Distúrbios cognitivos na doença de Parkinson: correlações eletrencefalográficas

Abstract

RESUMO -62 pacientes com diagnóstico de doença de Parkinson idiopática e 30 pacientes controle foram avaliados quanto a distúrbios mnemônicos e psíquicos, utilizando-se os critérios do DSM III-R, o mini-mental e a escala de Hamilton para depressão. Todos foram submetidos a eletrencefalograma (EEG) com fotoestimulação intermitente. Dos pacientes parkinsonianos, 24,2% apresentavam depressão psíquica, 14,5% ansiedade, 12,9% distimia, 3,2% demência e 45,2% não apresentavam quaisquer alterações de acordo com os critérios dos DSM III-R. Nos EEG evidenciavam-se ondas teta bilaterais com predomínio fronto-temporal ou temporal, com maior comprometimento à esquerda, em 58,1% desses pacientes. Em apenas 16 (7%) dos pacientes controle tais achados foram observados, porém, em nenhum dos dois grupos ocorreram alterações no EEG pela fotoestimulação. As alterações do EEG foram estatisticamente significantes quando se compararam pacientes parkinsonianos com pacientes controle (p<0,001); o mesmo não ocorreu quando se compararam pacientes parkinsonianos que apresentavam distúrbio psíquico com aqueles que não o apresentavam. PALAVRAS-CHAVE: doença de Parkinson, depressão, distúrbios cognitivos, alterações eletrencefalográficas. Mental impairment in Parkinson disease: clinical and electroencephalographic correlationsSUMMARY -Sixty-two patients with idiopathic Parkinson disease and 30 patients of a control group were clinically evaluated in the light of cognitive and/or psychic impairments according to DSM III-R, mini-mental state examination and Hamilton rating scale for depression. These patients were also submitted to electroencephalogram registration (EEG) with photic stimulation. From the parkinsonian group, 45.2% did not have mental manifestations as classified in the DSM III-R. Other 24.2% had depression, 14.5% had anxiety, 12,9% had dysthymic disorder and 3.2% had dementia. Considering the EEG, 58.1% of the parkinsonian patients had theta waves bilaterally, with predominance in frontal temporal or temporal areas, though more frequent on the left hemisphere than on the right one. Only 16.7% of the patients from the control group had these same findings in the EEG but neither of the two groups had their EEG modified by photic stimulation. The EEG findings were statistically significant when both groups were compared. However, these findings were not significant comparing parkinsonian patients with psychic impairment with the ones who did not have such impairments.KEY WORDS: Parkinson disease, depression, cognitive impairment, electroencephalographic findings. Na descrição original da doença que leva o seu nome, James Parkinson (1817) não menciona comprometimento intelectual e/ou cognitivo nesses pacientes. Somente no final do século XIX

Dementia, Mild Cognitive Impairment and Quantitative EEG in Patients with Parkinson's Disease

“…In the present PD study, the finding of cognitive changes in 53% of the cases, of which 22% of the individuals had dementia and 31% mild cognitive impairment, was within the ranges of prevalence found in the literature. 2,21 The PD patients showed greater slowing down on the qEEG as compared to healthy individuals in a way similar to other studies, 8 –10 and an association was shown between this increase in amplitudes in the slow ranges and the occurrence of dementia. 3,4,6,22…”

“…2 –7 Initial evaluations in patients with PD using the EEG showed a slowing of the basal rhythm in the posterior regions, associated with an increase in diffuse theta activity, or even slow, intermittent focal waves. 8,9 An increase in slow activities was also reported using the quantitative EEG (qEEG). 4,6,10 These alterations in the EEG and qEEG only occurred in PD patients with associated dementia.…”

Diagnóstico e manejo da demência da doença de Parkinson e demência com corpos de Lewy: recomendações do Departamento Científico de Neurologia Cognitiva e do Envelhecimento da Academia Brasileira de Neurologia

“…Furthermore, a prominent posterior slow-wave EEG activity with periodic fluctuations in the pre-alpha/theta range is a supportive biomarker for DLB diagnosis 56 . Some Brazilian studies have investigated the quantitative EEG changes concerning cognitive decline in PD patients, showing increased posterior theta and delta amplitude in patients with MCI-PD or PDD 57 ),( 58 and differences in EEG power and coherence in AD and PDD 59 ),( 60 .…”

“…Além disso, atividade no eletroencefalograma (EEG) de onda lenta posterior proeminente com flutuações periódicas na faixa pré-alfa / teta constitui um biomarcador de suporte no diagnóstico de DCL, sendo útil na distinção entre DCL e DA 56,57 . Estudos prévios com coortes brasileiras investigaram as mudanças quantitativas no EEG relacionadas ao declínio cognitivo em pacientes com DP, e encontraram amplitude posterior teta e delta aumentada em pacientes com CCL por DP ou DDP 57,58 , assim como diferenças no padrão do EEG entre DA e DDP 59,60 .…”

Diagnosis and management of Parkinson’s disease dementia and dementia with Lewy bodies: recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology

“…Furthermore, a prominent posterior slow-wave EEG activity with periodic fluctuations in the pre-alpha/theta range is a supportive biomarker for DLB diagnosis 56 . Some Brazilian studies have investigated the quantitative EEG changes concerning cognitive decline in PD patients, showing increased posterior theta and delta amplitude in patients with MCI-PD or PDD 57,58 and differences in EEG power and coherence in AD and PDD 59,60 .…”