RESUMO
Parkinson's Disease Sleep Scale (PDSS) is a specific scale for the assessment of sleep disturbances in subjects with Parkinson's Disease (PD). This cross-sectional study set out to validate the PDSS in a Brazilian Portuguese Version (PDSS-BR). Ninety-five patients with PD participated in the study; their PD symptoms were evaluated by Unified Parkinson's Disease Rating Scale (UPDRS sections I-IV) and Hoehn and Yahr scale. Patients completed Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Beck Depression Inventory (BDI) and PDSS-BR. PDSS-BR internal consistency was satisfactory (Cronbach's alpha: 0.82; all PDSS-BR items were significantly and positively associated with total score). Test-retest reliability for total PDSS-BR score was 0.94. PDSS-BR score was highly correlated with sleep PSQI scale (r(s) = -0.63; p < 0.0001) and moderately with ESS (r(s) = -0.32; p < 0.001) and UPDRS sections I (r(s) = -0.38; p < 0.0001) and II (r(s) = -0.36; p < 0.0001) and BDI (r(s) = -0.55; p < 0.0001). Depressive symptoms, as determined by the BDI, were associated with significantly worse quality of nocturnal sleep, as measured by the PDSS-BR. The psychometric attributes of the PDSS-BR were satisfactory and consistent with those of previous studies. In summary, PDSS-BR can be useful for clinical and research purposes in Brazil.
Assuntos
Psicometria/métodos , Transtornos do Sono-Vigília/diagnóstico , Transtornos do Sono-Vigília/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil , Depressão/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/complicações , Escalas de Graduação Psiquiátrica , Reprodutibilidade dos Testes , Estudos Retrospectivos , Índice de Gravidade de Doença , Transtornos do Sono-Vigília/etiologia , Estatística como AssuntoRESUMO
We previously reported on 131 parkinsonian patients of African-Caribbean and Indian origin attending movement disorders clinics in six London Hospitals, of whom approximately 20% manifested atypical parkinsonism with a late-onset, akinetic-rigid predominant syndrome, postural instability and minimal resting tremor refractory to levodopa therapy and dopamine agonists (see Hu et al., Neurology 2000;54[Suppl.3]: A188 and Hu et al., Mov Disord 2000;15[Suppl.3]:S212). To better elucidate the phenotype of these atypical patients (18)FDG/(18)F-dopa positron emission tomography (PET) were performed in a subgroup to look for cortical and striatal metabolic changes suggestive of multiple system atrophy (MSA), progressive supranuclear palsy (PSP), corticobasal degeneration (CBD), or dementia with Lewy bodies. Magnetic resonance imaging (MRI) rating of cerebral vascular lesion load, putaminal atrophy, and neuropsychological testing were also performed. Discriminant function analysis of (18)F-dopa/(18)FDG striatal metabolism in 43 patients failed to separate atypical ethnic minority from typical Caucasian Parkinson's disease (PD) patients. Additionally, atypical Indian and African-Caribbean patients did not show cortical reductions in glucose metabolism suggestive of PSP, CBD, or DLB. Cerebral vascular lesion load rated in these patients did not differ between atypical and typical PD groups, and none of the atypical patients had MRI changes suggestive of MSA or PSP. Our results suggest the atypical parkinsonian phenotype seen in African-Caribbean and Indian patients represents a levodopa-refractory form of PD separate from MSA or PSP in most patients.
Assuntos
População Negra , Encéfalo/diagnóstico por imagem , Metabolismo Energético/fisiologia , Transtornos Parkinsonianos/diagnóstico por imagem , População Branca , Adulto , Idoso , Córtex Cerebral/diagnóstico por imagem , Corpo Estriado/diagnóstico por imagem , Comparação Transcultural , Diagnóstico Diferencial , Feminino , Fluordesoxiglucose F18 , Humanos , Índia/etnologia , Doença por Corpos de Lewy/diagnóstico por imagem , Londres , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Atrofia de Múltiplos Sistemas/diagnóstico por imagem , Testes Neuropsicológicos , Radiografia , Cintilografia , Paralisia Supranuclear Progressiva/diagnóstico por imagem , Índias Ocidentais/etnologiaRESUMO
INTRODUCTION: Although the prevalence and pattern of parkinsonism in white caucasian population have been reported, little is known about the pattern and prevalence of parkinsonism in black and Asian patients (from the Indian subcontinent). We recently reviewed this topic and felt that contrary to popular belief parkinsonism may be commoner in UK. Furthermore, the pattern of parkinsonism appears to be different in this group. METHODS AND RESULTS: Based on this observation we have now set up a worldwide and British study involving Afro-Caribbean and India (patients originating from the Indian subcontinent) subjects. In the first leg of this study, we carried out a door to door knocking assessment for Parkinsonism in one electoral ward in London with a high Afro-Caribbean population and identified three cases of atypical parkinsonism. We have subsequently been reviewing the case files of over 150 patients attending Movement Disorders clinical in areas of London with a high population of the Afro-Caribbean and Indian population. So far, we have identified 18 cases of Parkinsonism in patients of Afro-Caribbean and Asian origin. Fourteen out of 18 cases show non familial atypical parkinsonism with signs of progressive supranuclear palsy in five, probable striato nigral degeneration in four, and a levodopa unresponsive progressive parkinsonism which falls but no dystonia in three, spino-cerebellar atrophy type three in one and autopsy proven Pick's disease in 1.4. High field Magnetic resonance imaging and CT brain scanning have been remarkable apart from non-specific cortical atrophy and signs of vascular disease in some. CONCLUSIONS: Our observations suggest that parkinsonism is probably more common than realized in the Afro-Caribbean and Asian populations and these patients may be more susceptible to atypical parkinsonism. The reason for this is unclear and may reflect genetic or environmental factors as has been postulated in relation to higher incidence of diabetes and ischaemic heart disease in migrant Asian population in UK. Further epidemiological studies addressing this issue are in progress. (AU)