Enfermedad de Parkinson

Enfermedad de Parkinson
  • 文章类型: Journal Article
    背景:帕金森病(PD)影响身体,认知,情感,以及遭受痛苦的人的社会领域。对患者来说,一个好的策略是加入一个协会,使用他们提供的服务。
    目的:本研究的目的是探索帕金森病患者在帕金森病患者中的经历和认知。
    方法:通过目的和理论抽样选择符合纳入标准的PD患者样本。半结构化定性访谈用于收集数据,通过专题现象学分析进行了分析。使用不同的策略,例如研究人员之间的三角测量,以确保方法的严谨性。
    结果:从10名参与者分析的数据导致了两个主题:协会的背景,收集跨学科治疗的重要性以及与其他患者的关系;以及他们如何看待自己的未来,它描述了PD患者的未来前景。
    结论:患者同意加入协会的重要性,感觉是一个群体的一部分,同时受益于接受跨学科团队的治疗。该协会在疾病的演变中起着相关的作用,因为这会影响病人对未来的想象.在与为患者服务的专业人员建立良好的治疗联盟的基础上制定策略,促进赋权,家庭治疗的坚持和连续性,从而改善PD患者的生活质量。
    BACKGROUND: Parkinson\'s disease (PD) affects the physical, cognitive, emotional, and social domains of people who suffer it. A good strategy for patients is to belong to an Association, using the services they offer.
    OBJECTIVE: The aim of this study was to explore the experiences and perceptions of patients with PD in a Parkinson\'s Association.
    METHODS: A sample of participants with PD who met the inclusion criteria was selected through purpose and theoretical sampling. Semi-structured qualitative interviews were used to collect the data, which was analyzed by thematic phenomenological analysis. Different strategies such as triangulation between researchers were used to ensure methodological rigor.
    RESULTS: The data analyzed from 10 participants led to two themes: the context of the Association, where the importance of interdisciplinary treatments and the relationship with other patients is collected; and how they see their future, which describes the future perspectives that patients with PD have.
    CONCLUSIONS: Patients agree on the importance of belonging to the Association, feeling part of a group, while benefiting from receiving therapies from the interdisciplinary team. The Association plays a relevant role in the evolution of the disease, as it influences how patients imagine their future. Developing strategies based on a good therapeutic alliance with professionals at the service of patients promotes the empowerment, adherence and continuity of treatments at home, which results in improving the quality of life of patients with PD.
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  • 文章类型: Case Reports
    进行性核上性麻痹(PSP),也被称为斯蒂尔-理查森-奥尔谢夫斯基综合征,是一种罕见的神经退行性疾病,其特征是各种运动和神经眼科症状。我们介绍了一个73岁的男性患者,有2型糖尿病和高血压病史,为步态障碍咨询的人,四肢颤抖,难以控制共轭凝视。体检时,发现与PSP一致,包括低omimia,肌肉僵硬,异常动作。帕金森病的最初误诊和随后的左旋多巴给药突出了在复杂神经系统疾病中准确诊断的重要性。该临床病例强调需要对神经眼科症状和体征进行彻底评估,以确保采用适当的治疗方法并提高患者的生活质量。
    Progressive Supranuclear Palsy (PSP), also known as Steele-Richardson-Olszewski syndrome, is a rare neurodegenerative disease characterized by a variety of motor and neuro-ophthalmological symptoms. We present the case of a 73-year-old male patient with a history of type 2 diabetes and high blood pressure, who consulted for gait disorders, tremors in the extremities, and difficulty controlling conjugate gaze. During physical examination, findings consistent with PSP were noted, including hypomimia, muscle rigidity, and abnormal movements. The initial misdiagnosis of Parkinson\'s disease and subsequent administration of levodopa highlight the importance of accurate diagnosis in complex neurological conditions. This clinical case highlights the need for a thorough evaluation of neuro-ophthalmological symptoms and signs to ensure an appropriate therapeutic approach and improve the quality of life of patients.
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  • 文章类型: Journal Article
    背景:对帕金森病(PD)患者进行可靠评估对于提供适当的治疗至关重要。临床评估是一项复杂而耗时的任务,尤其是运动迟缓,因为它的评估会受到考官经验程度的影响,患者合作和个体偏见。可以通过考虑来自几个专业人员的评估来获得临床评估的改进。然而,只有当评估者之间和内部的协议很高时,这才是正确的。最近,运动障碍协会强调,在COVID-19大流行期间,需要开发和验证远程评估PD患者运动状态的技术。因此,本研究采用多专家分析远程评估运动迟缓的客观策略.
    方法:参加了12名PD志愿者,他们被要求进行手指敲击,手打开/闭合和内旋/旋后动作。每个任务由14位PD健康专家为每个患者进行记录和评级。分数是在个人基础上评估的。评估者内部和评估者之间的一致性和相关性进行了估计。
    结果:结果表明,经验丰富的审查员之间的一致性和相关性很高,变异性低。此外,小组分析被认为具有解决个体不一致偏差的潜力.
    结论:此外,这项研究表明,需要一个有事先培训和经验的小组,同时指出了开发可以使用远程医疗评估PD患者的临床方案的重要性,以及包括一个专门的调解小组。此外,这项研究有助于对运动迟缓进行有效的远程评估。
    BACKGROUND: Reliable assessment of individuals with Parkinson\'s disease (PD) is essential for providing adequate treatment. Clinical assessment is a complex and time-consuming task, especially for bradykinesia, since its evaluation can be influenced by the degree of experience of the examiner, patient collaboration and individual bias. Improvement of the clinical evaluation can be obtained by considering assessments from several professionals. However, this is only true when inter and intra-rater agreement are high. Recently, the Movement Disorder Society highlighted, during the COVID-19 pandemic, the need to develop and validate technologies for remote assessment of the motor status of people with PD. Thus, this study introduces an objective strategy for the remote evaluation of bradykinesia using multi-specialist analysis.
    METHODS: Twelve volunteers with PD participated and these were asked to execute finger tapping, hand opening/closing and pronation/supination movements. Each task was recorded and rated by fourteen PD health experts for each patient. The scores were assessed on an individual basis. Intra and inter-rater agreement and correlation were estimated.
    RESULTS: The results showed that agreements and correlations between experienced examiners were high with low variability. In addition, group analysis was noted as possessing the potential to solve individual inconsistency bias.
    CONCLUSIONS: Furthermore, this study demonstrated the need for a group with prior training and experience, along with indicating the importance for the development of a clinical protocol that can use telemedicine for the evaluation of individuals with PD, as well as the inclusion of a specialized mediating group. In Addition, this research helps to the development of a valid remote assessment of bradykinesia.
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  • 文章类型: Observational Study
    目的:本研究的目的是评估沙芬酰胺和抗抑郁药之间可能的药理相互作用,特别是5-羟色胺综合征的出现和来自现实生活的数据。
    方法:我们对运动障碍科的帕金森病患者进行了一项回顾性观察研究,他们正在接受任何抗抑郁药物和沙芬酰胺的治疗。具体来说,筛查提示5-羟色胺综合征的症状.此外,我们收集了同时使用的时间,左旋多巴和其他抗帕金森病药物的剂量。
    结果:回顾了2018年9月至2019年9月研究期间的临床记录。78例接受safinamide治疗的PD患者,其中25例(32.05%)同时接受抗抑郁药治疗,最常见的是舍曲林和艾司西酞普兰。平均年龄为80岁±8.43,H&Y分期为3[2-4]。使用的左旋多巴的平均剂量为703.75mg±233.15。沙芬酰胺和抗抑郁药物联合治疗的中位持续时间为6个月(IQR20.5),5例超过18个月。无血清素综合征病例记录,它的任何典型表现都没有结合或孤立。
    结论:我们的实际临床实践研究表明,在PD患者中同时使用safinamide与抗抑郁药物似乎是安全且耐受性良好的,即使是长期的。然而,谨慎是必要的,个体化治疗方案并监测潜在的不良反应。
    OBJECTIVE: The aim of this study was to assess the possible pharmacological interactions between safinamide and antidepressants, and in particular the appearance of serotonin syndrome with data from real life.
    METHODS: We conducted a retrospective observational study of patients with Parkinson\'s disease from our Movement Disorders Unit, who were under treatment with any antidepressant drug and safinamide. Specifically, symptoms suggestive of serotonin syndrome were screened for. Also, we collected time of simultaneous use, doses of levodopa and other antiparkinsonian drugs.
    RESULTS: Clinical records were reviewed for the study period of September 2018 to September 2019. Seventy-eight PD patients who were treated with safinamide of which 25 (32.05%) had a concomitant treatment with an antidepressant drug, being sertraline and escitalopram the most frequent. Mean age was 80 years±8.43 and H&Y stage was 3 [2-4]. Mean dose of levodopa used was 703.75mg±233.15. Median duration of concomitant treatment with safinamide and antidepressant drug was 6 months (IQR 20.5), and over eighteen months in 5 cases. No case of serotonin syndrome was recorded, neither was any of its typical manifestations combined or in isolation.
    CONCLUSIONS: Our real clinical practice study suggests that concomitant use of safinamide with antidepressant drugs in PD patients seemed to be safe and well tolerated, even in the long term. However, caution is warranted, individualizing treatment regimens and monitoring the potential appearance of adverse effects.
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  • 文章类型: Journal Article
    目标:Covid-19影响了所有人,尤其是那些患有慢性病的人,包括帕金森病(PD)。Covid-19可能会影响PD患者的运动和神经精神症状。我们打算评估新冠肺炎对PD患者影响的不同方面。
    方法:647名PD患者通过在线提问者评估了大流行期间PD相关和Covid-19相关的临床表现以及既往病史。将它们与由673个人组成的年龄匹配的对照组和由1215个人组成的正常人群样本进行比较。
    结果:PD患者中Covid-19的患病率为11.28%。PD患者死亡率为1.23%。接受深部脑刺激(DBS)的PD患者中Covid-19的患病率为18.18%。在疾病持续时间和新冠肺炎的患病率之间没有发现显著的关联。在与SARS-CoV-19感染者直接接触的PD患者中,Covid-19的患病率在统计学上显着较高。在运动症状恶化和新冠肺炎之间没有发现统计学上的显著关联。PD患者和正常人群在某些心理障碍的患病率上可能存在差异,包括焦虑和睡眠障碍,Covid-19可能会影响心理状态。
    结论:PD患者可能遵循更严格的预防方案,这导致Covid-19的患病率和严重程度及其在这些患者中的后果较低。虽然新冠肺炎似乎没有像预期的那样影响PD的运动和心理方面,为了澄清这种影响,建议进行更准确的评估。
    OBJECTIVE: Covid-19 has affected all people, especially those with chronic diseases, including Parkinson\'s Disease (PD). Covid-19 may affect both motor and neuropsychiatric symptoms of PD patients. We intend to evaluate different aspects of Covid-19 impact on PD patients.
    METHODS: 647 PD patients were evaluated in terms of PD-related and Covid-19-related clinical presentations in addition to past medical history during the pandemic through an online questioner. They were compared with an age-matched control group consist of 673 individuals and a sample of the normal population consist of 1215 individuals.
    RESULTS: The prevalence of Covid-19 in PD patients was 11.28%. The mortality was 1.23% among PD patients. The prevalence of Covid-19 in PD patients who undergone Deep Brain Stimulation (DBS) was 18.18%. No significant association was found between the duration of disease and the prevalence of Covid-19. A statistically significant higher prevalence of Covid-19 in PD patients who had direct contact with SARS-CoV-19 infected individuals was found. No statistically significant association has been found between the worsening of motor symptoms and Covid-19. PD patients and the normal population may differ in the prevalence of some psychological disorders, including anxiety and sleeping disorders, and Covid-19 may affect the psychological status.
    CONCLUSIONS: PD patients possibly follow tighter preventive protocols, which lead to lower prevalence and severity of Covid-19 and its consequences in these patients. Although it seems Covid-19 does not affect motor and psychological aspects of PD as much as it was expected, more accurate evaluations are suggested in order to clarify such effects.
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  • 文章类型: Journal Article
    背景:轻度认知损害(MCI)在帕金森病(PD)中很常见。很少有研究比较有和没有由于PD(PD-MCI)导致的MCI患者的健康相关生活质量(HRQoL),其与患者主观认知和沟通困难的相关性尚未得到探讨。
    目的:我们旨在比较PD-MCI和不含MCI的PD(PD-nMCI)的HRQoL,并探讨其与主观认知和交际抱怨的可能关系。
    方法:我们纳入了29例PD-nMCI和11例PD-MCI患者。用帕金森病问卷-39(PDQ-39)评估HRQoL:其认知维度被用作主观认知投诉的量度,其主观交际抱怨的交际维度,和汇总指数(PDQ-39SI)作为HRQoL的指标。认知维度和沟通维度之间的非参数偏相关,并进行了调整后的PDQ-39SI。
    结果:与PD-nMCI患者相比,PD-MCI患者的主观认知和交流主诉更大,HRQoL更差。在PD-MCI组,主观认知和交际主诉均与调整后的HRQoL评分具有显著的直接相关性.
    结论:HRQoL似乎在PD-MCI中受到影响,并且可能受到更大的主观认知和交流抱怨的影响。包括患者报告的HRQoL结果测量,提供认知和言语康复,以及应对这些缺陷的心理治疗策略可以增强PD以患者为中心的方法。
    BACKGROUND: Mild Cognitive Impairment (MCI) is common in Parkinson\'s Disease (PD). Few studies have compared the Health-Related Quality of Life (HRQoL) in patients with and without MCI due to PD (PD-MCI), and its correlation to patients\' subjective cognitive and communicative difficulties has not been explored.
    OBJECTIVE: We aimed to compare HRQoL in PD-MCI and PD without MCI (PD-nMCI), and explore its possible relationship to subjective cognitive and communicative complaints.
    METHODS: We included 29 PD-nMCI and 11 PD-MCI patients. The HRQoL was assessed with the Parkinson\'s Disease Questionnaire-39 (PDQ-39): its Cognition dimension was used as a measure of subjective cognitive complaints, its Communication dimension for subjective communicative complaints, and the summary index (PDQ-39 SI) as an indicator of HRQoL. Non-parametric partial correlations between the Cognition and Communication dimensions, and the adjusted PDQ-39 SI were conducted.
    RESULTS: PD-MCI patients had greater subjective cognitive and communicative complaints and worse HRQoL than PD-nMCI patients. In the PD-MCI group, both subjective cognitive and communicative complaints exhibited significant direct correlations with the adjusted HRQoL scores.
    CONCLUSIONS: HRQoL seems to be affected in PD-MCI, and it might be influenced by greater subjective cognitive and communicative complaints. Including patient-reported outcome measures of HRQoL, and providing cognitive and speech rehabilitation, as well as psychotherapeutic strategies to face these deficits can enhance the patient-centred approach in PD.
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  • 文章类型: English Abstract
    背景:该研究旨在探讨由于2019年冠状病毒传染病(covid-19)大流行而在分娩期间帕金森病患者的生活质量。
    方法:研究是定量的,描述性和相关性。样本是51名帕金森病患者,来自Magallanes地区和智利南极洲,他们的信息是从RehabilingCorporationClubdeLeonesCruzdelSur的数据库中收集的,属于他们的。
    结果:主要结果表明,51.6%的帕金森氏病患者报告“良好且非常好”的生活质量,并且帕金森氏病问卷(PDQ-39)受影响的主要领域是:身体不适,流动性和情感幸福。根据对PDQ-39定性范围的分析,在covid-19大流行的禁闭期间受到最大损害的维度是:通信,耻辱和情感幸福。此外,女性的生活质量比男性差。最后,研究表明,症状的进展会影响帕金森病患者的生活质量。
    结论:结论:在禁闭期间,由于covid-19大流行,帕金森病患者的症状增加,生活质量下降,尤其是女人。
    BACKGROUND: The study was aimed to explore the quality of life of people with Parkinson\'s disease during confinement due to the coronavirus infectious disease 2019 (covid-19) pandemic.
    METHODS: The study was quantitative, descriptive and correlational. The sample was 51 people with Parkinson\'s disease, from the region of Magallanes and Chilean Antarctica, and whose information was collected from the database of the Rehabilitation Corporation Club de Leones Cruz del Sur, to which they belong.
    RESULTS: The main results show that 51.6% of people with Parkinson\'s disease report a «good and very good» quality of life and that the main domains of the Parkinson\'s Disease Questionnaire (PDQ-39) affected are: body discomfort, mobility and emotional well-being. According to the analysis of the qualitative ranges of the PDQ-39, the dimensions that were most compromised during the confinement by the covid-19 pandemic were: communication, stigma and emotional well-being. In addition, women had a poorer quality of life than men. Finally, it was shown that the progression of symptoms affects the quality of life of people with Parkinson\'s disease.
    CONCLUSIONS: In conclusion, during the confinement due to the covid-19 pandemic people with Parkinson\'s disease increased symptoms and presented a lower quality of life, especially women.
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  • 文章类型: Journal Article
    帕金森病(PD)是全球成年人中第二常见的神经退行性疾病。它的特征是黑质中多巴胺能神经元的死亡,在某些情况下,存在α-突触核蛋白的胞浆内包涵体,叫做路易体,这种疾病的病理标志。PD的临床诊断基于运动改变的存在。目前可用的治疗方法没有神经保护作用。PD的确切原因知之甚少。因此,近年来已经开发了使用诱导多能干细胞(iPSC)的更精确的临床前模型.体外研究可以提供有关PD发病机制的新信息,并可能有助于确定新的治疗靶标或开发新的药物。
    Parkinson\'s disease (PD) is the second most prevalent neurodegenerative disease among adults worldwide. It is characterised by the death of dopaminergic neurons in the substantia nigra pars compacta and, in some cases, presence of intracytoplasmic inclusions of α-synuclein, called Lewy bodies, a pathognomonic sign of the disease. Clinical diagnosis of PD is based on the presence of motor alterations. The treatments currently available have no neuroprotective effect. The exact causes of PD are poorly understood. Therefore, more precise preclinical models have been developed in recent years that use induced pluripotent stem cells (iPSC). In vitro studies can provide new information on PD pathogenesis and may help to identify new therapeutic targets or to develop new drugs.
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  • 文章类型: Journal Article
    背景:和性别和认知特征可能与特发性帕金森病运动症状的偏侧性有关。
    背景:帕金森病(PD)被公认为是一种固有的不对称疾病,具有运动症状的单侧发作。运动症状的偏侧性可能与性别有关,临床和人口统计学变量,和神经心理障碍。然而,可用数据不一致。本研究旨在探讨运动症状的偏侧性与特定认知领域的临床和人口统计学变量和缺陷之间的潜在关联。
    方法:我们回顾性地招募了97名患有特发性PD但没有痴呆的参与者;左侧有60人出现运动症状,右侧有37人出现运动症状。两组在年龄方面具有可比性,发病年龄,疾病持续时间,根据统一帕金森病评定量表和Hoehn和Yahr量表,神经功能缺损的严重程度。
    结果:具有左侧运动症状的参与者在施瓦布和英格兰日常生活活动量表上得分较低。我们的样本中男性多于女性(67%与33%)。两组中男女的比例不相等:左侧运动症状患者组中男性明显多于女性(77%vs.23%),而右侧运动症状患者组中男性和女性的百分比相似(51%vs.49%)。两组在所有神经心理任务中表现相似,但是女人,独立于横向,在命名任务中表现优于男性。
    结论:我们发现在左侧运动症状患者组中男性的患病率明显;该组在施瓦布和英格兰量表上得分也较低。女性可以预测在命名任务中的表现更好。在导致大脑不对称受累的疾病中,应始终考虑性别,比如PD。
    BACKGROUND: and Sex and cognitive profile may be related to the laterality of motor symptoms in idiopathic Parkinson\'s disease.
    BACKGROUND: Parkinson\'s disease (PD) is well recognised as an inherently asymmetric disease with unilateral onset of motor symptoms. The laterality of motor symptoms may be linked to sex, clinical and demographic variables, and neuropsychological disorders. However, the available data are inconsistent. This study aimed to explore the potential association between the laterality of motor symptoms and clinical and demographic variables and deficits in specific cognitive domains.
    METHODS: We retrospectively recruited 97 participants with idiopathic PD without dementia; 60 presented motor symptoms on the left side and 37 on the right side. Both groups were comparable in terms of age, age at disease onset, disease duration, and severity of the neurological deficits according to the Unified Parkinson\'s Disease Rating Scale and the Hoehn and Yahr scale.
    RESULTS: Participants with left-side motor symptoms scored lower on the Schwab and England Activities of Daily Living scale. Our sample included more men than women (67% vs. 33%). Both sexes were not equally represented in the 2 groups: there were significantly more men than women in the group of patients with left-side motor symptoms (77% vs. 23%), whereas the percentages of men and women in the group of patients with right-side motor symptoms were similar (51% vs. 49%). Both groups performed similarly in all neuropsychological tasks, but women, independently of laterality, performed better than men in the naming task.
    CONCLUSIONS: We found a clear prevalence of men in the group of patients with left-side motor symptoms; this group also scored lower on the Schwab and England Scale. Female sex was predictive of better performance in the naming task. Sex should always be considered in disorders that cause asymmetric involvement of the brain, such as PD.
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  • 文章类型: Journal Article
    背景:不同类型的疗法被证明可有效治疗帕金森病(PD)的运动和非运动症状。我们旨在就多巴胺激动剂(DA)疗法在帕金森病(PD)患者的不同临床情况下的使用达成共识。
    方法:本共识研究基于名义分组技术。最初,a由12名PD领域的神经科专家组成的共识小组确定了要解决的主题,并阐述了不同的基于证据的初步陈述。接下来,由48名西班牙神经学家组成的小组对基于互联网的系统投票计划发表了意见。最后,最初的想法根据小组的贡献进行了审查和重写,并由共识小组使用李克特型量表进行排名。采用定性和定量相结合的方法对数据进行分析。如果声明在投票过程中达到≥3.5分,就达成了共识。
    结果:共识小组提出了76项现实世界建议。讨论的主题包括12项与PD早期DA治疗有关的声明,关于运动并发症患者DA治疗策略的20条声明,与DA药物及其副作用相关的11种陈述,和33份关于特定临床方案中DA治疗的声明。共识小组没有就15项声明达成共识。
    结论:这种共识方法的发现代表了在PD的不同阶段和临床情况下帮助临床医生和患者适当使用DA的探索性步骤。
    BACKGROUND: Different types of therapies were proven effective for the medical management of motor and non-motor symptoms in Parkinson\'s disease (PD). We aimed to gain consensus on the dopamine agonist (DA) therapy use in different clinical scenarios of Parkinson\'s disease (PD) patients.
    METHODS: This consensus study was based on the nominal group technique. Initially, a consensus group comprising 12 expert neurologists in the PD field identified the topics to be addressed and elaborated different evidence-based preliminary statements. Next, a panel of 48 Spanish neurologists expressed their opinion on an internet-based systematic voting program. Finally, initial ideas were reviewed and rewritten according to panel contribution and were ranked by the consensus group using a Likert-type scale. The analysis of data was carried out by using a combination of both qualitative and quantitative methods. The consensus was achieved if the statement reached ≥ 3.5 points in the voting process.
    RESULTS: The consensus group produced 76 real-world recommendations. The topics addressed included 12 statements related to DA therapy in early PD, 20 statements concerning DA treatment strategy in patients with motor complications, 11 statements associated with DA drugs and their side effects, and 33 statements regarding DA therapy in specific clinical scenarios. The consensus group did not reach a consensus on 15 statements.
    CONCLUSIONS: The findings from this consensus method represent an exploratory step to help clinicians and patients in the appropriate use of DA in different stages and clinical situations of PD.
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