Jovany Luis Alves de Medeiros

Excessive daytime sleepiness in the elderly: association with cardiovascular risk, obesity and depression

OBJECTIVE To observe the relationship between Excessive Daytime Sleepiness (EDS) and the presence of risk factors for cardiovascular dysfunction, depression and obesity in the elderly. METHODS We interviewed 168 elderly from the community of Campina Grande, Paraíba. They were selected according to health districts in the period of 2010. We used the Epworth Sleepiness Scale to diagnose excessive daytime sleepiness (> 10 points); waist circumference for the risk of cardiovascular dysfunction (> 94 or > 80 cm); Geriatric Depression Scale for depression (>10 points) and body mass index for obesity (> 25 kg/m2). Association analysis was performed by the Chi-square test adjusted for sex and age group, adopting α < 0.05. RESULTS One hundred and sixty eight elderly individuals with mean age of 72.34 ± 7.8 years old participated in this study, being 122 (72.6%) women. EDS was identified in 53 (31.5%) of them; depression, in 72 (42.9%); overweight/obesity, in 95 (64.46%); and risk of cardiovascular dysfunction, in 129 (79.6%). Depressed men (78.6%, p = 0.0005) and risk of cardiovascular dysfunction (57.1%, p = 0.02) were more prone to EDS. In women, only obesity was related to sleepiness (42.1%, p = 0.01). Only those aged between 70 - 79 years old showed association between sleepiness and obesity. CONCLUSION It was found that obesity for women, and depression and cardiovascular dysfunction risking for men were associated with EDS in the elderly. The variable sex is a confusion condition for the association with sleepiness.

Restless legs syndrome in institutionalized elderly

Restless legs syndrome (RLS) is characterized by disturbing leg sensations associated to sleep complaints and excessive daytime somnolence. In the elderly, it affects 10 to 35%. Our objective was to determine the prevalence of RLS in institutionalized elderly, analyzing its relationship with clinical, laboratorial and neurophysiological features. We conducted a cross-sectional study of all the subjects under treatment on a chronic-care geriatric service by using face-to-face interviews, which include sleep complaints, the Epworth Sleepiness Scale and standardized questions addressing the four minimal criteria for RLS. The patients with RLS diagnosis received neurological examination, laboratorial tests and three of them, neurophysiological evaluation. The prevalence of RLS was 15.6%. Women were more affected and sleep complaints were frequent. There was no significance on other clinical, laboratorial or neurophysiological findings. We conclude that RLS is a prevalent condition in elderly, may lead to sleep complaints and is often underdiagnosed.

Cefaléias primárias: abordagem diagnóstica por médicos não-neurologistas

OBJECTIVE: To evaluate the knowledge of diagnostic and posture of non-neurologist doctors concerning primary headaches. METHOD: 91 doctors were asked to diagnose and establish procedures on three patient histories presenting clinic characteristics of migraine without aura (MA), chronic tension-type headache (CTTH) and migraine with aura (MO), according to the International Classification of Headaches - 2nd Edition (CIC-II). RESULTS: MSA: Two professionals (2.2%) were accurate in their diagnostic, 54 (59.3%) said it was migraine but did not specify the subtype. CTTC: 15 doctors (16.5%) diagnosed tension-type headache but did not specify the subtype. MCA: 26 (28.6%) said it was migraine, and only one doctor (1.1%) was right about the subtype. Sixteen doctors (17.6%) said to be aware of CIC-II. CONCLUSION: Most of non-neurologist doctors do not know the diagnostic criteria used to diagnose and to classify the most frequent forms of primary headaches.

Facial electroneurography in Bell's palsy: variability in the early stage and comparison between interpretation methods

To determine the variability of the abnormalities found in the electroneurography (ENG) of the facial nerve in cases of Bells palsy during the initial two week period was one of the objectives of the authors. A second one was to investigate the value of ENG as a tool to determine an early prognosis of recovery utilizing two different methods. In the first one the amplitude of the compound muscular action potential (CMAP) obtained on the paralyzed side was compared to this potential on the opposite (normal) side. The second method compared the CMAP on the paralyzed side to normal standardized data from normal individuals. A group of 33 patients with Bells palsy was followed until total recovery of for at least 4 months, if the recovery was not achieved earlier. It was observed that amplitude of the CMAP become stable towards the sixth day of palsy and this is a good time to establish the prognosis. Another conclusion is that both methods were equivalent to determine the prognosis in Bells palsy.

Dor e parestesias nos membros superiores e diagnóstico da síndrome do túnel do carpo

We studied the frequency and localization of pain and numbness in patients with carpal tunnel syndrome (CTS), in comparison with individuals of the general population, matched for sex and age, and we determined the sensitivity and the specificity of these symptoms for the CTS diagnosis. Pain was a common symptom in the two groups of patients. Numbness occurred more frequently in CTS group (p<0.05). In CTS patients, pain complaints were present in neck (42.8%), arms (36.8%) and hands (82.8%). Among controls, pain was more common in head (11.4%), trunk (37.1%), legs (22.8%). In our casuistics, in relation to the CTS diagnosis, the presence of pain and numbness have low sensitivity and high specificity when they occur in the arms, and high sensitivity and specificity when they occur in the hands.

Associação da depressão com as características sociodemográficas, qualidade do sono e hábitos de vida em idosos do Nordeste brasileiro: estudo seccional de base populacional

Introduction: Depressive disorders can be defined as episodes of depressed mood or loss of interest and pleasure in nearly all activities. Depression is considered a major mental disorder in the elderly, and may be related to quality of sleep and living habits as well as being influenced by sociodemographic factors. Objective: To determine the prevalence of depression among the elderly in the north-east of Brazil, and the relationship between the condition and socio-demographic profile, quality of sleep and living habits. Method: An epidemiological cross-sectional study was performed of the elderly population of the urban area of Campina Grande, Paraiba. The dependent variable presence of depression and the independent variables sociodemographic aspects, sleep quality, and living habits were investigated. Estimates of the prevalence of the variables were obtained and association measured using Poisson Regression. A 5% significance level was adopted for the estimates. Results: The study included 168 elderly patients with a mean age of 72.3 (±7.8) years, most of whom, 122 (72.6%), were women. Depression was identified in 72 elderly persons (42.9%). Elderly women were twice as associated with depression (PR=2.26) as men. A subjective quality of sleep of very good (PR=0.34), medium/high risk of sleep disturbance (PR = 4.08), taking sleeping medications once or twice (PR=5.21) and three times or more (PR=8.69) a week, daytime dysfunction once or twice (PR=14.40) and three times or more (PR=27) a week and poor quality of sleep on the Pittsburgh index were associated with depression in bivariate analysis, although there was no relationship following multivariable adjustment. Conclusion: The prevalence of depression was high in the studied population, being noticeably more frequent among elderly woman. However, it was not possible to detect an association between depression and living habits and sleep quality.

Eletroneurografia do nervo facial métodos de estimulação e registro

: In this study it is, intended to establish the more appropriate points to register the compound action potential from m. frontalis m. orbicularis oculi and nasolabial fold muscles. The optimum site for stimulating electrodes and differences between the first and the last compound action potentials after 20 consecutive stimuli delivered at 1 Hz were analysed.Neste estudo os autores se propoem a estabelecer os pontos mais adequados para o registro do potencial de acao muscular composto dos musculos frontal, orbicular do olho e musculos do sulco nasolabial, apos estimulacao do nervo facial. Tambem, o melhor posicionamento do eletrodo estimulador e a variacao entre as amplitudes do primeiro e ultimo potencial de acao muscular composto dos musculos do sulco nasolabial, apos 20 estimulos supramaximos sucessivos.

Facial nerve electroneurography: variability in normal subjects

Twenty normal individuals were submitted to facial nerve electroneurography using different techniques in order to determine the most accurate to obtain the latencies and amplitudes of the compound muscle action potentials (CMAP) of the facial muscles. First of all it was determined in which muscle or muscle group highest amplitude CMAP could be recorded with the lowest variability between sides and in test-retest. Different techniques were studied in order to determine which could give the best results. This was shown to be an arrangement of bipolar surface electrodes fixed to a plastic bar. The records with higher amplitude where obtained from the nasolabial fold muscles. Therefore 65 normal volunteers were examined using this technique and recording the potentials obtained over the nasolabial fold muscles. Normal values were determined (latency lower than 4.5 ms and amplitude larger than 2 mV--95% confidence limits).