RESUMO
Parkinson's disease (PD) is a neurodegenerative disorder which affects the quality of life of patient and their family. Sleep disorders appear in 80-90% of PD patients and have a great impact on the PD well-being. We examined the relationship of patients' sleep quality and depression on burden, mood, quality of life, and quality of sleep of their caregivers. A multicenter, regional (Veneto), observational, cross-sectional study that included 55 patient-caregiver pairs was conducted. Patients were assessed using Parkinson's Disease Sleep Scale (PDSS) and Epworth Sleepiness Scale (ESS) for sleep disorders, Beck Depression Inventory (BDI) as a measure of depression, and Parkinson's Disease Questionnaire (PDQ-39) as a measure of quality of life. Caregivers were evaluated by the Caregiver Burden Inventory (CBI) a measure of burden, BDI, SF-36 Health Survey as measures of HRQoL, and Medical Outcomes Study-Sleep Scale (MOS-SS) for quality of sleep. CBI, HRQoL, MOS-SS, and BDI scores displayed no association with patients' age, cognition (Mini Mental State Examination (MMSE) and Frontal Assessment Battery (FAB)), disease duration, and Hoehn and Yahr (H&Y), and UPDRS III scales whereas were significantly correlated with patients' quality of sleep, depression, and quality life. CBI and HRQoL were also associated respectively with patients' ESS and L-dopa daily dose. This study underscores the presence of a significant relationship between patient and caregiver quality of life. Interestingly, sleep quality and depression rather than motor disability best predicted caregivers' well-being.
Assuntos
Cuidadores , Efeitos Psicossociais da Doença , Doença de Parkinson/complicações , Transtornos do Sono-Vigília/complicações , Idoso , Antiparkinsonianos/uso terapêutico , Cuidadores/psicologia , Estudos Transversais , Depressão/complicações , Depressão/terapia , Avaliação da Deficiência , Dopaminérgicos/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/psicologia , Doença de Parkinson/terapia , Qualidade de Vida , Sono , Transtornos do Sono-Vigília/psicologia , Transtornos do Sono-Vigília/terapiaRESUMO
Previous studies have demonstrated that emotional facial expressions alter temporal judgments. Moreover, while some studies conducted with Parkinson's disease (PD) patients suggest dysfunction in the recognition of emotional facial expression, others have shown a dysfunction in time perception. In the present study, we investigate the magnitude of temporal distortions caused by the presentation of emotional facial expressions (anger, shame, and neutral) in PD patients and controls. Twenty-five older adults with PD and 17 healthy older adults took part in the present study. PD patients were divided into two sub-groups, with and without mild cognitive impairment (MCI), based on their neuropsychological performance. Participants were tested with a time bisection task with standard intervals lasting 400 ms and 1600 ms. The effect of facial emotional stimuli on time perception was evident in all participants, yet the effect was greater for PD-MCI patients. Furthermore, PD-MCI patients were more likely to underestimate long and overestimate short temporal intervals than PD-non-MCI patients and controls. Temporal impairment in PD-MCI patients seem to be mainly caused by a memory dysfunction. (JINS, 2016, 22, 890-899).
Assuntos
Emoções/fisiologia , Expressão Facial , Reconhecimento Facial/fisiologia , Doença de Parkinson/fisiopatologia , Percepção do Tempo/fisiologia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
We evaluated the efficacy of Botulinum toxin type A (BTXA) as an alternative to surgical intervention to facilitate phonation in 34 laryngectomized patients (31 males and 3 women) who were unable to produce tracheoesophageal voice because of spasm of the middle and inferior pharyngeal constrictor muscles (PCM). EMG was recorded to confirm activity in these muscles during attempted vocalization. Parapharyngeal nerve block (Carbocaine 2%, 5 cc) was used to demonstrate short-term fluent voice after relaxation of the pharyngeal constrictor muscle. At a later occasion, 100 U of Botox (Allergan) in ten patients and 50 U in two patients were injected unilaterally at one location in the PCM percutaneously under EMG guidance. All patients then underwent a voice therapy program. In 11 out of 12 patients an improvement of phonation was evident after 24-48 h and it was long lasting. This result was also seen in a patient previously myotomized without improvement. Only one patient needed to be reinjected every 3 months. At a follow-up after 3 months the EMG recorded in four patients showed a low-amplitude or complete absence of activity in the treated muscle. No side effects developed. BTX therapy, especially when associated with the speech therapy, is efficacious in restoring voice to laryngectomees who are unable to voice because of spasm of the PCMs. Our results confirm previous reports. This method is our approach of choice in managing PCM spasm because it is non-invasive, not painful, has few or no side effects, and is frequently long-lasting.
Assuntos
Toxinas Botulínicas Tipo A/administração & dosagem , Disfonia/tratamento farmacológico , Laringectomia/efeitos adversos , Laringectomia/reabilitação , Fonação/efeitos dos fármacos , Adulto , Idoso , Idoso de 80 Anos ou mais , Toxinas Botulínicas Tipo A/uso terapêutico , Clostridium botulinum/química , Disfonia/etiologia , Disfonia/reabilitação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Bloqueio Nervoso/métodos , Fármacos Neuromusculares/administração & dosagem , Músculos Faríngeos/efeitos dos fármacos , Músculos Faríngeos/fisiopatologia , Fonação/fisiologia , Espasmo/tratamento farmacológico , Espasmo/etiologia , Espasmo/reabilitação , Voz Esofágica/métodosRESUMO
BACKGROUND: Device-related infection is a common occurrence after deep brain stimulation (DBS) surgery, and may result in additional interventions and a loss of efficacy of therapy. This retrospective review aimed to evaluate the incidence, severity and management of device-related infections in 212 DBS procedures performed in our institute. METHODS: Data on 106 patients, in whom 212 DBS procedures were performed between 2001 and 2011 at our institute by a single neurosurgeon (M.P.), were reviewed to assess the incidence, severity, management and clinical characteristics of infections in the first year after the implantation of a DBS system. RESULTS: Infections occurred in 8.5% of patients and 4.2% of procedures. Of the nine infections, eight involved the neurostimulator and extensions, and one the whole system. The infections occurred 30.7 days after implantation: 7 within 30 days and 2 within 6 months. Infected and uninfected patients were comparable in terms of age, sex, indication for DBS implantation and neurostimulator location. In eight cases, the system components involved were removed and re-implanted after 3 months, while in one case the complete hardware was removed and not re-implanted. CONCLUSION: The overall incidence of postoperative infections after DBS system implantation was 4.2%; this rate decreased over time. All infections required further surgery. Correct and timely management of partial infections may result in successful salvage of part of the system.
Assuntos
Infecções Bacterianas do Sistema Nervoso Central/epidemiologia , Estimulação Encefálica Profunda/efeitos adversos , Eletrodos Implantados/efeitos adversos , Contaminação de Equipamentos/prevenção & controle , Infecções Relacionadas à Prótese/epidemiologia , Idoso , Infecções Bacterianas do Sistema Nervoso Central/fisiopatologia , Infecções Bacterianas do Sistema Nervoso Central/prevenção & controle , Estimulação Encefálica Profunda/métodos , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Infecções Relacionadas à Prótese/fisiopatologia , Infecções Relacionadas à Prótese/prevenção & controle , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
Despite the wide diffusion of subthalamic deep brain stimulation (STN-DBS) for Parkinson's disease, systematic practical recommendations for intraoperative electrophysiological monitoring are still lacking. In this paper, a shared protocol for intraoperative electrophysiological monitoring arising from the meetings of a panel of neurophysiologists of the DBS Study Group of the Italian Neurological Society is proposed. Intraoperative monitoring is composed by microrecordings and functional stimulation. In microrecordings, it is recommended to use at least 2-3 electrodes, descending with steps of 0.5-1 mm and waiting at least 60 s before changing the position. Functional stimulation is used to assess the clinical efficacy and the side effects induced by STN-DBS at different positions. Based on the therapeutic window, an algorithm to find the optimal target is proposed. The procedures for intraoperative monitoring for STN-DBS proposed here are safe, relatively cheap, take approximately 30-40 min per side and could offer valuable additional information to the surgeon.
Assuntos
Estimulação Encefálica Profunda , Monitorização Intraoperatória/métodos , Doença de Parkinson/cirurgia , Núcleo Subtalâmico/fisiologia , Algoritmos , Estimulação Encefálica Profunda/efeitos adversos , Impedância Elétrica , Estimulação Elétrica , Eletrodos Implantados , Eletrofisiologia , Humanos , Imageamento por Ressonância Magnética , Microeletrodos , Técnicas Estereotáxicas , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Intravenous (i.v.) thrombolysis with rt-PA within 3 h from symptom onset is the only approved treatment of pharmacological revascularization in acute ischemic stroke. However, little information exists on its use in elderly patients, in particular those aged >80 years, who at present are excluded from treatment. METHODS: In a multicenter Italian study on i.v. thrombolysis, patients aged >80 years (n = 41) were compared with those aged
Assuntos
Isquemia Encefálica/tratamento farmacológico , Fibrinolíticos/administração & dosagem , Acidente Vascular Cerebral/tratamento farmacológico , Terapia Trombolítica , Ativador de Plasminogênio Tecidual/administração & dosagem , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/complicações , Estudos de Coortes , Fibrinolíticos/efeitos adversos , Humanos , Infusões Intravenosas , Hemorragias Intracranianas/induzido quimicamente , Itália , Pessoa de Meia-Idade , Proteínas Recombinantes , Acidente Vascular Cerebral/etiologia , Ativador de Plasminogênio Tecidual/efeitos adversos , Resultado do TratamentoRESUMO
INTRODUCTION: Parkinson's disease (PD) is a movement disorder caused by deterioration of the dopaminergic system. Previous studies have demonstrated temporal as well as emotional facial recognition impairment in PD patients. Moreover, it has been demonstrated that emotional facial expressions alter temporal judgments. In the present study, we investigate the magnitude of temporal distortions caused by the presentation of emotional facial expressions (happiness, sadness, and neutral) in PD patients with mild cognitive impairment (PD-MCI) and controls. METHOD: Seventeen older adults with PD-MCI and 22 healthy older adults took part in the present study. Participants were tested with a time bisection task with standard intervals lasting 400 ms and 1600 ms. Moreover, a complete neuropsychological evaluation was conducted to characterize the sample. RESULTS: Differences between groups were observed indicating a general underestimation of time in PD-MCI patients. Temporal impairments in PD-MCI patients seem to be caused mainly by a dysfunction at the level of reference memory. The effect of emotional facial expressions on time perception was evident in both PD patients and controls, with an overestimation of perceived duration when happiness was presented and an underestimation when sadness was presented. CONCLUSION: Overall, our results indicate that reduced cognitive abilities might be responsible for the lower temporal ability observed in PD-MCI patients. Moreover, similar effects of emotional stimuli were observed in both PD-MCI patients and controls.
Assuntos
Disfunção Cognitiva/psicologia , Expressão Facial , Reconhecimento Facial , Felicidade , Doença de Parkinson/psicologia , Tristeza , Percepção do Tempo , Idoso , Idoso de 80 Anos ou mais , Aptidão , Atenção , Correlação de Dados , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos/estatística & dados numéricos , Doença de Parkinson/complicações , Distorção da Percepção , Psicometria , Valores de ReferênciaRESUMO
Non-motor symptoms are gaining relevance in Parkinson's disease (PD) management but little is known about their progression and contribution to deterioration of quality of life. We followed prospectively 707 PD patients (62 % males) for 2 years. We assessed non-motor symptoms referred to 12 different domains, each including 1-10 specific symptoms, as well as motor state (UPDRS), general cognition, and life quality. Hoehn & Yahr (H&Y) stage was used to categorize patient status (I-II mild; III moderate; IV-V severe). We found that individual non-motor symptoms had variable evolution over the 2-year follow-up with sleep, gastrointestinal, attention/memory and skin disturbances (hyperhidrosis and seborrhea) becoming more prevalent and psychiatric, cardiovascular, and respiratory disorders becoming less prevalent. Development of symptoms in the cardiovascular, apathy, urinary, psychiatric, and fatigue domains was associated with significant life-quality worsening (p < 0.0045, alpha with Bonferroni correction). During the observation period, 123 patients (17 %) worsened clinically while 584 were rated as stable. There was a fivefold greater increase in UPDRS motor score in worse compared with stable patients over 24 months (p < 0.0001 vs. baseline both in stable and worse group). The total number of reported non-motor symptoms increased over 24 months in patients with motor worsening compared to stable ones (p < 0.001). Thirty-nine patients died (3.4 % of patients evaluable at baseline) with mean age at death of 74 years. Deceased patients were older, had significantly higher H&Y stage and motor score, and reported a greater number of non-motor symptoms at baseline. In conclusion, overall non-motor symptom progression does not follow motor deterioration, is symptom-specific, and only development of specific domains negatively impacts quality of life. These results have consequences for drug studies targeting non-motor features.