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Doctoral Thesis
DOI
https://doi.org/10.11606/T.5.2021.tde-31082021-105600
Document
Author
Full name
Nariana Mattos Figueiredo Sousa
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2021
Supervisor
Committee
Brucki, Sônia Maria Dozzi (President)
Ferraz, Henrique Ballalai
Miotto, Eliane Correa
Rocha, Maria Sheila Guimarães
Title in Portuguese
Uso da Addenbrooke's Cognitive Examination III (ACE-III) em pacientes com doença de Parkinson idiopática
Keywords in Portuguese
Addenbrooke\'s Cognitive Examination III.
Comprometimento Cognitivo Leve
Demencia
Disfuncao cognitiva
Doenca de Parkinson
Testes Neuropsicologicos
Abstract in Portuguese
INTRODUÇÃO: A doença de Parkinson idiopática, condição neurodegenerativa progressiva, é caracterizada por sintomas, como tremor, rigidez, bradicinesia e instabilidade postural. As manifestações não motoras, como distúrbios do sistema nervoso autônomo, fadiga, distúrbios do sono, transtornos afetivos, alterações cognitivas e neuropsiquiátricas podem estar presentes ao longo da evolução da doença. O déficit cognitivo na doença de Parkinson idiopática é uma importante causa de incapacidade funcional nestes pacientes e a detecção precoce, com instrumentos sensíveis, pode auxiliar no acompanhamento longitudinal. OBJETIVOS: Investigar a acurácia diagnóstica, sensibilidade e especificidade, do Exame Cognitivo de Addenbrooke, terceira versão, como ferramenta de avaliação cognitiva breve em pacientes com diagnóstico de doença de Parkinson idiopática. MÉTODOS: Estudo de corte transversal, observacional, do tipo caso-controle. Foram selecionados 150 pacientes com Doença de Parkinson Idiopática, conforme os critérios de diagnóstico clínico do Banco de Cérebro da Sociedade Britânica de doença de Parkinson, e 60 controles saudáveis, pareados por idade, sexo e escolaridade. Realizada a aplicação da ACE-III e bateria neuropsicológica, através de testes que avaliam os domínios atencionais, mnemônicos, funções visuoespaciais/visuo-construtivas, funções executivas e linguagem. RESULTADOS: O grupo clínico foi dividido em quatro subgrupos, tais como cognição normal na doença de Parkinson (CN-DP - 24 pacientes - 16%), comprometimento cognitivo leve devido a doença de Parkinson (CCL-DP - 104 pacientes - 69,33%), demência devido à doença de Parkinson (D-DP - 22 pacientes - 14,66%) e indivíduos sem DPI e cognição normal (controles). Obtivemos notas de corte capazes de identificar alterações cognitivas entre os grupos: CCL-DP e D-DP de controles saudáveis, tendo notas de corte de 85/100 (sensibilidade=58,65%, especificidade=60%, AUC=0,64) e 81/100 pontos (sensibilidade=81,82%, especificidade=75%, AUC=0,88), para detectar CCL-DP e D-DP, respectivamente. A idade foi inversamente associada ao desempenho dos escores (totais e domínios da ACE-III), enquanto os anos de escolaridade exerceram uma correlação significantemente positiva no desempenho destes escores. Houve correlação significante com os testes neuropsicológicos padronizados para esta população. CONCLUSÕES: A detecção precoce de comprometimento cognitivo, através de instrumentos breves e sensíveis para esta população, como a ACE-III facilita a possibilidade de intervenção precoce e ajustes no estilo de vida.
Title in English
Use of Addenbrooke's Cognitive Examination III (ACE-III) in patients with idiopathic Parkinson's disease
Keywords in English
Addenbrooke's Cognitive Examination III.
Cognitive Dysfunction
Dementia
Mild Cognitive Impairment
Neuropsychological Tests
Parkinson disease
Abstract in English
INTRODUCTION: Parkinson's disease, progressive neurodegenerative condition, is characterized by symptoms, such as tremor, stiffness, bradykinesia; and postural instability. Non-motor manifestations, such as disorders of the autonomic nervous system, fatigue, sleep disorders, affective disorders, cognitive and neuropsychiatric disorders may be present throughout the course of the disease. Cognitive deficit in idiopathic Parkinson's disease is an important cause of functional disability in these patients and early detection, with sensitive instruments, can contribute to longitudinal monitoring. OBJECTIVES: To investigate the diagnostic accuracy, sensitivity and specificity of the Addenbrooke Cognitive Examination, third version, as a brief cognitive assessment tool in patients diagnosed with idiopathic Parkinson's disease. METHODS: Cross-sectional, observational, case-control study. 150 patients with IPD were selected, according to the clinical diagnosis criteria of the British Society of Parkinson's Disease Brain Bank, and 60 healthy controls, matched for age, sex and education. The application of ACE-III and neuropsychological battery was carried out, through tests that evaluate the attentional, mnemonic domains, visuospatial/visuoconstructive functions, executive functions and language. RESULTS: A total of 150 patients and 60 healthy controls were recruited for this study. The clinical group was divided into four subgroups, such as normal cognition in Parkinson's disease (NC-DP - 24 patients - 16%), mild cognitive impairment due to Parkinson's disease (MCI-DP - 104 patients - 69.33%) and dementia due to Parkinson's disease (D-PD - 22 patients - 14.66%). ACE-III was useful to differentiate groups: with cut-off scores of 85/100 (sensibility=58.65%, specificity=60%, AUC=0.64) e 81/100 pontos (sensibility =81.82%, specificity =75%, AUC=0.88), to detect MCI-PD and D-PD, respectively. Age was inversely associated with the performance of the scores (totals and domains of the ACE-III), while the years of schooling had a significantly positive correlation in the performance of these scores. There was a significant correlation with standardized neuropsychological tests for this population. CONCLUSIONS: The early detection of cognitive impairment, using brief and sensitive instruments for this population, as ACE-III, facilitates the possibility of early intervention and lifestyle adjustments.
 
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Publishing Date
2021-08-31
 
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