Objective: To evaluate the efficacy of Nintendo Wii training in quality of life in Parkinson’s disease (PD) patients when compared to traditional physical therapy (PT). Methods: A randomized, single-blinded trial wit...Objective: To evaluate the efficacy of Nintendo Wii training in quality of life in Parkinson’s disease (PD) patients when compared to traditional physical therapy (PT). Methods: A randomized, single-blinded trial with 2 parallel arms was performed in a referral center for movement disorders in North-eastern, Brazil. Forty-four PD outpatients that fulfilled the eligibility criteria with mild to moderate motor impairment were randomized. Both groups executed a warm up session for 10 minutes that consisted of trunk flexion, extension and rotation, associated with upper and lower limbs stretching. The PT group followed a program that consisted of trunk and limb mobilisation, balance, muscle strengthening, rhythmic movement, postural alignment, double-task execution, bimanual tasks, and gait training. The Nintendo Wii group executed a sequence of tasks according to a previously established protocol, with similar training exercises. Duration of exercises was 40 minutes per session, 3 days per week for 4 weeks. The primary endpoint was the total score obtained in the Parkinson’s disease quality of life questionnaire (PDQ-39) translated from English to Brazilian Portuguese by Oxford outcomes. Secondary endpoints were the scores achieved by each group in the following domains of PDQ-39 scale: mobility, activities of daily living (ADL), emotional well-being, stigma, social support, cognition, communication and bodily discomfort. Assessments were performed before and after intervention in both groups with subjects in the “on” period. Results: Subjects in the Nintendo Wii group showed greater improvement in the PDQ-39 total score when compared to PT group (p = 0.01). Also, significant differences were observed in ADL, stigma, social support and communication when comparing subjects before and after intervention in the Nintendo Wii group (p < 0.05). Conclusions: The results achieved in this trial suggest that rehabilitation using Nintendo Wii may have beneficial effects in quality of life of PD subjects, when compared to traditional PT. Further larger randomised controlled-trials are necessary to reassure these results.展开更多
Introduction: Dementia is frequently associated with Parkinson’s disease, especially in later stages. Efficacy of cholinesterase inhibitors (ChI) in Alzheimer’s dementia is well established. However, treatment with ...Introduction: Dementia is frequently associated with Parkinson’s disease, especially in later stages. Efficacy of cholinesterase inhibitors (ChI) in Alzheimer’s dementia is well established. However, treatment with ChI in Parkinson’s disease dementia (PDD) remains controversial. The objective of this systematic review and meta-analysis was to assess the effects of ChI in PDD. Methods: A comprehensive literature search was performed in MEDLINE, EMBASE and Cochrane library up to March 2014 using the descriptors “Parkinson’s disease”, “dementia in Parkinson’s disease”, “cognition”, “acetylcholinesterase inhibitors”, “cholinesterase inhibitors”, “anticholinesterase agents”, “rivastigmine”, “donepezil” and “galantamine” (Pubmed search strategy). All randomized, doubleblinded, placebo-controlled trials that met the eligibility criteria and assessed the effects of ChI in PDD were considered for analysis. There were no restrictions regarding paper language. Summary effect-sizes were presented as standardized mean differences (SMD) and the pooled analysis was performed with a fixed-effects model. Outcomes considered for analysis were the Mini Mental Status Exam (MMSE) score and the cognition scale for evaluation of dementia ADAS-Cog. The degree of heterogeneity between included studies was assessed through the I2 test. Results: After a comprehensive search, 175 references were retrieved. From these, five randomized trials involving 946PDD subjects were included in the review. Four studies used donepezil and only one study used rivastigmine. The pooled analysis of five studies that assessed the effects of ChI in MMSE total score showed a SMD of 0.24 (CI 95% 0.11 - 0.38). Three studies considered the effects of ChI on Adas-Cog and the pooled results showed a SMD of 0.21 (CI 95% 0.07 - 0.35). There was no significant heterogeneity between the studies. Conclusions: The results of this systematic review and meta- analysis suggest that ChI improves cognitive impairment in PDD subjects. Despite statistically significant, the translation of these results into relevant clinical improvement should be taken with caution, as the studies did not address what would be considered a clinically significant result.展开更多
文摘Objective: To evaluate the efficacy of Nintendo Wii training in quality of life in Parkinson’s disease (PD) patients when compared to traditional physical therapy (PT). Methods: A randomized, single-blinded trial with 2 parallel arms was performed in a referral center for movement disorders in North-eastern, Brazil. Forty-four PD outpatients that fulfilled the eligibility criteria with mild to moderate motor impairment were randomized. Both groups executed a warm up session for 10 minutes that consisted of trunk flexion, extension and rotation, associated with upper and lower limbs stretching. The PT group followed a program that consisted of trunk and limb mobilisation, balance, muscle strengthening, rhythmic movement, postural alignment, double-task execution, bimanual tasks, and gait training. The Nintendo Wii group executed a sequence of tasks according to a previously established protocol, with similar training exercises. Duration of exercises was 40 minutes per session, 3 days per week for 4 weeks. The primary endpoint was the total score obtained in the Parkinson’s disease quality of life questionnaire (PDQ-39) translated from English to Brazilian Portuguese by Oxford outcomes. Secondary endpoints were the scores achieved by each group in the following domains of PDQ-39 scale: mobility, activities of daily living (ADL), emotional well-being, stigma, social support, cognition, communication and bodily discomfort. Assessments were performed before and after intervention in both groups with subjects in the “on” period. Results: Subjects in the Nintendo Wii group showed greater improvement in the PDQ-39 total score when compared to PT group (p = 0.01). Also, significant differences were observed in ADL, stigma, social support and communication when comparing subjects before and after intervention in the Nintendo Wii group (p < 0.05). Conclusions: The results achieved in this trial suggest that rehabilitation using Nintendo Wii may have beneficial effects in quality of life of PD subjects, when compared to traditional PT. Further larger randomised controlled-trials are necessary to reassure these results.
文摘Introduction: Dementia is frequently associated with Parkinson’s disease, especially in later stages. Efficacy of cholinesterase inhibitors (ChI) in Alzheimer’s dementia is well established. However, treatment with ChI in Parkinson’s disease dementia (PDD) remains controversial. The objective of this systematic review and meta-analysis was to assess the effects of ChI in PDD. Methods: A comprehensive literature search was performed in MEDLINE, EMBASE and Cochrane library up to March 2014 using the descriptors “Parkinson’s disease”, “dementia in Parkinson’s disease”, “cognition”, “acetylcholinesterase inhibitors”, “cholinesterase inhibitors”, “anticholinesterase agents”, “rivastigmine”, “donepezil” and “galantamine” (Pubmed search strategy). All randomized, doubleblinded, placebo-controlled trials that met the eligibility criteria and assessed the effects of ChI in PDD were considered for analysis. There were no restrictions regarding paper language. Summary effect-sizes were presented as standardized mean differences (SMD) and the pooled analysis was performed with a fixed-effects model. Outcomes considered for analysis were the Mini Mental Status Exam (MMSE) score and the cognition scale for evaluation of dementia ADAS-Cog. The degree of heterogeneity between included studies was assessed through the I2 test. Results: After a comprehensive search, 175 references were retrieved. From these, five randomized trials involving 946PDD subjects were included in the review. Four studies used donepezil and only one study used rivastigmine. The pooled analysis of five studies that assessed the effects of ChI in MMSE total score showed a SMD of 0.24 (CI 95% 0.11 - 0.38). Three studies considered the effects of ChI on Adas-Cog and the pooled results showed a SMD of 0.21 (CI 95% 0.07 - 0.35). There was no significant heterogeneity between the studies. Conclusions: The results of this systematic review and meta- analysis suggest that ChI improves cognitive impairment in PDD subjects. Despite statistically significant, the translation of these results into relevant clinical improvement should be taken with caution, as the studies did not address what would be considered a clinically significant result.
