Parkinson’s disease (PD) is the second most common neurodegenerative disorder after Alzheimer’s-type dementia. It is known that these types of diseases cause a significant decline in the quality of life of the people who suffer from them and in their next of kin. Understanding the physical and psychosocial effects of neurodegenerative diseases contributes to clinical decisionmaking. It is for the above mentioned that the present study aims to examine the current evidence regarding the direct impact that phonoaaudiological disorders of motor origin generate on the quality of life in people with PD. A systematic review of the literature was carried out. The articles were searched in the following databases: PUBMED, SCIELO and WOS, during the months of June and July of the year 2020, constituting a sample of 12 works, with a maximum age of 10 years. The analysed publications mainly describe the aspects of quality of life that are affected in people with PD, who suffer dysphagia or dysarthria, all this through the application of different questionnaires which evaluate different aspects of this concept. The results of the review show the importance of considering within the intervention process the component of quality of life in people with E.P, since the scores obtained according to the instruments applied indicate a decrease of this component and even more with the progress of the disease, which translates into worse quality of life related to food and speech.
Parkinson’s disease
Impacto de los trastornos motores del habla y deglución sobre la calidad de vida de personas con enfermedad de Parkinson: una revisión sistemática de la literatura. Impact of motor speech and swallowing disorders in quality of life of people with Parkinson’s disease: a systematic review of the literature
Entrenamiento sensoriomotor en casa en personas mayores con Enfermedad Parkinson durante el periodo de confinamiento por COVID-19: Estudio piloto. Sensorimotor training at home in elderly people with Parkinson’s Disease during the period of confinement due to COVID-19: A pilot study
The pandemic caused those therapeutic activities associated with people with Parkinson’s disease to be suspended (PD) with the aim of preventing COVID-19 infections by increasing motor and non-motor symptoms, due to social isolation and stress. Therefore, there was a rise of care based on telemedicine to continue the treatment in the context of a health emergency, promoting training at home. The objective of this experimental research was to document the effects of a sensorimotor training program (NM-FITT®) in people with PD through weekly telematic follow-up during the COVID-19 pandemic. A quasi-experimental study was carried out with pre, inter and post test evaluations that characterized the physical, functional condition and quality of life, in an intervention group (n=5) and a control group (n=5) of elderly people (69.5 ±4.5 years) with PD in Hoehn & Yahr stages 1 to 3, for 18 weeks, through an exercise manual, video calls and telephone follow-up. Favorable and significant effects were demonstrated on all the parameters studied after the application of the intervention in detriment of the health condition of the persons who did not participate in the home training program.
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Enfermedad de Parkinson y Respuesta Autonómica al Dolor. Parkinson’s Disease And Autonomic Pain Response.
A clinical case of PD is provided in which we analyze the autonomic involvement in response to pain, using various neurophysiological parameters. After the neurophysiological examination of pain thresholds (hand grip), this patient with 13 years history of Parkinson’s disease, showed a peripheral decrease that made the measurement of blood pressure not very stable. Sympathetic activity and nociceptive sensitivity were diminished, expressing the postganglionar noradrenergic myocardial denervation as it is widely known in parkinsonian patients. It is important to have in mind the autonomic nervous system involvement in Parkinson’s disease.
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Prevalencia de la Enfermedad de Parkinson: Estudio Puerta-Puerta en la Provincia de Manabí-Ecuador. Prevalence of Parkinson’s Disease: Door-to-door Study in Manabi-Ecuador.
Parkinson’s disease (PD) is one of the most frequent neurodegenerative disorders after dementias, with a worldwide prevalence of more than 1% in patients older than 65 years. In Ecuador, there are not direct statistical data on this disease. The aim of our research lies in establishing for the first time, the prevalence of Parkinson’s disease in the province of Manabi. For that, a door-to-door study was designed in two phases. They were selected 116,983 people, over forty years old. During the first phase, they were evaluated by survey, according to the London Brain Bank criteria for diagnosis. In the second phase, patients who met the criteria were referred to a neurologist for a definitive diagnosis. A total of 285 people (0.24%) were positive for Parkinson’s disease, predominating those aged over 61 years (33.33%), and with a slightly higher prevalence among males (56.14%) than in women (43.86%).
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The incongruities of the NPI−Q score obtained by the caregiver versus that obtained directly from the non−demented patient with Parkinson’s disease.
Background: Neuropsychiatric symptomatology frequently accompanies Parkinson’s disease. Purpose: In this work (a one point time analytical study), we wished to explorer the Neuropsychiatric Inventory in its shorter format (NPI–Q) in seventy consecutive patients. To find out in what way information obtained from the caregiver (CG) is correlated with that which the patients provide. If this tool, designed to evaluate patients with dementia, can be applied to non-demented subjects with Parkinson’s disease (NDP).
Method: The study, the NPI–Q Spanish version was employed, first with the CG alone and subsequently, with the individual patient alone by a researcher with no knowledge of the previous result from the CG. The weighted kappa correlation coefficient was measured to evaluate the CG–NDP consistency rate (Test–retest reliability; obtained by judging the reproductibility or stability of a instrument over time; two or more observers; or two or more times); a value of 0.7 or higher was accepted as significant. Because the correlation results were found to be insignificant, a post–hoc analysis was performed. We study the convergent validity (Validity–Construct–related, include examining the logical relations that should exist with other measures, know too as convergent validity) analyzed using the Spearman rank correlation statistic values greater than (r <0.29 are weak correlations; r <0.3– .58 are moderate correlations and; r < 0.59 are high correlations the convergent validity).
Results: The consistency inter-rater (CG–NDP), were without any significant agreement; in the inter- tems correlations the best values were for the patients; and in the Spearman’s correlations (a measure of converging validity), the values obtained on the NDP were more significant.
Conclusions: We can assume that the patient’s NDP is the best source of information, and hence for these patients, we consider that the NPI–Q (reported by the CG) is not the best tool to evaluate the Neuropsychiatric symptomatology of NDP sufferers.
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Neurogénesis en el Cerebro Adulto: Promesas y Posibilidades en la Enfermedad de Parkinson.
Dopamine is an important neurotransmitter implicated in the regulation of mood, motivation and movement. Here, we have reviewed recent data suggesting that dopamine, in addition to being a neurotransmitter, also plays a role in the regulation of endogenous neurogenesis in the adult mammalian brain. In addition, we approach a highly controversial question: can the adult human brain use endogenous neurogenesis to replace the dopaminergic neurons in the substantia nigra that are lost in Parkinson’s disease?
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Concurrent Validity of the Hamilton Depression Rating Scale and the Beck Depression Inventory versus the ICD-10 Diagnostic Criteria among Patients with Parkinson’s Disease.
Objective: To examine the concurrent validity of the Hamilton Depression Rating Scale and the Beck Depression Inventory for quantifying depression in patients with Parkinson’s disease, using the ICD-10 Diagnostic Criteria as the gold standard, and to determine if the somatization items considered are pertinent.
Methods: The study involved one hundred and forty consecutive PD patients –102 men and 38 women– with a mean age of 68.7 years and mean disease duration of 6.7 years. Sensitivity, specificity, positive and negative predictive values and likelihood ratios were obtained with a 95% CI. ROC Curves (AUC) were also performed.
Results: Based on ROC measurement of discriminative ability, our results suggest that both scales were poor at recognizing mild depression, somewhat better at recognizing moderate depression and adequate for distinguishing severe depression, though with poor specificity. Comparisons of HDRS-21, HDRS-12, BDI-21 and BDI-16 to determine concurrent validity all gave similar results for each depression level and no important differences between the complete scales (all 21 items) and abbreviated forms (without somatic items) were noted.
Conclusions: We conclude that both scales possess similar psychometric properties, but our results cannot be compared with those of other studies that used DSM-IV criteria as their gold standard. These observations led to the following conclusions: (1) the evaluation scales and criteria that comprise them were not designed for PD; (2) the somatic items observed in our patients were a product of PD; and (3) as the severity of the illness increased, so did the number of items that were confused as elements of depression.
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Pálido-Ansotomía Lenticular: Un blanco quirúrgico efectivo en la Enfermedad de Parkinson.
Briefly we described the posteroventral pallidotomy technique introducing a new target situated more anteriorly to the classic Laitinen´s pallidotomy, in this way we obtain relief in the whole motor signs of Parkinson´s disease. We believe it is the result of the interruption of efferents fibers from pallidum to motor thalamus, and coagulation of the majority of somatomotor cells of the posteroventral pallidum.
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Terapia Celular en la Enfermedad de Parkinson.
The pathological hallmark of Parkinson’s disease is a gradual loss of nigrostriatal dopamine-containing neurons and is responsible for cardinal motor symptoms of the disease. Current therapeutic strategies are mostly based on pharmacological enhancement of the dopaminergic neurotransmission. This therapeutic approach has several long-term side effects, such as dyskinesias and fluctuations of response and is therefore limited in its use. Transplantation of fetal dopaminergic precursor cells has provided the proof that a cell replacement therapy can ameliorate clinical symptoms in affected patients. Novel therapies aiming at a stimulation of an endogenous dopamine production within the brain at a continuous rate might provide a more physiological and elegant way to overcome the dopaminergic deficiency in parkinsonian brains. This article will review recent studies demonstrating the potential of these alternative cell graft sources for treating Parkinson’s disease.
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La Memoria de Trabajo y su relación con otras funciones cognitivas en la Enfermedad de Parkinson.
Parkinson’s Disease (PD) is a neurological illness due to degeneration of the dopaminergic neurons of the nigro-striatal pathway. Each of the five frontal-subcortical circuits contributes in a different way to PD’s symptoms. The clinical manifestations are variable; they include non cognitive deficits like: rigidity, tremor, bradykinesia, and other motor deficits like hypomimic (mask-like face), hypophonia, dysarthria, dystonia and abnormal postures among others. The emotional disorders in PD include depression and anxiety. The frontotemporal dementia in PD has been described. The neuropsychological examination of the PD patient is done considering whether the main symptoms are bradykinesia and rigidity, since these patients show more severe cognitive decline. We must examine the attention, which is between the normal limits in simple tasks, but it shows deficits in more complex tasks; memory and learning are disturbed, orientation is intact; in verbal functions we evaluate vocabulary, syntaxes and grammar which are relatively intact, although the sentence length tend to be reduced; the visuospatial disorders are frequent in PD; thinking and reasoning must also be examined, in both of them there is normal performance and they show a realistic appreciation of their condition and limitations; the executive functions are evaluated, there are consistent failures in tests that require concept formation and thinking flexibility. PD treatment can be medical using L-Dopa, or surgery through techniques by lesion or stimulation to different surgical targets like the internal globus pallidus, the subthalamic nucleus, or the ventral medial thalamic nucleus, unilateral or bilaterally. The PD repercussions in working memory (WM) will be studied related to executive functions, speech, cronometraje, saccades and attention.
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Depression and Anxiety in Parkinson’s Disease, Metric Properties of the Beck´s Depression and Anxiety Inventories. A K2 Factorial Design.
Background: Study to investigate the concurrent validity of the Beck Depression Inventory and Beck Anxiety Inventory evaluation scales against the ICD-10.
Methods: A K2 factorial design for studying the metrics properties of the BDI and BAI in parkinsonian outpatients.
Results: 147 parkinsonian patients were included; 44 patients has anxiety and depression; only depression 19; only anxiety 31; finally 53 subjects don’t have depression or anxiety. The BDI AUC was [0.858]. The BAI AUC was of [0.907]. The cut score was of 14/15 for the BDI and 13/14 for the BAI. The factorial design resulted in the two factors (depression and anxiety) has the best functional correlation in the regression.
Conclusions: The results we present bear out this lack of dimensionality, since we found that the BDI AUC-measured discriminative ability for anxiety was [0.739]. With regard to the BAI, this is employed to discriminate the depressed, AUC values of [0.771].
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The “8-foot Up and Go” Test as a Physical Performance Measurement in Parkinson’s Disease: A Pilot Study.
Blackground: Parkinson disease (PD), is a movement disorder, so physical assessment should be a key component in the diagnosis of individuals suffering from this disease. There is a neeed to assess the utility of some motor tests in PD, specially those which include assessment of straight line walking and turning.
Objective: This pilot study aimed to asses the utility of the “8-foot up and go” test as a physical performance measurement in PD, as well as the relationship between functional mobility and quality of life in this population.
Material and Methods: Twenty-four patients with a diagnosis of idiopathic Parkinson’s disease volunteered and finished the study. They performed the “8 foot up-and-go” test and answered the 9-item Parkinson’s Disease Questionnaire.
Results: The motor test’s total score correlated significantly with different sub-scales of the 9-item Parkinson’s Disease Questionnaire, especially with the mobility sub-scale and with the total score.
Conclusions: The “8 foot up-and-go” test is useful and easy to perform by Parkinson’s disease patients and it has turned out to be a clear indicator of the way the illness affects their quality of life.
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Estimulación Cerebral Profunda y Enfermedad de Parkinson: Documento Instructivo para el Manejo Multidisciplinario en el Hospital Regional Dr. Teodoro Maldonado Carbo
Neuromodulation by deep brain stimulation (DBS) in the treatment of Parkinson’s disease has developed new research in its pathophysiology. By electrical stimulation of established surgical targets, clinical response can be modified and optimized, improving quality of life. Even though its efficacy, DBS is not indicated for all patients. Selection criteria must be considered and a multidisciplinary team -with roles and responsibilities clearly defined- must evaluate the patient.
