The impact of cognitive performance on quality of life in individuals with Parkinson's disease

Background: Evidence points to the occurrence of cognitive impairment in all stages of PD, constituting a frequent and debilitating symptom, due to high impact on quality of life and mortality of patients. Objective: To correlate cognitive performance with quality of life in PD. Methods: The sample was drawn from a Movement Disorders Clinic of a reference hospital in Porto Alegre. Inclusion criteria were: PD diagnosis, according to the United Kingdom Parkinson’s Disease Society Brain Bank criteria for idiopathic PD (Hughes et al. 1992) and patient consent to participate. Patients with other neurological pathologies and those submitted to deep brain stimulation were excluded. The evaluation consisted of a cognitive testing battery (composed of eight tests for assessing cognitive performance), and a questionnaire on quality of life (PDQ-39) and depression (BDI). Results: The sample comprised 85 individuals with PD, with a mean age of 62.9 years (±10.7), mean disease duration of 10.4 years (±5.7), and mean educational level of four years (±4.3). There was a significant relationship between total score on the PDQ and all cognitive tests, showing that poor cognitive performance was correlated with poor quality of life. Moreover, a significant correlation was observed between cognitive tests and depression, H&Y, education level, and age. Conclusion: It may be concluded that the individuals with PD in this sample showed a correlation between poorer quality of life and worse cognitive performance. Poor performance was also correlated with more advanced stage, older age, low level of education and depression.Embasamento: As evidências apontam a ocorrência de comprometimento cognitivo em todas as fases da doença de Parkinson (DP), sendo este um sintoma não motor frequente e incapacitante, devido ao alto impacto na qualidade de vida e mortalidade dos pacientes. Objetivo: correlacionar a performance cognitiva com qualidade de vida na DP. Métodos: A amostra foi oriunda de um Ambulatório de Distúrbios do Movimento de um hospital referência de Porto Alegre. Os critérios de inclusão utilizados foram ter diagnóstico de DP e consentir em participar do estudo. Exclui-se pacientes com outras patologias neurológicas ou pacientes com estimulação cerebral profunda. A avaliação foi composta por uma anamnese, bateria de testes cognitivos (composta por oito testes), questionários sobre qualidade de vida (PDQ-39) e depressão (BDI). Resultados: A amostra foi composta por 85 indivíduos com DP, com média de idade de 62,9 anos (±10,7), média do tempo de doença de 10,4 anos (±5,7) e média de escolaridade de 7,4 anos (±4,3). Verificou-se relação significativa entre escore total do PDQ com todos os testes cognitivos, demonstrando que pior performance cognitiva está relacionada com pior qualidade de vida. Além disso, foi observado correlação significativa entre os testes cognitivos com depressão, H&Y, escolaridade e idade. Conclusão: Pode-se concluir que na presente amostra indivíduos com DP apresentaram correlação entre pior qualidade de vida com pior desempenho cognitivo. Isto também foi observado com estágio avançado da doença, idade avançada, baixa escolaridade e depressão

The impact of deep brain stimulation on the quality of life and swallowing in individuals with Parkinson's Disease

Introduction Deep brain stimulation (DBS) is an established treatment for Parkinson’s disease (PD). However, there is little evidence regarding the effect of DBS on dysphagia. Objective To assess the swallowing and quality of life of individuals with PD before and after DBS surgery. Methods Our sample consisted of people who had undergone DBS surgery in a referral hospital in the state of Rio Grande do Sul, Brazil. The inclusion criteria were a diagnosis of PD and having undergone DBS surgery. A cognitive screening, through a questionnaire about depression and quality of life, was conducted. Evaluations of each patient’s swallowing were performed before and after surgery. The assessment consisted of anamnesis, clinical assessment, the Functional Oral Intake Scale, clinical evaluation of swallowing, and the Hoehn and Yahr scale. Results The sample included 10 individuals, all male, with a mean age of 57.3 years ( 4.7), a mean disease duration of 13.0 years ( 2.4), and mean level education of 8.1 years ( 4.0). In the clinical evaluation of the swallowing, a significant improvement after DBS was not observed. However, little changes in the signs and symptoms of dysphagia that had a positive impact on the quality of life were observed. Furthermore, there was no relation between the patients’ motor subtype and swallowing pre- and post-DBS. Conclusion There was an improvement in the quality of life of the patients after DBS. However, the improvement in the clinical signs and symptoms of dysphagia did not cause an overall improvement in the swallowing function

Translation and cultural adaptation of swallowing disturbance questionnaire for brazilian portuguese

Objetivo: traduzir e adaptar culturalmente para o português brasileiro o Swallowing disturbance questionnaire (SDQ) para detecção de risco de disfagia em indivíduos com Doença de Parkinson (DP). Métodos: realizou-se tradução para o português, retradução para o inglês, análise de confiabilidade do instrumento, sendo a versão final aplicada aos participantes e realizado o reteste após duas semanas. Selecionou-se os participantes em um ambulatório de distúrbios do movimento de um hospital de referência no Rio Grande do Sul. Incluiu-se indivíduos com diagnóstico de DP. Excluiu-se indivíduos com alteração de linguagem ou audição que impossibilitasse a compreensão do questionário e com diagnóstico de outras doenças neurológicas. Resultados: a amostra foi composta por 23 indivíduos. Os participantes responderam a todas as questões. Não houve eliminação de nenhuma questão. Na análise da confiabilidade teste-reteste o coeficiente de correlação intraclasse do escore final nos dois momentos foi de 0,912 com p<0,001 (95%IC=0,792- 0,963), demonstrando que os dados são altamente homogêneos. Na análise por questão, não houve diferença significante entre os dois momentos de aplicação. O valor de α de Cronbach do instrumento foi de 0,63. Conclusão: houve equivalência cultural do SDQ para o português brasileiro, com boa confiabilidade interna do instrumento.Purpose: to translate and culturally adapt to Brazilian Portuguese Swallowing the disturbance questionnaire (SDQ) for dysphagia detection risk in individuals with Parkinson’s disease (PD). Methods: this was translated into Portuguese, back-translation into English, instrument reliability analysis, the final version applied to participants and conducted retesting after two weeks. Was selected participants at a clinic for movement disorders of a reference hospital in Rio Grande do Sul. It was included individuals diagnosed with PD. It excluded individuals with impaired speech or hearing that prevented the understanding of the questionnaire and diagnosis of other neurological diseases. Results: the sample consisted of 23 individuals. The participants answered all questions. There was no question of disposal. In the analysis of test-retest reliability intraclass correlation coefficient of the final score in the two periods was 0.912 with p <0.001 (95% CI = 0.792 to 0.963), demonstrating that the data are highly homogeneous. In the analysis by question, there was no significant difference between the two application times. The value of α Cronbach the instrument was 0.63. Conclusion: there was cultural equivalence of the SDQ for Brazilian Portuguese, with good internal reliability of the instrument

Quality of life (QOL) in Parkinson´s disease : the PDQ-39 evaluates QV in disfagic individuals?

Objetivo: Avaliar o impacto da disfagia na qualidade de vida (QV) de indivíduos com Doença de Parkinson (DP) através do instrumento recomendado para essa população. Métodos: Participaram deste estudo pacientes com diagnóstico de DP. Todos os participantes foram submetidos à avaliação fonoaudiológica de deglutição com as consitências sólida (pão francês) e líquida (água), responderam ao PDQ-39 e tiveram o estadiamento da DP classificado pela escala de Hoehn &Yahr. Resultados: Foram avaliados 31 indivíduos com DP, sendo 21 (67,7%) do gênero masculino. A média de idade foi 59,6 anos (± 11,3), variando de 38 a 79 anos e o tempo doença desde o diagnóstico foi, em média, 9,8 (±4,8) anos. A disfagia esteve presente em 74,2% dos indivíduos avaliados e na correlação entre o PDQ-39 total e a presença de disfagia houve significância apenas no domínio estigma. Conclusão: Em indivíduos com DP avaliados através do PDQ-39 não fica evidente o impacto da disfagia na percepção de QV dessa população.Objective: To assess the impact of dysphagia on the overall quality of life (QOL) of patients with Parkinson’s disease (PD) through the tool recommended for this population. Methods: The study included 31 patients diagnosed with PD. All participants underwent clinical assessment of swallowing the solid consistency (French bread) and liquid (water), answered to the PDQ-39 and had the staging of PD classified by Hoehn & Yahr scale. Results: We evalueted 31 subjects with PD, 21 (67.7%) were male. The mean age was 59.6 years (± 11.3), ranging from 38 to 79 years and the disease time since diagnosis was on average 9.8 (± 4.8) years. Dysphagia was present in 74.2% of the individuals and the correlation between the PDQ-39 the presence of dysphagia was significant only in stigma domain. Conclusion: In patients with PD assessed by PDQ-39 is not evident the impact of dysphagia on the perception of overall QoL of this population

Correlação entre aspectos cognitivos e disfagia em pacientes com esclerose lateral amiotrófica

Introdução: As alterações cognitivas já são identifcadas em 30-50% da população com ELA. A disfagia, por sua vez, é um sintoma muito presente, sendo inclusive um dos principais sintomas quando há envolvimento bulbar. Essas alterações podem trazer implicações clínicas importantes com o avanço da doença. Objetivo: correlacionar os aspectos cognitivos e a disfagia em pacientes acometidos pela ELA. Métodos: Estudo transversal, observacional e descritivo. Foram incluídos indivíduos com diagnóstico de ELA e que concordaram em assinar o TCLE. Foram excluídos indivíduos que realizaram terapia fonoaudiológica para disfagia previamente, apresentaram ausência de linguagem oral que impossibilitasse a realização dos testes cognitivos, estar sem alimentação por Via Oral e desistência antes de completar todas as etapas. Foram realizadas avaliações da cognição e da disfagia. Resultados: A amostra inicial foi composta por 86 participantes, onde 69 entraram nos critérios de exclusão. Foram avaliados 17 pacientes, com idade media de 49,8 (±11,3) e escolaridade de 7,1 (± 2,8). O tempo de doença foi analisado em meses, tendo uma mediana 24 (P25=10;-P75=72) meses. Nesta amostra, 70,6% são do gênero masculino. 47,1% dos indivíduos apresentaram disfagia, a mesma correlacionou-se com a cognição nos testes FAB (p=0,019), Teste de Trilhas A (p=0,006) e BDI (p=o,015). Conclusão: Nesta amostra, as funções executivas e depressão impactaram na disfagia em indivíduos com ELA.Introduction: Cognitive alterations are already identified in 30-50% of the population with ALS. Dysphagia, on the other hand, is a very present symptom, being even one of the main symptoms when there is bulbar involvement. These changes may have important clinical implications as the disease progresses. Objective: to correlate the cognitive aspects and dysphagia in patients affected by ALS. Methods: Cross-sectional, observational and descriptive study. Individuals with a diagnosis of ALS were included who agreed to sign the ICF. We excluded individuals who underwent therapy for dysphagia previously, had no oral language that would make it impossible to perform the cognitive tests, be without oral feeding and withdrawal before completing all the steps. Evaluations of cognition and dysphagia were performed. Results: The initial sample consisted of 86 participants, where 69 entered the exclusion criteria. Seventeen patients were evaluated, with a mean age of 49.8 (± 11.3) and schooling of 7.1 (± 2.8). Disease time was analyzed in months, with a median 24 (P25 = 10; P75 = 72) months. In this sample, 70.6% were male. 47.1% of the individuals presented dysphagia, the same correlated with cognition in the FAB tests (p = 0.019), Trail Making Test A (p = 0.006) and BDI (p = 0, 015). Conclusion: In this sample, executive functions and depression had an impact on dysphagia in individuals with ALS