Mauro César Quintão Cunningham

Parkinsonism and Parkinson's disease in the elderly: A community-based survey in Brazil (the Bambuí study)

Several community‐based surveys on the prevalence of Parkinsonism and Parkinsons disease have been conducted worldwide, with variations on their methodology and results. The objective of this study is to assess the prevalence of Parkinsonism and its causes in a cohort of individuals age 64 years or older in Bambuí, a Brazilian town. In phase I, 1,186 people older than 64 years responded to a 9‐question screening questionnaire for Parkinsonism. In phase II, all subjects who scored ≥ 2 points on the test were examined independently by at least 2 movement disorder‐trained physicians. A movement disorder senior specialist excluded or confirmed the diagnosis in all suspected cases. The response rate was high for both phases (96% for phase I and 94% for phase II). The prevalence rate per 100 population over 64 years of age in this group was 7.2% for Parkinsonism of all types (n = 86). The most frequent causes were idiopathic Parkinsons disease and drug‐induced Parkinsonism, with prevalence rates of 3.3% (n = 39) and 2.7% (n = 32), respectively. The prevalence of vascular Parkinsonism was 1.1% (n = 13). We found 1 case of posttraumatic Parkinsonism and another with multiple system atrophy. In this first population‐based study of Parkinsonism conducted in Brazil, the prevalence in a cohort of elderly subjects was higher than the observed in other populations worldwide, especially because of the high rates of drug‐induced and vascular Parkinsonism. The prevalence of Parkinsons disease was similar to that observed in elderly people in door‐to‐door surveys in other American, European, and Eastern countries.

Obsessive compulsive behavior, hyperactivity, and attention deficit disorder in Sydenham chorea.

The authors investigated obsessive-compulsive behavior, obsessive-compulsive disorder (OCD), and attention deficit and hyperactivity disorder (ADHD) in 50 healthy subjects, 50 patients with rheumatic fever without chorea, and 56 patients with Sydenham chorea. Obsessive-compulsive behavior, OCD, and ADHD were more frequent in the Sydenham chorea group (19%, 23.2%, 30.4%) than in the healthy subjects (11%, 4%, 8%) and in the rheumatic fever without chorea group (14%, 6%, 8%). ADHD was more common in persistent Sydenham chorea.

Treatment of Sydenham chorea with corticosteroids

Despite treatment with valproic acid and neuroleptics, a significant proportion of patients with Sydenham chorea (SC) remain with chorea. We evaluated the effect of intravenous methyl‐prednisolone followed by oral prednisone in patients with SC refractory to conventional treatment. Patients were enrolled in the study if they failed to improve with conventional treatment, despite the development of side effects. Chorea was rated on a 0 to 4 score. Five patients, 3 of them women, were included in the study. The median pretreatment rating score of the chorea was 3 (range, 3–4) and dropped to 1 (range, 0–2) after a median follow‐up of 7 months (range, 3–7 months). Two patients developed Cushing syndrome. Our data suggest that intravenous methyl‐prednisolone followed by oral prednisone is an effective and well‐tolerated treatment of refractory SC.

Prevalence and clinical classification of tremor in elderly—A community-based survey in Brazil

Prevalence data on different types of tremor among the elderly population are very scarce. The objective of this study was to study the prevalence of tremor in a community‐dwelling elderly population in the town of Bambuí, Brazil. The authors studied 1186 inhabitants aged≥64 years. This was a 2‐phase study in which all participants who screened positive in a questionnaire for tremor and parkinsonism or who used drugs capable of causing/suppressing tremor were examined. In this population, the prevalence rate was 17.4% for tremor, 7.4% for essential tremor, 5.6% for parkinsonian tremor, 2.8% for enhanced physiological tremor, and 1.6% for other causes. There were no gender differences in prevalence rates for all types. Patients who had Parkinsons disease with tremor were older than those who had essential tremor, whereas patients who had enhanced physiological tremor were significantly younger. The age‐specific prevalence of tremor increased with advancing age for both men and women. The prevalence of tremor in the studied population was high and increased with advancing age. Essential tremor, parkinsonian tremor, and enhanced physiological tremor were the most commonly identified causes.

Nerve conduction study in Sydenham's chorea.

Sydenhams chorea (SC) is a late complication of group A β‐hemolytic streptococci infection presumably caused by an abnormal autoimmune reaction. Despite rare case reports of peripheral neuropathy associated with streptococcal infection, there is no investigation of peripheral nerve in SC. We performed nerve conduction studies in a cohort of patients with SC. The neurophysiology investigation comprised measurement of amplitude and sensory conduction velocity of median, ulnar, and sural nerves; amplitude and motor conduction velocity; and F‐wave latency of median, ulnar, fibular, and tibial nerves. Twenty‐six patients entered the study (12 females, 14 males; mean age 12.8 ± 3.6 years). Thirteen subjects had absent or decreased deep reflexes. All investigated neurophysiological parameters fell within the normal range for our population. We failed to find neurophysiological evidence of peripheral nerve involvement in patients with a history of SC. Our findings suggest that the possible autoimmune dysfunction in SC patients is not targeted against epitopes present in peripheral nerves.

Acoustic analysis of prosody in Sydenham's chorea

There are few studies of language and speech in patients with Sydenhams chorea (SC). We have done an acoustic analysis of fundamental frequency (F0), duration and intensity of declarative and interrogative sentences made by 20 SC patients, 20 patients with rheumatic fever (RF) without chorea, and compared them with 20 healthy age-matched controls (CO). Each group included 12 females. We found that there is no difference between the RF and CO groups in all studied parameters. Patients with SC, however, presented with a speech characterized by decreased F0 range (difference between minimum and maximum F0), shorter duration of sentences, and higher intensity of the first syllable of sentences. The findings were not influenced by the nature of the sentences (i.e. , declarative or interrogative), but for all variables they were significantly more severe in males than females. In conclusion, we have demonstrated that patients with acute SC have an impairment of modulation of F0 and longer duration of emission of sentences, resulting in a monotone and slow speech. This pattern is similar to what has been described in other basal ganglia illnesses, such as Parkinsons disease, Huntingtons disease and Wilsons disease.

Síndrome de opsoclonia-mioclonia-ataxia em paciente com AIDS

ABSTRACT We report the case of a 38-year-old woman with AIDS who developed opsoclonus-myoclonus-ataxia syndrome during a period different from other cases reported in literature. Opsoclonus-myoclonus-ataxia syndrome had already been reported as the initial neurological presentation of AIDS, as well as at the time of HIV-seroconversion and immune reconstitution syndrome. Our case is unique since the patient had an elevated CD4 count and negative viral load in the period when the opsoclonus-myoclonus-ataxia syndrome occurred.

Prevalence of major psychiatric disorders in a cohort of oldest old in Brazil: The Pietà study

consensus discussion. Results: 639 individuals (55.3% of the total oldestold population) were fully evaluated, being 408 women (63.8%) and 231 men(36.2%),aged81.1 65.2years,withmeanschoolingof2.6 62.8years. Dementia was diagnosed in 176 subjects, (prevalence¼27.5%), while CIND was identified in 166 (prevalence¼26.0%). Among dementia patients, only 39 cases (6.1%) had a previous diagnosis of this condition. Patients with dementia were significantly older (p<0.0001) and less educated (p¼0.001). Prevalence of dementia was also higher in women, although the difference was not statistically significant (p¼0.06). CIND prevalence was similar in both genders. When compared with the cognitively healthy individuals (n¼227),CINDsubjectsweresignificantlyolder(p¼0.004),buthadasimilar schooling. A previous history of depression was more frequent among dementia (p¼0.002) and CIND (p¼0.007) patients. Conclusions: Prevalence of CIND and dementia was high in this oldest-old population, although dementia was highly under-diagnosed. Age and previous history of depression were associated with both diagnoses, while low education dementia was associated only with dementia.

Successful brain aging in a cohort of oldest old in Brazil: The Pietà study

evaluation (delayed recall task, category fluency and clock drawing), the Geriatric Depression Scale, the Mini International Neuropsychiatric Interview and to physical and neurological examination. Individuals with suspected cognitive impairment and a subset of cognitively healthy individuals were also submitted to a comprehensive neuropsychological and functional evaluation. Dementia and CIND were diagnosed according to standard criteria, accounting for the educational level, after an extensive two-phase clinical consensus discussion. Results: 639 individuals (55.3% of the total oldestold population) were fully evaluated, being 408 women (63.8%) and 231 men (36.2%), aged 81.1 6 5.2 years, with mean schooling of 2.6 6 2.8 years. Dementia was diagnosed in 176 subjects, (prevalence1⁄427.5%), while CIND was identified in 166 (prevalence1⁄426.0%). Among dementia patients, only 39 cases (6.1%) had a previous diagnosis of this condition. Patients with dementia were significantly older (p<0.0001) and less educated (p1⁄40.001). Prevalence of dementia was also higher in women, although the difference was not statistically significant (p1⁄40.06). CIND prevalence was similar in both genders. When compared with the cognitively healthy individuals (n1⁄4227), CIND subjects were significantly older (p1⁄40.004), but had a similar schooling. A previous history of depression was more frequent among dementia (p1⁄40.002) and CIND (p1⁄40.007) patients. Conclusions: Prevalence of CIND and dementia was high in this oldest-old population, although dementia was highly under-diagnosed. Age and previous history of depression were associated with both diagnoses, while low education dementia was associated only with dementia.