Preditor de Qualidade de Vida em Indivíduos com Doença de Parkinson Moderada

​

O objetivo deste estudo foi verificar dentre os sintomas motores, sintomas não motores e o medo de cair quais seriam os principais preditores de qualidade de vida em indivíduos nos estágios 2 e 3 da doença de Parkinson (DP). Trinta e nove indivíduos com DP (64,1±9,1 anos, 10,3±4,7 duração da DP) avaliados no
estado on da medicação participaram do estudo. A disfunção motora foi avaliada por meio dos seguintes testes: parte III da Escala Unificada de Avaliação da Doença de Parkinson (UPDRS-III), teste Timed up and Go (TUG), Teste de Sistema de Avaliação do Equilíbrio (BESTest) e uma repetição máxima dos membros inferiores (1RM no leg press). A disfunção não motora foi avaliada por meio dos seguintes testes: Avaliação Cognitiva de Montreal (MoCA), Inventário de Depressão de Beck (IDB) e o Índice de Qualidade do Sono de Pittsburgh (PSQI). O medo de cair foi avaliado por meio da Escala Internacional de Eficácia de Quedas (FES-I). A qualidade de vida foi avaliada por meio do teste Questionário da Doença de Parkinson (PDQ-39). Uma regressão múltipla linear, método stepwise foi empregada para verificar o principal preditor do escore da PDQ-39. A única variável independente que entrou no modelo de regressão múltipla linear (stepwise) e mostrou uma alta capacidade para explicar o escore de qualidade de vida de indivíduos com DP foi a FES-I (R2 ajustado = 0,73, P<0,0001). Assim, como implicação clínica, é possível sugerir que estratégias de treinamento físico que promovam diminuição no medo de cair podem impactar positivamente na qualidade de vida de indivíduos com DP moderada.

REFERÊNCIAS

Fahn S. Description of Parkinson's disease as a clinical syndrome. Ann N Y Acad Sci. 2003;991:1-14.

Jankovic J. Parkinson's disease: clinical features and diagnosis. J Neurol Neurosurg Psychiatry. 2008;79(4):368-76.

Marsden CD. Parkinson's disease. Lancet. 1990;335(8695):948-52.

Muslimovic D, Post B, Speelman JD, Schmand B, de Haan RJ, Group CS. Determinants of disability and quality of life in mild to moderate Parkinson disease. Neurology. 2008;70(23):2241-7.

Barbieri FA, Rinaldi NM, Santos PC, Lirani-Silva E, Vitorio R, Teixeira-Arroyo C, et al. Functional capacity of Brazilian patients with Parkinson's disease (PD): relationship between clinical characteristics and disease severity. Arch Gerontol Geriatr. 2012;54(2):e83-8.

Carod-Artal FJ, Ziomkowski S, Mourao Mesquita H, Martinez-Martin P. Anxiety and depression: main determinants of health-related quality of life in Brazilian patients with Parkinson's disease. Parkinsonism Relat Disord. 2008;14(2):102-8.

Winter Y, von Campenhausen S, Arend M, Longo K, Boetzel K, Eggert K, et al. Health-related quality of life and its determinants in Parkinson's disease: results of an Italian cohort study. Parkinsonism Relat Disord. 2011;17(4):265-9.

Martinez-Martin P, Rodriguez-Blazquez C, Kurtis MM, Chaudhuri KR, Group NV. The impact of non-motor symptoms on health-related quality of life of patients with Parkinson's disease. Mov Disord. 2011;26(3):399-406.

Adkin AL, Frank JS, Jog MS. Fear of falling and postural control in Parkinson's disease. Mov Disord. 2003;18(5):496-502.

Bloem BR, Grimbergen YA, Cramer M, Willemsen M, Zwinderman AH. Prospective assessment of falls in Parkinson's disease. J Neurol. 2001;248(11):950-8.

Bloem BR, van Vugt JP, Beckley DJ. Postural instability and falls in Parkinson's disease. Adv Neurol. 2001;87:209-23.

Gazibara T, Pekmezovic T, Kisic Tepavcevic D, Svetel M, Tomic A, Stankovic I, et al. Health-related quality of life in patients with Parkinson's disease: Implications for falling. Parkinsonism Relat Disord. 2015;21(6):573-6.

Kadastik-Eerme L, Rosenthal M, Paju T, Muldmaa M, Taba P. Health-related quality of life in Parkinson's disease: a cross-sectional study focusing on non-motor symptoms. Health Quality Life Outcomes. 2015;13:83.

Menon B, Nayar R, Kumar S, Cherkil S, Venkatachalam A, Surendran K, et al. Parkinson's Disease, Depression, and Quality-of-Life. Indian J Psychol Med. 2015;37(2):144-8.

Hoehn MM, Yahr MD. Parkinsonism: onset, progression and mortality. Neurology. 1967;17(5):427-42.

Nantel J, McDonald JC, Bronte-Stewart H. Effect of medication and STN-DBS on postural control in subjects with Parkinson's disease. Parkinsonism Relat Disord. 2012;18(3):285-9.

Fasano A, Aquino CC, Krauss JK, Honey CR, Bloem BR. Axial disability and deep brain stimulation in patients with Parkinson disease. Nature Rev Neurol. 2015;11(2):98-110.

Visser JE, Allum JH, Carpenter MG, Esselink RA, Speelman JD, Borm GF, et al. Subthalamic nucleus stimulation and levodopa-resistant postural instability in Parkinson's disease. J Neurol. 2008;255(2):205-10.

Hughes AJ, Daniel SE, Kilford L, Lees AJ. Accuracy of clinical diagnosis of idiopathic Parkinson's disease: a clinico--pathological study of 100 cases. J Neurol Neurosurg Psychiatry. 1992;55(3):181-4.

Goetz CG, Poewe W, Rascol O, Sampaio C, Stebbins GT, Counsell C, et al. Movement Disorder Society Task Force report on the Hoehn and Yahr staging scale: status and recommendations. Mov Disord. 2004;19(9):1020-8.

Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189-98.

Corcos DM, Robichaud JA, David FJ, Leurgans SE, Vaillancourt DE, Poon C, et al. A two-year randomized controlled trial of progressive resistance exercise for Parkinson's disease. Mov Disord. 2013;28(9):1230-40.

Silva-Batista C, Corcos DM, Roschel H, Kanegusuku H, Gobbi LT, Piemonte ME, et al. Resistance training with instability for patients with Parkinson's Disease. Med Sci Sports Exerc. 2016;48(9):1678-87.

Dibble LE, Hale TF, Marcus RL, Gerber JP, LaStayo PC. High intensity eccentric resistance training decreases bradykinesia and improves Quality Of Life in persons with Parkinson's disease: a preliminary study. Parkinsonism Relat Disord. 2009;15(10):752-7.

Peto V, Jenkinson C, Fitzpatrick R. PDQ-39: a review of the development, validation and application of a Parkinson's disease quality of life questionnaire and its associated measures. J Neurol. 1998;245(Suppl 1):S10-4.

Fahn S, Elton RL, Members. UP. Unified Parkinson’s disease rating scale. In: Fahn S, Marsden CD, Goldstein M, Calne DB, editors. Recent developments in Parkinson’s disease, Vol 2 Florham Park, NJ: Macmillan Healthcare Information. 1987:153-63, 293-304.

Berg KO, Maki BE, Williams JI, Holliday PJ, Wood-Dauphinee SL. Clinical and laboratory measures of postural balance in an elderly population. Arch Phys Med Rehabil. 1992;73(11):1073-80.

Podsiadlo D, Richardson S. The timed "Up & Go": a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991;39(2):142-8.

Rinalduzzi S, Trompetto C, Marinelli L, Alibardi A, Missori P, Fattapposta F, et al. Balance dysfunction in Parkinson's disease. BioMed research international. 2015;2015:434683.

Horak FB, Wrisley DM, Frank J. The Balance Evaluation Systems Test (BESTest) to differentiate balance defi cits. Phys Ther. 2009;89(5):484-98.

Brown LE, Weir JP. ASEP procedures recommendation I: accurate assessment of muscular strength and power. J Exercise Physiologyonline. 2001;4(3):1-21.

Nasreddine ZS, Phillips NA, Bedirian V, Charbonneau S, Whitehead V, Collin I, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005 Apr;53(4):695-9.

Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: psychometric properties. J Consulting Clin Psychol. 1988 Dec;56(6):893-7.

Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Archi Genl Psychiatry. 1961;4:561-71.

Hogl B, Arnulf I, Comella C, Ferreira J, Iranzo A, Tilley B, et al. Scales to assess sleep impairment in Parkinson's disease: critique and recommendations. Mov Disord. 2010;25(16):2704-16.

Carpenter JS, Andrykowski MA. Psychometric evaluation of the Pittsburgh Sleep Quality Index. J Psychosomatic Res. 1998;45(1):5-13.

Buysse DJ, Reynolds CF, 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193-213.

Jonasson SB, Nilsson MH, Lexell J. Psychometric properties of four fear of falling rating scales in people with Parkinson's disease. BMC Geriatr. 2014;14:66.

Yardley L, Beyer N, Hauer K, Kempen G, Piot-Ziegler C, Todd C. Development and initial validation of the Falls Effi cacy Scale-International (FES-I). Age Ageing. 2005;34(6):614-9.

Brozova H, Stochl J, Roth J, Ruzicka E. Fear of falling has greater influence than other aspects of gait disorders on quality of life in patients with Parkinson's disease. Neuro Endocrinol Letters. 2009;30(4):453-7.

Grimbergen YA, Schrag A, Mazibrada G, Borm GF, Bloem BR. Impact of falls and fear of falling on health-related quality of life in patients with Parkinson's disease. J Parkinson's Disease. 2013;3(3):409-13.

Mak MK, Pang MY, Mok V. Gait difficulty, postural instability, and muscle weakness are associated with fear of falling in people with Parkinson's disease. Parkinsons Dis. 2012;2012:901721.

Mak MK, Pang MY. Fear of falling is independently associated with recurrent falls in patients with Parkinson's disease: a 1-year prospective study. J Neurol. 2009;256(10):1689-95.

Shulman LM, Gruber-Baldini AL, Anderson KE, Vaughan CG, Reich SG, Fishman PS, et al. The evolution of disability in Parkinson disease. Mov Disord. 2008;23(6):790-6.

Acessar