No description available.

The aim of this work was to study the environmental and genetic factors for Parkinson???s disease (PD) in Chinese and Australian. Using a case-control method, environmental factors for PD were studied in a Chinese population (n=528) in Hong Kong. Current smoking (OR=0.437; p=0.013) and infrequent tea drinking (OR=1.51; p=0.02) were found to be protective factors, whereas family history and pesticide exposure during farming in females were found to be risk factors in the univariate analysis. In the multivariate analysis, current smoking reached borderline significance at the 5% level and the variables, years exposed to pesticides and family history were significant at the 10% level. Similarly, a case-control study involving 534 subjects was conducted in Australia. A positive family history was the strongest risk factor (OR=3.4; p&lt0.001). In addition, rural residency was found to be another risk factor (OR=1.8; p&lt0.001). Hypertension, stroke and well water ingestion were inversely correlated with PD (OR=0.2; p&lt0.001, OR=0.2; p&lt0.001 and OR=0.7; p&lt0.03 respectively). When genetic factors were examined in the Chinese population, no association to PD were found for the polymorphisms of the following candidate genes: CYP-2D6 debrisoquine hydroxyalse gene, dopamine transporter gene and monamine oxidase B (MAOB) gene. Furthermore, the Ala53Thr and Ala30Pro mutations of the alpha-synuclein gene were not found amongst this large Chinese population, indicating that variations of this gene are probably rare in Chinese. When candidate genes were studied amongst Caucasian Australians, the poor metaboliser genotype of CYP-2D6 was found to be weaky associated with PD (OR=1.36) in a meta-analysis. The length of the GT repeat alleles of MAOB gene were found to be significantly associated with PD (&gt188 base pair and 186 base pair) while angiotensin converting enzyme gene polymorphism was not found to be associated with PD. A pilot study was then conducted in Randwick, New South Wales to find out the latest prevalence of PD as well as putative risk factors in a random population. A validation study was carried out for a screening tool (questionnaire) for PD, which was then used for the main study. A total of 730 subjects were involved (527 in the community and 203 in institutions). The survey found that PD prevalence was between 3.6% and 4.9% (higher in aged care facilities). The putative risk factors positively identified were ???family history???(p&lt0.01) and ???exposure to chemicals at work or in surrounding environment??? (p&lt0.05). The age adjusted prevalence rate of PD revealed at least 42.5 % increase in the disease compared to 1966. We conclude that there may be an increase in the disease in Australia due to aging and other risk factors.

The aim of this work was to study the environmental and genetic factors for Parkinson???s disease (PD) in Chinese and Australian. Using a case-control method, environmental factors for PD were studied in a Chinese population (n=528) in Hong Kong. Current smoking (OR=0.437; p=0.013) and infrequent tea drinking (OR=1.51; p=0.02) were found to be protective factors, whereas family history and pesticide exposure during farming in females were found to be risk factors in the univariate analysis. In the multivariate analysis, current smoking reached borderline significance at the 5% level and the variables, years exposed to pesticides and family history were significant at the 10% level. Similarly, a case-control study involving 534 subjects was conducted in Australia. A positive family history was the strongest risk factor (OR=3.4; p&lt0.001). In addition, rural residency was found to be another risk factor (OR=1.8; p&lt0.001). Hypertension, stroke and well water ingestion were inversely correlated with PD (OR=0.2; p&lt0.001, OR=0.2; p&lt0.001 and OR=0.7; p&lt0.03 respectively). When genetic factors were examined in the Chinese population, no association to PD were found for the polymorphisms of the following candidate genes: CYP-2D6 debrisoquine hydroxyalse gene, dopamine transporter gene and monamine oxidase B (MAOB) gene. Furthermore, the Ala53Thr and Ala30Pro mutations of the alpha-synuclein gene were not found amongst this large Chinese population, indicating that variations of this gene are probably rare in Chinese. When candidate genes were studied amongst Caucasian Australians, the poor metaboliser genotype of CYP-2D6 was found to be weaky associated with PD (OR=1.36) in a meta-analysis. The length of the GT repeat alleles of MAOB gene were found to be significantly associated with PD (&gt188 base pair and 186 base pair) while angiotensin converting enzyme gene polymorphism was not found to be associated with PD. A pilot study was then conducted in Randwick, New South Wales to find out the latest prevalence of PD as well as putative risk factors in a random population. A validation study was carried out for a screening tool (questionnaire) for PD, which was then used for the main study. A total of 730 subjects were involved (527 in the community and 203 in institutions). The survey found that PD prevalence was between 3.6% and 4.9% (higher in aged care facilities). The putative risk factors positively identified were ???family history???(p&lt0.01) and ???exposure to chemicals at work or in surrounding environment??? (p&lt0.05). The age adjusted prevalence rate of PD revealed at least 42.5 % increase in the disease compared to 1966. We conclude that there may be an increase in the disease in Australia due to aging and other risk factors.

Os estudos realizados até o momento demonstram que os instrumentos descritos na literatura possuem pouca capacidade de identificar os indivíduos em risco de quedas e portanto, existe a necessidade do desenvolvimento de novos testes ou de uma bateria de testes para essa população. Este estudo teve como objetivo traduzir e validar a Escala de Equilíbrio e Marcha (GABS) para aplicação em pacientes com doença de Parkinson (DP), determinar as características clínicas que estariam associadas ao maior risco de quedas em pacientes com DP e sujeitos saudáveis e analisar a utilidade do teste de Estabilidade Postural para avaliar o risco de quedas nos pacientes com DP. Foram selecionados pacientes do Ambulatório de Distúrbios do Movimento (AEXP) do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto Universidade de São Paulo, com diagnóstico de DP e controles saudáveis. Os participantes foram avaliados por meio da versão motora simplificada da UPDRS, escalas de HY, SE, FOGQ, FES-I, BBS e GABS. Fizeram parte do estudo 107 pacientes com DP e 80 controles e pode-se verificar que a versão brasileira da GABS mostrou ser válida e confiável, com ótima consistência interna e boa confiabilidade inter e intraexaminador. Além disso, obteve validade convergente consistente, com correlações boas com outros instrumentos que avaliam o mesmo conceito. Somado a esses resultados, a GABS teve boa acurácia, sensibilidade, especificidade, valor preditivo positivo e valor positivo negativo considerável. Quando a GABS foi comparada com a BBS, as duas escalas tiveram resultados semelhantes. Entretanto, a GABS mostrou ser uma escala mais completa que a BBS, pois avalia diversos aspectos relacionados ao risco de quedas, como a instabilidade postural, alterações na marcha, o freezing e o medo de quedas, mostrando ser um instrumento mais interessante de ser utilizado em futuros ensaios clínicos e estudos prospectivos de evolução clínica da doença. Com relação às quedas, o principal ambiente relacionado às quedas nos pacientes com DP foi o doméstico e a marcha a principal causa, já nos controles o principal local das quedas também foi o doméstico e a principal causa de quedas foram os obstáculos presentes no ambiente. Além disso, maior tempo de doença e maior medo de quedas foram os fatores que mais contribuíram para explicar as quedas da população com DP. O teste de Estabilidade Postural conseguiu diferenciar os indivíduos com DP que sofreram quedas dos que não sofreram quedas, obteve correlações significativas com outros instrumentos que avaliam o equilíbrio e teve boa confiabilidade interexaminador. / Most studies to date have shown that the instruments available for the assessment of fall risk are inadequate for the identification of vulnerable individuals. Therefore, new tests assessing fall risk are strongly needed. This study aimed to translate and validate the Gait and Balance Scale (GABS) for use in patients with Parkinson\'s disease (PD), describe the clinical characteristics of a sample of patients with PD and controls that are related to the fall risk and analyze the Postural Stability test and it validity for assessing fall risk in patients with PD. We selected 107 PD patients at the Movement Disorders Outpatient Clinic of the School of Medicine of Ribeirão Preto - Universidade de São Paulo (USP) and 80 healthy controls. Participants were evaluated using the simplified version of the UPDRS motor scale, HY, SE, FOGQ, FES-I, BBS, and GABS. The Brazilian version of the GABS showed to be valid and reliable, with excellent internal consistency and good test-retest reliability. Furthermore, satisfactory convergent validity with other instruments that assess the same construct was found. In addition to these results, the GABS had good accuracy, sensitivity, specificity, positive predictive value, and negative predictive value. When the GABS was compared with the BBS, the two scales had similar results. However, the GABS showed to be more complete and could analyze more aspects related to fall risk in PD, as postural instability, gait deficits, freezing and fear of falling. Among controls, most falls also occurred indoors, however, they were mostly related to environmental hazards, and not gait. Longer disease duration and greater fear of falling were the factors that most contributed to explain falls in the population with PD. The Postural Stability test is able to differentiate individuals with PD who had experienced falls from those who had not, had significant correlation with others balance instruments and had good interexaminer reliability.

Os estudos realizados até o momento demonstram que os instrumentos descritos na literatura possuem pouca capacidade de identificar os indivíduos em risco de quedas e portanto, existe a necessidade do desenvolvimento de novos testes ou de uma bateria de testes para essa população. Este estudo teve como objetivo traduzir e validar a Escala de Equilíbrio e Marcha (GABS) para aplicação em pacientes com doença de Parkinson (DP), determinar as características clínicas que estariam associadas ao maior risco de quedas em pacientes com DP e sujeitos saudáveis e analisar a utilidade do teste de Estabilidade Postural para avaliar o risco de quedas nos pacientes com DP. Foram selecionados pacientes do Ambulatório de Distúrbios do Movimento (AEXP) do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto Universidade de São Paulo, com diagnóstico de DP e controles saudáveis. Os participantes foram avaliados por meio da versão motora simplificada da UPDRS, escalas de HY, SE, FOGQ, FES-I, BBS e GABS. Fizeram parte do estudo 107 pacientes com DP e 80 controles e pode-se verificar que a versão brasileira da GABS mostrou ser válida e confiável, com ótima consistência interna e boa confiabilidade inter e intraexaminador. Além disso, obteve validade convergente consistente, com correlações boas com outros instrumentos que avaliam o mesmo conceito. Somado a esses resultados, a GABS teve boa acurácia, sensibilidade, especificidade, valor preditivo positivo e valor positivo negativo considerável. Quando a GABS foi comparada com a BBS, as duas escalas tiveram resultados semelhantes. Entretanto, a GABS mostrou ser uma escala mais completa que a BBS, pois avalia diversos aspectos relacionados ao risco de quedas, como a instabilidade postural, alterações na marcha, o freezing e o medo de quedas, mostrando ser um instrumento mais interessante de ser utilizado em futuros ensaios clínicos e estudos prospectivos de evolução clínica da doença. Com relação às quedas, o principal ambiente relacionado às quedas nos pacientes com DP foi o doméstico e a marcha a principal causa, já nos controles o principal local das quedas também foi o doméstico e a principal causa de quedas foram os obstáculos presentes no ambiente. Além disso, maior tempo de doença e maior medo de quedas foram os fatores que mais contribuíram para explicar as quedas da população com DP. O teste de Estabilidade Postural conseguiu diferenciar os indivíduos com DP que sofreram quedas dos que não sofreram quedas, obteve correlações significativas com outros instrumentos que avaliam o equilíbrio e teve boa confiabilidade interexaminador. / Most studies to date have shown that the instruments available for the assessment of fall risk are inadequate for the identification of vulnerable individuals. Therefore, new tests assessing fall risk are strongly needed. This study aimed to translate and validate the Gait and Balance Scale (GABS) for use in patients with Parkinson\'s disease (PD), describe the clinical characteristics of a sample of patients with PD and controls that are related to the fall risk and analyze the Postural Stability test and it validity for assessing fall risk in patients with PD. We selected 107 PD patients at the Movement Disorders Outpatient Clinic of the School of Medicine of Ribeirão Preto - Universidade de São Paulo (USP) and 80 healthy controls. Participants were evaluated using the simplified version of the UPDRS motor scale, HY, SE, FOGQ, FES-I, BBS, and GABS. The Brazilian version of the GABS showed to be valid and reliable, with excellent internal consistency and good test-retest reliability. Furthermore, satisfactory convergent validity with other instruments that assess the same construct was found. In addition to these results, the GABS had good accuracy, sensitivity, specificity, positive predictive value, and negative predictive value. When the GABS was compared with the BBS, the two scales had similar results. However, the GABS showed to be more complete and could analyze more aspects related to fall risk in PD, as postural instability, gait deficits, freezing and fear of falling. Among controls, most falls also occurred indoors, however, they were mostly related to environmental hazards, and not gait. Longer disease duration and greater fear of falling were the factors that most contributed to explain falls in the population with PD. The Postural Stability test is able to differentiate individuals with PD who had experienced falls from those who had not, had significant correlation with others balance instruments and had good interexaminer reliability.

No description available.

Hintergrund: Das idiopatische Parkinson-Syndrom (IPS) ist die zweithäufigste neurode-generative Erkrankung nach Morbus Alzheimer. Bei über 60-Jährigen liegt die Prävalenz bei bis zu zwei Prozent. Die somatischen Symptome verursachen vielfältige Beeinträchtigungen der Grob- und Feinmotorik und damit der Alltagsaktivitäten, viele Patienten leiden zusätzlich unter neuropsychiatrischen Symptomen. Das prominenteste neuropathologische Korrelat des IPS ist der Untergang dopaminerger Neurone in der Substantia Nigra. Dessen Ursachen sind nicht vollständig bekannt. Mit der Dopaminsubstitution steht eine erfolgreiche, jedoch nur symptomatische Therapie der chronisch progredienten Erkrankung zur Verfügung. Epidemiologisch besteht ein bidirektionaler Zusammenhang zwischen dem IPS und depressiven Störungen. Bis zu 40% der IPS-Patienten leidet unter klinisch relevanten depressiven Symptomen (IPS-D). Einige von ihnen erfüllen nicht die gängigen Diagnosekriterien depressiver Störungen, leiden jedoch unter vergleichbaren Einschränkungen der Lebensqualität und des Funktionsniveaus. IPS-D ist ferner mit schnellerem Krankheitsprogress, höherer Angehörigenbelastung, Heimunterbringung und höheren sozioökonomischen Kosten assoziiert. In der Praxis ist von einer Untererkennung und -versorgung der IPS-D auszugehen. Die Spontanremissionsraten sind gering, auch bei Patienten unter antidepressiver medikamentöser Therapie bleibt häufig eine Restsymptomatik bestehen. Die pathogenetischen Mechanismen der IPS-D sind nur teilweise verstanden, es ist von einem komplexen Vulnerabilitäts-Stress-Modell mit neurobiologischen und psychosozialen Komponenten auszugehen. Ferner bestehen vermutlich Subtypen der IPS-D mit unterschiedlichen Ursachenkonstellationen und therapeutischen Bedürfnissen. Medikamentöse Interventionen sind weniger wirksam als bei primären depressiven Störungen. Psychosoziale Interventionen, speziell kognitive Verhaltenstherapie, sind ersten Studien zufolge eine vielversprechende Therapieoption. Die Zugangsbarrieren zu Psychotherapie sind jedoch relativ hoch. Das Ziel der vorliegenden Arbeit war die Entwicklung einer niederschwelligen, speziell auf die IPS-D zugeschnittenen psychoedukativen Gruppenintervention. Hierfür wurde didaktisch und inhaltlich auf edukative Patientenprogramme zum IPS sowie Techniken der Psychoedukation und kognitiven Verhaltenstherapie als am besten beforschten Psychotherapieverfahren primärer depressiver Störungen zurückgegriffen. Es wurde eine multi-modale, ressourcenaktivierende, neunwöchige Intervention konzipiert, in deren Rahmen Informationen vermittelt und praktische Übungen zur Krankheitsbewältigung durchgeführt werden. In einem zweiten Schritt sollte Durchführbarkeit, Akzeptanz und subjektive Nützlichkeit sowie die Wirksamkeit der entwickelten Intervention auf die IPS-D an einer Patien-tenstichprobe evaluiert werden. Es wurde postuliert, dass sich die Intervention als gut durchführ bar erweist, von den Patienten gut angenommen wird und dass die fremd- und selbstgeratete Depressivität, das Belastungserleben und subjektive psychische Wohlbefinden durch die Intervention gebessert werden. Forschungsmethoden: Zur Überprüfung der Hypothesen wurde eine unizentrische, raterverblindete Studie mit kontrollierter Randomisierung und Wartekontrollgruppe an einer Patientenstichprobe mit IPS-D durchgeführt. Es erfolgte eine randomisierte Zuweisung der Teilnehmer zu Kontroll- (KG) oder Interventionsgruppe (IG) nach entsprechend des Ergebnis der Montgomery-Åsberg Depression Rating Scale (MADRS) stratifizierten Paaren. Aufgrund von Rekrutierungsproblemen wurden Teilnehmer der KG später in die IG eingeschlossen. Insgesamt wurden 26 Patienten in die Studie eingeschlossen, fünf von ihnen brachen die Teilnahme ab oder wurden aufgrund von Verletzungen des Studienprotokolls ausgeschlossen, fünf nahmen sowohl an KG als auch IG teil. Somit konnten 26 Fälle unter Berücksichtigung der zweifach allokierten Patienten und 19 Patienten gemäß Studienprotokoll ausgewertet werden. Zur Evaluation des Programms kamen entsprechende Fragebögen zum Einsatz. Primäres Outcomemaß der Wirksamkeitsprüfung war die fremdgeratete Depressivität gemäß MADRS. Weiterhin wurden bei Studienbeginn, unmittelbar postinterventionell sowie nach weiteren sechs Monaten selbstgeratete Depressivität, Lebensqualität, Belastungserleben, subjektives Wohlbefinden, Funktionsniveau und somatische Parameter der Erkrankung erhoben. Zur Auswertung des mehrfaktoriellen Versuchsplans mit zwei Faktorstufen (Gruppen) und drei Messzeitpunkten mit abhängigen Stichproben und Stichprobenziehung mit Zurücklegen wurden unter anderem Varianzanalysen mit Messwiederholung und lineare kovarianzanalytische Modelle mit drei Prüffaktoren und Ausgangswertadjustierung erstellt. Ergebnisse: Die Intervention erwies sich als gut durchführbar und wurde durch die Pati-enten gut akzeptiert. Die Rücklaufquote der Evaluationsfragebögen war mit 90% gut. Die meisten Patienten bewerteten das Programm als anschaulich und verständlich, die orga-nisatorischen Rahmenbedingungen als gut und die Inhalte als „hilfreich“. Insbesondere der Austausch mit Gleichbetroffenen wurde positiv bewertet. Es zeigte sich eine ausreichende Konzentrationsfähigkeit und bis auf wenige Ausnahmen ein gutes Verständnis der vermittelten Inhalte. In der per Protokoll analysierten Stichprobe konnten keine signifikanten Interventionseffekte nachgewiesen werden. Für die laut Studienprotokoll ausgewerteten ersten zwei Interventionsdurchgänge zeigte sich im Verglich mit der KG eine mit d=1,1 starke Reduktion der gesamten sowie der rein psychischen depressiven Symptomatik (Gesamtstichprobe: d=0,2 bzw. d=0,6), welche jedoch nur für die erstgenannte Teilstichprobe und nur unter Auslassung der somatischen Symptome statistische Signifikanz erreichte. Mit 38,5% erreichte ein nahezu signifikant größerer Teil der IG der Gesamtstichprobe Remission (p=0,063), bei 69,2% war die psychische Symptomatik mindestens um zwei Punkte gebessert, was als Minimum klinischer Relevanz gesehen wird. Die Effekte konnten über den Katamnesezeitraum nicht aufrechterhalten werden. In KG und IG kam es zu unterschiedlich starken Veränderungen der einzelnen depressiven Symptome mit einer stärkeren Reduktion von Traurigkeit, Untätigkeit und Suizidgedanken in der IG. Als Moderatorvariable der Treatmentresponse wurde lediglich die Teilnahme an einem der drei Interventions-Durchgänge identifiziert. Es konnten keine Interventionseffekte auf die wei-teren erhobenen psychischen Parameter erreicht werden. Schlussfolgerungen: In Anbetracht der spärlichen Studienlage und des hohen Bedarfs hat diese Untersuchung einer niederschwelligen psychosozialen Intervention zur Besserung der IPS-D einen Beitrag zum Erkenntnisgewinn geleistet. Zum Zeitpunkt des Studienbeginns war noch keine, aktuell sind nur drei kontrollierte Studien dieser Art publiziert. Das untersuchte Gruppenprogramm hat sich als gut durchführbar und für die Patienten annehmbar und subjektiv hilfreich erwiesen. Leider konnten mit den gewählten Untersuchungsmethoden zusammenfassend keine signifikanten Interventionseffekte auf die IPS-D nachgewiesen werden. Dennoch wurde, je nach Analyseverfahren, eine mäßige bis starke Reduktion der depressiven Kernsymptomatik in der IG erreicht, welche im Vergleich zu anderen unkontrollierten und kontrollierten Studien im Gruppensetting als etwas gleichwertig einzuschätzen ist, im Vergleich zu Einzel-KVT jedoch als geringer. Es zeigte sich, dass die Gruppenzusammensetzung Auswirkungen auf den Erfolg der Intervention haben kann. Die Divergenz von fremdgerateter Depressivität, subjektiver Nützlichkeit und anderen Maßen psychischen Wohlbefindens weist darauf hin, dass durch die Intervention möglicherweise positive Veränderungsprozesse angestoßen, nicht aber abgeschlossen wurden. Die untersuchte Intervention kann nach leichter Modifizierung, insbesondere dem Einbezug von Angehörigen, eine hilfreiche Ergänzung im Behandlungsplan der IPS-D darstellen. Bei Persistenz der depressiven Symptomatik sollte jedoch individualisierte KVT und Pharmakotherapie zum Einsatz kommen. Es erscheint wichtig, ins Bewusstsein zu rücken, dass die IPS-D keine unabwendbare Begleiterscheinung des IPS sein muss. Neben weiterer Forschung zu psychosozialen Interventionen in verschiedenen Settings sollte die Abgrenzung verschiedener IPS-D-Subtypen mit Blick auf die Wahl verschiedener therapeutischer Strategien vorangetrieben werden. Dies gilt auch für die Wahl des optimalen Zeitpunktes, der Intensität und inhaltlichen Schwerpunktsetzung psychosozialer Interventionen wie der untersuchten.

A Doença de Parkinson, uma condição neurodegenerativa e progressiva, está relacionada à morte de neurônios localizados na Substância Negra compacta, um dos componentes dos Núcleos da Base. Quando há a morte de neurônios dopaminérgicos nigrais, esta via modulatória é perdida, levando ao desequilíbrio entre as vias direta e indireta, esta última tendo sua atividade aumentada em detrimento da outra. O estriado tem um papel importante no recebimento e filtração de sinais motores corticais e talâmicos e suas maiores populações neuronais são GABAérgicas, demonstrando a importância do neurotransmissor GABA nesta modulação. O estriado recebe projeções dopaminérgicas vindas da Substância Negra compacta e, na falta desta aferentação, surgem os sintomas e sinais da Doença de Parkinson. Nosso objetivo é caracterizar a liberação de GABA nesta estrutura, avaliando os efeitos de outros transmissores e também o papel de alguns sinalizadores intracelulares neste processo. Para isto, empregamos o método de superfusão e liberação de GABA radiomarcado, previamente carregado, em tecido picado in vitro. A lesão nigral é produzida por cirurgia estereotáxica e microinjeção de 6-OHDA no feixe medial prosencefálico (mfb). Diversas drogas foram utilizadas para avaliarmos diferentes passos na liberação do transmissor. Concluímos que a liberação é fortemente dependente de cálcio e segue o modelo de exocitose vesicular, além de a subpopulação neuronal GABAérgica estrital estudada sofrer pouca influência de aferências glutamatérgicas e colinérgicas. No entanto, drogas dopaminérgicas regulam complexamente a liberação de GABA no estriado e ela também é bastante dependente de calmodulina. Conjecturamos se algumas drogas antipsicóticas que agem sobre calmodulina devem seu efeito terapêutico, ou parte dele, a esta ação e se, no modelo de DP de lesão unilateral por 6-OHDA, há comunicação entre os hemisférios lesado e não lesado após o estabelecimento da lesão e processo de rearranjo neuronal / Parkinsons disease, a progressive and neurodegenerative condition, is related to the death of neurons located in Substantia Nigra compacta, a component of Basal Ganglia. When nigral dopaminergic neurons die, this modulatory pathway is lost leading to imbalance between direct and indirect pathways, the latter having its activity increased over the former. Striatum has an essential role in receiving and filtering motor signals from cortex and thalamus and its major neuronal populations are composed by GABAergic neurons, showing how important is GABA in this modulation. Striatum receives dopaminergic projections from Substantia Nigra compacta and in its absence the typical signals and symptoms of the disease arise. We aimed to characterize GABA relase at this structure, assessing the effect of other transmitters as well the role of some intracellular signaling molecules in this process. For that, we employed the superfusion method and release of preloaded radiolabeled GABA from chopped striatal tissue. Nigral injury was produced by stereotaxic surgery and 6-OHDA microinjection at medial forebrain bundle (mfb). Several drugs were used to evaluate different steps in transmitter release. We concluded that the release is strongly calcium-dependent and follows vesicular exocytosis model; in addition the striatal GABAergic subpopulation of neurons studied here undergo little influence of glutamatergic and cholinergic afferents. However, dopaminergic drugs complexly regulate striatal GABA release and it also shows high involvement of calmodulin. We wonder if some antipsychotic drugs that act over calmodulin owe their therapeutical effects, or at least part of it, to this activity and if in 6-OHDA unilateral lesion parkinsonism model there is communication between injuried and healthy hemispheres after the establishment of the injury and neuronal rearrangement process

Resumo: A população com doença de Parkinson (DP) convive com um distúrbio neurodegenerativo, crônico e progressivo que mesmo com uma terapia farmacológica ótima, não vê cessar o seu agravamento. A prática de atividades físicas (AF) é uma medida sustentável necessária para atingir os objetivos do seu tratamento, e atender as demandas atuais da saúde pública. O hábito de praticar atividade física é melhor abordada por meio de modelos teóricos da mudança do comportamento. O presente estudo objetivou analisar os fatores associados à prática de atividades físicas em parkinsonianos, utilizando o Modelo Transteorético e a Teoria Cognitivo-Social. A pesquisa foi de delineamento transversal do tipo descritivo correlacional. Participaram do estudo 65 indivíduos (de ambos os gêneros; com 66 l 9 anos de idade) diagnosticados com DP, vinculados aos serviços de saúde do município de Rio Claro e região ou à Associação Brasil-Parkinson situada na cidade de São Paulo. Foi utilizado um questionário composto por: dados pessoais, nível da gravidade da doença, estágios de mudança do comportamento, auto-eficácia, preferências em relação à prática de atividade física e barreiras percebidas. A interpretação dos resultados permitiu concluir que as variáveis da teoria cognitivo-social (auto-eficácia e percepção de barreiras) são potenciais mediadores da prática de AF em parkinsonianos. Além disso, eles já mantêm ou cogitam praticar AF regularmente; estão em média confiantes que podem superar algumas barreiras; percebem barreiras principalmente no domínio físico (bradicinesias, perda do equilíbrio, acinesias, rigidez muscular, ter uma doença, tremores, medo de cair), seguido pelo domínio da motivação (preguiça) e domínio ambiental (falta de companhia, clima ruim); seus tipos de AF preferidas são a caminhada... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The population with Parkinson's disease (PD) faces a neurodegenerative, chronic and progressive disturbance, which even under an optimum pharmacological therapy it does not cease its aggravation. The practice of physical activities (PA) is a necessary and sustainable strategy that contributes for attaining both the treatment goals, and meeting the current demands of the public health. The habit of exercising is better approached by behavior change theoretical models. The present study aims to analyze the correlates of PA practice in Parkinson's disease patients, based on the Transtheoretical Model and the Social Cognitive Theory. It was a cross-sectional and descriptivecorrelational research design. Sixty-five individuals (both gender; 66 l 9 yearold) with diagnosis of PD; under medical treatment; living at Rio Claro or São Paulo city and their surrounding areas and; being affiliated or not to Brazil-Parkinson Association. A questionnaire comprising personal data, disease severity level, behavior change stage, self-efficacy, preferences and perceived barriers regarding the practice of PA, was applied. Data were analyzed by means of descriptive statistics and mostly by the Spearman correlation test. The results interpretation allowed concluding that the Social Cognitive Theory variables (self-efficacy and perceived barriers) are potential mediators of PA in Parkinson's disease patients. Besides, they are already intending to or actually practicing PA on a regular basis; on average, they are confident that they are able to overcome some barriers; they perceive barriers mainly those in the physical domain ( bradikinesias, balance loss, akinesias, muscular rigidity, have a disease, tremors, fear of falling), followed by those in the motivation domain (laziness) and third, those in the environmental domain... (Complete abstract, click electronic access below) / Orientador: Sebastião Gobbi / Coorientador: José Luiz Riani Costa / Banca: Tânia Rosane Bertoldo Benedetti / Banca: Florindo Stella / Mestre

A Doença de Parkinson, uma condição neurodegenerativa e progressiva, está relacionada à morte de neurônios localizados na Substância Negra compacta, um dos componentes dos Núcleos da Base. Quando há a morte de neurônios dopaminérgicos nigrais, esta via modulatória é perdida, levando ao desequilíbrio entre as vias direta e indireta, esta última tendo sua atividade aumentada em detrimento da outra. O estriado tem um papel importante no recebimento e filtração de sinais motores corticais e talâmicos e suas maiores populações neuronais são GABAérgicas, demonstrando a importância do neurotransmissor GABA nesta modulação. O estriado recebe projeções dopaminérgicas vindas da Substância Negra compacta e, na falta desta aferentação, surgem os sintomas e sinais da Doença de Parkinson. Nosso objetivo é caracterizar a liberação de GABA nesta estrutura, avaliando os efeitos de outros transmissores e também o papel de alguns sinalizadores intracelulares neste processo. Para isto, empregamos o método de superfusão e liberação de GABA radiomarcado, previamente carregado, em tecido picado in vitro. A lesão nigral é produzida por cirurgia estereotáxica e microinjeção de 6-OHDA no feixe medial prosencefálico (mfb). Diversas drogas foram utilizadas para avaliarmos diferentes passos na liberação do transmissor. Concluímos que a liberação é fortemente dependente de cálcio e segue o modelo de exocitose vesicular, além de a subpopulação neuronal GABAérgica estrital estudada sofrer pouca influência de aferências glutamatérgicas e colinérgicas. No entanto, drogas dopaminérgicas regulam complexamente a liberação de GABA no estriado e ela também é bastante dependente de calmodulina. Conjecturamos se algumas drogas antipsicóticas que agem sobre calmodulina devem seu efeito terapêutico, ou parte dele, a esta ação e se, no modelo de DP de lesão unilateral por 6-OHDA, há comunicação entre os hemisférios lesado e não lesado após o estabelecimento da lesão e processo de rearranjo neuronal / Parkinsons disease, a progressive and neurodegenerative condition, is related to the death of neurons located in Substantia Nigra compacta, a component of Basal Ganglia. When nigral dopaminergic neurons die, this modulatory pathway is lost leading to imbalance between direct and indirect pathways, the latter having its activity increased over the former. Striatum has an essential role in receiving and filtering motor signals from cortex and thalamus and its major neuronal populations are composed by GABAergic neurons, showing how important is GABA in this modulation. Striatum receives dopaminergic projections from Substantia Nigra compacta and in its absence the typical signals and symptoms of the disease arise. We aimed to characterize GABA relase at this structure, assessing the effect of other transmitters as well the role of some intracellular signaling molecules in this process. For that, we employed the superfusion method and release of preloaded radiolabeled GABA from chopped striatal tissue. Nigral injury was produced by stereotaxic surgery and 6-OHDA microinjection at medial forebrain bundle (mfb). Several drugs were used to evaluate different steps in transmitter release. We concluded that the release is strongly calcium-dependent and follows vesicular exocytosis model; in addition the striatal GABAergic subpopulation of neurons studied here undergo little influence of glutamatergic and cholinergic afferents. However, dopaminergic drugs complexly regulate striatal GABA release and it also shows high involvement of calmodulin. We wonder if some antipsychotic drugs that act over calmodulin owe their therapeutical effects, or at least part of it, to this activity and if in 6-OHDA unilateral lesion parkinsonism model there is communication between injuried and healthy hemispheres after the establishment of the injury and neuronal rearrangement process