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- Speech and voice response to a Levodopa challenge in late-stage Parkinson’s diseasePublication . Fabbri, Margherita; Guimarães, Isabel; Cardoso, Rita; Coelho, Miguel; Guedes, Leonor Correia; Rosa, Mário M; Godinho, Catarina; Abreu, Daisy; Gonçalves, Nilza; Antonini, Angelo; Ferreira, JoaquimBackground: Parkinson’s disease (PD) patients are affected by hypokinetic dysarthria, characterized by hypophonia and dysprosody, which worsens with disease progression. Levodopa’s (l-dopa) effect on quality of speech is inconclusive; no data are currently available for late-stage PD (LSPD). Objective: To assess the modifications of speech and voice in LSPD following an acute l-dopa challenge. Method: LSPD patients [Schwab and England score <50/Hoehn and Yahr stage >3 (MED ON)] performed several vocal tasks before and after an acute l-dopa challenge. The following was assessed: respiratory support for speech, voice quality, stability and variability, speech rate, and motor performance (MDS-UPDRS-III). All voice samples were recorded and analyzed by a speech and language therapist blinded to patients’ therapeutic condition using Praat 5.1 software. results: 24/27 (14 men) LSPD patients succeeded in performing voice tasks. Median age and disease duration of patients were 79 [IQR: 71.5–81.7] and 14.5 [IQR: 11–15.7] years, respectively. In MED OFF, respiratory breath support and pitch break time of LSPD patients were worse than the normative values of non-parkinsonian. A correlation was found between disease duration and voice quality (R = 0.51; p = 0.013) and speech rate (R = −0.55; p = 0.008). l-Dopa significantly improved MDS-UPDRS-III score (20%), with no effect on speech as assessed by clinical rating scales and automated analysis. conclusion: Speech is severely affected in LSPD. Although l-dopa had some effect on motor performance, including axial signs, speech and voice did not improve. The applicability and efficacy of non-pharmacological treatment for speech impairment should be considered for speech disorder management in PD.
- Undernutrition in institutionalized elderly patients with neurological diseases: comparison between different diagnostic criteriaPublication . Miranda, Diana; Cardoso, Rita; Gomes, R; Guimarães, Isabel; Abreu, Daisy; Godinho, C; Pereira, P; Domingos, Josefa; Pona, N; Ferreira, JoaquimObjectives: To determine and compare the frequency of undernutrition in institutionalized elderly patients with neurological diseases at admission using different nutritional assessment tools. Design: Cross-sectional observational study. Setting: One long-term care institution specialized in neurodegenerative diseases. Participants: 92 Elderly people (aged ≥ 65 years) with at least one neurological condition. Measurements: Mini Nutritional Assessment (MNA), body mass index (BMI), mid-arm (MAC) and calf circumferences (CC) were used for nutritional status assessment. Presence and severity of dysphagia, polypharmacy and feeding difficulties were also assessed. Results: According to MNA, 77.1% of the participants were undernourished at admission. BMI identified 46.8%, MAC identified 44.6% and CC identified 22.8% of undernourished participants. Undernutrition was more frequent in Alzheimer’s disease, stroke and dementia syndromes. 63% had dysphagia for at least one food consistence and most of these patients were malnourished. MNA revealed best concordance with BMI and MAC than with CC. BMI and feeding difficulties were the major risk factors for undernutrition. Conclusion: Undernutrition prevalence in institutionalized elderly with neurological diseases at admission is high. Nutritional assessment tools revealed low concordance between them.
- Psychosocial impact of Parkinson’s disease-associated dysarthria: cross-cultural adaptation and validation of the Dysarthria Impact Profile into european portuguesePublication . Cardoso, Rita; Guimarães, Isabel; Santos, Helena; Loureiro, Rita; Domingos, Josefa; Abreu, Daisy; Gonçalves, Nilza; Pinto, Serge; Ferreira, JoaquimAim: The present study sought to make a cross-cultural adaptation of the Dysarthria Impact Profile (DIP) for European Portuguese (EP) and validate it for use in Parkinson’s disease (PD) patients. Methods: The cross-cultural adaptation was carried out in accordance with the guidelines. The EP version of the DIP was administered to 80 people with PD, and 30 sex- and age-matched control participants. Psychometric properties, acceptability, feasibility reliability (internal consistency and intrarater agreement) and validity (construct, convergent and known-groups validity) were assessed using other assessment tools (motor disability and impairment, and voice impact). Results: Overall, the EP-DIP final version has the same conceptual meaning, semantics, idiomatic and score equivalences as the original version. Statistical analyses showed adequate feasibility (missing data <5%), good acceptability (ceiling or floor effects <15%; high requests of assistance to complete the questionnaire), satisfactory internal consistency (Cronbach’s α = 0.9), weak-to-moderate intrarater reliability, good construct validity, strong convergent validity (with the Voice Handicap Index; Spearman’s P = −0.8) and good known-groups validity (between those with PD and control participants). Conclusions: The EP-DIP version displays the salient features of a valid patient-based assessment tool used to measure the psychosocial impact of slight-to-mild dysarthria in people with PD.
- Dysphagia predicts poor outcome in late-stage Parkinson's diseasePublication . Fabbri, Margherita; Coelho, Miguel; Abreu, Daisy; Guedes, Leonor Correia; Rosa, Mario M; Godinho, Catarina; Cardoso, Rita; Guimarães, Isabel; Antonini, Angelo; Zibetti, Maurizio; Lopiano, Leonardo; Ferreira, Joaquim J
- Cross-cultural adaptation and validation of the swallowing disturbance questionnaire and the sialorrhea clinical scale in portuguese patients with Parkinson’s diseasePublication . Cardoso, Rita; Guimarães, Isabel; Santos, Helena; Carvalho, Joana; Abreu, Daisy; Gonçalves, Nilza; Ferreira, JoaquimIntroduction: To date, no valid outcome measure has been developed in European Portuguese (EP) to evaluate the Parkinsons’ Disease (PD) patients’ (PwP) reports regarding their swallowing disturbances. Objectives: The aim of this study was to translate and cross-culturally adapt the Swallowing Disturbance Questionnaire (SDQ) and the Sialorrhea Clinical Scale for PD (SCS-PD) into EP and to determine its clinimetric properties in PwP. Materials and Methods: The original English SDQ and SCS-PD versions were cross-culturally adapted following recommendations established in international guidelines. The validation process involved 75 PwP and 65 healthy sex- and age-matched participants. Results: The EP versions of the SDQ and SCS-PD are equivalent to the original versions (content, depth, and scoring). Statistical analyses for the SDQ tool revealed good feasibility (missing data <5%), acceptability (no floor or ceiling effects), excellent internal consistency (Cronbach's = 0.95), good construct validity (78.5% revealed large to moderate loadings), moderate convergent validity (r = 0.60), good divergent validity (r = 0.40), good known-groups validity (p-value<.05) and a fair sensitivity and specificity (AUC = 0.700). Statistical analyses for the SCS-PD tool shows good feasibility, reasonable acceptability (floor effect), good internal consistency (Cronbach's a¼0.85), good construct validity (85.7% showed between large to moderate loadings), good convergent validity (r = 0.78), good divergent validity (r = 0.39), good known groups validity (p-value < .05) and a fair sensitivity and specificity (AUC = 0.704). Conclusions: The EP versions of the SDQ and SCS-PD maintained the characteristics of the original versions and therefore consistent tools to be used in PwP.
- Frenchay dysarthria assessment (FDA-2) in Parkinson’s disease: cross-cultural adaptation and psychometric properties of the european portuguese versionPublication . Cardoso, Rita; Guimarães, Isabel; Santos, Helena; Loureiro, Rita; Domingos, Josefa; Abreu, Daisy; Gonçalves, Nilza; Pinto, Serge; Ferreira, JoaquimHypokinetic dysarthria is a common symptom in those with Parkinson’s disease (PD); there is currently no standardized or validated tool for assessing speech in this population. To translate into European Portuguese (EP) the FDA-2 and perform a cultural adaptation followed by an evaluation of its psychometric properties in PD in a sample of people with PD in different stages of disease progression. Translation, back-translation, experts’ analysis, pretest and final version test were performed. The EP version of the FDA-2 was administered to 80 people with PD (PwP) with dysarthria, feasibility and acceptability, reliability (internal consistency and inter-rater reliability) and validity (face and convergent) were measured. Overall, the EP-FDA-2 proved to be similar to the original demonstrating the same conceptual meanings, semantics, idiomatic and score equivalences. It has good feasibility (missing data\5 %), acceptability (ceiling and floor effects \15 %), a high reliability of the total score (0.94), an excellent inter-rater agreement for the total score (0.96) and moderate to large construct validity for 81 % of its items. It is well correlated with the gold standard for disease severity assessment in PD, the MDS-UPDRS. The EPFDA- 2 has shown the salient features of a valid tool that can be used by speech and language therapists in the assessment of dysarthria in PD in clinical practice as in the research field.