Muscle strength and executive function as complementary
					parameters for the assessment of impairment in Parkinson's
					disease

Barbirato, Dannyel; Carvalho, Alessandro; Araujo, Narahyana Bom de; Martins, José Vicente; Deslandes, Andrea

doi:10.1590/0004-282X20130175

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ARTICLES • Arq. Neuro-Psiquiatr. 71 (12) • 01 Dec 2013 • https://doi.org/10.1590/0004-282X20130175 copy

Muscle strength and executive function as complementary parameters for the assessment of impairment in Parkinson's disease

Força muscular e função executiva como parâmetros complementares para a avaliação do comprometimento da doença de Parkinson

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective

To evaluate the relationship between the quantitative results of functional and cognitive performance of patients with Parkinson's disease (PD) and disease severity; and to study the relationship between patients' functional and cognitive capacity and motor impairment (Unified Parkinson's Disease Rating Scale - UPDRS III).

Method

Twenty-nine subjects clinically diagnosed with PD were classified into three groups according to disease severity using the modified Hoehn and Yahr Scale (H&Y). They were submitted to functional (Senior Fitness Test) and neuropsychological tests. Stepwise regression analysis showed a significant association between H&Y and upper limb strength (r ² =0.30; p=0.005) and executive function (r ² =0.37; p=0.004). In relation to UPDRS III, there was a significant association between lower limb strength (r ² =0.27; p=0.010) and global cognitive status (r ² =0.24; p=0.024).

Conclusion

The implementation of simple tests of functional capacity associated with neuropsychological testing can help to assess disease severity and motor impairment, and can be used to monitor the response to treatment in PD.

Parkinson's disease; cognitive function; functional capacity; executive function; disease severity

	Group 1	Group 2	Group 3
	H&Y (1–1.5)	H&Y (2–2.5)	H&Y (3)	F	p
	n=6 (4M / 2F)	n=17 (14M / 3F)	n=6 (3M / 3F)
Age (years) ^a	59.50 (58.00–66.50)	63.00 (53.50–72.50)	64.00 (58.75–77.00)	0.968	0.616
Weight (kg)	72.81±19.12	69.81±15.87	65.17±10.25	0.367	0.696
Height (cm)	168.33±9.14	167.00±8.91	161.33±5.81	1.261	0.301
Education (years)	7.50 (6.25–9.75)	8.50 (5.00–15.75)	6.00 (5.00–9.50)	0.875	0.689
Duration of disease (years)	6.33±3.67	5.65±2.52	6.00±2.28	0.149	0.863
Comorbidities (n ^o ) ^a	1.50 (1.00–2.00)	1.00 (0.50–2.00)	1.00 (0.75–2.00)	0.773	0.680
Medications (n ^o ) ^a	2.50 (1.75–3.25)	2.00 (2.00–3.00)	3.00 (2.00–3.25)	0.674	0.714
UPDRS III motor (score)	24.83±9.20 ^b	35.71±10.10	43.17±7.47 ^b	5.727	0.009 ^c
MMSE (score) ^a	28.00 (27.75–29.25)	26.00 (24.00–28.50)	23.00 (20.75–27.50)	5.839	0.054
Hamilton (score)	3.67±2.16	6.94±4.34	7.50±4.72	1.702	0.202

Functional capacity	Group 1	Group 2	Group 3	F	P
	H&Y (1–1.5)	H&Y (2–2.5)	H&Y (3)
	n=6 (4M / 2F)	n=17 (14M / 3F)	n=6 (3M /3F)
Berg Balance Scale (points)	53.33±2.80	51.88±3.50	50.50±5.28	0.836	0.445
Functional Reach (cm)	25.88±8.99	24.13±6.89	28.23±10.57	0.578	0.568
8-Foot UP and Go Test (seconds) ^a	8.22 (7.95–10.35)	9.87 (8.47–11.31)	11.54 (7.78–15.16)	1.917	0.383
TUG modified (seconds)	10.43±1.78	14.31±6.01	14.14±4.17	1.337	0.280
10 Meter Walk Test (seconds) ^a	7.52 (5.80–8.57)	7.21 (5.89–8.12)	9.85 (6.67–13.15)	2.048	0.359
2-Minute Step Test (repetitions) ^a	63.50 (49.00–77.75)	54.00 (39.50–78.00)	30.00 (22.50–53.50)	3.479	0.176
Arm Curl Test (repetitions)	17.17±3.76 ^b	14.41±4.15	11.17±3.54 ^b	3.440	0.047 ^c
Chair Stand Test (repetitions)	12.60±4.04	10.71±3.37	8.67±2.07	1.987	0.158
Back Scratch Test (cm)	-19.50±14.72	-25.85±12.48	-24.75±13.73	0.519	0.601
Chair Sit and Reach Test (cm) ^a	-16.00 (0.00–21.25)	0.00 (0.00–(-16.50))	-9.50 (-3.75–(-15.88))	2.158	0.340

Cognitive aspects	Group 1	Group 2	Group 3	F	P
	H&Y (1–1.5)	H&Y (2–2.5)	H&Y (3)
	n=6 (4M / 2F)	n=17 (14M / 3F)	n=6 (3M /3F)
TMT A (seconds) ^a	44.00 (35.75–64.00)	82.00 (38.00–103.00)	99.00 (54.00–129.25)	2.754	0.252
TMT B (seconds)	118.50±48.89	184.64±135.79	147.80±106.53	0.723	0.496
Stroop Core Test (seconds) ^a	25.00 (17.75–28.50)	30.50 (24.25–34.00)	34.50 (26.00–65.00)	4.517	0.104
Digit Foward Test (score)	5.83±1.47	5.35±1.97	4.33±1.75	1.072	0.357
Digit Backward Test (score) ^a	5.00 (3.75–6.00)	5.00 (3.50–6.00)	2.50 (2.00–4.25)	5.177	0.075
Digit Symbol Test (score)	24.00±10.14	17.75±10.87	12.17±9.83	1.899	0.171
Similarities (score)	16.00±2.97	16.41±5.44	13.83±5.04	0.601	0.556
Verbal Fluency Test (score)	21.17±5.00	18.82±3.84	13.00±5.66 ^b	5.521	0.010*
Rey Figure (score) ^a	33.00 (30.75–34.00)	29.00 (17.25–33.75)	22.00 (12.50–31.00)	4.694	0.096
Rey Figure delayed recall (score)	19.17±9.28 ^c	9.46±6.59	5.00±4.47	6.215	0.008 ^d

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[1] Correspondence : Andrea Deslandes; Rua Sylvio da Rocha Pollis 300 / casa 02 / Barra da Tijuca; 22793-395; Rio de Janeiro; RJ - Brasil; E-mail: camazdeslandes@gmail.com