QUALITY OF LIFE AND COGNITION IN PATIENTS WITH PARKINSON\u27S DISEASE DURING THE COVID-19 PANDEMIC

Introduction: Restrictive isolation contributes to the containment of the virus, but it also has negative consequences for mental health. This study aimed to assess the quality of life, during the pandemic, in patients with Parkinson\u27s disease (PD), compare it with measures before the pandemic, and identify factors that may be associated with non-compliance with cognitive intervention activities. Methods: The PDQ-39 questionnaire was reapplied in a sample of PD patients previously followed up in rehabilitation program. In addition, a questionnaire to assess the follow-up of cognitive training activities was elaborated. Results: Twenty-two individuals with mean age of 62.72(7.49) years and a mean duration of the disease of 8.7(3.30) years participated in this study. There was a statistically significant difference in the total score of the PDQ-39(p=0.048), as well as in the mobility (p=0.038), stigma (p=0.035), social support(p=0.045), and cognition(p=0.026) dimensions. When analyzing the questionnaire, it was observed that most of the sample was able to follow the guidelines received during the cognitive training group (77.3%), mainly reading activities (41%), games (35%), and applications (35%). However, 77.3% reported worsening cognition, with attention (50%) and memory (34%) being highlighted, as well as sadness, discouragement, and indisposition (72%), anxiety (77.27%), and difficulty falling asleep (68%). A total of 86.36% perceived the need for professional support in mental health. Conclusion: This study showed the impact of the pandemic on individuals with PD, leading to a worse perception of quality of life and subjective complaints related to sleep disturbance, cognitive impairment, and neuropsychiatric symptoms (depression and anxiety)

IMPACT OF COGNITION ON THE OCCURRENCE OF FALLS IN PATIENTS WITH PARKINSON\u27S DISEASE

Introduction: Falls are common in Parkinson\u27s disease (PD), happening to up to 68% of these individuals. Patients with PD present motor and gait impairment that increase the fall risks by three times. This study aimed to compare cognitive impairment and the occurrence of falls in PD patients. Methods: Retrospective and cross-sectional study through data collection in electronic medical records searching for the occurrence of falls (dichotomous and coded responses: 1=yes and 2=no) in the period of up to three months of cognitive assessment. For data analysis, descriptive statistics, and inferential analyses (Mann-Whitney U Test) were performed to compare the cognitive tests’ scores between the two groups (who answered Yes/fallers and non-fallers). A significance level of p<0.05 was adopted. Results: There was no difference between the subgroups (fallers=23; non-fallers=60) regarding age (p=0.28), schooling (0.51) and years of disease progression (0.99). No difference was observed between the subgroups for most cognitive variables, except Trail Making Test (B and delta). There was a tendency to differ in Addenbrooke\u27s cognitive examination III (ACE-III) (total and attention and memory domains), with lower performance for the fallers subgroup. Worse functionality and more frequent cognitive issues were observed in those with reported falls. Conclusion: It was observed that cognitive measures, especially attentional and memory measures, interfere with episodes of falls in patients with PD. It is necessary to increase the sample and balance between the subgroups for further evidence of these results

Use of Addenbrooke\'s Cognitive Examination III (ACE-III) in patients with idiopathic Parkinson\'s disease

INTRODUÇÃO: A doença de Parkinson idiopática, condição neurodegenerativa progressiva, é caracterizada por sintomas, como tremor, rigidez, bradicinesia e instabilidade postural. As manifestações não motoras, como distúrbios do sistema nervoso autônomo, fadiga, distúrbios do sono, transtornos afetivos, alterações cognitivas e neuropsiquiátricas podem estar presentes ao longo da evolução da doença. O déficit cognitivo na doença de Parkinson idiopática é uma importante causa de incapacidade funcional nestes pacientes e a detecção precoce, com instrumentos sensíveis, pode auxiliar no acompanhamento longitudinal. OBJETIVOS: Investigar a acurácia diagnóstica, sensibilidade e especificidade, do Exame Cognitivo de Addenbrooke, terceira versão, como ferramenta de avaliação cognitiva breve em pacientes com diagnóstico de doença de Parkinson idiopática. MÉTODOS: Estudo de corte transversal, observacional, do tipo caso-controle. Foram selecionados 150 pacientes com Doença de Parkinson Idiopática, conforme os critérios de diagnóstico clínico do Banco de Cérebro da Sociedade Britânica de doença de Parkinson, e 60 controles saudáveis, pareados por idade, sexo e escolaridade. Realizada a aplicação da ACE-III e bateria neuropsicológica, através de testes que avaliam os domínios atencionais, mnemônicos, funções visuoespaciais/visuo-construtivas, funções executivas e linguagem. RESULTADOS: O grupo clínico foi dividido em quatro subgrupos, tais como cognição normal na doença de Parkinson (CN-DP - 24 pacientes - 16%), comprometimento cognitivo leve devido a doença de Parkinson (CCL-DP - 104 pacientes - 69,33%), demência devido à doença de Parkinson (D-DP - 22 pacientes - 14,66%) e indivíduos sem DPI e cognição normal (controles). Obtivemos notas de corte capazes de identificar alterações cognitivas entre os grupos: CCL-DP e D-DP de controles saudáveis, tendo notas de corte de 85/100 (sensibilidade=58,65%, especificidade=60%, AUC=0,64) e 81/100 pontos (sensibilidade=81,82%, especificidade=75%, AUC=0,88), para detectar CCL-DP e D-DP, respectivamente. A idade foi inversamente associada ao desempenho dos escores (totais e domínios da ACE-III), enquanto os anos de escolaridade exerceram uma correlação significantemente positiva no desempenho destes escores. Houve correlação significante com os testes neuropsicológicos padronizados para esta população. CONCLUSÕES: A detecção precoce de comprometimento cognitivo, através de instrumentos breves e sensíveis para esta população, como a ACE-III facilita a possibilidade de intervenção precoce e ajustes no estilo de vida.INTRODUCTION: Parkinson\'s disease, progressive neurodegenerative condition, is characterized by symptoms, such as tremor, stiffness, bradykinesia; and postural instability. Non-motor manifestations, such as disorders of the autonomic nervous system, fatigue, sleep disorders, affective disorders, cognitive and neuropsychiatric disorders may be present throughout the course of the disease. Cognitive deficit in idiopathic Parkinson\'s disease is an important cause of functional disability in these patients and early detection, with sensitive instruments, can contribute to longitudinal monitoring. OBJECTIVES: To investigate the diagnostic accuracy, sensitivity and specificity of the Addenbrooke Cognitive Examination, third version, as a brief cognitive assessment tool in patients diagnosed with idiopathic Parkinson\'s disease. METHODS: Cross-sectional, observational, case-control study. 150 patients with IPD were selected, according to the clinical diagnosis criteria of the British Society of Parkinson\'s Disease Brain Bank, and 60 healthy controls, matched for age, sex and education. The application of ACE-III and neuropsychological battery was carried out, through tests that evaluate the attentional, mnemonic domains, visuospatial/visuoconstructive functions, executive functions and language. RESULTS: A total of 150 patients and 60 healthy controls were recruited for this study. The clinical group was divided into four subgroups, such as normal cognition in Parkinson\'s disease (NC-DP - 24 patients - 16%), mild cognitive impairment due to Parkinson\'s disease (MCI-DP - 104 patients - 69.33%) and dementia due to Parkinson\'s disease (D-PD - 22 patients - 14.66%). ACE-III was useful to differentiate groups: with cut-off scores of 85/100 (sensibility=58.65%, specificity=60%, AUC=0.64) e 81/100 pontos (sensibility =81.82%, specificity =75%, AUC=0.88), to detect MCI-PD and D-PD, respectively. Age was inversely associated with the performance of the scores (totals and domains of the ACE-III), while the years of schooling had a significantly positive correlation in the performance of these scores. There was a significant correlation with standardized neuropsychological tests for this population. CONCLUSIONS: The early detection of cognitive impairment, using brief and sensitive instruments for this population, as ACE-III, facilitates the possibility of early intervention and lifestyle adjustments

Rehabilitation in severe memory deficit: A case study

ABSTRACT The term amnesia refers to a pathological state of mind in which memory and learning are affected to a greater extent than other cognitive functions in a patient without altered level of consciousness. The aim of the current study was to describe a case of severe amnesia in a patient during neurological rehabilitation and to report the importance of preserved cognitive functions to compensate for the mnemonic deficit. VJA presented a clinical condition suggestive of encephalopathy due to caloric-protein malnutrition following several abdominal surgical procedures for complicated choledocholithiasis. A descriptive analysis of the results was carried out to outline the goals attained and the factors limiting implementation of memory aids. After the intervention program, consisting of individual and group activities, VJA showed improvement in level of recall with repetition of tasks, but still required constant external monitoring. Longitudinal follow-up is necessary to obtain more consistent results