The aim of this study was to investigate the prevalence of patent foramen ovale (PFO) in a consecutive unselected cohort of migraine patients (with and without aura) and compare it with a group of ischaemic young and elderly stroke patients. One hundred and forty-one migraine patients were compared with 330 stroke patients (130 young patients; 200 elderly patients) selected from our hospital stroke data bank. PFO was assessed with transcranial Doppler sonography with i.v. injection of agitated saline. The prevalence of PFO was 51.7% in migraine with aura (MA) patients, 33.7% in migraine without aura (MoA) patients, 33.8% in young stroke patients and 20.5% in elderly stroke patients (P < 0.001). The prevalence of PFO in cryptogenic stroke in young and elderly stroke patients was, respectively, 41.1% and 25% (P = 0.04). The difference between MA and MoA patients was significant (odds ratio = 2.1). The prevalence of PFO in MA patients is higher than in MoA patients and in young cryptogenic stroke patients.

Cross-cultural adaptation and independent psychometric assessment of the Scales for Outcomes in Parkinson's disease-Cognition (SCOPA-COG), Brazilian version was performed. Parkinson's disease (PD) patients were evaluated by means of the SCOPA-Motor scale, Hoehn and Yahr staging (HY), Clinical Impression of Severity Index-PD (CISI-PD), Parkinson Psychosis Rating Scale, and Hospital Anxiety and Depression Scale. Cognition was evaluated using the MiniMental State Examination (MMSE), Short Portable Mental Status Questionnaire (SPMSQ), and SCOPA-COG. The following attributes were explored: acceptability, scaling assumptions, reliability, precision, and construct validity. One hundred fifty-two patients were assessed (mean age, 63.2 years; disease duration, 7.8 years; median HY stage, 3). Mean SCOPA-COG and MMSE were 18.2 and 25.7, respectively. The internal consistency of the SCOPA-COG (Cronbach's alpha ϭ 0.81; item-total correlation, 0.38 -0.62) was satisfactory. While the intraclass correlation coefficient value was 0.80, weighted kappa ranged from 0.30 (dice task) to 0.72 (animal fluency task). The standard error of measurement value for the SCOPA-COG was 3.2, whereas the smallest real difference was 8.9. SCOPA-COG total scores significantly decreased as the HY stage increased (Kruskal-Wallis, P Ͻ 0.0001). Age, years of education, and PD duration (all, P Ͻ 0.001) were observed to have an independent, significant effect on the SCOPA-COG. The SCOPA-COG is a short, reliable, valid instrument that is sensitive to cognitive deficits specific to PD. © 2007 Movement Disorder SocietyKey words: SCOPA-COG; Parkinson's disease; precision; predictors; psychometric attributes According to a recent systematic review of prevalence studies of dementia in Parkinson's disease (PD), 24 to 31% of PD patients have dementia, and 3 to 4% of the dementia population may be attributable to PD. 1 About 50% of patients with dementia-free PD are found to have mild cognitive impairment. Significant risk factors for the development of dementia in PD include increasing age, older age at diagnosis, longer disease duration, increasing severity of motor symptoms, and the onset of hallucinations. [1][2][3][4][5][6][7] Although the Mini-Mental State Examination (MMSE) has been extensively used for cognitive assessment of PD patients, it has some limitations. The MMSE has a significant ceiling effect and fails to cover a full range of cognitive domains, particularly global and executive functions. Alternative cognitive screening methods, such as the Cambridge Cognitive Assessment (CAMGOG), 8 have been proposed. However, the CAM-COG is not a specific tool for cognitive evaluation in PD. Recently, a specific cognitive questionnaire for PD, the Scales for Outcomes in Parkinson's disease-Cognition (SCOPA-COG), has been developed. 9 The Latin American population is becoming older, and the proportion of people with PD and dementia is expected to increase accordingly. 10 In coming decades, population aging may be more pronounced in Brazil, a countr...

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Cross-cultural adaptation and psychometric assessment of the Scales for Outcomes in Parkinson's Disease-Autonomic questionnaire (SCOPA-AUT) Brazilian Portuguese version. 150 consecutive Parkinson's disease (PD) patients were evaluated by means of the SCOPA-motor scale (SCOPA-M), SCOPA-cognition (SCOPA-COG), Hoehn and Yahr staging (H&Y), nonmotor symptoms scale (NMSS), PD questionnaire (PDQ-39), and SCOPA-AUT. The following psychometric attributes were explored: acceptability, scaling assumptions, reliability, precision, and construct validity. Patients' age (mean +/- standard deviation) was 63.1 +/- 11.1 years (56.7% men; duration of disease, 8.7 +/- 5.3 years; median H&Y, 2). Mean SCOPA-AUT was 23.0 +/- 11.2. SCOPA-AUT did not show floor or ceiling effect. As a whole, the SCOPA-AUT item-domain correlation was satisfactory, except for items 2 (Saliva), 7 (Faecal incontinence), 16 (Syncope), and 19 (Cold intolerance) (|r(S)| = 0.03-0.32). Internal consistency was adequate, except for thermoregulatory and cardiovascular domains (alpha coefficients, 0.56 and 0.63, respectively). Intraclass correlation coefficient for the total score was 0.71, whereas weighted kappa for individual items ranged from 0.15 to 0.71 (only items 4 and 7 were <0.40). Standard error of measurement was 6.04. The SCOPA-AUT total score correlated closely with the NMSS total score (r(S) = 0.65) and PDQ-39 Summary Index (r(S) = 0.61) and at a moderate level with H&Y staging (r(S) = 0.35) and SCOPA-MS total score (r(S) = 0.39) (all r(S) values, P < 0.0001). Correlation of SCOPA-AUT with SCOPA-COG was weak. SCOPA-AUT significantly increased as the H&Y stage increased (Kruskal-Wallis, P < 0.0001). The SCOPA-AUT Brazilian Portuguese version is an acceptable, reliable, and valid questionnaire to evaluate autonomic dysfunction in PD.

The objective of this study was to illustrate the analysis of longitudinal validity, responsiveness, and importance of change, using the SCOPA-Psychosocial Questionnaire (SCOPA-PS) as a source of empirical data. Sixty-seven patients with PD in Hoehn and Yahr (HY) stage 2 were followed up for 1 year and assessed by means of the Schwab and England Scale, Unified PD Rating Scale (UPDRS), Hospital Anxiety and Depression Scale (HADS), PDQ-39, and SCOPA-PS. A range of methods was applied to enable each of the target attributes to be analyzed from different conceptual stances. The SCOPA-PS displayed satisfactory acceptability (no floor or ceiling effect), internal consistency (alpha = 0.80-0.84), convergent validity (r(S) = 0.70-0.82 with PDQ-39), and precision (SEM = 8.80), both at baseline and at the end of follow-up. The threshold value for significant change ranged from 17.25 (1.96 SEM) to 24.39 (Smallest real difference and Reliable change index). Threshold values for a clinically meaningful change were 0.73-1.26 (effect size, standardized response mean, responsiveness statistic). Change in SCOPA-PS scores correlated strongly with change in total UPDRS, HADS, and PDQ-39 scores, and reliably detected 70% of cases that worsened according to the PDQ-39. The minimally important change (MIC) for "minimally impaired" patients as per the PDQ39 was 8.30-9.10 points. Indices such as 1.96 SEM, effect size, and correlation with the change in other measures provide useful information about different concepts of responsiveness. The MIC should be determined for each specific setting, using distribution- and anchor-based methods. The SCOPA-PS showed satisfactory longitudinal attributes and responsiveness in stage-2 Brazilian patients with PD across 1 year of follow-up.