A Síndrome de Fragilidade (SF) e a Doença de Parkinson (DP) podem ser expressões comuns do envelhecimento. Há abundância de evidências relatando a importância da fragilidade como causa significativa de morbidade e mortalidade entre os idosos. Especificamente em países subdesenvolvidos, como o Brasil, onde a SF tem, possivelmente, maior prevalência, o conceito de fragilidade pode ser uma ferramenta importante para a identificação rápida e eficiente de pacientes com risco aumentado de desenvolver doenças graves e irreversíveis, ou mesmo morte. Não há estudos observacionais que detalhem a relação da SF e a DP. Para mensurar a SF, estudamos 90 pacientes com DP e usamos os critérios de Fried desenvolvidos em 2001, abrangentes, sensíveis e de fácil aplicação, levando em consideração cinco fatores: velocidade de marcha, atividade física, exaustão física, força de apreensão da mão dominante e perda de peso não intencional. Mensuramos a severidade e evolução da DP através da escala Unified Parkinsons Disease Rating Scale (UPDRS), amplamente usada na literatura. Acrescentamos a estas escalas o teste Mini Exame do Estado Mental (MEEM) para melhor acompanhar a cognição. Mensuramos, então, estas três escalas, no início do estudo, após 3 meses e, finalmente, ao final do estudo, após 6 meses, entre 2 de janeiro de 2016 e 10 de julho de 2016 (183 dias). Valorizamos a comparação entre o momento incicial e final do estudo. Nesta tese procuramos observar pacientes com DP e a prevalência da SF e estudar características desta coorte que possam ter influência no aparecimento e evolução do fenótipo da SF. Procuramos avaliar correlações possíveis entre estas características, que possam ajudar a entender a SF e seus determinantes. Nesta coorte, obtivemos correlação positiva entre a idade destes pacientes e o aumento da prevalência de pacientes frágeis e pré-frágeis. O mesmo pôde ser observado em relação à escolaridade, ou seja, pacientes com menos anos de escolaridade apresentaram fenótipo pré-frágil ou frágil em maior proporção. Observamos correlação positiva e significativa entre a escala UPDRS aferida no momento inicial e o fenótipo de fragilidade ao final do estudo. Com o objetivo de aprofundar esta relação encontramos, especificamente, dentre as 4 partes da escala UPDRS, correlação específica e significativa entre a primeira parte (aspectos não motores da DP) e a evolução para fragilidade após 6 meses. Encontramos associação também entre o MEEM aferido no momento inicial e a progressão para SF ao final do estudo, achado que ajuda a corroborar a relação entre a primeira parte da escala UPDRS e a SF. Além disto, encontramos associação entre o tempo de caminhada no momento inicial do estudo e a evolução para SF e pior avaliação na escala UPDRS após 6 meses. Em associação a este achado, a presença de atividade física na rotina destes pacientes mostrou ter um efeito protetor em relação à SF. Foi significativo notar que as escalas UPDRS no primeiro momento e após 6 meses não mostraram alterações estatisticamente significativas em suas médias, de 71,20 e 70,91, respectivamente. Concluímos, assim, que devem haver fatores intrínsecos à DP com repercussão importante na evolução destes pacientes para SF. Pensamos que estes fatores estão reunidos dentro da parte I da escala UPDRS e do MEEM com estreita relação ao hábito de exercitar-se. Os fatores cognitivos, principalmente, de difícil mensuração e com ampla repercussão na vida destes pacientes, devem ser melhor estudados e valorizados em trabalhos prospectivos futuros sobre a DP e a SF / Frailty Syndrome (SF) and Parkinson\'s disease (PD). Frailty and DP may be common expressions of aging. There is an abundance of evidence reporting the importance of frailty as a significant cause of morbidity and mortality among the elderly. Specifically in underdeveloped countries, such as Brazil, where SF is possibly more prevalent, the concept of frailty can be an important tool for the rapid and efficient identification of patients at increased risk of developing serious and irreversible diseases, or even death. There is a lack of observational studies that detail the relationship between SF and PD. To measure SF, we studied 90 patients with Parkinson\'s Disease and used the Fried criteria developed in 2001, comprehensive, sensitive and easy to apply, taking into account five factors: andwalking speed, physical activity, physical exhaustion, dominant hand grasping force and unintentional weight loss. We measured the severity and progression of PD through the Unified Parkinsons Disease Rating Scale (UPDRS), widely used in the literature. We added to these scales the Mini Mental State Exam (MMSE) to better monitor cognition. We then measured these three scales at baseline, after 3 months, and finally at the end of the study, after 6 months, between January 2, 2016 and July 10, 2016 (183 days), giving priority for the period between the first moment and the last one of the study. In this thesis, we sought to observe patients with PD and the prevalence of SF and to study characteristics of this cohort that may influence the appearance and evolution of the SF phenotype. We tried to evaluate possible correlations between these characteristics, which may help to understand SF and its determinants. In this cohort, we had a positive correlation between the age of these patients and the increase in the prevalence of frail and pre-frail patients. The same could be observed in relation to schooling, that is, patients with less years of schooling presented a pre-frail or frail phenotype in greater proportion. We observed a positive and significant correlation between the UPDRS scale at baseline and the frailty phenotype at the end of the study. In order to deepen this relationship, we found, specifically among the 4 parts of the UPDRS scale, a specific and significant correlation between the first part (non-motor aspects of PD) and the evolution to frailty after 6 months. We also found an association between the MMSE measured at baseline and progression to SF at the end of the study, a finding that helps to corroborate the relationship between the first part of the UPDRS scale and SF. In addition, we found an association between the walking speed at the initial time of the study and the evolution to SF and worse evaluation on the UPDRS scale after 6 months. In association with this finding, the presence of physical activity in the routine of these patients showed to have a protective effect in relation to SF. It was significant to note that the UPDRS scales at the first moment and after 6 months did not show statistically significant changes in their means of 71.20 and 70.91, respectively. We conclude, therefore, that there must be intrinsic factors to PD with important repercussion in the evolution of these patients for the development of SF. We believe that these factors are brought together in Part I of the UPDRS and the MMSE with a close relationship to the practice of exercising. Cognitive factors, especially those that are difficult to measure and with a great repercussion in the life of these patients, should be better studied and evaluated in future prospective studies on PD and SF

A Síndrome de Fragilidade (SF) e a Doença de Parkinson (DP) podem ser expressões comuns do envelhecimento. Há abundância de evidências relatando a importância da fragilidade como causa significativa de morbidade e mortalidade entre os idosos. Especificamente em países subdesenvolvidos, como o Brasil, onde a SF tem, possivelmente, maior prevalência, o conceito de fragilidade pode ser uma ferramenta importante para a identificação rápida e eficiente de pacientes com risco aumentado de desenvolver doenças graves e irreversíveis, ou mesmo morte. Não há estudos observacionais que detalhem a relação da SF e a DP. Para mensurar a SF, estudamos 90 pacientes com DP e usamos os critérios de Fried desenvolvidos em 2001, abrangentes, sensíveis e de fácil aplicação, levando em consideração cinco fatores: velocidade de marcha, atividade física, exaustão física, força de apreensão da mão dominante e perda de peso não intencional. Mensuramos a severidade e evolução da DP através da escala Unified Parkinsons Disease Rating Scale (UPDRS), amplamente usada na literatura. Acrescentamos a estas escalas o teste Mini Exame do Estado Mental (MEEM) para melhor acompanhar a cognição. Mensuramos, então, estas três escalas, no início do estudo, após 3 meses e, finalmente, ao final do estudo, após 6 meses, entre 2 de janeiro de 2016 e 10 de julho de 2016 (183 dias). Valorizamos a comparação entre o momento incicial e final do estudo. Nesta tese procuramos observar pacientes com DP e a prevalência da SF e estudar características desta coorte que possam ter influência no aparecimento e evolução do fenótipo da SF. Procuramos avaliar correlações possíveis entre estas características, que possam ajudar a entender a SF e seus determinantes. Nesta coorte, obtivemos correlação positiva entre a idade destes pacientes e o aumento da prevalência de pacientes frágeis e pré-frágeis. O mesmo pôde ser observado em relação à escolaridade, ou seja, pacientes com menos anos de escolaridade apresentaram fenótipo pré-frágil ou frágil em maior proporção. Observamos correlação positiva e significativa entre a escala UPDRS aferida no momento inicial e o fenótipo de fragilidade ao final do estudo. Com o objetivo de aprofundar esta relação encontramos, especificamente, dentre as 4 partes da escala UPDRS, correlação específica e significativa entre a primeira parte (aspectos não motores da DP) e a evolução para fragilidade após 6 meses. Encontramos associação também entre o MEEM aferido no momento inicial e a progressão para SF ao final do estudo, achado que ajuda a corroborar a relação entre a primeira parte da escala UPDRS e a SF. Além disto, encontramos associação entre o tempo de caminhada no momento inicial do estudo e a evolução para SF e pior avaliação na escala UPDRS após 6 meses. Em associação a este achado, a presença de atividade física na rotina destes pacientes mostrou ter um efeito protetor em relação à SF. Foi significativo notar que as escalas UPDRS no primeiro momento e após 6 meses não mostraram alterações estatisticamente significativas em suas médias, de 71,20 e 70,91, respectivamente. Concluímos, assim, que devem haver fatores intrínsecos à DP com repercussão importante na evolução destes pacientes para SF. Pensamos que estes fatores estão reunidos dentro da parte I da escala UPDRS e do MEEM com estreita relação ao hábito de exercitar-se. Os fatores cognitivos, principalmente, de difícil mensuração e com ampla repercussão na vida destes pacientes, devem ser melhor estudados e valorizados em trabalhos prospectivos futuros sobre a DP e a SF / Frailty Syndrome (SF) and Parkinson\'s disease (PD). Frailty and DP may be common expressions of aging. There is an abundance of evidence reporting the importance of frailty as a significant cause of morbidity and mortality among the elderly. Specifically in underdeveloped countries, such as Brazil, where SF is possibly more prevalent, the concept of frailty can be an important tool for the rapid and efficient identification of patients at increased risk of developing serious and irreversible diseases, or even death. There is a lack of observational studies that detail the relationship between SF and PD. To measure SF, we studied 90 patients with Parkinson\'s Disease and used the Fried criteria developed in 2001, comprehensive, sensitive and easy to apply, taking into account five factors: andwalking speed, physical activity, physical exhaustion, dominant hand grasping force and unintentional weight loss. We measured the severity and progression of PD through the Unified Parkinsons Disease Rating Scale (UPDRS), widely used in the literature. We added to these scales the Mini Mental State Exam (MMSE) to better monitor cognition. We then measured these three scales at baseline, after 3 months, and finally at the end of the study, after 6 months, between January 2, 2016 and July 10, 2016 (183 days), giving priority for the period between the first moment and the last one of the study. In this thesis, we sought to observe patients with PD and the prevalence of SF and to study characteristics of this cohort that may influence the appearance and evolution of the SF phenotype. We tried to evaluate possible correlations between these characteristics, which may help to understand SF and its determinants. In this cohort, we had a positive correlation between the age of these patients and the increase in the prevalence of frail and pre-frail patients. The same could be observed in relation to schooling, that is, patients with less years of schooling presented a pre-frail or frail phenotype in greater proportion. We observed a positive and significant correlation between the UPDRS scale at baseline and the frailty phenotype at the end of the study. In order to deepen this relationship, we found, specifically among the 4 parts of the UPDRS scale, a specific and significant correlation between the first part (non-motor aspects of PD) and the evolution to frailty after 6 months. We also found an association between the MMSE measured at baseline and progression to SF at the end of the study, a finding that helps to corroborate the relationship between the first part of the UPDRS scale and SF. In addition, we found an association between the walking speed at the initial time of the study and the evolution to SF and worse evaluation on the UPDRS scale after 6 months. In association with this finding, the presence of physical activity in the routine of these patients showed to have a protective effect in relation to SF. It was significant to note that the UPDRS scales at the first moment and after 6 months did not show statistically significant changes in their means of 71.20 and 70.91, respectively. We conclude, therefore, that there must be intrinsic factors to PD with important repercussion in the evolution of these patients for the development of SF. We believe that these factors are brought together in Part I of the UPDRS and the MMSE with a close relationship to the practice of exercising. Cognitive factors, especially those that are difficult to measure and with a great repercussion in the life of these patients, should be better studied and evaluated in future prospective studies on PD and SF

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The diploma thesis deals with the non-invasive analysis of progression of Parkinson´s disease using the acoustic analysis of speach. Hypokinetic dysarthria in connection with Parkinson´s disease as well as speech parameters are described in this work. Speech parameters are sorted according to the speech component they affect. The work uses the phonation of vowels "a" speech task as the most commonly used speech task in the field of pathological speech processing, because of its resistance to demographic and linguistic characteristics of the speakers. Based on obtained knowledge, in MATLAB development enviroment were created systém for UPDRS III scale estimation. The UPDRS III scale is based on subjective diagnosis given by the doctor. At first, one individual parameter is used for the UPDRS III scale value estimation. Then the feature selection using SFFS algorithm is applied to gain feature combination with minimal estimation errror. Attention i salso paid to correlation between individual symptoms and UPDSR III scale.

Parkinson's is a chronic, progressive, neurodegenerative disease. The most common treatment is levodopa/carbidopa, which suppresses the symptoms of the disease. In this report, a cost-utility analysis of the MyFID levodopa/carbidopa micro tablet dispenser has been conducted. The method used was a continuous-time Markov chain with states based on the score in MDS-UPDRS II and MDS-UPDRS III. The model was simulated over a time horizon of five years and was started at different disease severity levels. The results obtained from the simulations were a dominant ICER for all model versions except when the simulation was started in the earliest stages of the disease, where it was moderate to high. The conclusion was that the treatment method with the micro / Parkinsons är en kronisk, progressiv, neurodegenerativ sjukdom. Den vanligaste behandlingen är levodopa/carbidopa, som undertrycker symptomen av sjukdomen. I denna rapport har en kostnadsnyttoanalys av MyFID levodopa/ carbidopa-mikrotablettdispensern genomförts. Metoden som användes var en kontinuerlig Markovkedja med tillstånd baserade på poängen i MDS-UPDRS II och MDS-UPDRS III. Modellen simulerades över en tidsperiod av fem år och startades vid olika svårighetsgrader av sjukdomen. Resultaten som erhölls från simuleringarna visade en dominerande ICER för alla modellversioner förutom när simuleringen startades i de tidigaste stadierna av sjukdomen, där den visade en måttligt till hög kostnad. Slutsatsen var att behandlingen med hjälp av mikrotablettdispensern var kostnadseffektiv i de måttliga till senare stadierna av sjukdomen.

Parkinson's disease (PD) is a progressive, neurological movement disorder. The stability of eye movements in PD is not well understood but many patients report difficulty doing tasks that require stabilized fixation and gaze. The ability to stabilize an image on the retina is critical is acquiring visual information. The purpose of this study was to compare the stability of fixational eye movements of PD patients to those of age-matched controls. Eye movements during simple fixation tasks were recorded from 66 subjects (ages 52 to 84), and 36 age-matched controls (ages 58-85). The absolute velocity of the fixational eye movements were recorded and correlated to a clinical measure of disease progression as measured by the Unified Parkinson's Disease Rating Scale (UPDRS). Unstable, non-rhythmic eye movements were seen in the PD patients. There were significant differences in the absolute velocity and standard deviation between the control group and the PD group in both the horizontal and vertical directions. The correlation of the absolute velocity to the UPDRS was not significant. Parkinson's disease does appear to affect the stability of eye movements. The instabilities in the eye movements appear to precede body tremor. This could lead to an early method for diagnosis and analysis of the disease.

Parkinson's disease (PD) is a neurodegenerative disease that affects motor abilities with increasing severity as the disease progresses. Traditional methods for diagnosing PD require specialists scoring qualitative symptoms using the motor subscale of the Unified Parkinson's Disease Rating Scale (UPDRS-III). Using force-plate data during quiet standing (QS), this study uses machine learning to target the characterization and prediction of PD and UPDRS-III. The purpose of predicting different subscores of the UPDRS-III is to give specialists more tools to help make an informed diagnosis and prognosis. The classification models employed classified PD with a sensitivity of 87.5% and specificity of 83.1%. Stepwise forward regression indicated that features correlated with base of support were most useful in the prediction of head rigidity (r-square = .753). Although there is limited data, this thesis can be used as an exploratory study that evaluates the predictability of UPDRS-III subscores using QS data. Similar prediction models can be implemented to a home setting using low-cost force plates as a novel telemedicine technique to track disease progression.

Bakgrund: Unified Parkinson’s Disease Rating Scale är ett bedömningsinstrument som är frekvent använt, både i Sverige och internationellt, inom vården för personer med Parkinsons sjukdom. Under 2001 granskades och reviderades instrumentet vilket resulterade i en ny version benämnt Movement Disorder Society Unified Disease Rating Scale. Del III av MDSUPDRS syftar till att undersöka motoriska symtom och anses viktiga i bland annat fysioterapeuters utredning och som utvärdering efter behandling. I dagsläget saknas en svensk validerad översättning av del III. Syfte: Syftet med detta arbete var att översätta del III av bedömningsinstrumentet MDSUPDRS från engelska till svenska och därefter undersöka innehållsvaliditet för den svenska versionen. Metod: Översättningen skedde genom forward translation, backward translation samt analys av innehållsvaliditet genom Content Validity Index (CVI). Översättningen undersöktes med hjälp av fem forskningspersoner, sakkunniga inom området. Validitet analyserades under två skattningsomgångar utifrån följande CVI-delar med tillhörande referensvärden: I-CVI (0,80), S-CVI/AVE (0,90) och S-CVI/UA (0,80). Resultat: Efter två omgångar skattade samtliga forskningspersoner 20 av 24 frågor som relevanta med ett I-CVI-värde på 1,0. Resterande fyra frågor uppnådde ett I-CVI-värde på 0,80. Värdena för S-CVI/AVE och S-CVI/UA var 0,97 respektive 0,83, vilket innebar att dessa översteg de uppsatta referensvärdena. Skalan kan därmed i sin helhet ses som valid, då samtliga CVI-värden uppnådde de uppsatta referensvärdena. Slutsats: Den översatta versionen kan i sin helhet betraktas som valid. / Background: The Unified Parkinson’s Disease Rating Scale is a frequently used assessment tool world wide in clinics in care of people with Parkinson’s disease. In 2001, the assessment tool were reviewed and revised, which was titled Movement Disorder Society Unified Parkinson’s Disease Rating Scale. Part III of MDS-UPDRS aims to investigate motor symptoms and is considered important in, among other things, physiotherapists' investigation, and as evaluation after treatment. Currently, a Swedish validated translation of Part III is lacking. Aim: The aim of this study is to translate part III of MDS-UPDRS from english to swedish, and then analyze content validity for the swedish version. Method: The translation was done with the use of forward translation, backward translation and the content validity was analyzed with Content Validity Index (CVI). The translation were analyzed in two rounds, with help by five individual proficient to the area. The content validity were set by following domains and reference values: I-CVI (0,80), S-CVI/AVE (0,90) and SCVI/UA (0,80). Results: After two rounds, 20 questions out of 24 reached an I-CVI of 1,0. The remaining four questions reached an I-CVI of 0,80. The values of S-CVI/AVE and S-CVI/UA were 0,97 and 0,83 which meant that it exceeded the set reference values. The integer scale can be considered valid based on the reference values on S-CVI/AVE and S-CVI/UA. Conclusion: The integer translated version of MDS-UPDRS part III can be considered valid.

This study focuses on the development of an objective, automated method to extract clinically useful information from sustained vowel phonations in the context of Parkinson’s disease (PD). The aim is twofold: (a) differentiate PD subjects from healthy controls, and (b) replicate the Unified Parkinson’s Disease Rating Scale (UPDRS) metric which provides a clinical impression of PD symptom severity. This metric spans the range 0 to 176, where 0 denotes a healthy person and 176 total disability. Currently, UPDRS assessment requires the physical presence of the subject in the clinic, is subjective relying on the clinical rater’s expertise, and logistically costly for national health systems. Hence, the practical frequency of symptom tracking is typically confined to once every several months, hindering recruitment for large-scale clinical trials and under-representing the true time scale of PD fluctuations. We develop a comprehensive framework to analyze speech signals by: (1) extracting novel, distinctive signal features, (2) using robust feature selection techniques to obtain a parsimonious subset of those features, and (3a) differentiating PD subjects from healthy controls, or (3b) determining UPDRS using powerful statistical machine learning tools. Towards this aim, we also investigate 10 existing fundamental frequency (F_0) estimation algorithms to determine the most useful algorithm for this application, and propose a novel ensemble F_0 estimation algorithm which leads to a 10% improvement in accuracy over the best individual approach. Moreover, we propose novel feature selection schemes which are shown to be very competitive against widely-used schemes which are more complex. We demonstrate that we can successfully differentiate PD subjects from healthy controls with 98.5% overall accuracy, and also provide rapid, objective, and remote replication of UPDRS assessment with clinically useful accuracy (approximately 2 UPDRS points from the clinicians’ estimates), using only simple, self-administered, and non-invasive speech tests. The findings of this study strongly support the use of speech signal analysis as an objective basis for practical clinical decision support tools in the context of PD assessment.