Frailty phenotype and the role of levodopa challenge test in geriatric inpatients with mild parkinsonian signs

Abstract

Deficiency in dopaminergic system function may be one of the hypothetical reasons of the frailty syndrome but its role still remains unclear. The aim of our study was to assess the frailty phenotype prevalence in geriatric inpatients with mild parkinsonian signs (MPS) and to investigate levodopa test in the frail patients with MPS. We examined 118 participants: 90 with MPS and 28 in control group (without MPS). The frailty syndrome presence was evaluated by the Fried criteria. Deficiency in dopaminergic system function was assessed by one of the modifications of an acute levodopa challenge test (LCT): in MPS group every patient was examined by performing Up and Go Test and also Step Test before and 3 h after taking 125 mg of Madopar (levodopa + benserazide). Sixty-nine study subjects (58%) met criteria for frailty. Fifty-five participants in MPS group (61.1% of MPS group) and fourteen (50%) in control group. All of the patients that scored positive in walk speed criterion of frailty were frail. When all MPS patients were considered, the number of components scored positive for frailty was directly related to the walk speed (r = -0.70, p < 0.0001). In MPS group LCT scores were significantly higher for frailty patients compared to non-frailty (p = 0.0027). When all MPS patients were considered, the number of components scored positive for frailty was directly related LCT score (r = 0.37, p = 0.0004). There was a relationship between LCT and walk speed (r = -0.31, p = 0.0032). Our observations provide new information about the relationship between frailty and MPS, suggest the need for increased awareness of frailty in MPS patients and conversely. Our study provides data for a discussion on pathophysiological background of the frailty syndrome (FS), emphasizing the theories of the important impact of dopaminergic system deficit and encourages further research on the role of LCT in measuring it.

Fragilidade e doença de Parkinson

“…alterações hormonais, mediadores inflamatórios, alterações da modulação imunológica, a sarcopenia (Vetrano et al, 2018a) -com perda de massa, força e função muscular, deficiência dopaminérgica (Seiffert et al, 2017) e deficiências de vitaminas, como a vitamina D (Ruiz et al, 2012). Múltiplos sistemas (gastrointestinal, urinário, imunológico, entre outros) estão obrigatoriamente envolvidos, porém a SF está, frequentemente, ligada ao baixo desempenho cognitivo, físico (Kehler et al, 2018) e da mobilidade do indivíduo (Cesari et al, 2016a,b;Dent et al, 2016;Brinkman et al, 2018).…”

“…O fenótipo desenvolvido por Fried et al (2001), no entanto, destaca-se, ainda nos dias de hoje, como a forma mais difundida para o diagnóstico da SF (Nunes et al, 2015;Op het Veld et al, 2015;Cesari et al, 2016b). Sua aplicação é de fácil e imediata execução, pois não envolve grande curva de aprendizado (Chang, Lin, 2015;Seiffert et al, 2017). Seus dados são potencialmente simples e podem ser coletados em diversos ambientes (Da Mata et al, 2016;Griffin et al, 2018) e profissionais da saúde, sendo comparados tanto transversalmente (Op het Veld et al, 2015) como longitudinalmente (Griffin et al, 2018).…”

“…Apesar disto, como afirmado em parágrafos anteriores, há poucos trabalhos na literatura relacionando o seguimento da DP com a SF (Ahmed et al, 2008;Roland et al, 2012a,b,c;Roland et al, 2014;Seiffert et al, 2017;Li et al, 2010) pois, normalmente, estudos com SF excluem de sua coorte doenças neurodegenerativas.…”

“…Apesar da DP e a SF apresentarem etiologias diferentes, estão potencialmente relacionadas quanto ao prognóstico (Ahmed et al, 2008), e a progressão de ambas converge para um estado de incapacidade igualmente grave e incapacitante. Não é difícil verificar a razão disto se considerarmos, como explicitado em parágrafos anteriores, que a disfunção dos gânglios da base na DP pode desencadear um desequilíbrio estrutural nos vários sistemas fisiológicos do idoso resultando em sarcopenia, ataxia de marcha, depressão e, principalmente, redução drástica da capacidade do paciente para realizar as atividades da vida diária e da vida civil e laborativa (Ahmed et al, 2008;Li et al, 2010;Chaudhuri et al, 2011;Vetrano et al, 2018 (Li et al, 2010;Seiffert et al, 2017;Onder et al, 2018;Vetrano et al, 2018b), mas o campo parece estar apenas começando a ser explorado.…”

The Future of Ageing: not more of the same

“…Mitnitski et al (2017) present their network model of health deficits to better understand how changes in health are captured by the frailty index, FI. Similarly, the condition of the elderly is measurable by using simple tests, such as Up-and Go test, which can be very useful for assessing the muscle strength (Zarzeczny et al 2017), and the frailty syndrome involving the role of the dopaminergic system (Seiffert et al 2017). …”