Carolina Garrett

Modulation of nutritional state in Parkinsonian patients with bilateral subthalamic nucleus stimulation

Chronic bilateral subthalamic stimulation (DBS-STN) provides considerable clinical benefits in Parkinson disease patients, with improvement in primary symptoms and resolution of side effects of chronic pharmacological treatment. Apart from its therapeutic effects on PD symptoms, DBS-STN also appears to induce weight gain, which may itself induce critical metabolic disorders and limit the benefits of surgery. No data are available in literature showing the efficacy of a nutritional intervention to prevent rapid and/or excessive weight gain after DBS-STN. Fifty-seven PD patients were included in this study and were divided into two groups: Group 1 comprised 16 patients with a nutritional intervention immediately after surgery (1xa0week after); Group 2 comprised 41 patients with a nutritional intervention in a later period after surgery (mean time of 2.5xa0±xa01.6xa0years). Weight, body mass index (BMI), percentage of fat mass, levodopa daily dose (LDD) and part III of the Unified Parkinson’s disease rating scale (UPDRS) were studied before and after an individualized and structured nutritional intervention. Three months after nutritional intervention, Group 1 had a mean BMI (24.1xa0±xa02.99), that was not significantly different (pxa0=xa00.114) from BMI before intervention, with stability of the weight and in percentage of fat mass. In Group 2 all the patients gained weight, reaching to 13.17xa0±xa010%; a total of 63% of patients became overweight (BMI 25xa0kg/m2). Three months after nutritional intervention, Group 2 had a mean BMI (24.80xa0±xa02.45) that was significantly (pxa0=xa00.03) different from BMI before intervention (26.75xa0±xa02.99), although percentage of fat mass was higher in women. With this study, we have conclude that nutritional intervention adequate to patient-age, disease characteristics, medical therapy with l-dopa and physical activity, is effective incontrolling weight after DBS-STN surgery.

Predictors and moderators of quality of life in Alzheimer's disease patients

BACKGROUNDnAlzheimers disease (AD) is a chronic degenerative disease leading to global cognitive and functional decline. Quality of Life (QOL) is an important variable in the effectiveness of intervention programs in dementia.nnnOBJECTIVEnThis study analyzed the relationships between gender, psychological variables and QOL, the predictors of QOL, and the role of spirituality as a moderator between functionality and QOL.nnnMETHODnA cross-sectional study was conducted with 128 patients with mild AD.nnnRESULTSnBeing a male, good social support, and high functionality were significant predictors of better QOL. Spirituality was a moderator in the relationship between functionality and QOL.nnnCONCLUSIONnThese results reinforce the importance of gender, psychological morbidity, social support, and functionality, with special emphasis on the role of spirituality, regarding intervention programs that promote QOL, in patients with mild AD.

Follow-up of renal function in Parkinson patients with bilateral deep brain stimulation.

Although the clinical effectiveness of deep brain stimulation of the subthalamic nucleus (DBS-STN) on the motor symptoms of Parkinson’s disease (PD) has been demonstrated, non-motor effects of neurostimulation need further study. In a previous study we reported that PD patients subjected to DBS-STN demonstrated a decline in estimated glomerular filtration rate (GFR), calculated by creatinine clearance (CC, mL/min), one week after the beginning of stimulation [1]. In the present study we report follow-up data of these patients to assess whether this reduced kidney function was an acute phenomenon following surgery or whether DBS-STN exerts a long term influence on kidney function. Seventeen patients (11 men and 6 women) with a mean age of 61 7 years at the time of surgery and a mean duration of disease of 14.3 4.9 years were evaluated before surgery, 1 week after surgery and at the first follow-up visit (8.5 3.0 weeks). Thirteen patients were from the previous study (6 patients were unable to collect 24 h urine samples) and we included four new patients. Unified Parkinson’s Disease Rating Scale (UPDRS) parts III (motor), mean dose of levodopa, 24 h urine volume, urine ionogram and biochemistry, blood ionogram and biochemistry and CC were analyzed. CC, fractional excretion of sodium and potassiumwere calculated as previously reported [2]. Creatinine was measured by the Jaffe’ method

Evaluation of Metabolic State in Striatal Rat Model of Parkinson's Disease: before and after Deep Brain Stimulation

Weight loss occurs during the natural history of Parkinson’s disease (PD). This non-motor manifestation of the disease is reversed by deep brain stimulation of the sub thalamic nucleus (DBS-STN) therapeutics which is often associated with weight gain. Although it has been proposed that PD is associated with alterations in central energy metabolism the mechanisms responsible for this weight variation remain unknown. This study evaluates the weight profile and nutritional state of the 6-hydroxydopamine (6-OHDA) rat model of PD subjected to DBS-STN. Rats were rendered parkinsonian by bilateral injections of 6-OHDA into the striatum and electrodes were implanted bilaterally at the level of the STN. Rats were placed in metabolic cages for evaluation of weight, food and liquid intake and urine and fecal volume before and 2 and 4 weeks after the beginning of stimulation. Before stimulation began (2 weeks after 6-OHDA lesion), weight and metabolic parameters were similar between parkinsonian rats with and without electrodes and matched control rats. Two weeks after stimulation began (4 weeks after 6-OHDA lesion) and at the end of the study, 4 weeks after stimulation began (6 weeks after 6-OHDA lesion), body weight and the metabolic parameters evaluated remained unaltered between animal groups. Furthermore, at the end of the study, no statistically significant differences were found in efficiency of eating (change in weight/amount of food eaten) or weight gain between groups. In conclusion, in the rat model of PD with striatal dopaminergic neurodegeneration neither induction of PD or DBS-STN influenced weight variation or metabolic state. Additional mechanisms may be required to induce the altered metabolic state observed in PD patients before and after STN-DBS.