Equilíbrio postural e fatores associados ao risco de quedas em idosos com diabetes mellitus tipo 2 / Postural balance and associated factors with the fall risk assessed in older adults with type 2 diabetes mellitus

Resumo Objetivo Identificar os fatores clínico-funcionais associados ao risco de quedas, avaliado pelo Mini-BESTest, em idosos com diabetes mellitus tipo 2 (DM2). Método Trata-se de um estudo transversal. Um total de 145 idosos com idade =60 anos foram avaliados por meio das variáveis sociodemográficas (sexo, faixa etária, estado civil, nível de educação e percepção geral da saúde, audição e visão) Mini-BESTest, Mini-Mental State Examination (MMSE), Escala de Depressão Geriátrica (GDS-15) e o teste Timed Up and Go (TUG) (dupla tarefa). Foi utilizado um modelo de regressão logística múltipla. Resultados O domínio de orientação sensorial apresentou a pontuação média mais elevada, seguido pelos domínios estabilidade na marcha, ajustes posturais antecipatórios e respostas posturais. Os fatores associados ao risco de quedas em idosos foram: percepção visual ruim/muito ruim OR 3.40 (1,50-7,72); presença de doenças respiratórias OR 8.00 (1,32-48,46); sensação de tontura OR 2.53 (1,10-5,80); e tempo do teste Timed Up and Go (TUG) (dupla tarefa) igual ou superior a 13,5 segundos OR 3.31 (1,03-10,64). Conclusão Os idosos deste estudo apresentaram um equilíbrio postural comprometido, principalmente no domínio das respostas posturais. O conhecimento dos fatores associados ao risco de quedas em idosos com DM2 permite uma orientação mais eficaz na avaliação, prevenção e intervenção, visando minimizar a ocorrência de quedas e preservar ou otimizar o equilíbrio postural. Diversos fatores influenciaram esse resultado, tais como sobrepeso, baixa atividade física e nível educacional, várias comorbidades, polifarmácia, diagnóstico de DM2 por mais de dez anos, percepção negativa da saúde geral e da visão, e sintomas depressivos.

Abstract Objective Identify clinical-functional factors associated to the risk of falls, assessed by Mini-BESTest in older adults with type 2 diabetes mellitus (T2DM). Method This cross-sectional study. A total of 145 older adults aged ≥60 years were evaluated through sociodemographic variables (sex, age group, married, education level, general health status hearing and vision), Mini-BESTest, Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS-15) and dual-task Timed Up and Go Test (TUG) Multiple logistic regression model was used. Results The sensory orientation domain presented the highest average score, followed by the gait stability, anticipatory postural adjustments and postural responses domains. Factors associated to the risk of falls in older adults are: poor/very poor visual perception OR 3.40 (1.50-7.72); have respiratory diseases OR 8.00 (1.32-48.46); feeling dizzy OR 2.53 (1.10-5.80); and TUGT (dual task) time equal to or greater than 13.5 seconds OR 3.31 (1.03-10.64). Conclusion Older adults in this study presented impaired postural balance, mainly in the postural responses domain. The knowledge of the factors associated with the risk of falls in older adults with T2DM allows for better guidance in prevention, assessment and intervention, in order to minimize the occurrence of falls and maintain or optimize postural balance. Several factors influenced this outcome, such as overweight, low physical activity and education, several comorbidities, polypharmacy, T2DM diagnosis for more than ten years, negative perception of general health and vision, and depressive symptoms.

Comparison of the Effects of an Exergame-Based Program with Conventional Physiotherapy Protocol Based on Core Areas of the European Guideline on Postural Control, Functional Mobility, and Quality of Life in Patients with Parkinson's Disease: Randomized Clinical Trial.

Introduction: Impairment of postural control and functional mobility are debilitating symptoms of Parkinson's disease (PD). In addition to limiting performance in activities of daily living, it is associated with a higher prevalence of falls in this population. Particularly, dysfunction in postural control does not respond to dopaminergic replacement therapy, but physiotherapy can improve this outcome in patients with PD. Objective: The aim of this study was to analyze the effects of training based on Kinect Adventures games compared with a conventional physiotherapy protocol based on the core areas of the European physiotherapy guideline in patients with PD on postural control, functional mobility, self-perception of confidence in the balance, quality of life (QoL), lower limb muscle strength, transfer skill and motor function, as well as to observe adherence and safety interventions. Methods: Thirty-eight patients diagnosed with idiopathic PD were randomized into two groups, and performed 14 training sessions, twice a week for 60 minutes. The primary outcome assessed postural control using the Mini-Balance Evaluation Systems Test (Mini-BESTest). The following were evaluated as secondary outcomes: limit of stability; balance functional reserve and center of pressure area by computerized posturography; functional mobility by the Timed Up and Go test; self-confidence in balance through the Activities-specific Balance Confidence scale; QoL through the Parkinson's Disease Questionnaire; lower limb muscle strength by the Five Times Sit-To-Stand test; and motor function by the Unified Parkinson's Disease Rating Scale. Results: Patients completed training sessions with high rates of safety and adherence. After training, there was a significant improvement in postural control, motor function, and QoL. Conclusion: Both interventions proved to be safe, applicable, and effective to improve postural control, QoL, and motor function in patients with PD. However, there was no difference between the effects of Kinect Adventures games and conventional physiotherapeutic protocol in patients with PD. Brazilian Registry of Clinical Trials (RBR-27kqv5).

Detection of passive movement in lower limb joints is impaired in individuals with Parkinson's disease.

OBJECTIVE: Sensory information is crucial when performing daily activities, and Parkinson's disease may diminish sensitivity to sensory cues. This study aimed to examine the detection threshold of passive motion of knee and ankle joints in individuals with Parkinson's disease. METHODS: Eighteen individuals in the early stages of idiopathic Parkinson's disease (age: 62.7 ±â€¯7.3 years) and 18 healthy matched controls (age: 62.5 ±â€¯7.1 years) first performed a simple reaction time test. Participants were asked to perform ten trials, during which they had to watch a square on a screen and press a button as quickly as possible when the square lit up. Thereafter, the participants were tested for their detection threshold of passive motion of their lower limb joints. Participants were seated in a specially designed chair and their knee or ankle joint was passively moved at a velocity of 0.5º/s. Participants kept their eyes closed and were instructed to press a button as quickly as possible when any joint motion was detected. RESULTS: Individuals with Parkinson's disease needed more time to perform the reaction time test than did the control participants. Individuals with Parkinson's disease also needed larger angular displacement, even when reaction time was used as a covariate measure, to detect any passive motion, in both knee (0.70ºâ€¯±â€¯0.20º) and ankle (1.03ºâ€¯±â€¯0.23º) joints than did the control participants [(0.57ºâ€¯±â€¯0.20º) and (0.84ºâ€¯±â€¯0.27º), respectively]. CONCLUSION: Impaired joint proprioception can be observed in the early stages of Parkinson's disease, which may compromise the use of proprioception cues from lower limbs.

Immersive virtual reality is effective in the rehabilitation of older adults with balance disorders: A randomized clinical trial.

QUESTION: What are the effects of immersive virtual reality (IVR) training compared to conventional physiotherapy on body balance and risk of falls in older adults with balance disorders? DESIGN: A randomized controlled trial with two intervention arms, concealed allocation, per-protocol analysis, and blinded assessment. PARTICIPANTS: Thirty-seven older adults with balance disorders and risk of falling. INTERVENTION: Participants were randomized into two groups: a control group, which received balance training with conventional physiotherapy using multimodal circuit exercises, and an experimental group, which received balance training using immersive virtual reality. Both groups received 16 individual sessions, twice a week. OUTCOME MEASURES: The primary outcome was functional balance. Secondary outcomes were static balance, gait speed, functional range, dizziness symptoms, and fear of falling. Safety was ensured by assessing any adverse events during the intervention. RESULTS: After 16 sessions, in the intragroup analysis, the functional balance score in the experimental group increased by 3.00 (95% CI 1.42 to 4.57) and in the control group by 3.88 (95% CI 2.16 to 5.59). Both groups improved in assessments of sensory interaction and anterior reach. Only the experimental group presented increased mobility and reduced dizziness. After two months, there was a maintenance of gains in functional balance and a reduction of the gains in functional reach for both groups. In the intergroup comparison, there was no significant difference. CONCLUSION: Immersive Virtual Reality training proved to be effective for balance-related outcomes, although it was not superior to conventional therapy. TRIAL REGISTRATION: RBR-3tk7fw.

Parkinson's disease delays predictable visual cue processing without affecting complex and unpredictable visual cue processing in postural control.

This study examined the influence of visual information of different complexities and predictability on the body sway of individuals with Parkinson's disease (PD) during upright stance. Twenty-one individuals at initial stages of PD (62.1 ± 7.2 years), under dopaminergic medication, and 21 controls (62.3 ± 7.1 years) stood inside a moving room, performing 10 trials of 60 s. In the first trial, the room remained motionless. Then, the room oscillated in an anterior-posterior direction. There were three blocks of three trials. In the first block, the room oscillated at 0.2 Hz (periodic simple condition); in the second block, periodic frequencies of 0.1, 0.3, and 0.5 Hz were combined (periodic complex condition); in the third block, non-periodic frequencies of 0.1, 0.3, and 0.5 Hz were combined (non-periodic complex condition). Participants were not informed about the room movement. The displacement of the room and trunk were registered using an OPTOTRAK system. Postural sway was examined using mean sway amplitude, and the relationship between visual information and body sway used coherence, gain, and phase. There was no group difference when the room remained motionless. Upon visual manipulation, the PD group displayed larger sway magnitude in the non-periodic complex condition. Individuals with PD also lagged behind the moving room (lower phase values) compared to controls, only in the periodic simple condition. In the remaining measures, there was no group difference. These results suggest that individuals with PD use complex and unpredictable visual information, similar to controls, during upright stance. However, PD might affect the predictable visual cues processing.

A quantitative analysis of postural control in elderly patients with vestibular disorders using visual stimulation by virtual reality / Análise quantitativa do controle postural em pacientes idosos com disfunção vestibular utilizando a estimulação visual por realidade virtual

Abstract Introduction: Postural instability is one the most common disabling features in vestibular disorders. Objective: This study aimed to analyze the limit of stability and the influence of manipulation of visual, somatosensorial and visual-vestibular information on postural control in older adults with vestibular disorder, with and without a history of falls. Methods: Cross-sectional study. Participants - 76 elderly patients with vestibular disorder (G1, without falls; G2, with falls) and 41 healthy elderly subjects (control group; CG). Using posturography, analyzed were limit of stability area, body center of pressure, and velocity of oscillation in the standing position in 10 conditions, including open/closed eyes, unstable surface with eyes closed, saccadic and optokinetic stimuli, and visual-vestibular interaction. Results: Limit of stability area in CG was better compared with G1-2, and center of pressure values were worse in G1 than in CG. Center of pressure area in all conditions and velocity of oscillation in the following conditions: open/closed eyes, optokinetic stimulation, and visual-vestibular interaction showed worse values in G2 than in CG. Center of pressure area in the following conditions: open/closed eyes, saccadic and optokinetic stimuli, visual-vestibular interaction, and unstable surface with eyes closed showed worse values in G2 than in G1. Conclusion: Older adults with vestibular disorder presented reduced limit of stability and increased postural sway in the following conditions: conflict between visual and somatosensory information and visual-vestibular interaction. Deterioration in postural control was significantly associated with history of falls.

Resumo Introdução: Instabilidade postural é uma das características incapacitantes mais comuns nos distúrbios vestibulares. Objetivo: Analisar o limite de estabilidade e a influência da manipulação de informações visuais, somatossensoriais e visuais-vestibulares no controle postural em idosos com disfunção vestibular, com e sem histórico de quedas. Método: Estudo transversal. Participantes: 76 idosos com distúrbios vestibulares (G1, sem quedas; G2, com quedas) e 41 idosos saudáveis (grupo controle; GC). Com o uso da posturografia, foram analisadas a área do limite de estabilidade, centro de pressão e velocidade de oscilação na posição ereta em 10 condições, incluindo olhos abertos/fechados, superfície instável com olhos fechados, estímulos sacádicos e optocinéticos e interação visual-vestibular. Resultados: A área de limite de estabilidade no GC foi melhor comparada com o G1-2 e os valores do centro de pressão foram piores no G1 do que no GC. A área do centro de pressão em todas as condições e a velocidade de oscilação nas seguintes condições: olhos abertos/fechados, estímulo optocinético e interação visual-vestibular mostraram valores piores no G2 do que no GC. A área do centro de pressão nas seguintes condições: olhos abertos/fechados, estímulos sacádicos e optocinéticos, interação visual-vestibular e superfície instável com olhos fechados apresentou valores piores no G2 do que no G1. Conclusão: Idosos com disfunção vestibular apresentaram redução de limite de estabilidade e aumento da oscilação postural nas seguintes condições: conflito entre informação visual e somatossensorial e interação visual-vestibular. A deterioração no controle postural foi significantemente associada ao histórico de quedas.

Enriched environment and exercise effects on parvalbumin expression and distribution in the hippocampal formation of developing rats.

Several models of environmental enrichment and physical exercise have been used to explore the experience effects on brain functions and plasticity, mainly in adult animals. In order to examine the early influence of these stimuli on developing brain, the present study used calcium-binding protein parvalbumin as neuroplastic marker in the hippocampal formation of male Wistar rats subjected to environmental enrichment or physical exercise from postnatal days 21 to 60 (P21-P60). In our study, no significant difference in hippocampal expression and distribution of parvalbumin was found between enriched and control rats. However, a significant increase in parvalbumin protein expression as well as in the number of neurons stained with parvalbumin was observed in the hippocampal formation of rats submitted to daily treadmill exercise when compared to the control rats. The hippocampal region with the highest number of parvalbumin neurons in exercised rats was Cornus of Amon 2 e 3 (CA2/CA3). These findings indicate that developing brain may be differentially sensitive to environmental stimulation models. Specifically, our results show that hippocampal expression and distribution of parvalbumin in developing rats may be more influenced by exercise than by enriched environment. The mechanisms are not yet known.

People in early stages of Parkinson's disease are able to intentionally reweight the use of visual information for postural control.

BACKGROUND: Parkinson's disease (PD) leads to several changes in motor control, many of them related to informational or cognitive overload. The aim of this study was to investigate the influence of knowledge and intention on the postural control performance and on the coupling between visual information and body sway in people with and without PD standing upright. METHODS: Participants were 21 people with PD (62.1 ± 7.2 years), stages 1 and 2 (Hoehn & Yahr scale), under dopaminergic medication, and 21 people in the control group (62.3 ± 7.1 years). Participants stood upright inside a moving room, performing seven trials of 60 s. In the first trial, the room remained motionless. In the others, the room oscillated at 0.2 Hz in the anterior-posterior direction: in the first block of three trials, the participants were not informed about the visual manipulation; in the second block of three trials, participants were informed about the room movement and asked to resist the visual influence. An OPTOTRAK system recorded the moving room displacement and the participants' sway. The variables mean sway amplitude (MSA), coherence and gain were calculated. RESULTS: With no visual manipulation, no difference occurred between groups for MSA. Under visual manipulation conditions, people with PD presented higher MSA than control, and both groups reduced the sway magnitude in the resisting condition. Control group reduced sway magnitude by 6.1%, while PD group reduced by 11.5%. No difference was found between groups and between conditions for the coupling strength (coherence). For the coupling structure (gain), there was no group difference, but both groups showed reduced gain in the resisting condition. Control group reduced gain by 12.0%, while PD group reduced by 9.3%. CONCLUSIONS: People with PD, under visual manipulation, were more influenced than controls, but they presented the same coupling structure between visual information and body sway as controls. People in early stages of PD are able to intentionally alter the influence of visual information.

A quantitative analysis of postural control in elderly patients with vestibular disorders using visual stimulation by virtual reality.

INTRODUCTION: Postural instability is one the most common disabling features in vestibular disorders. OBJECTIVE: This study aimed to analyze the limit of stability and the influence of manipulation of visual, somatosensorial and visual-vestibular information on postural control in older adults with vestibular disorder, with and without a history of falls. METHODS: Cross-sectional study. Participants - 76 elderly patients with vestibular disorder (G1, without falls; G2, with falls) and 41 healthy elderly subjects (control group; CG). Using posturography, analyzed were limit of stability area, body center of pressure, and velocity of oscillation in the standing position in 10 conditions, including open/closed eyes, unstable surface with eyes closed, saccadic and optokinetic stimuli, and visual-vestibular interaction. RESULTS: Limit of stability area in CG was better compared with G1-2, and center of pressure values were worse in G1 than in CG. Center of pressure area in all conditions and velocity of oscillation in the following conditions: open/closed eyes, optokinetic stimulation, and visual-vestibular interaction showed worse values in G2 than in CG. Center of pressure area in the following conditions: open/closed eyes, saccadic and optokinetic stimuli, visual-vestibular interaction, and unstable surface with eyes closed showed worse values in G2 than in G1. CONCLUSION: Older adults with vestibular disorder presented reduced limit of stability and increased postural sway in the following conditions: conflict between visual and somatosensory information and visual-vestibular interaction. Deterioration in postural control was significantly associated with history of falls.

The effects of dual task gait and balance training in Parkinson's disease: a systematic review.

In patients with Parkinson's disease (PD), the ability to perform simultaneous tasks may be impaired. However, there is no consensus as to whether the strategy of use dual task (DT) should be used with PD patients during gait and balance training because DT can increase the risk of falls. Therefore, it is necessary to critically analyze the relevant studies and evaluate the indications for the use of DT and its effects as a therapeutic strategy. The aim of this systematic review was to explore the effects of DT gait and balance training in individuals with PD. A total of 602 studies were found. After applying the eligibility criteria, seven studies were selected (three clinical trials, one uncontrolled clinical trial, and three pilot studies). Despite the poor methodological quality, the studies indicated the use of DT during gait and balance training may be beneficial for people with mild to moderate PD in compare of single-task or no intervention. The use of DT during training presented benefits related to gait (gait speed, step length and cadence) and balance (mediolateral and anteroposterior balance in closed-eyes tests). The current scenario shows that using DT in the training seems not to be harmful and could be part of the rehabilitation of PD patients. Further clinical trials are needed to confirm the findings, and it would be the most importance that these studies stratify individuals with degrees of disease severity to verify the effect of using the DT during training.

Dual-task demands in various motor skills through Parkinson's disease progression

Aim: The aim of this study was to investigate the effects of adding a cognitive task on the performance of three different motor tasks with different demands, discrete skills, serial skills and continuous skills, by individuals with mild, moderate, and severe idiopathic Parkinson' disease (PD). We also investigate the effect of the cognitive task in the secondary task and the cost of the dual-task. Method: This is a cross-sectional study. Individuals with idiopathic PD were divided in three groups with respect to motor severity (mild, moderate and severe groups). Participants' performances were assessed in single and DT conditions including Sit-to-Stand test (SST), Timed Up and Go (TUG), and 10-meter Walk test (T10W). Cognitive task used was verbal fluency Results: The results show that dual task impact the performance of all primary tasks. DT negatively affects the performance of the motor tasks. And there is a different impact according the severity of the disease, severe ones are more affected than mild and moderate. Conclusion: In conclusion, adding a concurrent cognitive task negatively affected the performance of discrete, serial and continuous motor tasks, and this effect is more noticeable in severe than in mild patients. Under dual-task conditions, patients improved their cognitive task performance for gait and TUG, suggesting a prioritization of the secondary task for these tasks. There was no difference between the costs of the three tasks.Abstract Aim: The aim of this study was to investigate the effects of adding a cognitive task on the performance of three different motor tasks with different demands, discrete skills, serial skills and continuous skills, by individuals with mild, moderate, and severe idiopathic Parkinson' disease (PD). We also investigate the effect of the cognitive task in the secondary task and the cost of the dual-task. Method: This is a cross-sectional study. Individuals with idiopathic PD were divided in three groups with respect to motor severity (mild, moderate and severe groups). Participants' performances were assessed in single and DT conditions including Sit-to-Stand test (SST), Timed Up and Go (TUG), and 10-meter Walk test (T10W). Cognitive task used was verbal fluency Results: The results show that dual task impact the performance of all primary tasks. DT negatively affects the performance of the motor tasks. And there is a different impact according the severity of the disease, severe ones are more affected than mild and moderate. Conclusion: In conclusion, adding a concurrent cognitive task negatively affected the performance of discrete, serial and continuous motor tasks, and this effect is more noticeable in severe than in mild patients. Under dual-task conditions, patients improved their cognitive task performance for gait and TUG, suggesting a prioritization of the secondary task for these tasks. There was no difference between the costs of the three tasks.(AU)

Análise da funcionalidade de idosos hospitalizados em uma enfermaria de Clínica Médica / Functioning of older people patients hospitalized in the medical clinic / Análisis de la funcionalidad de ancianos hospitalizados en una enfermería de Clínica Médica

Analisar a funcionalidade dos idosos internados na enfermaria de um Hospital Geral Estadual de São Paulo. Trata-se de um estudo transversal, descritivo e analítico, desenvolvido com 100 idosos, idade igual ou superior a 60 anos, internados em até 24 horas. As seguintes variáveis foram analisadas: sociodemográficas e clínico-funcionais. Os idosos com faixa etária avançada e alterações clínicas-funcionais apresentam diminuição da funcionalidade, com dependência parcial nas atividades instrumentais de vida diária.

To analyze the functional status of elderly hospitalized patients at General Hospital of the State Public Service of São Paulo. This cross-sectional study, included 100 admissions of patients aged 60 years and older, were evaluated within 24 hours of admission. The following variables were assessed: sociodemographic and clinical-functional. The older people with advancing age and clinic and functional decline are partially dependent to perform instrumental activities of daily living.

Analizar la funcionalidad de los ancianos internados en la enfermería de un Hospital General Estatal de São Paulo. Se trata de un estudio transversal, descriptivo y analítico, desarrollado con 100 ancianos, edad igual o superior a 60 años, internados en hasta 24 horas. Las siguientes variables fueron analizadas: sociodemográficas y clínicofuncionales. Los ancianos con rango de edad avanzada y alteraciones clínicas-funcionales presentan disminución de la funcionalidad, con dependencia parcial en las actividades instrumentales de vida diaria.

Effects of virtual rehabilitation versus conventional physical therapy on postural control, gait, and cognition of patients with Parkinson's disease: study protocol for a randomized controlled feasibility trial.

BACKGROUND: There is an association among postural instability, gait dysfunction, and cognitive impairment in subjects with Parkinson's disease (PD). Difficulty in dividing attention, response inhibition, and visuospatial attention deficiencies may contribute to the impairment of motor performance during daily activities. There are strong evidences that physical therapy can prevent physical and cognitive decline in individuals with PD. Recently, the European Physiotherapy Guideline (EPG) was developed based on randomized clinical trials about the effectiveness of the physical therapy to improve the functional deficiencies of individuals with PD. The EPG did not include the use of promising new intervention as virtual reality in PD due the lack of studies about its safety, feasibility and effectiveness. Therefore, this study protocol had as objective to evaluate the feasibility, safety and effectiveness of a physical therapy program-based on the European Physiotherapy Guideline (EPG) compared to Kinect-based training on postural control, gait, cognition, and quality of life (QoL) of Individuals with PD. METHODS/DESIGN: A single-blind, parallel, randomized, controlled feasibility trial will be conducted with a sample of 32 individuals diagnosed with idiopathic PD. Participants will be allocated into control group (CG) and experimental group (EG). The intervention of the CG will be conventional physical therapy, and the intervention of the EG will be a supervised practice of five Kinect games. Both groups will perform 14 sessions of 1 h each one, twice a week over 7 weeks. Process outcomes will be safety, feasibility, adherence, and acceptability. Safety will be assessed by the proportion of participants who experienced intervention-related adverse events or any serious adverse event during the study period. Feasibility will be assessed through the scores of the games recorded in all training sessions. Adherence will be assessed through the participant's attendance. Acceptability will be the motivation of the participants regarding the interventions. Clinical outcomes will be (1) postural control, (2) cognitive function, (3) balance, (4) gait, and (5) QoL. Individuals will be assessed pre- and post-interventions and after 30 days by a blinded evaluator. DISCUSSION: This protocol will clarify if an intervention based on Kinect games will be feasible, safe, and acceptable for individuals with PD compared to conventional physical therapy. We will verify whether the proposed interventions can improve clinical outcomes as postural control, gait, cognition, and QoL of individuals with PD. Our hypothesis is that both Kinect games and conventional physical therapy will be feasible, safe, and acceptable for individuals with PD and will promote positive clinical effects. The results of this feasibility study will be used to design a future definitive clinical trial. TRIAL REGISTRATION: Unique identification number in WHO Trial Registration: U1111-1171-0371. Brazilian Clinical Trial Registration Number RBR-27kqv5, registration date: February, 2016.

Presence or absence of cognitive complaints in Parkinson's disease: mood disorder or anosognosia?

We intended to evaluate whether non-demented Parkinsons's disease (PD) patients, with or without subjective cognitive complaint, demonstrate differences between them and in comparison to controls concerning cognitive performance and mood. We evaluated 77 subjects between 30 and 70 years, divided as follows: PD without cognitive complaints (n = 31), PD with cognitive complaints (n = 21) and controls (n = 25). We applied the following tests: SCOPA-Cog, Trail Making Test-B, Phonemic Fluency, Clock Drawing Test, Boston Naming Test, Neuropsychiatric Inventory, Hospital Anxiety and Depression Scale (HADS) and Beck Depression Inventory. PD without complaints presented lower total score on Scales for outcome of Parkinson's disease-cognition as compared to controls (p = 0.048). PD with complaints group showed higher scores on HADS (p = 0.011). PD without complaints group showed poorer cognitive performance compared to controls, but was similar to the PD with complaints group. Moreover, this group was different from the PD without complaints and control groups concerning mood.

Presence or absence of cognitive complaints in Parkinson's disease: mood disorder or anosognosia? / Presença ou ausência de queixas cognitivas na doença de Parkinson: transtorno de humor ou anosognosia?

ABSTRACT We intended to evaluate whether non-demented Parkinsons’s disease (PD) patients, with or without subjective cognitive complaint, demonstrate differences between them and in comparison to controls concerning cognitive performance and mood. We evaluated 77 subjects between 30 and 70 years, divided as follows: PD without cognitive complaints (n = 31), PD with cognitive complaints (n = 21) and controls (n = 25). We applied the following tests: SCOPA-Cog, Trail Making Test-B, Phonemic Fluency, Clock Drawing Test, Boston Naming Test, Neuropsychiatric Inventory, Hospital Anxiety and Depression Scale (HADS) and Beck Depression Inventory. PD without complaints presented lower total score on Scales for outcome of Parkinson’s disease-cognition as compared to controls (p = 0.048). PD with complaints group showed higher scores on HADS (p = 0.011). PD without complaints group showed poorer cognitive performance compared to controls, but was similar to the PD with complaints group. Moreover, this group was different from the PD without complaints and control groups concerning mood.

RESUMO Avaliar se pacientes com doença de Parkinson (DP) sem demência, com ou sem queixa cognitiva subjetiva, demonstram diferenças entre eles e comparativamente aos controles relativos a desempenho cognitivo e humor. Avaliados 77 indivíduos entre 30 e 70 anos: PD sem queixas cognitivas (n = 31), PD com queixas cognitivas (n = 21) e controles (n = 25). Testes aplicados: SCOPA-cognição, Trail Making Test-B, Fluência Fonêmica, Teste do Relógio, Teste Nominativo de Boston, Inventário Neuropsiquiátrico, Escala Hospitalar de Depressão e Ansiedade (HADS)e Inventário de Depressão de Beck. PD sem queixas apresentaram menor pontuação total na SCOPA-cognição, comparativamente aos controles (p = 0,048). Por outro lado, PD com queixas apresentaram maior pontuação no HADS (p = 0,011) em comparação aos controles. O grupo PD sem queixas mostrou pior desempenho cognitivo em comparação aos controles, mas foi semelhante ao PD com queixas. Este grupo foi diferente dos grupos PD sem queixas e controle em relação ao humor.

Variations of ATP and its metabolites in the hippocampus of rats subjected to pilocarpine-induced temporal lobe epilepsy.

Although purinergic receptor activity has lately been associated with epilepsy, little is known about the exact role of purines in epileptogenesis. We have used a rat model of temporal lobe epilepsy induced by pilocarpine to study the dynamics of purine metabolism in the hippocampus during different times of status epilepticus (SE) and the chronic phase. Concentrations of adenosine 5'-triphosphate (ATP), adenosine diphosphate (ADP), adenosine monophosphate (AMP), and adenosine in normal and epileptic rat hippocampus were determined by microdialysis in combination with high-performance liquid chromatography (HPLC). Extracellular ATP concentrations did not vary along 4 h of SE onset. However, AMP concentration was elevated during the second hour, whereas ADP and adenosine concentrations augmented during the third and fourth hour following SE. During chronic phase, extracellular ATP, ADP, AMP, and adenosine concentrations decreased, although these levels again increased significantly during spontaneous seizures. These results suggest that the increased turnover of ATP during the acute period is a compensatory mechanism able to reduce the excitatory role of ATP. Increased adenosine levels following 4 h of SE may contribute to block seizures. On the other hand, the reduction of purine levels in the hippocampus of chronic epileptic rats may result from metabolic changes and be part of the mechanisms involved in the onset of spontaneous seizures. This work provides further insights into purinergic signaling during establishment and chronic phase of epilepsy.

Influence of sensory information on static balance in older patients with vestibular disorder / Influência das informações sensoriais no equilíbrio corporal estático de idosos vestibulopatas

Introduction: With aging, the sensory systems suffer an accumulation of degenerative, infectious and/or traumatic processes that may hinder the body balance maintenance. Objective: To assess the influence of sensory information on static body balance of elderly individuals with vestibular disorders. Methods: Cross-sectional study of elderly individuals with vestibular disorders. The Clinical Test of Sensory Interaction and Balance and posturography integrated with virtual reality (Balance Rehabilitation UnitTM) were used. Posturography parameters analyzed included center of pressure and velocity of body sway. Results: 123 individuals with mean age of 73.11 were assessed. Worst performance was observed in the Clinical Test of Sensory Interaction and Balance condition of visual dome-unstable surface. Differences between conditions were: firm surface-open eyes/firm surface-closed eyes, unstable surface-open eyes/unstable surface-closed eyes (p < 0.001), and unstable surface-closed eyes/unstable surface-visual dome. Considering center of pressure and velocity of body sway, significant differences were observed between the following conditions: firm surface-open eyes/firm surface-closed eyes: firm surface-saccadic stimulus/firm surfacevertical optokinetic stimulus; firm surface-optokinetic stimuli/firm surface-visual-vestibular interaction; and firm surface-visual-vestibular interaction/unstable surface. Worse performances were observed in conditions firm surface-closed eyes, firm surface-vertical optokinetic stimulus, F-visual-vestibular interaction, and unstable surface-closed eyes. There was a difference in the center of pressure between firm surface-closed eyes/firm surface-saccadic stimulus, with a worse performance in the condition of firm surface-closed eyes, and of velocity of body sway, between firm surface-saccadic stimulus/firm surface-horizontal optokinetic stimulus (p < 0.001). Conclusion: Static body balance in elderly ...

Introdução: Com o envelhecimento, o sistema sensorial sofre um acúmulo de processos degenerativos, infecciosos e/ou traumáticas que podem dificultar a manutenção do equilíbrio corporal. Objetivo: Avaliar a influência das informações sensoriais no equilíbrio corporal estático de idosos vestibulopatas. Método: Estudo transversal, cuja amostra foi constituída por idosos vestibulopatas. Empregaram-se o Clinical Test of Sensory Interaction and Balance (CTSIB) e a posturografia integrada à realidade virtual (Balance Rehabilitation Unit.). Os parâmetros avaliados à posturografia foram: área do centro de pressão (COP) e velocidade de oscilação (VOC). Resultados: Foram avaliados 123 idosos, com média etária de 73,11 anos. O pior desempenho ocorreu na condição cúpula visual-superfície instável (SI) do CTSIB. As diferenças entre as condições foram: superfície firme (SF)-olhos abertos (OA)/SF-olhos fechados (OF) e SI-OA/SI-OF (p < 0,001); SI-OF/SI-cúpula visual. Observou-se diferença da área do COP e da VOC entre as condições: SF-OA/SF-OF; SF-estímulo sacádico/SF-estímulo optocinético vertical; SF-estímulos optocinéticos/SF-interação visuo-vestibular (IVV); SF-IVV/SI, com pior desempenho nas condições SF-OF, SF-estímulo optocinético vertical, SF-IVV e SI-OF. Observou-se diferençado COP entre as condições SF-OF/SF-estímulo sacádico, com pior desempenho na condição SF-OF, e da VOC entre as condições SF-estímulo sacádico e SF-estímulo optocinético horizontal (p < 0,001). Conclusão: O equilíbrio corporal estático de idosos vestibulopatas é pior à medida que as condições sensoriais são mais desafiadoras, ou seja, em SI e SE, estímulos visuais como os optocinéticos e interação visuovestibular e OF. .

Influence of sensory information on static balance in older patients with vestibular disorder.

INTRODUCTION: With aging, the sensory systems suffer an accumulation of degenerative, infectious and/or traumatic processes that may hinder the body balance maintenance. OBJECTIVE: To assess the influence of sensory information on static body balance of elderly individuals with vestibular disorders. METHODS: Cross-sectional study of elderly individuals with vestibular disorders. The Clinical Test of Sensory Interaction and Balance and posturography integrated with virtual reality (Balance Rehabilitation Unit) were used. Posturography parameters analyzed included center of pressure and velocity of body sway. RESULTS: 123 individuals with mean age of 73.11 were assessed. Worst performance was observed in the Clinical Test of Sensory Interaction and Balance condition of visual dome-unstable surface. Differences between conditions were: firm surface-open eyes/firm surface-closed eyes, unstable surface-open eyes/unstable surface-closed eyes (p<0.001), and unstable surface-closed eyes/unstable surface-visual dome. Considering center of pressure and velocity of body sway, significant differences were observed between the following conditions: firm surface-open eyes/firm surface-closed eyes: firm surface-saccadic stimulus/firm surface-vertical optokinetic stimulus; firm surface-optokinetic stimuli/firm surface-visual-vestibular interaction; and firm surface-visual-vestibular interaction/unstable surface. Worse performances were observed in conditions firm surface-closed eyes, firm surface-vertical optokinetic stimulus, F-visual-vestibular interaction, and unstable surface-closed eyes. There was a difference in the center of pressure between firm surface-closed eyes/firm surface-saccadic stimulus, with a worse performance in the condition of firm surface-closed eyes, and of velocity of body sway, between firm surface-saccadic stimulus/firm surface-horizontal optokinetic stimulus (p<0.001). CONCLUSION: Static body balance in elderly individuals with vestibular disorders is worse when the sensory conditions are more challenging, i.e. stable and unstable surfaces, visual stimuli, such as optokinetic and visual-vestibular interaction, and with the eyes closed.

Postural control in Parkinson's disease.

INTRODUCTION: Postural instability is one of the most disabling features of Parkinson's disease. OBJECTIVE: To evaluate postural balance in Parkinson's disease. METHODS: Thirty patients with Parkinson's disease were compared with controls using Tetrax™ interactive balance system posturography. RESULTS: For different positions, patients with Parkinson's disease showed a significantly higher weight distribution index, fall index, Fourier transformation at low-medium frequencies (F2-F4), and significantly lower right/left and toe/heel synchronization versus controls. CONCLUSION: Postural imbalance in Parkinson's disease patients is characterized by the abnormalities of weight distribution index, synchronization index, Fourier transformation index, and fall index as measured by Tetrax™ posturography.

Postural control in Parkinson's disease / Controle postural na Doença de Parkinson

Introduction: Postural instability is one of the most disabling features of Parkinson's disease. Objective: To evaluate postural balance in Parkinson's disease. Methods: Thirty patients with Parkinson's disease were compared with controls using Tetrax™ interactive balance system posturography. Results: For different positions, patients with Parkinson's disease showed a significantly higher weight distribution index, fall index, Fourier transformation at low-medium frequencies (F2–F4), and significantly lower right/left and toe/heel synchronization versus controls. Conclusion: Postural imbalance in Parkinson's disease patients is characterized by the abnormalities of weight distribution index, synchronization index, Fourier transformation index, and fall index as measured by Tetrax™ posturography. .

Introdução: A instabilidade postural é um dos principais problemas na doença de Parkinson. Objetivo: Avaliar o controle postural na doença de Parkinson. Método: Um grupo de 30 pacientes com doença de Parkinson foi comparado com um grupo controle à posturografia estática do Tetrax Interactive Balance System (Tetrax™). Resultados: Em diferentes condições sensoriais, houve diferenças significantes entre os dois grupos, tendo sido encontrados nos parkinsonianos valores maiores do índice de distribuição de peso, do índice de risco de queda e da faixa de frequência F2-4 e valores menores da sincronização da oscilação postural direito-esquerda e dedos/calcanhares. Conclusão: O comprometimento do controle postural em pacientes com doença de Parkinson é caracterizado por alterações na distribuição de peso, na sincronização da oscilação postural direita/esquerda e dedos/calcanhares, nas faixas de frequência de oscilação postural e no índice de risco de queda à posturografia do Tetrax™. .