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1.
Artigo em Inglês | MEDLINE | ID: mdl-33806474

RESUMO

In this study, we measured the convergence rate using the mean-squared error (MSE) of the standardized neuropsychological test to determine the severity of Parkinson's disease dementia (PDD), which is based on support vector machine (SVM) regression (SVR) and present baseline data in order to develop a model to predict the severity of PDD. We analyzed 328 individuals with PDD who were 60 years or older. To identify the SVR with the best prediction power, we compared the classification performance (convergence rate) of eight SVR models (Eps-SVR and Nu-SVR with four kernel functions (a radial basis function (RBF), linear algorithm, polynomial algorithm, and sigmoid)). Among the eight models, the MSE of Nu-SVR-RBF was the lowest (0.078), with the highest convergence rate, whereas the MSE of Eps-SVR-sigmoid was 0.110, with the lowest convergence rate. The results of this study imply that this approach could be useful for measuring the severity of dementia by comprehensively examining axial atypical features, the Korean instrumental activities of daily living (K-IADL), changes in rapid eye movement sleep behavior disorder (RBD), etc. for optimal intervention and caring of the elderly living alone or patients with PDD residing in medically vulnerable areas.


Assuntos
Doença de Alzheimer , Doença de Parkinson , Atividades Cotidianas , Idoso , Algoritmos , Humanos , Testes Neuropsicológicos , Doença de Parkinson/diagnóstico , Doença de Parkinson/epidemiologia , Máquina de Vetores de Suporte
2.
Artigo em Russo | MEDLINE | ID: mdl-33834712

RESUMO

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.


Assuntos
Doenças do Sistema Nervoso Autônomo , Hipertensão , Hipotensão Ortostática , Doença de Parkinson , Pressão Sanguínea , Feminino , Humanos , Hipertensão/epidemiologia , Doença de Parkinson/complicações , Doença de Parkinson/tratamento farmacológico , Doença de Parkinson/epidemiologia
3.
BMC Geriatr ; 21(1): 202, 2021 03 23.
Artigo em Inglês | MEDLINE | ID: mdl-33757451

RESUMO

BACKGROUND: Antidepressant use is more common in people with Parkinson's disease (PD), but it is unknown when this difference emerges. METHODS: We studied the incidence of antidepressant use in six-month periods from 10 years before to 15 years after PD diagnosis in the nationwide register-based Finnish Study on Parkinson's disease (FINPARK). This study included 20,456 community dwellers with clinically verified PD diagnosed during 1996-2015 and 140,291 matched comparison persons. RESULTS: Altogether 44.3% of people with PD initiated antidepressants, compared to 25.0% of people without PD. The difference was largest 6 months before PD diagnosis (incidence rate ratio 5.28, 95% CI 4.80-5.80; 9.02 and 1.68 initiations/100 person-years in people with and without PD, respectively). The difference emerged already 7 years before the diagnosis and remained above the comparison group for most of the study period. CONCLUSIONS: Persons with PD may have symptoms that require antidepressant treatment years before and after diagnosis. The symptoms needing antidepressant treatment may be clinical signs of possible PD and they should be considered as a need to assess clinical status in person diagnosed with PD.


Assuntos
Doença de Parkinson , Antidepressivos/uso terapêutico , Estudos de Coortes , Finlândia/epidemiologia , Humanos , Incidência , Doença de Parkinson/diagnóstico , Doença de Parkinson/tratamento farmacológico , Doença de Parkinson/epidemiologia
5.
Arq Neuropsiquiatr ; 79(1): 38-43, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33656110

RESUMO

BACKGROUND: Restless legs syndrome or Willis-Ekbom disease is a disorder characterized by unpleasant sensations associated with the need to mobilize the lower limbs. In Parkinson disease patients, restless legs syndrome is associated with worse quality of life and excessive sleepiness. Regarding other factors, results of different studies are controversial. OBJECTIVE: To determine the factors associated with the restless legs syndrome presence in Parkinson disease patients. METHODS: A cross-sectional study was conducted in 88 consecutive Parkinson disease patients from the outpatient clinic for 21 months. Participants underwent a clinical interview, assessment based on standardized scales (Epworth Sleepiness Scale, Parkinson Disease Questionnaire - 39, Pittsburgh Sleep Quality Index, International Restless Legs Syndrome Study Group rating scale), and video-polysomnography. RESULTS: Out of the 88 participants, 25 had restless legs syndrome. In the multivariate analysis, restless legs syndrome in Parkinson disease has been associated with the symptom of smell loss and quality of sleep and life. In the univariate analysis, restless legs syndrome in Parkinson disease has occurred more frequently in women with higher frequency of insomnia, constipation, and anosmia than in the group without restless legs syndrome. CONCLUSION: Restless legs syndrome is a prevalent condition in patients with Parkinson disease and is associated with specific characteristics in this group of patients.


Assuntos
Doença de Parkinson , Síndrome das Pernas Inquietas , Estudos Transversais , Feminino , Humanos , Doença de Parkinson/complicações , Doença de Parkinson/epidemiologia , Polissonografia , Qualidade de Vida , Síndrome das Pernas Inquietas/epidemiologia , Síndrome das Pernas Inquietas/etiologia
7.
Neurology ; 96(12): e1672-e1679, 2021 03 23.
Artigo em Inglês | MEDLINE | ID: mdl-33608417

RESUMO

OBJECTIVE: To evaluate the effects of long-term tumor necrosis factor (TNF) inhibition on the risk and age at onset of Parkinson disease (PD), we performed a 2-sample Mendelian randomization study using genome-wide association studies (GWAS) summary statistics. METHODS: Genetic variants in the vicinity of TNFRSF1A, the gene encoding TNF receptor 1 (TNFR1), were identified as predictive of pharmacologic blockade of TNFR1 signaling by anti-TNF therapy, based on genetic associations with lower circulating C-reactive protein (CRP; GWAS n = 204,402). The effects of TNF-TNFR1 inhibition were estimated for PD risk (ncases/controls = 37,688/981,372) and age at PD onset (n = 28,568) using GWAS data from the International Parkinson's Disease Genomics Consortium and 23andMe, Inc. To validate variants as proxies of long-term anti-TNF treatment, we also assessed whether variant associations reflected anticipated effects of TNFR1 inhibition on Crohn disease, ulcerative colitis, and multiple sclerosis risk (n = 38,589-45,975). RESULTS: TNF-TNFR1 signaling inhibition was not estimated to affect PD risk (odds ratio [OR] per 10% lower circulating CRP = 0.99; 95% confidence interval [CI] 0.91-1.08) or age at onset (0.13 years later onset; 95% CI -0.66 to 0.92). In contrast, genetically indexed TNF-TNFR1 signaling blockade predicted reduced risk of Crohn disease (OR 0.75; 95% CI 0.65-0.86) and ulcerative colitis (OR 0.84; 95% CI 0.74-0.97) and increased multiple sclerosis risk (OR 1.57; 95% CI 1.36-1.81). Findings were consistent across models using different genetic instruments and Mendelian randomization estimators. CONCLUSIONS: Our findings do not imply that TNF-TNFR1 signaling inhibition will prevent or delay PD onset. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that TNF-TNFR1 signaling inhibition is not associated with the risk or age at onset of PD.


Assuntos
Doença de Parkinson/epidemiologia , Inibidores do Fator de Necrose Tumoral/uso terapêutico , Idade de Início , Idoso , Proteína C-Reativa/metabolismo , Feminino , Estudo de Associação Genômica Ampla , Humanos , Doenças Inflamatórias Intestinais/tratamento farmacológico , Masculino , Análise da Randomização Mendeliana , Pessoa de Meia-Idade , Polimorfismo de Nucleotídeo Único , Receptores Tipo I de Fatores de Necrose Tumoral/genética , Fatores de Risco , Fator de Necrose Tumoral alfa/antagonistas & inibidores
9.
Rev Neurol (Paris) ; 177(3): 272-274, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33610345

RESUMO

BACKGROUND: Governments around the world have imposed varied containment measures to curb the spread of the COVID-19 infection. The psychological impact could be highly negative in patients with neurologic condition like Parkinson's Disease (PD). METHODS: We prospectively evaluated symptoms of depression and anxiety in 50 (26 females; mean age at 60.4) non demented Moroccan PD patients, using Hospital Anxiety and Depression Scale (HADS), at the beginning and after 6 weeks of a full confinement. RESULTS: At the first evaluation, 28% of patients had depression while 32% had anxiety. After 6 weeks of confinement, some patients got worse and others got better scores but no significant statistical difference for both troubles was seen. CONCLUSION: Our results show that there is no significant impact of 6 weeks of confinement on overall anxiety and depression scores. However, confinement could have an unexpected positive psychological impact on a significant number of PD patients.


Assuntos
Ansiedade/epidemiologia , Depressão/epidemiologia , Pandemias , Doença de Parkinson/epidemiologia , Quarentena/psicologia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Marrocos/epidemiologia , Doença de Parkinson/complicações , Doença de Parkinson/psicologia , Estresse Psicológico/epidemiologia , Estresse Psicológico/psicologia , Inquéritos e Questionários
10.
J Affect Disord ; 283: 329-334, 2021 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-33578346

RESUMO

BACKGROUND: Individuals with major depressive disorder (MDD) have a higher risk of developing Parkinson disease (PD). This study investigated whether response to treatment with antidepressants for MDD can determine patients at risk of developing PD later in life. METHODS: We enrolled 3303 patients with newly-diagnosed MDD and 13,212 controls between 2002 and 2004 using Taiwan's Nationwide Health Insurance Research Database. We stratified patients with MDD according to the number of antidepressant regimens prescribed to them and the age at MDD onset and followed all participants until the end of 2013. During follow-up, we evaluated patients for the possibility of developing PD. RESULTS: Patients with MDD had a greater likelihood of developing PD than controls. Patients with difficult-to-treat (DTT) MDD had a higher risk of developing PD than the other MDD subgroups (hazard ratio [HR] = 3.44, 95% confidence interval [95% CI]: = 1.99-5.95). When stratified by age (<50, 50-65, >65 years), DTT patients with middle-age or late-onset MDD exhibited elevated risks of developing PD (50-65 years: HR: 7.03, 95% CI: 2.95-16.76; >65 years: HR: 2.89, 95% CI: 1.26-6.65). DISCUSSION: Patients with MDD and an onset age of >50 years who responded poorly to antidepressant treatment have an associated higher risk of subsequently developing PD. Therefore, when treating patients with MDD, clinicians should provide intensive antidepressant treatment and evaluations for PD so that risk-prevention measures can be implemented upon MDD diagnosis.


Assuntos
Transtorno Depressivo Maior , Doença de Parkinson , Idade de Início , Idoso , Antidepressivos/efeitos adversos , Transtorno Depressivo Maior/tratamento farmacológico , Transtorno Depressivo Maior/epidemiologia , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Doença de Parkinson/tratamento farmacológico , Doença de Parkinson/epidemiologia
12.
Neurology ; 96(10): e1391-e1401, 2021 03 09.
Artigo em Inglês | MEDLINE | ID: mdl-33536275

RESUMO

OBJECTIVE: To investigate the longitudinal association among high-density lipoprotein cholesterol (HDL-C) level, HDL-C variability, and the risk of developing Parkinson disease (PD). METHODS: We conducted a nationwide, population-based cohort study. We included 382,391 patients aged ≥65 years who underwent at least 3 health examinations provided by the Korean National Health Insurance System from 2008 to 2013 and followed up until 2017. Individuals with a history of PD and missing values were excluded (n = 1,987). We assessed HDL-C variability using 3 indices, including variability independent of the mean (VIM). A multivariate-adjusted Cox proportional hazards regression analysis was performed. RESULTS: Among the 380,404 participants, 2,733 individuals were newly diagnosed with PD during a median follow-up period of 5 years. The lowest quartile (Q1) group of baseline HDL-C and mean HDL-C was associated with increased PD incidence as compared with the highest quartile (Q4) group (adjusted hazard ratio [aHR], 1.20; 95% confidence interval [CI], 1.08-1.34; and aHR, 1.16; 95% CI, 1.04-1.30, respectively). The Q4 group of HDL-C variability (VIM) was associated with increased PD incidence compared to the Q1 group (aHR, 1.19; 95% CI, 1.06-1.33). The group with the Q1 of baseline HDL-C and with the Q4 of HDL-C variability had the highest risk of PD incidence (aHR, 1.6; 95% CI, 1.31-1.96). CONCLUSION: Lower HDL-C level and greater HDL-C variability were associated with a higher incidence of PD.


Assuntos
HDL-Colesterol/sangue , Doença de Parkinson/sangue , Idoso , Estudos de Coortes , Comorbidade , Feminino , Seguimentos , Humanos , Incidência , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/epidemiologia , Modelos de Riscos Proporcionais , República da Coreia/epidemiologia , Medição de Risco , Fatores de Risco
13.
Int Orthop ; 45(3): 643-647, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33403438

RESUMO

PURPOSE: The purpose of this study was to compare the functional outcomes, activity levels, mortalities, implant survival rates, and complications of total knee arthroplasty (TKA) of patients with Parkinson's disease (PD) with those of patients in a control group over a minimum ten year follow-up period. METHODS: From January 2007 to December 2009, 46 TKAs were performed in 29 patients with PD (PD group). Fifty-eight matched patients without PD were used as the control group in a two-to-one ratio using propensity scoring matching. The functional outcomes, activity levels, mortalities, implant survival rates, and complications of TKA in patients with PD and control group were compared. RESULTS: The mean Knee Society knee scores in PD and control group improved from 36.8 and 37.1 pre-operatively to 60.0 and 80.7 points at the final follow-up, respectively (p < 0.05). Outdoor ambulatory patients at the final follow-up included 13 of 20 (65.0 %) in PD group and 51 of 54 (94.4%) patients in control group (p < 0.05). The cumulative mortality rates in PD and control group were 31% (9/29) and 6.9% (4/58) (p < 0.05), at final follow-up, respectively. Kaplan-Meier survivorship analysis with revision of either components as endpoints in PD and control group estimated 89.7% and 98.3% chances of survival for ten years, respectively. CONCLUSIONS: TKAs in patients with PD were shown to have worse functional outcomes and higher mortality over a minimum ten year follow-up period. Therefore, the necessity of the procedure should be considered carefully depending on patient needs and conditions.


Assuntos
Artroplastia do Joelho , Prótese do Joelho , Doença de Parkinson , Artroplastia do Joelho/efeitos adversos , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Articulação do Joelho/cirurgia , Prótese do Joelho/efeitos adversos , Doença de Parkinson/epidemiologia , Resultado do Tratamento
14.
Neurosci Lett ; 745: 135626, 2021 02 06.
Artigo em Inglês | MEDLINE | ID: mdl-33440238

RESUMO

OBJECTIVES: Anxiety disorder is a common non-motor symptom in patient with Parkinson's disease (PD). We aimed to explore its pathogenesis and identify plasma biomarkers using untargeted metabolomics analysis. METHODS: Consecutive PD patients and healthy controls were recruited. Clinical data were assessed and patients with Parkinson's disease related anxiety disorder (PDA) were recognized. Fast plasma samples were obtained and untargeted liquid chromatography-mass spectrometry-based metabolomics analysis was performed. Based on the differentially expressed metabolites from the above metabolomics analysis, correlation analyses and receiver operating characteristic curves (ROC) were further employed. RESULTS: According to the clinical data, PDA patients had lower plasma levels of total cholesterol, triglyceride, low-density lipoprotein cholesterol, and apolipoprotein B. There were thirty-nine differentially expressed metabolites in PDA patients when compared with the other two groups from the metabolomics analysis, respectively. Fourteen lipid metabolites were simultaneously altered between these two groups, and all of them were significantly decreased. They can be further subcategorized into fatty acyls, glycerolipids, sterol lipids, sphingolipids, and prenol lipids. The plasma levels of thirteen metabolites were negatively correlated with HAMA scores except 10-oxo-nonadecanoic acid. Based on the ROC curves, the fourteen lipid metabolites can be diagnostic biomarkers for PDA patients separately and the areas under the curve of the fourteen lipid metabolites ranged from 0.681 to 0.798. CONCLUSIONS: Significantly lower plasma lipoproteins can be found in PDA patients. A panel of fourteen lipid metabolites were also significantly decreased and can be clinical biomarkers for the diagnosis of PDA patients.


Assuntos
Transtornos de Ansiedade/sangue , Metabolismo dos Lipídeos/fisiologia , Lipídeos/sangue , Lipoproteínas/sangue , Metabolômica/métodos , Doença de Parkinson/sangue , Idoso , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/epidemiologia , Biomarcadores/sangue , Bases de Dados Factuais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/diagnóstico , Doença de Parkinson/epidemiologia
15.
Neurology ; 96(6): e895-e903, 2021 02 09.
Artigo em Inglês | MEDLINE | ID: mdl-33408141

RESUMO

OBJECTIVE: To determine whether high baseline dietary antioxidants and total nonenzymatic antioxidant capacity (NEAC) is associated with a lower risk of Parkinson disease (PD) in men and women, we prospectively studied 43,865 men and women from a large Swedish cohort. METHODS: In the Swedish National March Cohort, 43,865 men and women aged 18-94 years were followed through record linkages to National Health Registries from 1997 until 2016. Baseline dietary vitamin E, vitamin C, and beta-carotene intake, as well as NEAC, were assessed by a validated food frequency questionnaire collected at baseline. All exposure variables were adjusted for energy intake and categorized into tertiles. Multivariable Cox proportional hazard regression models were fitted to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) for PD. RESULTS: After a mean follow-up time of 17.6 years, we detected 465 incidence cases of PD. In the multivariable adjusted model, dietary vitamin E (HR 0.68, 95% CI 0.52-0.90; p for trend 0.005) and vitamin C (HR 0.68, 95% CI 0.52-0.89; p for trend 0.004) were inversely associated with the risk of PD when comparing participants in the highest vs the lowest tertiles of exposure. No association was found with estimated intake of dietary beta-carotene or NEAC. CONCLUSION: Our findings suggest that dietary vitamin E and C intake might be inversely associated with the risk of PD. No association was found with dietary beta-carotene or NEAC. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that dietary vitamin E and C intake are inversely associated with the risk of PD.


Assuntos
Antioxidantes/administração & dosagem , Ácido Ascórbico/administração & dosagem , Alimentos/estatística & dados numéricos , Doença de Parkinson/epidemiologia , Sistema de Registros , Vitamina E/administração & dosagem , beta Caroteno/administração & dosagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Suécia/epidemiologia , Adulto Jovem
16.
Bratisl Lek Listy ; 122(2): 158-160, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33502886

RESUMO

OBJECTIVE: Polypharmacy and multiple diseases are common in geriatric practice; however, such kind of multiple interventions might result in adverse effects. Some previous studies have found the association of polypharmacy and Parkinson's disease, to confirm this relationship, we conducted a meta-analysis to analyze this issue quantitively. MATERIALS AND METHODS: In total, we included 8 studies, 165,689 polypharmacy subjects and 373,660 non-polypharmacy controls, and 5644 PD patients among these subjects and controls. RESULTS: For model without any adjustment, polypharmacy group has a significantly higher prevalence than control, OR = 2.53, 95 %CI [2.00, 3.20] (p < 0.001). However, this model showed a very high heterogeneity (I2 = 91 %, p < 0.001). In age, gender and disease history adjusted model, polypharmacy group has a significantly higher prevalence than control, OR = 1.43, 95 %CI [1.35, 1.52], p < 0.001. The heterogeneity decreased to zero (I2 = 0 %, p < 0.45). CONCLUSION: In this study we have found an association between PD risk and polypharmacy, a better designed prospective long-term cohort study might be required for further discussion on this issue (Tab. 1, Fig. 5, Ref. 14).


Assuntos
Doença de Parkinson , Estudos de Coortes , Humanos , Doença de Parkinson/tratamento farmacológico , Doença de Parkinson/epidemiologia , Polimedicação , Prevalência , Estudos Prospectivos
17.
J Neural Transm (Vienna) ; 128(1): 37-48, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33392827

RESUMO

Information about Parkinson's disease (PD) patients with severe COVID-19 is scarce. We aimed to analyze the clinical characteristics, outcomes, and risk factors affecting the prognosis of PD patients with severe COVID-19 infection. Clinical data of severe COVID-19 patients admitted at the Union Hospital, Wuhan between 28th January and 29th February 2020 were collected and analyzed. 10 patients (1.96%) had a medical history of PD with a mean (SD) age of 72.10 (± 11.46) years. The clinical characteristics and outcomes of severe COVID-19 with and without PD patients were then compared. There was no significant difference in overall mortality between the PD and non-PD patients with severe COVID-19 (p > 0.05). In PD patients with severe COVID-19, the proportion of patients with critical type, disturbance of consciousness, incidence of complications, white blood cells count and neutrophils counts on admission seem higher in the non-survivors. PD patients with older age, longer PD duration, and late stage PD may be highly susceptible to critical COVID-19 infection and bad outcome. The PD patients with consciousness disorders and complications that progressed rapidly are at increased risk of death.


Assuntos
/epidemiologia , Transtornos da Consciência/epidemiologia , Doença de Parkinson/epidemiologia , Idoso , Idoso de 80 Anos ou mais , /mortalidade , China/epidemiologia , Comorbidade , Transtornos da Consciência/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/mortalidade , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença
18.
Rev. neurol. (Ed. impr.) ; 72(1): 9-15, 1 ene., 2021. tab
Artigo em Espanhol | IBECS | ID: ibc-200035

RESUMO

INTRODUCCIÓN: Recientemente, se ha incrementado la atención hacia causas metabólicas de la pérdida de células dopaminérgicas en la enfermedad de Parkinson (EP), dada la intolerancia a la glucosa que pueden presentar estos pacientes. Un síndrome caracterizado por resistencia a la insulina es el síndrome metabólico. OBJETIVO: Determinar la prevalencia y las características clínicas del síndrome metabólico y sus componentes en pacientes con EP. PACIENTES Y MÉTODOS: Se analizaron variables de 99 pacientes con EP. Se registraron escalas que evalúan las funciones motora, no motora y cognitiva, los trastornos del sueño y la calidad de vida. El síndrome metabólico se diagnosticó según los criterios de la Organización Mundial de la Salud. RESULTADOS: La prevalencia de síndrome metabólico se notificó en un 8%. Al subdividir a los pacientes en función de los criterios positivos de síndrome metabólico, no se observaron diferencias significativas en las funciones motora y cognitiva, la calidad de vida ni los trastornos del sueño entre los grupos. No obstante, pacientes con síndrome metabólico mostraron peores puntuaciones en la escala de síntomas no motores en comparación con pacientes sin el síndrome, especialmente en cuanto a tracto gastrointestinal, estado de ánimo/apatía, función sexual, problemas perceptivos y misceláneos. No se observaron diferencias significativas en las características clínicas al agrupar a los pacientes sobre la base del componente único de síndrome metabólico presente. CONCLUSIÓN: El síndrome metabólico podría tener un efecto sobre la sintomatología no motora en la EP, ya que los pacientes con este síndrome mostraron peores puntuaciones en la escala de síntomas no motores


INTRODUCTION: Focus on the metabolic causes underlying dopaminergic cell loss in Parkinson's disease (PD) has increased lately. Glucose imbalances have been shown to be present in patients with PD. A syndrome characterized principally by insulin resistance and glucose dysregulations is metabolic syndrome. Scarce literature has evaluated the relation between these two diseases. AIM: To determine the prevalence and clinical features of metabolic syndrome and its components in patients with PD. PATIENTS AND METHODS: We analyzed data from 99 patients with PD diagnosis. Scales that evaluate motor, non-motor, and cognitive function, as well as sleep disorders and quality of life were registered. Metabolic syndrome was diagnosed according to the World Health Organization criteria. RESULTS: Metabolic syndrome was reported in 8% of the population. When subdividing patients based on positivity to metabolic syndrome criteria, no significant differences in motor and cognitive function, as well as quality of life and sleep disorders were observed between groups. However, patients with metabolic syndrome showed worse scores in Non-Motor Symptom Scale compared to patients without the syndrome, especially gastrointestinal, mood/apathy, sexual function, perceptual and miscellaneous symptoms. No significant differences in clinical correlates were observed when grouping patients based on which single metabolic syndrome component was present. CONCLUSION. Metabolic syndrome might have an effect on non-motor symptomatology in PD, as patients with metabolic syndrome showed worse scores in Non-Motor Symptom Scale


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Síndrome Metabólica/epidemiologia , Síndrome Metabólica/fisiopatologia , Doença de Parkinson/epidemiologia , Doença de Parkinson/fisiopatologia , Estudos Prospectivos , Qualidade de Vida , Transtornos do Sono-Vigília/epidemiologia , Transtornos do Sono-Vigília/fisiopatologia , Prevalência , Distribuição por Sexo , Escolaridade , Fatores de Risco , Estatísticas não Paramétricas , Análise de Variância , México/epidemiologia
19.
Ann Neurol ; 89(3): 587-597, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33349939

RESUMO

OBJECTIVE: This study was undertaken to identify preoperative predictive factors of long-term motor outcome in a large cohort of consecutive Parkinson disease (PD) patients with bilateral subthalamic nucleus deep brain stimulation (STN-DBS). METHODS: All consecutive PD patients who underwent bilateral STN-DBS at the Grenoble University Hospital (France) from 1993 to 2015 were evaluated before surgery, at 1 year (short-term), and in the long term after surgery. All available demographic variables, neuroimaging data, and clinical characteristics were collected. Preoperative predictors of long-term motor outcome were investigated by performing survival and univariate/multivariate Cox regression analyses. Loss of motor benefit from stimulation in the long term was defined as a reduction of less than 25% in the Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) part III scores compared to the baseline off-medication scores. As a secondary objective, potential predictors of short-term motor outcome after STN-DBS were assessed by performing univariate and multivariate linear regression analyses. RESULTS: In the long-term analyses (mean follow-up = 8.4 ± 6.26 years, median = 10 years, range = 1-17 years), 138 patients were included. Preoperative higher frontal score and off-medication MDS-UPDRS part III scores predicted a better long-term motor response to stimulation, whereas the presence of vascular changes on neuroimaging predicted a worse motor outcome. In 357 patients with available 1-year follow-up, preoperative levodopa response, tremor dominant phenotype, baseline frontal score, and off-medication MDS-UPDRS part III scores predicted the short-term motor outcome. INTERPRETATION: Frontal lobe dysfunction, disease severity in the off-medication condition, and the presence of vascular changes on neuroimaging represent the main preoperative clinical predictors of long-term motor STN-DBS effects. ANN NEUROL 2021;89:587-597.


Assuntos
Estimulação Encefálica Profunda , Doença de Parkinson/terapia , Núcleo Subtalâmico , Adulto , Idoso , Transtornos Cerebrovasculares/diagnóstico por imagem , Transtornos Cerebrovasculares/epidemiologia , Disfunção Cognitiva/epidemiologia , Disfunção Cognitiva/psicologia , Função Executiva , Feminino , Seguimentos , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Testes Neuropsicológicos , Doença de Parkinson/epidemiologia , Doença de Parkinson/fisiopatologia , Doença de Parkinson/psicologia , Prognóstico , Modelos de Riscos Proporcionais , Índice de Gravidade de Doença , Resultado do Tratamento
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