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Francisco Eduardo Costa Cardosohttp://lattes.cnpq.br/4158841513358745Henrique Balallai FerrazHélio Afonso Ghizoni TeiveSarah Teixeira CamargosPaulo CaramelliFrancisco Eduardo Costa Cardosohttp://lattes.cnpq.br/3439109580349925Pérola de Oliveira2023-02-07T13:33:08Z2023-02-07T13:33:08Z2021-09-02http://hdl.handle.net/1843/49667https://orcid.org/0000-0003-1824-5578Introdução A doença de Parkinson (DP) apresenta variadas manifestações clínicas e distintos prognósticos. Ela se caracteriza por um conjunto de sintomas motores e não motores que podem variar desde um quadro de independência até a completa incapacidade laborativa e de cuidados pessoais. Até o momento, não está claro quais seriam os marcadores de subtipos da doença que poderiam alertar para formas de pior prognóstico. Porém, existem alguns estudos que mostram que a presença do transtorno comportamental do sono REM (TCSR) pode estar associada a progressão mais rápida dos sintomas motores e está relacionado a presença de outros sintomas não motores como disfunção autonômica e declínio cognitivo. Questiona-se ainda se as disautonomias estão primariamente associadas ao TCSR, já que são relatadas nas formas idiopáticas deste transtorno de sono e compartilham alguns núcleos reguladores centrais, ou se são mais graves nos pacientes com diagnóstico de DP e TCSR, marcando assim um subtipo da doença. Objetivo O objetivo deste estudo é determinar se o TCSR é um marcador de subtipo da DP e se as disfunções autonômicas em pacientes com DP estão associadas, primariamente, ao TCSR. Métodos Foram avaliados 120 pacientes com diagnóstico de DP e 48 controles. Os pacientes com DP foram alocados em dois subgrupos de acordo com a presença ou ausência do TCSR. Foram aplicadas escalas para avaliação do estágio da doença e grau de incapacidade através das escalas de Hoehn Yahr (HY) e escala de atividades de vida diária de Schwab e England e a Movement Disorders Society Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) completa. Para rastreio de declínio cognitivo foi aplicado o mini-exame do estado mental de Folstein (MEEM) e para avaliação da qualidade de vida foi usado o Parkinson Disease Questionnaire–39 (PDQ-39). Todos os participantes foram submetidos a realização de ressonância magnética de encéfalo, polissonografia e testes de reatividade autonômica. Resultados Foram avaliados 120 pacientes com DP, sendo 55 com DP+TCSR e 65 sem TCSR. Dentre as medicações utilizadas, houve maior percentual de uso de levodopa nos pacientes com TCSR (p =0,04). Na análise do exame neurológico, foi observada a presença de marcha anormal mais comumente no subgrupo com TCSR (p =0,01) e maior uso de auxílio-locomoção no subgrupo com TCSR (p=0,005). Na avaliação das escalas aplicadas, a escala de atividades de vida diária de Schwab e England apresentou menor pontuação no grupo TCSR (p=0,001). Em relação à parte II da MDS-UPDRS, relacionada aos aspectos motores de experiências da vida diária, apresentou pontuação mais elevada nos pacientes com TCSR (p=0,02). A presença de disautonomia franca foi mais frequente nos pacientes com TCSR (p=0,002). Conclusão Os achados deste estudo sugerem que os pacientes com DP e TCSR apresentam quadro clínico mais grave com maior dependência, mais sintomas motores e alterações disautonômicas mais acentuadas.Introduction Parkinson's disease (PD) has several clinical manifestations and distinct prognoses. It is characterized by a set of motor and non-motor symptoms that can range from independence to complete incapacity for work and personal care. So far, it is not clear which would be the subtype markers of the disease that could alert to forms of worse prognosis. However, there are some studies showing that the presence of REM sleep behavior disorder (RBD) may be associated with faster progression of motor symptoms and is related to the presence of other non-motor symptoms such as autonomic dysfunction and cognitive decline. It is also questioned whether dysautonomia are primarily associated with RBD, as they are reported in idiopathic forms of this sleep disorder and share some central regulatory nuclei, or if they are more severe in patients diagnosed with PD and RBD, thus marking a subtype of disease. Objectives The aim of this study is to determine whether RBD is a PD subtype marker and whether autonomic dysfunctions in PD patients are primarily RBD associated. Methods A total of 120 patients diagnosed with PD and 48 controls were evaluated. PD patients were classified into two subgroups according to the presence or absence of RBD. Scales were applied to assess the stage of the disease and degree of disability using the Hoehn Yahr (HY) scales and the Schwab and England daily life activities scale and the complete Movement Disorders Society Unified Parkinson’s Disease Rating Scale (MDS-UPDRS). Folstein's mini-mental state examination was applied to screen for cognitive decline and the Parkinson Disease Questionnaire – 39 (PDQ-39) was used to assess quality of life. All participants underwent brain magnetic resonance, polysomnography and autonomic reactivity tests. Results A total of 120 patients with PD were evaluated, 55 with PD+RBD and 65 without RBD. Among the medications used, there was a higher percentage of levodopa use in patients with RBD (p = 0.04). In the analysis of the neurological examination, the presence of normal gait was observed most commonly in the subgroup that does have TCSR (p = 0.01) and greater use of locomotion aid in the subgroup with TCSR (p = 0.005). In the evaluation of the applied scales, the scale of activities of daily living by Schwab and England showed the smallest score in the TCSR group (p = 0.001). In relation to part II of the MDS-UPDRS, related to the motor aspects of daily life experiences, it presented a higher score in patients with TCSR (p = 0.02). Dysautonomia was more frequent in patients with RBD (p = 0.002). Conclusion In conclusion, this study suggests that PD and RBD patients have more severe PD phenotype with greater dependence, more motor symptoms and more marked dysautonomic changes.porUniversidade Federal de Minas GeraisPrograma de Pós-Graduação em Ciências Aplicadas à Saúde do AdultoUFMGBrasilMED - DEPARTAMENTO DE CLÍNICA MÉDICAhttp://creativecommons.org/licenses/by-nc-nd/3.0/pt/info:eu-repo/semantics/openAccessDoença de ParkinsonTranstorno do Comportamento do Sono REMDoenças do Sistema Nervoso AutônomoEpidemiologiaDoença de ParkinsonTranstorno comportamental do sono REMDoenças do sistema nervoso autônomoEpidemiologiaCategorização da doença de Parkinson de acordo com a presença de transtorno comportamental do sono rem: associação com disfunção autonômica e gravidade da doençaCategorization of Parkinson's disease according to the presence of REM sleep behavior disorder: association with autonomic dysfunction and disease severityinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/doctoralThesisreponame:Repositório Institucional da UFMGinstname:Universidade Federal de Minas Gerais (UFMG)instacron:UFMGORIGINALTese Doutorado - Revisada II.pdfTese Doutorado - Revisada II.pdfapplication/pdf4959970https://repositorio.ufmg.br/bitstream/1843/49667/7/Tese%20Doutorado%20-%20Revisada%20II.pdfb729573e868ed2f46cc21b0813ed55c6MD57CC-LICENSElicense_rdflicense_rdfapplication/rdf+xml; charset=utf-8811https://repositorio.ufmg.br/bitstream/1843/49667/8/license_rdfcfd6801dba008cb6adbd9838b81582abMD58LICENSElicense.txtlicense.txttext/plain; charset=utf-82118https://repositorio.ufmg.br/bitstream/1843/49667/9/license.txtcda590c95a0b51b4d15f60c9642ca272MD591843/496672023-02-07 10:33:09.347oai:repositorio.ufmg.br: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ório InstitucionalPUBhttps://repositorio.ufmg.br/oaiopendoar:2023-02-07T13:33:09Repositório Institucional da UFMG - Universidade Federal de Minas Gerais (UFMG)false
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