La manifestación de su presencia
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A detailed description of the used instruments is given below. Neuropsychiatric manifestations.
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They were indicated as present according to the following items from the neuropsychiatric inventory NPI 5 : Delusions ; Hallucinations ; Apathy or indifference and Depression or dysphoria. It was considered present if 1 or more positive answers were reported. It was classified as a absent, without clinical evidence of cognitive disorder or b present, with or without repercussion in the daily life. The classification was according to clinical evaluation and the MMP score.
In this test a score below 24 points is suggestive of cognitive disorder 9. It was considered to be abnormal if at least 1 of the following manifestations existed: a constipation: Less than 3 bowel movements per week; b urinary frequency: urinating 1 or more times each 2 hours on the day or more than 2 times per night; c erectile dysfunction and d symptomatic orthostatic hypotension.
They were considered to be present if insomnia or diurnal somnolence were reported. To evaluate the relationship between NMM and subtypes of motor manifestations the total UPDRS motor score was divided into 6 motor domains, as previously described 8. Tremor scored from 0 to 28 , rigidity scored from 0 to 20 , bradykinesia scored from 0 to 36 , facial expression and speech scored 0 to 4 each one and axial impairment scored from 0 to In addition, the motor domains were grouped into 2 subscores that represented predominantly dopaminergic subscore A: tremor, rigidity, bradykinesia, and facial expression and nondopaminergic subscore B: speech and axial impairment deficiency based on levodopa responsiveness 8.
All patients were on antiparkinsonian therapy. Statistical analysis. Groups were defined as with or without each manifestation. The correlations were established by means of spearman's rank correlation coefficient.
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Later a multivariable logistic regression analysis was done to establish the factor s that better explained the onset of NMM. The analysis included age of onset, time of evolution of the PD, clinical characteristics of the disease and demographical variables. In those cases with significant multivariable analysis a loess test was applied to determine the linearity of the associations.
The statistics software SSPS A total of patients were included 55 women.
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Table 1 shows the characteristics of the population. Wearing off in The NMM were present in patients One NMM was present in The characteristics of the patients for each NMM are shown in Table 2. Neuropsychiatric manifestations were present in The multivariable analysis showed that the years of evolution of PD are a main risk factor for the development of cognitive disorder and autonomic failure.
Also the non-dopaminergic score is a risk factor for the cognitive disorder.
Dyskinesia appeared as a risk factor for the development of sleep disorders Table 2. It is noteworthy that the non-dopaminergic index calculated as indicated from the UPDRS III is correlated with all the NMM, whereas the dopaminergic index is correlated only with neuropsychiatric and cognitive manifestations. In this ambulatory movement disorder center-based study, we evaluated some characteristics of the PD patients for assessing the role of demographic and clinical features on the development of NMM.
We have found that the features associated with the onset of NMM in our population, are mainly those related to the progression of the PD. This study shows that neuropsychiatric manifestations and autonomic dysfunction have a similar pattern of risk factors. The years of evolution of the PD and the presence of cognitive dysfunction appear as risk factors for these NMM, probably reflecting a common pathogenic mechanism involved linked to the progression of the neurodegenerative process.
A recent study has shown that dementia in PD patients is associated with significantly more impairment in autonomic, depressive and psychotic domains 13 as is also shown in our study. Additionally, we report here that the axial impairment as reflected by the non dopaminergic index is related to the cognitive dysfunction.
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