[Criteria of syndrome frailty in Parkinson´s disease]. / Kriterii starcheskoi astenii pri bolezni Parkinsona.

OBJECTIVE: To evaluate syndrome frailty by the Fried phenotype in patients with Parkinson's disease (PD). MATERIAL AND METHODS: Seventy-three patients over 65 years of age with Hoehn and Yahr stage 2-4 PD were tested for the presence of subjective criteria of the Fried phenotype of syndrome frailty: fatigue, difficulty in performing habitual activities, weight loss and objective criteria: grip strength and walking speed. The relationships of the objective criteria of Fried with indicators of age, sex, sports history, prescription of PD, the number of medications, blood pressure and MDS UPDRS part III scores, the severity of depression on the Beck scale and cognitive disorders on the MOCA were evaluated. RESULTS: All patients complained of fatigue, difficulties in performing habitual activities. Four people noted a decrease in body weight of more than 5 kg per year. Objective criteria of Fried were absent in 38 (51%) patients, 23 (32%) people had one objective criterion: reduced walking speed (less than 0.8 m/s) or hand strength (less than 16 kg for women and 26 kg for men), in 12 (17%) people both objective criteria were reduced. The values of objective criteria of weakness were correlated with age, sex and MDS UPDRS part III total scores. CONCLUSION: Frailty syndrome is difficult to diagnose in patients with PD due to the coincidence of complaints of the underlying disease and the syndrome. Objective criteria of the Fried phenotype suggest the presence of syndrome frailty in patients. The increase in the age of the patient, the female sex and the severity of PD are interrelated with the presence of objective criteria for the frailty of an elderly person.

[Rehabilitation's possibility of the patients with severe Parkinson's disease]. / Vozmozhnosti reabilitatsii patsientov na razvernutoi stadii bolezni Parkinsona.

OBJECTIVE: The application of the individual rehabilitating approach by hypokinesia and lack of physical activity in severe Parkinson's disease patient. MATERIAL AND METHODS: In the study were 43 patients with Parkinson's disease (17 men and 26 women; at the age 68.39±7.18 years) with 3-4 stage Hoehn and Yahr included. The physical state was previously defined. 10 individual complex lessons with the power exercises, the transfer training with external cueing, flexibility, balance-therapy, preparation of somatoreception to walking and the walking were in patient's stage with walking speed evaluation after the therapy conducted. RESULTS: Before the treatment 25 (58%) persons could not the test «6 minutes walking¼ perform, the time of the test «Up and Go¼ was lengthened and the grip strength was decreased, moreover in women the grip strength was less critical level. After the treatment the all patients participated in the test «6 minutes walking¼. Walking distance increased by 32.17 meter; p<0.01. THE CONCLUSION: The individual complex rehabilitation in patient stage's approach in severe Parkinson's disease patient let improve the walking.

[The assessment of physical fitness level, the functional status and the social features of the elderly that decided to engage in physical exercises.]

For the sake of maintaining active longevity of the elderly the adequate, individually selected physical activity, that was get after the integrated assessment of physical fitness level, the functional status and the social features, is necessary. 121 women (mean age 66,77±5,37) who decided to engage in physical exercises were included in the study. For every participant professional, social and sport anamnesis, the presence of illnesses, the clinical information and the functional tests (Stange, orthostatic, «6 minutes walking¼, «Up and go¼) were evaluated. Was get, that 75,21% participants of the study had hypertension. The normal type of systolic blood pressure reaction during orthostatic test was present in 71,07% people, by diastolic blood pressure - in 84,29% people. The body mass index corresponded to the excess body weight. The indices of the grip strength, spirometry were decreased, but were not critical. The indices of the grip right and left arm correlated with age (R=0,33; p<0,01; R=0,31; p<0,01). The results of the tests «Up and Go¼ and «6 minutes walking¼ were evaluated as normal. The orthopedic examination has revealed the flatfoot and scoliosis. 91,73% of the retired individuals did not have a job. Cause of retirement for the majority of patients were stuff cuts after the age 60, which was not in accordance with the satisfactory physical state of the participants of the investigation. Therefore, nowadays the questions of part-time employment of the elderly and re-education of the people with the age «50+¼, together with the development of physical exercise programs are of great importance.

[The high blood pressure in patients with Parkinson's disease]. / Povyshennoe arterial'noe davlenie u bol'nykh bolezn'yu Parkinsona.

OBJECTIVE: To evaluate the relationships between blood pressure (BP), duration of the high BP, reaction of the cardiovascular system on the physical load with the duration of Parkinson's disease (PD) and motor disorders in PD patients. MATERIAL AND METHODS: Fifty-six women with PD and high BP in the anamnesis and 91 women with arterial hypertension, stage 1 were included in the study. The groups of the patients did not differ by age (67.14±7.75 vs. 67.24±5.70 years; p>0.05). The patients were asked about the duration of high BP, the maximal systolic and diastolic BP (SBP and DBP) and presence of antihypertensive therapy, the patients with PD were additionally asked about the duration of the disease, the medicine for PD treatment, the vegetative dysfunction features. The assessment of the orthostatic reaction was determined by transition of the patient from the supine position to the sitting position. Three types of the reaction were isolated: normal, orthostatic hypotension and hypertension. The assessment of motor function in patients with PD was performed using MDS UPDRS, part III. RESULTS: Before and after the orthostatic test, patients with PD and history of arterial hypertension showed normal SBP and DBP levels, while those with isolated hypertension had elevated mean BP corresponding to the high-normal level: the difference in BP levels between the two groups was significant (134.89±17.19 vs. 124.64±18.19 mm Hg; p<0.05; 130.43±19.88 vs. 122.80±19.08 mm Hg; p<0.05). Patients with isolated hypertension were less likely to receive BP-lowering treatment - 30 (32.61%) vs. 10 (18.87%); p=0.04. There were no differences in the frequency of hypertensive and orthostatic reactions between the groups. The total score of motor disorders in patients with PD was correlated with the duration of high BP (R= -0.26; p=0.04). Among the patients with PD, 37 had hypertension prior to the neurologic disorder, 7 were diagnosed with two diseases simultaneously, while the remaining 12 had PD as the initial diagnosis, developing hypertension later in life. The score of the points of the motor disturbances was greater in patients who had developed two diseases simultaneously with the simultaneous developing of the illnesses (15.88±9.36 vs. 19.84±8.01 vs. 26.14±9.68; p<0.05, χ2=10.47, df=2). CONCLUSION: The development of arterial hypertension in patients with PD aggravates the disease.

[Nordic walking in winter as the multitask training in patients with Parkinson's disease]. / Zimnyaya skandinavskaya khod'ba kak mul'tizadanie u patsientov s bolezn'yu Parkinsona.

OBJECTIVE: To evaluate an influence of 8-week course of winter nordic walking as the multitask on the spatial-temporal characteristics of walking and motor disturbances in patients with Parkinson's disease (PD). MATERIAL AND METHODS: Eleven patients (3 men and 8 women, mean age 66.82±3.97 years) with Hoehn and Yahr stage 1 to 2 PD were included in the study. Preliminary medical examination, including the anthropometric profile with the calculation of the body mass index (BMI), the grip strength on the right and left sides, spirometry, functional tests with the physical load (orthostatic test with the determination of systolic and diastolic blood pressure (SBP and DPB) and type of reaction (normal, hypertonic, hypotonic), the 6 Minute Walk Test, timed Up and Go test), was performed to evaluate the physical state. The evaluation of motor function was performed using the unified Parkinson's disease rating scale of the Movement Disorder Society (MDS UPDRS), part III. A 8-week course of nordic walking training was carried out at the certified track on the stadium localized outside of the city, in the wood and parks area in the winter. RESULTS: Compared to the first training, gait velocity increased at the 3rd session, the step length at the 6th. The improvement of the spatial-temporal characteristics of walking was accompanied by the improvement of the motor function as measured by MDS UPDRS, part III. CONCLUSION: Winter nordic walking as multitask is the effective measure of exercise treatment in patients with PD, because it improves the spatial-temporal characteristics of walking and the motor function.

[The correction of motor disorders by special physical exercises in patients with the late cerebellar ataxia]. / Korrektsiia dvigatel'nykh rasstroistv spetsial'nymi fizicheskimi uprazhneniiami u bol'nykh s pozdnei mozzhechkovoi ataksiei.

AIM: The selection of special physical exercises for patients with late cerebellar ataxia based on the biomechanics of balance and gait and evaluation of the clinical effect of therapy. MATERIAL AND METHODS: Twelve male patients with the diagnosis of late cerebellar ataxia were included in the study. The mean age was 49.33±8.80 years. The daily program of therapeutic exercises included training lessons with the exercise physician. The duration of training lessons was 25-30 minutes every day besides the independent task-repetitions 5-6 times a day during 12 days. To evaluate a clinical effect, the Scale for the assessment and rating of ataxia (SARA) was administered before the lessons and on the 12-th day of therapy. RESULTS AND CONCLUSION: The authors developed the program of physical exercises for patients with late cerebellar ataxia based on the feeling of body weight and consecutive movements of the sole that were taken from techniques of classical dance steps. After 12 days of training, the total scores on SARA decreased (12.75±4.47 vs. 9.00±4.81, p<0.01) due to the decrease in the scores of gait (3.41±1.16 vs. 2.25±0.86, p<0.01) and stance (2.67±0.98 vs. 1.42±1.08, p<0.01). Therefore, special physical exercises are a necessary component of the therapy of late cerebellar ataxia.

[The power exercises as a risk factor of Parkinson's disease]. / Silovaia fizicheskaia nagruzka kak faktor riska bolezni Parkinsona.

AIM: To study the relationship between the physical condition, degree of motor disturbances and power loading in former athletes with Parkinson's disease (PD). MATERIAL AND METHODS: The study included 20 men with PD, including 10 power athletes with training loads in the youth for more than 5 years and 10 non-athletic patients. A medical history of PD and accompanied hypertension were analyzed, body mass index and power hand index were measured and the orthostatic test from supine to sitting position was made. Motor function was assessed with the unified Parkinson's disease rating scale of the Movement Disorder Society (MDS UPDRS) - part III. RESULTS AND CONCLUSION: Former athletes with PD were younger compared to non-athletic patients (57.44±8,14 vs. 66.78±4.29 years; p<005) and had longer duration of the disease (6.56±5,36 vs. 3.60±3.50 years; p<0.05). The orthostatic reaction of the former athletes was accompanied by increasing of diastolic blood pressure (DBP), while there was a decrease in DBD in the non-athletic men. Hypokinetic syndrome was more pronounced in the former athletes. The slowing of movements (bradykinesia) were accessed as 3 points on MDS UPDRS in 6 people and 4 points in 4. The results show the impact of power training on the course and presentations of PD in former athletes.

[Longitudinal global and regional left ventricular function in patients with hypertensive disease (tissue Doppler echocardiography data)]. / Prodol'naia global'naia i segmentarnaia funktsii levogo zheludochka u bol'nykh gipertonicheskoi bolezn'iu po dannym tkanevoi doppler-ékhokardiografii.

Impulse tissue doppler study was carried out in 154 patients with hypertensive disease (age 35-60 years) and 39 practically healthy volunteers (mean age 43.4+/-5.5 years). According to left ventricular geometry the following groups of patients were distinguished (after A.Ganau): with normal geometry (n=47), with concentric remodeling (n=12), with concentric hypertrophy (n=53), and with eccentric hypertrophy (n=42). Tissue doppler spectrum was registered from mitral annulus and 15 left ventricular segments. The following characteristics were obtained: in each annular spectrum - maximal velocities of peaks s(m), e(m), a(m), ratio e(m)/a(m), isovolumic relaxation time (ivrt) and their average values (from 6 measurements); in each left ventricular segmental spectrum - maximal velocities of waves s, e, a, ratio e/a and segmental ivrt. Compared with healthy persons patients with hypertension had lowered longitudinal global systolic function of the left ventricle. Patients with concentric left ventricular hypertrophy had least values of e(m), e(m)/a(m), ivrt(m) and greatest number of dysfunctional (e/a<1.0 and ivrt>90 ms) segments. Some hypertensive patients with normal values of transmitral blood flow had signs of segmental diastolic dysfunction. Among patients with normal left ventricular geometry isolated segmental diastolic dysfunction was revealed according to e/a in 12 of 20 (60%), according to ivrt in 11 of 22 (50%). All patients with concentric and eccentric left ventricular hypertrophy had segmental diastolic dysfunction. Thus impulse tissue doppler study is indicated to patients with hypertension and normal parameters of transmitral flow for assessment of longitudinal segmental diastolic left ventricular function.