Thesis (Ph. D.)--University of Texas at Austin, 2008. / Vita. Includes bibliographical references.

nÃo hà / O trabalho avalia em duas fases as alteraÃÃes clÃnicas, alteraÃÃes do sono, a alteraÃÃo cognitiva e as alteraÃÃes de estruturas cerebrais atravÃs de RessonÃncia MagnÃtica (RM) e morfologia baseada em voxel (VBM) em pacientes com DoenÃa de Parkinson. Foram estudados 100 pacientes (71% masculino), com idade entre 40 e 80 anos (66,1+9,5), recrutados do AmbulatÃrio de DistÃrbios do Movimento do Hospital UniversitÃrio Walter CantÃdio. A amostra faz parte de uma coorte longitudinal (Sleep-For-PD study). Foram estudadas as alteraÃÃes do sono e seus fatores associados e preditivos. A escala de sono da DoenÃa de Parkinson (PDSS) que avalia alteraÃÃes de sono na DP, a escala Pittsburgh Sleep Quality Index (PSQI) que avalia a qualidade do sono, a escala Epworth Sleepiness Scale (ESS) que avalia o grau subjetivo de sonolÃncia e a escala Unified Parkinsonâs Disease Scale (UPDRS partes I, II, III e IV) que avalia a gravidade da doenÃa foram estudados. Os sintomas depressivos foram avaliados atravÃs das escalas Beck Depression Inventory (BDI-II) e Hospital Anxiety Depression (HAD). Os pacientes foram submetidos ao Mini Exame do Estado Mental (MEEM) que avaliou o grau de alteraÃÃo cognitiva e a escala de distÃrbio comportamental do sono REM (RBD). A dose de levodopa (DEL) foi avaliada. Pacientes com alteraÃÃes do sono (PDSS) apresentaram mais alucinaÃÃes diurnas, mais alteraÃÃo cognitiva, mais ansiedade, depressÃo e maior gravidade dos sintomas parkinsonianos (p<0,05). Pacientes com mà qualidade de sono (PSQI) tiveram mais sintomas depressivos. Os escores PDSS correlacionaram-se ainda com a funÃÃo cognitiva (MEEM), os sintomas depressivos (BDI e HAD), a qualidade do sono (PSQI), a gravidade da doenÃa e com a escala de RBD. Os escores PSQI correlacionaram-se com o MEEM, atividades de vida diÃria (UPDRS II) e sintomas de depressÃo/ansiedade (BDI e HAD). Gravidade de sintomas relacionados a atividades da vida diÃria (p=0,002), sintomas depressivos (p=0,01) e ansiedade (p=0,01) foram fatores independentes preditivos das alteraÃÃes do sono (PDSS). A DEL e o MEEM foram preditores da mà qualidade do sono (p=0,02). A escala RBD (p=0,002) e a UPDRS I (p=0,02) foram preditores do grau de sonolÃncia. ConcluÃmos que alteraÃÃes de sono, mà qualidade de sono e sonolÃncia diurna excessiva sÃo comuns na DP. As escalas PDSS, PSQI e ESS tÃm fatores associados e preditivos distintos. A escala PDSS apresenta maior abrangÃncia na avaliaÃÃo do sono na DP. Na segunda fase, foram avaliadas as estruturas cerebrais por RM, a presenÃa de alteraÃÃes cognitivas e fatores associados em 39 pacientes com DP e em 10 indivÃduos controles pareados por idade. As imagens de RM foram processadas de acordo com o protocolo para processamento de VBM. A variÃvel de desfecho usada foi o volume de substÃncia cinzenta. Nossos dados evidenciaram que pacientes com DP apresentaram maior comprometimento cognitivo e maior ansiedade. Pacientes com DP e alteraÃÃes cognitivas apresentaram maior gravidade da doenÃa. NÃo houve diferenÃa no volume de substÃncia cinzenta entre os pacientes com DP com e sem alteraÃÃes cognitivas. Estes achados provavelmente deveram-se a atrofia cerebral precoce nos pacientes cognitivamente intactos. Pacientes com DP, quando comparados aos controles, revelaram reduÃÃes de volume de substÃncia cinzenta na Ãnsula esquerda e cÃrtex prÃ-frontal esquerdo, demonstrando envolvimento assimÃtrico do cÃrebro na DP. / The present study evaluates clinical abnormalities, sleep disturbances, cognitive alterations and structural brain changes using Magnetic Resonance Imaging (MRI) with Voxel Based Morphometry (VBM) in patients with Parkinson`s Disease (PD). In the first phase of the study one hundred patients (71% male), aged between 40 and 80 years (66,1+9,5) were studied. Patients were recruited from a movement disorders clinics at Walter CantÃdio University Hospital. The study is part of a larger longitudinal cohort study (Sleep-For-PD study). Sleep abnormalities and their associated and predictive factors were scrutinized. Many clinical questionnaires were used, including the Parkinson`s Disease Sleep Scale (PDSS), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS) and the Unified Parkinsonâs Disease Rating Scale (UPDRS part I, II, III e IV). Depressive symptoms were evaluated with Beck Depression Inventory (IDB-II) and Hospital Anxiety Depression scale (HAD). The Minimental state examination (Folstein) (MMSE) evaluated the extent of cognitive dysfunction. REM sleep symptoms were evaluated by the REM Sleep Behavior Disorder (RBD) Scale. The levodopa equivalent dose was evaluated (DEL). Patients with sleep abnormalities (PDSS) had more diurnal visual hallucinations, cognitive dysfunction, anxiety, depression and worse parkinsonian symptoms (p<0.05). Patients with worse sleep quality (PSQI) had more depressive symptoms. PDSS scores were correlated with cognitive function (MEEM), depressive symptoms (BDI and HAD), sleep quality (PSQI), severity of PD and the RBD scale. PSQI scores were correlated with MMSE scores, activity of daily living symptoms (UPDRS II) and depression / anxiety (BDI e HAD). Activities of daily living (p=0.002), depressive symptoms (p=0.01) and anxiety (p=0.01) were independent predictors of sleep abnormalities (PDSS). The levodopa equivalent dose and MMSE scores were independent predictors of worse sleep quality (p=0.02). The RBD scale (p=0.002) and UPDRS I (p=0.02) were independent predictors of somnolence. We conclude that sleep disorders, disturbed sleep quality and excessive diurnal somnolence are common in PD. The PDSS, PSQI and ESS scales have distinct associated and predictive factors. PDSS scale is associated with a greater number of factors in PD patients. In the second phase of the study thirty-nine PD patients and ten control subjects were evaluated with regard to the presence of cognitive alterations. Structural brain abnormalities were also evaluated with MRI and VBM technique. The Gray matter volume was used as the ending variable. PD patients had more cognitive impairment and more anxiety. Patients with PD and cognitive alterations had worse disease severity. We found no difference in the volume of gray matter between the subgroups of PD patients with and without cognitive alterations, probably due to early brain atrophy in the patients without cognitive abnormalities. A significant reduction in gray matter volume in the left insula and left prefrontal cortex was observed when comparing PD patients in relation to controls. These findings indicate an asymmetrical brain involvement in PD, the left hemisphere being more affected.

A cross-sectional, retrospective study, using data from the Victoria Longitudinal Study, was conducted to investigate the impact of impending death on test performance on the Mini-Mental State Examination (MMSE), a measure of general cognitive functioning. Test score on the MMSE of individuals collected between one to five years before death was compared to the MMSE test score of individuals who are still alive. Results revealed a significant difference between the MMSE total score of individuals who died within three years post-measurement and survivors, and those who died between three to five years after measurement. When the individual items were analyzed, only the "WORLD" and "copy pentagon" items obtained results similar to the total score, providing support for the specificity of impending death effect on fluid abilities. The cause of death (CardioKerebro-vascular disease and non-CardioICerebro-vascular disease), however, did not differentiate the groups, suggesting that the mechanism of impending death may not be disease-related. Our results revealed that the influence of impending death on cognitive functioning could be observed on the MMSE; the source of the influence is still unknown, however. Despite the statistical significance, our findings did not appear to be clinically meaningful. As a result, our findings suggest that it may not be necessary to collect new normative data that are removed of the effects of impending death.

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Wong, Adrian. / "August 2007." / Thesis (Ph.D.)--Chinese University of Hong Kong, 2007. / Includes bibliographical references (p. 183-221). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in English and Chinese.

Thesis (Ph. D.)--University of North Texas, Aug., 2009. / Title from title page display. Includes bibliographical references.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.