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Abstract Introduction Postural balance impairment can affect the quality of life of patients with Parkinson’s disease. Previous studies have described connections of the vestibular system with postural functions, suggesting a potential participation of the basal ganglia in receiving vestibular stimuli. This systematic review aims to summarize the evidence on the effectiveness of vestibular rehabilitation on postural balance in patients with Parkinson’s disease. Methods A systematic review was conducted using the electronic databases: PubMed, Embase, Scopus and PEDro. The study selection was independently conducted by two reviewers, and disagreements were evaluated by a third reviewer. The included studies had no restrictions on publication dates or languages and the last update occurred in July 2023. Results From the 485 studies found in the searches, only 3 studies were deemed eligible for the systematic review involving a total of 130 participants. The Berg Balance Scale was described as the tool for evaluation of postural balance in all studies. The meta-analysis showed statistically significant results in favor of vestibular rehabilitation (MD = 5.35; 95% CI = 2.39, 8.31; P

BackgroundParkinson’s disease (PD) is the second most common neurodegenerative illness and has the highest increase rate in recent years. There is growing evidence to suggest that PD is linked to higher osteoporosis rates and risk of fractures.ObjectiveThis study aims to estimate the prevalence and factors associated with osteoporosis as defined by the National Osteoporosis Foundation (NOF) and World Health Organization in patients with mild to moderate PD.MethodsWe performed a cross-sectional study at a tertiary public hospital in Fortaleza, Brazil, dating from May 2021 until April 2022. The study sample was comprised of patients with mild to moderate PD who were at least 40 years old and who had the ability to walk and stand unassisted. Bone Mineral Density (BMD) of both the hip (neck of the femur) and the lumbar spine were obtained via properly calibrated Dual Energy X-ray Absorptiometry (DXA) scanning. The FRAX (Fracture Risk Assessment Tool) score was used to determine a person’s 10-year risk of major osteoporotic fracture. The Revised European Working Group on Sarcopenia in Older People (EWGSOP 2) was used as a basis to confirm a sarcopenia diagnosis with the following parameters: low muscle strength gauged by handgrip strength and low muscle quantity by DXA. Physical performance was carefully evaluated by using the Short Physical Performance Battery test. Osteoporosis and osteopenia were diagnosed following the NOF guidelines and WHO recommendations.ResultsWe evaluated 107 patients in total, of whom 45 (42%) were women. The group’s mean age was 68 ± 9 years, and the mean disease time span was 9.9 ± 6.0 years and mean motor UPDRS was 43 ± 15. We found that 42.1% and 34.6% of the sample had osteopenia and osteoporosis following NOF criteria, respectively, and 43% and 33.6% following the WHO recommendations. Lower lean appendicular mass was associated to osteopenia and osteoporosis in multinomial logistic regression analysis in both diagnostic criteria.ConclusionOur findings provide additional evidence for the protective role of lean mass against osteoporosis in patients with PD.

ABSTRACT. The prevalence of cognitive impairment in Parkinson's disease (PD) is about 20% to 60%. The Mini-Mental Status Examination (MMSE) is the most used cognitive screening test. Objective: To evaluate the influence of clinical and demographic characteristics, specifically the education level, on the MMSE score in PD patients of a northeast Brazilian sample. Methods: We performed a cross-sectional study of 198 PD patients at a Movement Disorders outpatient clinic in Fortaleza, CE, Brazil. Participants were assessed by detailed clinical history, modified Hoehn and Yahr staging (HY), geriatric depression scale (GDS) and MMSE. Results: We found that 68% of patients had MMSE scores below the Brazilian thresholds, which were based in Brucki et al. study (2003). There was a statistically significant difference in the bivariate analysis between educational level and cut-off classification for MMSE. More years of formal schooling were associated with more patients scoring below threshold. We found that 75%, 68.8%, and 79.7% of individuals with more than 11, 9 to 11, and 4 to 8 years of formal schooling, respectively, were below the suggested Brazilian Brucki's threshold. GDS and age were negatively correlated with total MMSE and all its domains. There was no correlation between disease duration and MMSE. Subjects with hallucinations had lower scores. Conclusion: Most of the sample had lower performance according to Brazilian thresholds, but there was no control group and no neuropsychological test in this study. Further studies in northeast Brazil are needed to review MMSE cut-off values.

Introduction Parkinson’s disease (PD) is the second most common neurodegenerative disorder in Brazil. Physical activity is a complementary intervention in managing inherent declines associated with the disease like strength, balance, gait, and functionality and benefit health-related outcomes. Here, we report the PARK-BAND Study protocol, which aims to investigate potential benefits of power training using elastic devices in participants with PD. Our intervention will be provided in patients with PD using elastic devices like elastic bands and tubes. Therefore, we used the term Park from Parkinson’s disease and band from elastic bands.Methods and analysis This randomised single-blind single-centre two-arm parallel, superiority trial will include 50 participants with PD attending the clinical setting. Those who meet the eligibility criteria and provide consent to participate will be randomised in a 1:1 ratio to either the exercise group, which will receive power training programme or the health education group, which will receive the education programme. Randomisation will be performed by permuted block randomisation with a block size of eight. Both groups will receive a 12-week intervention. The exercise group will have two sessions per week and the health education group will have one session per week. Changes from baseline in bradykinesia, as assessed by the Unified Parkinson's Disease Rating Scale motor examination subscore and physical functional performance, will be the primary outcomes. Secondary outcomes include other neurological, neurophysiological and physical variables, as well as the quality of life, depression, cognition, sleep quality and disturbances, assessed before and after interventions. We hypothesise that the exercise group will have greater improvement in primary and secondary outcomes than the health education group.Ethics and dissemination The study is approved by the Research Ethics Committee of Hospital Universitário Walter Cantidio and all participants will provide their written informed consent (register number 91075318.1.0000.5045).Trial results will be disseminated via peer reviewed journal articles and conference presentations, reports for organisations involved with PD and for participants.Trial registration number Registro Brasileiro de Ensaios Clínicos Registry (RBR-5w2sqt); Pre-results.

BACKGROUND:Sarcopenia is a complex and multifactorial geriatric condition seen in several chronic degenerative diseases. This study aimed to screen for sarcopenia and fall risk in a sample of Parkinson's disease (PD) patients and to investigate demographic and clinical factors associated. METHODS:This is a cross-sectional study. We evaluated 218 PD patients at the Movement Disorders Clinic in Fortaleza, Brazil, and collected clinical data including experiencing falls in the six months prior to their medical visit. Probable sarcopenia diagnosis was confirmed by using a sarcopenia screening tool (SARC-F questionnaire) and the presence of low muscle strength. RESULTS:One hundred and twenty-one patients (55.5%) were screened positive for sarcopenia using the SARC-F and 103 (47.4%) met the criteria for probable sarcopenia. Disease duration, modified Hoehn and Yahr stage, Schwab and England Activities of Daily Living Scale score, levodopa equivalent dose, probable sarcopenia and positive SARC-F screening were all associated with experiencing falls. Disease duration, lower quality of life and female gender were independently associated with sarcopenia. Experiencing falls was significantly more frequent among patients screened positive in the SARC-F compared to those screened negative. CONCLUSIONS:Sarcopenia and PD share common pathways and may affect each other's prognosis and patients' quality of life. Since sarcopenia is associated with lower quality of life and increased risk of falls, active case finding, diagnosis and proper management of sarcopenia in PD patients is essential.

O objetivo do estudo foi comparar os parâmetros antropométricos e perfil glicêmico de idosos diabéticos tipo 2 praticantes de atividade física regular e não praticantes. MÉTODOS: O estudo, do tipo transversal, envolveu 70 idosos com diabetes mellitus tipo 2, com idade entre 60 e 80 anos. A coleta de dados foi através de questionário estruturado abordando: a) características demográficas dos pacientes (idade e nível de escolaridade) e b) características do padrão de atividade física (frequência, duração (min) e tempo (meses) da prática de exercícios físicos). Foram realizadas medidas antropométricas e verificação do perfil glicêmico (glico-hemoglobina). Os dados foram analisados no programa STATA versão 9.0. Foram calculados a média e desvio padrão da média (DP) e realizado o teste de análise de variância (ANOVA). Para verificar a associação de variáveis qualitativas, utilizou-se o teste exato de Fisher e as associações entre as variáveis quantitativas foram estimadas através do coeficiente de correlação de Pearson, com uma confiança de 95%. O nível de significância foi de p

ABSTRACT. The prevalence of Parkinson's disease (PD) tends to increase worldwide in the coming decades. Thus, the incidence of falls is likely to increase, with a relevant burden on the health care system. Objective: The objective of this study was to evaluate clinical factors and drug use associated with falls in PD patients. Methods: We conducted a cross-sectional study at the Movement Disorders outpatient clinic of a tertiary hospital in Northeast Brazil. We performed structured interviews to collect sociodemographic and clinical data. Functional capacity was assessed using the Schwab and England Activities of Daily Living Scale and the modified Hoehn and Yahr Staging Scale. We divided the study sample into non-fallers (no falls) and fallers (≥1 fall), and non-recurrent (≤1 fall) and recurrent fallers (>1 fall). Results: The study population comprised 327 PD patients (48% women), with a mean age of 70 years. The mean disease duration was 9.9±6.9 years. The most prevalent comorbidities were depression (47.2%), hypertension (44.0%), and type 2 diabetes mellitus (21.5%). The logistic regression analysis revealed that hallucinations, amantadine, and catechol-O-methyltransferase inhibitors (entacapone) were independently associated with falls in PD patients. Also, hallucinations, dyskinesia, and the use of amantadine were independently associated with recurrent falls. Conclusions: Health care providers play an essential role in fall prevention in PD patients, particularly by identifying older adults experiencing dyskinesia and visual hallucinations. Prospective studies should investigate the use of amantadine as a risk factor for falls in PD patients.

Resumo Objetivo: caracterizar o conhecimento e a prática de atividades físicas em idosos diabéticos tipo 2, assistidos em um ambulatório de referência da cidade de Fortaleza, comparando-os com idosos não-diabéticos. Métodos : O estudo, do tipo transversal, envolveu 44 idosos com Diabetes Mellitus tipo 2 (DM2) e 44 sem DM2, avaliados por meio de um questionário sobre prática, recomendações, orientações e conhecimentos de atividades físicas. Os dados foram analisados por meio do teste Qui-quadrado. O nível de significância foi de p