Deep Brain Stimulation (DBS) is a widely used surgical technique in individuals with Parkinson's disease (PD) that can lead to significant reductions in motor symptoms.ObjectivesTo determine, from publications, the most commonly used instruments for cognitive evaluation of individuals with PD undergoing DBS.MethodsA systematic review of the databases: PubMed, Medline, EBECS, Scielo and LILACS was conducted, using the descriptors "Deep Brain Stimulation", "Verbal Fluency", "Parkinson Disease", "Executive Function", "Cognition" and "Cognitive Assessment" in combination.ResultsThe Verbal Fluency test was found to be the most used instrument for this investigation in the studies, followed by the Boston Naming Test. References to the Stroop Test, Trail Making Test, and Rey's Auditory Verbal Learning Test were also found.ConclusionsThe validation of instruments for this population is needed as is the use of batteries offering greater specificity and sensitivity for the detection of cognitive impairment.
Introduction Subthalamic nucleus deep brain stimulation (STN-DBS) improves motor function in individuals with Parkinson disease (PD). The evidence about the effects of STN-DBS on the voice is still inconclusive. Objective To verify the effect of STN-DBS on the voice of Brazilian individuals with PD. Methods Sixteen participants were evaluated on the Unified Parkinson Disease Rating Scale—Part III, and by the measurement of the acoustic modifications in on and off conditions of stimulation. Results The motor symptoms showed significant improvement with STN-DBS on. Regarding the acoustic measures of the voice, only the maximum fundamental frequency (fhi) showed a statistical difference between on- and off-conditions, with reduction in off-condition. Conclusion Changes in computerized acoustic measures are more valuable when interpreted in conjunction with changes in other measures. The single finding in fhi suggests that DBS-STN increases vocal instability. The interpretation of this result should be done carefully, since it may not be of great value if other measures that also indicate instability are not significantly different.
Subthalamic nucleus deep brain stimulation (STN-DBS) is a surgical technique to treat motor symptoms in patients withParkinson's disease (PD). Studies have shown that STN-DBS may cause a decline in verbal fluency performance. We aimed to verify the effects of STN-DBS on the performance of phonemic verbal fluency in Brazilian PD patients. Sixteen participants were evaluated on the Unified Parkinson's Disease Rating Scale -Part III and for phonemic fluency ("FAS" version) in the conditions of on-and off-stimulation. We identified two different patterns of phonemic verbal fluency outcomes. The results indicate that there may be no expected pattern of effect of bilateral STN-DBS in the phonemic fluency, and patients may present with different outcomes for some reason not well understood.Keywords: Parkinson disease; deep brain stimulation; language; cognition. RESUMOA estimulação cerebral profunda do núcleo subtalâmico (ECP-NST) é uma técnica cirúrgica para tratar sintomas motores na doença de Parkinson (DP). Estudos têm mostrado que ECP-NST pode causar um declínio no desempenho de fluência verbal. O objetivo do estudo foi verificar os efeitos da ECP-NST sobre o desempenho da fluência verbal fonêmica em indivíduos brasileiros com DP. Dezesseis participantes foram avaliados quanto ao desempenho motor (UPDRS-III) e à fluência verbal fonêmica (versão "FAS") nas condições de estimulação ligada e desligada. Identificamos dois padrões diferentes de resultados de fluência verbal fonêmica. Os resultados indicam que pode não haver um padrão esperado de efeito de ECP-NST bilateral na fluência fonêmica, e os pacientes podem apresentar desfechos diferentes de acordo com alguma razão não bem compreendida.Palavras-chave: doença de Parkinson; estimulação encefálica profunda; linguagem; cognição. Subthalamic nucleus deep brain stimulation (STN-DBS)is a procedure used to treat patients with Parkinson's disease (PD) when pharmacological treatment is no longer efficient 1 . It has been proven that DBS suppresses motor symptoms and reduces the total dose of the antiparkinsonian drugs 2,3 . Among the adverse effects of STN-DBS in patients with PD, the postoperative decline in verbal fluency is well documented 4,5,6,7,8,9,10,11 . However, there are fewer studies about the effect of the stimulation per se, comparing on-and off-stimulation conditions 12,13,14 . Longitudinal studies verified a worsening of verbal fluency in the first months after surgery, but an improvement in the later studied months 9 . These authors suggest that this effect of the DBS on the verbal fluency may be due to the micro-lesions caused by the implantation procedure of the electrodes in the STN.The verbal fluency test evaluates the capacity to search and retrieve data stored in long-term memory within a certain category and demonstrates the capacities of
Palliative care extends the focus on the disease's look to the patient and his family, with a proposal that is present since the diagnosis, remaining concomitant with the diseasemodifying treatment and growing as it approaches the final phase of life. Dying slowly means that there will be more time to think about death and the possibility of what to do with it. At this time, the externalization of desires and outbursts about this process of mourning still in life requires the viability of the organs essential for the speech function when they are no longer present or no longer produce the same movements or the lungs are not as strong enough to make themselves heard it becomes a challenge for the watering of the water to complete. Therefore, this brief communication brings a reflection on the audiologist's performance in the aid of the communication of the patients in palliative care, well next to the team, considering their technical training to the linguistic aspects involved in this process.
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