Annelise Ayres

The Impact of Dysphagia Therapy on Quality of Life in Patients with Parkinson's Disease as Measured by the Swallowing Quality of Life Questionnaire (SWALQOL)

Introduction  Dysphagia is a common symptom in Parkinsons disease (PD) and it has been associated with poor quality of life (QoL), anxiety, depression. Objective  The aim of this study was to evaluate the quality of life in individuals with PD before and after SLP therapy. Methods  The program consisted of four individual therapy sessions. Each session comprised guidelines regarding food and postural maneuvers (chin down). The Quality of Life in Swallowing Disorders (SWAL-QOL) questionnaire was applied before and after therapy. Results  The sample comprised of 10 individuals (8 men), with a mean (SD) age of 62.2 (11.3) years, mean educational attainment of 7.5 (4.3) years, and mean disease duration of 10.7 (4.7) years. Thirty percent of patients were Hoehn and Yahr (H&Y) stage 2, 50% were H&Y stage 3, and 20% were H&Y stage 4. Mean scores for all SWAL-QOL domains increased after the intervention period, with significant pre- to post-therapy differences in total score (p = 0.033) and domain 4 (symptom frequency) (p = 0.025). There was also a bias significance for domain 5 (food selection) (p = 0.095). Conclusion  Patients exhibited improvement in swallowing-related quality of life after a SLP therapy program. The earlier in the course of PD, greater the improvement observed after therapy.

Comparison Trail Making Test between individuals with Parkinson’s disease and health controls: Suggestions of cutoff point.

Some of the most common losses in Parkinson’s disease (PD) are the changes in executive functions. The Trail Making Test is an important test to evaluate the executive functions. The objective of this study was to verify the cutoff point of the Trail Making Test for individuals with PD compared to healthy controls. This was a cross-sectional case-control study. The inclusion criteria for the case group were a diagnosis of PD and having taken PD medicine before the evaluation. Individuals with other neurological disorders and atypical or secondary parkinsonism were excluded. The inclusion criterion for the control group was absence of neurological impairment, and participants were paired by age and level of education with patients with PD. The following protocols were applied to individuals from the two groups: Mini-Mental State Examination (MMSE) and Trail Making Test (TMT) A and B and verbal TMT (vTMT) A and B. The sample was composed of 78 individuals, with 39 persons in both groups. In the Mann-Whitney test, a significant difference was verified in TMT A and B and vTMT B between the groups, and the case group presented worse results. We suggest a cutoff point for TMT A of 103 seconds, TMT B of 297.5 seconds, and vTMT B of 77.5 seconds. In conclusion, the TMT B verbal and written test can differentiate patients with PD from healthy controls. It can be used as a fast application test for executive function screening.

Benefit from the Chin-Down Maneuver in the Swallowing Performance and Self-Perception of Parkinson’s Disease Patients

Aims. To verify the effectiveness of the maneuver application in swallowing therapy with PD. Materials and Method. We performed an open-label trial, with three groups compounds by PD individuals: the experimental group, control group, and orientation group. The study included PD patients with dysphagia. A cognitive screening, through a questionnaire about depression and quality of life, was conducted. Swallowing assessment was performed through (1) fiberoptic endoscopic evaluation of swallowing (FEES); (2) clinical evaluation and Functional Oral Intake Scale (FOIS); and (3) assessment of the quality life related to swallowing (SWALQOL). A therapeutic program, which consisted of chin-down postural maneuver and orientations on feeding, was applied. Both groups (EG and OG) received on-month therapeutic program. Results. A significant improvement in swallowing, evaluated by clinical assessment, was observed in solid (p < 0.001) and liquid (p = 0.022) consistencies in EG when compared to OG and CG. Patients in EG presented improvement in QoL, with the significant difference in comparison with the other groups, about domain frequency of symptoms (p = 0.029) in SWALQOL questionnaire. Conclusion. The postural maneuver chin-down improved swallowing performance and self-perception, but not the laryngeal signs. This trial is registered with registration number NCT02973698.

Tradução e adaptação cultural do swallowing disturbance questionnaire para o português-brasileiro

Objetivo: traduzir e adaptar culturalmente para o portugues brasileiro o Swallowing disturbance questionnaire (SDQ) para deteccao de risco de disfagia em individuos com Doenca de Parkinson (DP). Metodos: realizou-se traducao para o portugues, retraducao para o ingles, analise de confiabilidade do instrumento, sendo a versao final aplicada aos participantes e realizado o reteste apos duas semanas. Selecionou-se os participantes em um ambulatorio de disturbios do movimento de um hospital de referencia no Rio Grande do Sul. Incluiu-se individuos com diagnostico de DP. Excluiu-se individuos com alteracao de linguagem ou audicao que impossibilitasse a compreensao do questionario e com diagnostico de outras doencas neurologicas. Resultados: a amostra foi composta por 23 individuos. Os participantes responderam a todas as questoes. Nao houve eliminacao de nenhuma questao. Na analise da confiabilidade teste-reteste o coeficiente de correlacao intraclasse do escore final nos dois momentos foi de 0,912 com p<0,001 (95%IC=0,792-0,963), demonstrando que os dados sao altamente homogeneos. Na analise por questao, nao houve diferenca significante entre os dois momentos de aplicacao. O valor de α de Cronbach do instrumento foi de 0,63. Conclusao: houve equivalencia cultural do SDQ para o portugues brasileiro, com boa confiabilidade interna do instrumento.

The impact of cognitive performance on quality of life in individuals with Parkinson's disease

Background Evidence points to the occurrence of cognitive impairment in all stages of PD, constituting a frequent and debilitating symptom, due to high impact on quality of life and mortality of patients. Objective To correlate cognitive performance with quality of life in PD. Methods The sample was drawn from a Movement Disorders Clinic of a reference hospital in Porto Alegre. Inclusion criteria were: PD diagnosis, according to the United Kingdom Parkinsons Disease Society Brain Bank criteria for idiopathic PD (Hughes et al. 1992) and patient consent to participate. Patients with other neurological pathologies and those submitted to deep brain stimulation were excluded. The evaluation consisted of a cognitive testing battery (composed of eight tests for assessing cognitive performance), and a questionnaire on quality of life (PDQ-39) and depression (BDI). Results The sample comprised 85 individuals with PD, with a mean age of 62.9 years (±10.7), mean disease duration of 10.4 years (±5.7), and mean educational level of four years (±4.3). There was a significant relationship between total score on the PDQ and all cognitive tests, showing that poor cognitive performance was correlated with poor quality of life. Moreover, a significant correlation was observed between cognitive tests and depression, H&Y, education level, and age. Conclusion It may be concluded that the individuals with PD in this sample showed a correlation between poorer quality of life and worse cognitive performance. Poor performance was also correlated with more advanced stage, older age, low level of education and depression.