Paula Luciana Scalzo

Increased serum levels of soluble tumor necrosis factor-α receptor-1 in patients with Parkinson's disease

Parkinsons disease (PD) is characterized by a progressive and irreversible loss of dopaminergic neurons. Inflammatory mechanisms have been implied in the pathophysiology of PD. In this study, we assessed serum levels of TNF-alpha and the soluble forms of their receptors, sTNFR1 and sTNFR2, in 46 PD patients and 23 control subjects. Patients with PD had higher levels of sTNFR1 (p=0.048). The concentration of sTNFR1 and sTNFR2 correlated with age (p=0.006 and p=0.022, respectively). Higher levels of sTNFR1 were associated with later disease onset (p=0.048). These results corroborate the role of inflammatory events in the process of neurodegeneration in PD which can be of special relevance in the sporadic form of PD with later onset.

Serum levels of interleukin-6 are elevated in patients with Parkinson's disease and correlate with physical performance.

Some studies have demonstrated altered circulating levels of cytokines, including IL-6, in Parkinsons disease (PD), implying a possible involvement of inflammatory and immune-mediated mechanisms in its pathogenesis. Moreover, the increased production of inflammatory cytokines has been associated with cognitive impairment and poor physical performance in the elderly. We compared serum levels of IL-6 in 44 PD patients and 22 healthy subjects, and correlated them with PD specific instruments and functional tests. Serum levels of IL-6 were significantly increased in PD (p=0.015). There was no correlation between serum levels of IL-6 and instruments traditionally used to assess PD severity. However, we found that PD patients with higher serum levels of IL-6 spent more time at functional mobility tests and had lower gait speed. Also, these patients had major problems to keep balance during functional tasks that required postural changes and that had a reduced base support. These results showed that high levels of IL-6 can be involved with an acceleration of muscle catabolism leading to sarcopenia, therefore contributing to weakness and fatigue, and may also be associated with functional disability in PD.

Validation of the brazilian version of the berg balance scale for patients with parkinson's disease

BACKGROUND Changes in balance occur with the progression of Parkinsons disease (PD). OBJECTIVE To validate the Brazilian version of the Berg Balance Scale (BBS) for PD patients, determining its reliability and internal consistency and correlating it with PD-specific instruments. METHOD We evaluated 53 patients (M/F 37/16, mean age+/-SD, 62+/-7.9 years) with PD (mean+/-SD, 7.8+/-4.4 years). Unified Parkinsons Disease Rating Scale (UPDRS), Schwab and England Scale (SandE , Hoehn and Yahr Staging Scale (HY) and BBS were used to assess patients. Statistical analyses for inter-rater reliability, internal consistency and correlations among BBS, UPDRS, SandE and HY were performed. RESULTS The mean scores+/-SD on UPDRS and BBS were, respectively, 41.6+/-17.8 and 47.2+/-8.2. The median on SandE and HY scales were 80% and 2.5, respectively. The BBS presented a high intra-class correlation coefficient (ICC=0.84) and internal consistency (Cronbrachs alpha=0.92). There was a statistically significant correlation between BBS and disease duration (r(s)= -0.520, p<0.001), UPDRS subscales II and III (r(s)= -0.467, p=0.011; r(s)= -0.374, p=0.046, respectively), stage of disease (HY; r(s)= -0.507, p<0.001) and the activities of daily living (SandE; r(s)=0.492, p<0.001). CONCLUSION The BBS is a promising tool for the assessment of balance in PD, correlating with the stage of disease and the level of independence.

Depressive symptoms and perception of quality of life in Parkinson's disease

BACKGROUND Depression has been proposed as a major contributor to poor quality of life (QoL) in Parkinsons disease (PD). OBJECTIVE To evaluate the relationship between depressive symptoms and QoL in subjects with PD. METHOD Beck Depression Inventary (BDI) was used to evaluate depressive symptoms and Parkinsons Disease Quality of Life Questionnaire (PDQ-39) to assess the perception of the QoL. RESULTS Thirty seven patients (19 male/ 18 female) with a typical onset PD and mean disease duration of 7.7 years were studied. Higher scores on BDI correlated with poorer perception of the QoL. This association occurred at the expense of the following PDQ39 domains: mobility, activities of daily living, social support, cognition and emotional well-being dimensions. PD severity also correlated with QoL. CONCLUSION Our study corroborates the assumption that depressive symptoms contributed significantly to QoL in PD.

Plasma levels of soluble tumor necrosis factor receptors are associated with cognitive performance in Parkinson's disease.

Inflammatory mechanisms have been implicated in a series of neuropsychiatric conditions, including behavioral disturbances, cognitive dysfunction, and affective disorders. Accumulating evidence also strongly suggests their involvement in the pathophysiology of Parkinsons disease (PD). This study aimed to evaluate plasma levels of inflammatory biomarkers, and their association with cognitive performance and other non‐motor symptoms of PD. PD patients and control individuals were subjected to various psychometric tests, including the Mini‐Mental State Examination (MMSE), Frontal Assessment Battery (FAB), and Becks Depression Inventory (BDI). Biomarker plasma levels were measured by enzyme‐linked immunosorbent assay (ELISA). PD patients exhibited worse performance on MMSE and the programming task of FAB, and presented higher soluble tumor necrosis factor receptor (sTNFR) plasma levels than control individuals. Among PD patients, increased sTNFR1 and sTNFR2 concentrations were associated with poorer cognitive test scores. After multiple linear regression, sTNFR1 and education remained a significant predictor for FAB scores. Our data suggest that PD is associated with a proinflammatory profile, and sTNFRs are putative biomarkers of cognitive performance, with elevated sTNFR1 levels predicting poorer executive functioning in PD patients.

Impact of changes in balance and walking capacity on the quality of life in patients with Parkinson's disease

UNLABELLED Parkinsons disease (PD) is characterized by motor symptoms that cause the decline of functional capacity and affect the quality of life (QoL). OBJECTIVE To evaluate the impact of changes in balance and walking capacity on the PD. METHODS The instruments used were: Unified Parkinsons Disease Rating Scale (UPDRS), modified Hoehn and Yahr Scale (HY), Schwab and England scale (SE), quality of life questionnaire (PDQ-39), Berg balance Scale (BBS) and six-minute walk test (6MWT). RESULTS Thirty-six patients with mean disease duration of 7.3 years were assessed. Lower scores on the BBS and shorter distances walked during the 6MWT correlated with a poorer perception of QoL. This correlation occurred at the expense of the mobility and daily living activities domains. CONCLUSION Our results indicated that the impairment in balance while performing functional activities and the reduction in walking capacity are important factors that negatively affect the perception of QoL in PD patients.

Serum Levels of Chemokines in Parkinson’s Disease

Objective: Neuroinflammatory processes seem to contribute to the degeneration of dopaminergic neurons in Parkinson’s disease (PD). Chemokines play a role in the pathogenesis of inflammatory diseases, acting mainly as mediators of leukocyte recruitment to inflammatory sites. The aim of the present study was to compare the serum levels of chemokines between healthy subjects and PD patients and to correlate these levels with the severity of PD. Methods: We used ELISA to measure the levels of CCL3, CCL11, CCL24, CXCL8 and CXCL10 chemokines in the serum of PD patients (n = 47) and age- and gender-matched controls (n = 23). Patients were also clinically evaluated with the Unified Parkinson’s Disease Rating Scale, the Modified Hoehn and Yahr Staging Scale and the Modified Schwab and England Activities of Daily Living Scale. Results: There was no significant difference in serum levels of chemokines between controls and PD patients. There was no correlation between the serum levels of chemokines and the clinical measures of disease severity. Conclusions: These findings suggest that serum levels of chemokines may not be considered as potential biomarkers of PD.

Efeito de um treinamento de equilíbrio em um grupo de mulheres idosas da comunidade: estudo piloto de uma abordagem específica, não sistematizada e breve

Objetivo: Verificar o efeito de um programa de treinamento de equilibrio, de curto periodo, com exercicios especificos e sem associacao de treinamentos sistematizados de forca muscular, em um grupo de mulheres idosas residentes na comunidade. Metodos: Trata-se de um estudo piloto com seis mulheres que participaram de uma intervencao visando o treinamento de equilibrio. Os testes de campo utilizados foram: “Escala de Equilibrio Funcional de Berg – Versao Brasileira”, Timed Up & Go, Chair Stand, e Marcha Tandem. Entrevistas foram realizadas sobre percepcao de saude e medo de quedas. O treinamento consistiu em atividades realizadas em grupo, com tarefas isoladas e circuitos fechados. Foi realizado duas vezes por semana, com uma hora de duracao em cada dia, por um periodo de oito semanas. Resultados: Verificou-se que houve melhora no equilibrio a partir da analise dos resultados obtidos. Conclusao: Um treinamento de equilibrio especifico, nao sistematizado, breve e realizado em um grupo de mulheres idosas da comunidade mostrou ter um efeito na melhora das medidas de equilibrio, porem ainda se faz necessario avaliar o impacto isolado do treino de forca sistematizado sobre as medidas de equilibrio.Objective: verify the effect of a group program of balance training in a short period, with specific exercises and without association of systematic strength training, on a community dwelling older women. Methods: it is a pilot study with six women that participate of an intervention with balance training. Tests: BBS (Brazilian version); Timed Up & Go, Chair Stand and Tandem Gait. Interview: health perception and fear of falling. Training: Group activities with isolated exercises and closed circuits. It was done twice a week, with duration of one hour per day, for a period of eight weeks. Results: The training, without systematic strength training, improved the balance of participants. Conclusions: An specific, non-systematic, short and at group balance training of a community dwelling older women had some effects on balance measures, however, it is necessary to assessment the isolated impact of a systematic strength training on the balance measures.

Evaluation of fatigue in Parkinson’s disease using the Brazilian version of Parkinson’s Fatigue Scale

Kummer A, Scalzo P, Cardoso F, Teixeira AL. Evaluation of fatigue in Parkinson’s disease using the Brazilian version of Parkinson’s Fatigue Scale.
Acta Neurol Scand: 2011: 123: 130–136.
© 2010 The Authors Journal compilation

Cognitive Status Correlates with CXCL10/IP-10 Levels in Parkinson’s Disease

Cognitive impairment and depressive symptoms are of great interest in Parkinsons disease (PD), since they are very common and lead to increased disability with poor quality of life. Inflammatory mechanisms have been implicated in PD and its nonmotor symptoms. In the current pilot study, we aimed to evaluate plasma levels of chemokines in PD patients and to analyze the putative association of chemokines with depressive symptoms and cognitive performance. We hypothesized that higher chemokines levels are associated with worse cognitive performance and increased depressive symptoms in PD. For this purpose, 40 PD patients and 25 age- and gender-matched controls were subjected to a clinical evaluation including cognitive and mood tests. Peripheral blood was drawn and plasma levels of CCL2/MCP-1, CCL11/eotaxin, CCL24/eotaxin-2, and CXCL10/IP-10 were measured by enzyme-linked immunosorbent assay. PD patients and control individuals presented comparable plasma concentrations of all the evaluated chemokines. In PD patients, CXCL10/IP-10 plasma levels correlated positively with Hoehn and Yahr staging scale. In addition, the higher CXCL10/IP-10 levels, the worse performance on cognitive tests. Although there was no significant difference between PD patients and control individuals regarding chemokines levels, our preliminary results showed that CXCL10/IP-10 may be associated with cognitive status in PD.