicted decline in global cognition, visuomotor attention and visuospatial memory declines (p < 0.05). WMH volumes at baseline did not predict motor decline. CONCLUSION: White matter hyperintensity burden at baseline predicted cognitive but not motor decline in early to mid-stage PD. The motor decline observed after 2 years in these older adults with PD is probably related to the primary neurodegenerative process than comorbid white matter pathology.

Contribution of Hip Abductors Muscles on Bone Mineral Density and Functionality in Older Women.

BACKGROUND: Despite the well-established role of muscle in maintaining bone mass and physical performance, there are still few studies that assess the relationship between muscle groups and specific bone sites and its contribution to physical function in older people. The aim of the study is to verify the association between hip and knee's muscle strength and bone mineral density of the femoral neck (BMD-FN) and investigated which muscle strength that are related with BMD-FN is associated with physical function in older women. METHODOLOGY: This is a cross-sectional study of 94 women over the age of 60 years, physically independent. Muscle strength of the hip and knee was evaluated using an isokinetic dynamometer (Biodex, USA) to obtain peak torque (PT). The BMD-FN was obtained using dual-energy x-ray absorption densitometry (DXA). Physical function was evaluated by the Timed Up and Go (TUG), gait speed (GS), five times stand to sit (5TSS) and single-leg stance (SS). To verify the association between muscle strength (independent variable) and the BMD-FN (dependent variable) and the relationship between muscle strength (independent variable) and clinical tests (dependent variable), the multiple linear regression was carried out, adjusted for age, time of menopause, height and level of physical activity. All of the analyses were carried out by the SPSS 17.0 software, with a level of p < 0.05 significance. RESULTS: We found an association between the hip abductors PT and the BMD-FN and between hip abductors PT and all clinical tests. CONCLUSION: We observe that hip abductor muscle strength contributes to BMD-FN and to performance in several clinical tests in older women. These findings reinforce the importance of this musculature not only for improving balance and gait, but also it can be a strategy to maintain/improve bone mass in the femoral neck in this population.

Trunk muscle function and anterior and posterior limits of stability in community-dwelling older adults.

BACKGROUND: Understanding of the influence of trunk muscles on the older adult's limit of stability (LOS) is important for clinical practice. OBJECTIVE: To compare the anterior and posterior LOS and the flexor and extensor trunk muscle function; verify the association of trunk muscles and LOS, and the association of LOS and the previous falls of community-dwelling older adults. METHODS: Sample characterization data, trunk muscle function (peak torque - PT and torque steadiness - TS), LOS and previous falls (6 months) were collected from 79 older people. Comparisons were made between the variables of the anterior/posterior LOS (Reaction time, Movement velocity, Maximum excursion, Directional control), between trunk extensors/flexors muscle function and between TS at 10% and at 50%. Associations were made between the anterior/posterior LOS and the number of previous falls and between LOS and trunk muscle function. RESULTS: The posterior LOS was worse than the anterior LOS, except for the reaction time. The flexor muscles obtained a lower PT, but better performance in TS. The TS at 10% of the trunk extensor was associated with the posterior directional control (p = 0.032). There was no association between trunk muscle function and the anterior LOS, or between previous falls and LOS. CONCLUSIONS: The older adults presented worse performance in the posterior LOS and worse TS in the trunk extensor muscles, although the trunk extensor muscles presented a higher PT. Although no association between LOS and previous falls, the better the TS at 10% of the trunk extensors, better posterior directional control.

Functional performance of older adults: A comparison between men and women.

The objective of this study was to compare the functional performance of community-dwelling older adults of both sexes and investigate the possible mediation aspects that may influence the sex differences regarding socioeconomic and anthropometric characteristics, health status, and quadriceps muscle strength. 233 Brazilian older adults were assessed, and men's and women's sociodemographic data, physical activity level, quadriceps muscle strength, functional performance (gait speed and the SPPB), and history of falls were compared. Sex differences in functional performance were observed even after statistically adjusting the model (age, body mass, income, physical activity level, and occurrence of falls). When quadriceps muscle strength was included in the adjusted model, the sex difference remained only for gait speed. When stature was included in the adjusted model, the sex difference in gait speed disappeared. Our results suggest that the sex difference in functional performance assessed by the SPPB can be explained due to the fact that men are stronger than women. In addition, the sex difference regarding gait speed was explained by the sex difference in stature. Public actions that encourage older women to practice physical activities that promote increased muscle strength can positively interfere with their best functional performance for as long as possible.

The effect of low-level laser therapy and physical exercise on pain, stiffness, function, and spatiotemporal gait variables in subjects with bilateral knee osteoarthritis: a blind randomized clinical trial.

Objective: To evaluate the effects of individual and combination therapies (low-level laser therapy and physical exercises) on pain, stiffness, function, and spatiotemporal gait variables in subjects with bilateral knee osteoarthritis (OA).Methods: Subjects with knee OA (Grades 1-3) were evaluated and randomized into four groups: Control Group (CG), untreated; Laser Group (LG), treated with laser at 808 nm, 5.6 J; Exercise Group (EG), treated with exercise; and Laser + Exercise Group (LEG), treated with laser and exercises. The treatment was carried out twice a week for 2 months. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire was applied for evaluation and reevaluation; evaluation of spatiotemporal gait variables was performed using GAITRite equipment.Results: The EG showed significant improvement in pain (p = 0.006) and function (p = 0.01) according to WOMAC. Regarding gait variables, in intergroup analysis after 8 weeks all groups receiving intervention showed a significant increase in gait speed: LG versus CG (p = 0.03); EG versus CG (p = 0.04) and LEG versus CG (p = 0.005). Only the group treated with laser + exercise showed a significant increase (p = 0.009) in the cadence and duration of single right limb support (p = 0.04), and only the groups treated with exercise and laser + exercise showed significant decreases in the duration of right limb support (p = 0.035 and p = 0.003, respectively), compared to the CG.Conclusions: The group treated only with exercise showed improvement in WOMAC questionnaire scores. Regarding the gait variables, all groups undergoing the interventions showed increases in the gait speed compared to the CG. The laser and exercise combination therapy provided the best results for the other gait variables (cadence and duration of right limb support and duration of single right limb support).Implications for rehabilitationThere are differences in gait patterns in patients with knee OA, including decreased gait speed, cadence, and step length.The results shown in the present study provide additional information about the physical therapy approaches that should be chosen during clinical practical to improve gait performance in individuals with knee osteoarthritis.The improvement in gait performance is a relevant issue due to the fact that is associated to physical independence and better quality of life.

Performance of Faller and Nonfaller Older Adults on a Motor-Motor Interference Task.

Typically, falls in older adults occur when 2 tasks are performed simultaneously, due to the increased motor demand required to maintain stability and attention to perform the other task. The authors' purpose was to investigate walking while grasping, transporting, and placing a dowel on a predetermined target while manipulating difficulty levels of the manual task. Faller and nonfaller older adults performed a walking block (manual tasks combined with gait) and a stationary block (upright stance combined with manual tasks). The manual task involved grasping, transporting, and placing the dowel over a target. The results showed that fallers underperformed when compared with nonfallers in the task of placing the dowel over the target. The main difference observed between the groups was found in the condition that required allocation of attention between tasks and greater accuracy in the final placement of the object. Fallers showed gait stability similar to the nonfallers, but fallers were less accurate than nonfallers in the object placement task, especially for the highest level of difficulty. Thus, fallers seem to use a stability-first strategy. Fallers had problems in executing the manual tasks, which suggests a more global change in motor behavior rather than specific changes to balance control.

Brazilian Portuguese version of the Revised Fibromyalgia Impact Questionnaire (FIQR-Br): cross-cultural validation, reliability, and construct and structural validation.

PURPOSE: This study aimed to culturally adapt and validate the Revised Fibromyalgia Impact Questionnaire (FIQR) to Brazilian Portuguese, by the use of analysis of internal consistency, reliability, and construct and structural validity. METHOD: A total of 100 female patients with fibromyalgia participated in the validation process of the Brazilian Portuguese version of the FIQR (FIQR-Br).The intraclass correlation coefficient (ICC) was used for statistical analysis of reliability (test-retest), Cronbach's alpha for internal consistency, Pearson's rank correlation for construct validity, and confirmatory factor analysis (CFA) for structural validity. RESULTS: It was verified excellent levels of reliability, with ICC greater than 0.75 for all questions and domains of the FIQR-Br. For internal consistency, alpha values greater than 0.70 for the items and domains of the questionnaire were observed. Moderate (0.40 < r < 0.70) and strong (r > 0.70) correlations were observed for the scores of domains and total score between the FIQR-Br and FIQ-Br. The structure of the three domains of the FIQR-Br was confirmed by CFA. CONCLUSIONS: The results of this study suggest that that the FIQR-Br is a reliable and valid instrument for assessing fibromyalgia-related impact, and supports its use in clinical settings and research. The structure of the three domains of the FIQR-Br was also confirmed. Implications for Rehabilitation Fibromyalgia is a chronic musculoskeletal disorder characterized by widespread and diffuse pain, fatigue, sleep disturbances, and depression. The disease significantly impairs patients' quality of life and can be highly disabling. To be used in multicenter research efforts, the Revised Fibromyalgia Impact Questionnaire (FIQR) must be cross-culturally validated and psychometrically tested. This paper will make available a new version of the FIQR-Br since another version already exists, but there are concerns about its measurement properties. The availability of an instrument adapted to and validated for Brazilian Portuguese may make it possible to reliably verify the effects of rehabilitation programs on disability from fibromyalgia. The FIQR-Br showed results comparable with other versions of the FIQR in other languages, thereby enabling comparison of effects of rehabilitation interventions on disability from fibromyalgia conducted in Brazil with results of studies carried out in other parts of the world.

Relationship between pelvic floor muscle strength and sexual dysfunction in postmenopausal women: a cross-sectional study.

INTRODUCTION AND HYPOTHESIS: The prevalence of sexual dysfunction in postmenopausal women is high. Theoretically pelvic floor muscle (PFM) strength could influence sexual function, but to date there is scant evidence on this topic. The aim of this study was to evaluate the relationship between PFM strength and sexual function in postmenopausal women. The relationship between reported urinary incontinence (UI) and sexual dysfunction was also investigated. METHODS: This was a cross-sectional study including 113 postmenopausal women. PFM strength was evaluated using vaginal manometry. Sexual function was evaluated using the Female Sexual Function Index (FSFI). A score of ≤26.5 was considered to indicate sexual dysfunction. Urinary incontinence reports were evaluated using the International Consultation on Incontinence Questionnaire-Urinary Incontinence (ICIQ-UI) Short Form. Statistical analysis was performed using Spearman's rank correlation coefficient (ρ), the Mann-Whitney test and 95 % confidence intervals. RESULTS: The median age of the women was 53 years (range 42 - 65 years) and their median body mass index was 27.9 kg/m2 (range 20 - 42 kg/m2). Women without sexual dysfunction showed significantly higher PFM strength (median 41.8, range 11.3 - 94.0 cmH2O) than women with sexual dysfunction (median 30.3, range 3 - 112 cmH2O; p = 0.02). A weak correlation was found between the total FSFI score and the total ICIQ-UI score (ρ = -0.21, p = 0.03). CONCLUSIONS: Postmenopausal women with sexual dysfunction showed lower PFM strength than women without sexual dysfunction. There was a weak correlation between urinary incontinence severity and sexual function.

Muscle hypertrophy in quadriplegics with combined electrical stimulation and body weight support training.

We describe the analysis of muscle hypertrophy in complete quadriplegics after 6 months of treadmill gait training with neuromuscular electrical stimulation (NMES). We aim to evaluate the effect of treadmill gait training using NMES, with 30-50% body weight relief, on muscle mass. Fifteen quadriplegics were divided into gait (n=8) and control (n=7) groups. The gait group (GG) performed training, associated to partial body weight support, for 6 months, twice a week, for 20 min. Control group (CG) individuals performed only conventional physiotherapy, but did not perform gait training using NMES. Magnetic resonance imaging (MRI) was performed over quadriceps, at the beginning and after 6 months. The MRI was done to determine the average of cross-sectional area of the quadriceps. Moreover, a gray scale was used to separate the muscle from the conjunctive tissue (when the value is closer to 225, there is a higher amount of muscle tissue). After 6 months there was an increase of cross-sectional area in the gait group (from 49.81+/-9.36 to 57.33+/-10.32 cm2; P=0.01), but not in the control group (from 43.60+/-7.56 to 41.65 +/- 9.44 cm2; P=0.17). The gray scale did not show significant differences after 6 months; however, the mean value of the gray scale inside the quadriceps in the gait group increased by 7.7% and in the control group decreased by 11.4%. Treadmill gait associated with NMES was efficient to promove quadriceps muscle hypertrophy in quadriplegics with chronic lesions even when a partial body weight support was provided.