Sintomas não motores da doença de Parkinson e sua relação com a progressão do UPDRS após dois anos de acompanhamento

Abstract

Introduction: Parkinson's disease (PD) is a neurodegenerative disease whose motor impairment has as cardinal symptoms tremor, bradykinesia, gait rigidity and postural instability. It also presents non-motor symptoms (NMS), among which depression, cognitive decline, intestinal constipation, anosmia, pain and REM sleep disorder stand out. These impact on the quality of life and mortality of patients. Objective: To investigate in PD patients the existence of an association between the NMS and the progression of the worsening of the UPDRS after two years of follow-up and to assess whether the age of onset of symptoms determines different associative patterns between scales. Methods: The sample consisted of 48 members (43 to 92 years old, both gender), diagnosed with PD, subdivided according to the age of onset of symptoms in Early onset PD group (<50 years old), and Late onset PD group (> 50 years). At the time of recruitment, sample Base-line (n48; Early onset PD n23; Late onset PD n25), were apllied the scales of Mini Mental State Examination Scale (MMSE), Mattis Dementia Rating Scale (DRS), Nitrini Figures Test, Verbal fluency of animals (FV animals), Pfeffer Scale (QPAF), Apathy Scale, Beck Depression Inventory (BDI), Neuropsychiatric Inventory (NPI) and Unified Parkinson's Disease Rating Scale (UPDRS). After 2 years, the Follow-up sample (n31; Early onset PD n16; Late onset PD n15), the UPDRS scale was reapplied. A cross-sectional analysis was performed, comparing the groups, and a longitudinal analysis, comparing each group with itself after 2 years, in addition to associative statistical testing (gamma statistics) between the performance on each scale and the Δ-UPDRS [Final UPDRS (Follow-up) - Initial UPDRS (Base-line)]. Results: The Early onset PD group had a significantly longer mean time of diagnosis (difference of 5.96 years, (Base-line) and 5.18 years, (Follow-up) and better performance in the Nitrini figure test. Significant in the UPDRS parts III and total in the Early onset PD group and UPDRS parts II, III and total in the Late onset PD group. The worsening of the UPDRS did not differ between groups. Significant negative associations were found in the Early onset PD group (Δ-UPDRS I and DRS scale; Δ-UPDRS II and the scales of DRS, Nitrini figures, Apathy scale; Δ-UPDRS III and the scales of MEEM, Nitrini figures; Total Δ-UPDRS and the scales of DRS, Nitrini figures, FV animals) and in the Late onset PD group (Δ-UPDRS I and the DRS scale; Δ-UPDRS II and the scales of DRS and BDI) associating lower scores on the referred scales with the more pronounced worsening of the Δ-UPDRS scores. Positive association between Δ-UPDRS III and the scales of QFAP and DRS were found in the Late onset PD group, relating most other scores on these scales the most marked worsening of the Δ-UPDRS scores. Conclusion: The greater intensity of NMS, especially cognitive decline, correlates with worse functional and motor performance on the UPDRS scale. Associations vary according to the age of onset of symptoms, occurring in greater numbers in the Early onset PD group and occasionally in the Late onset PD group.