Risco de disfagia, força muscular respiratória e tempo máximo de fonação em idosos com Doença de Parkinson em estágio inicial: estudo observacional

Abstract

Introduction: Parkinson's disease (PD) is a chronic idiopathic disease of the central nervous system, which leads to progressive neuronal loss in the ventrolateral cell group of the compact part of the black matter of the midbrain, causing neurotransmitter dopamine depletion. As a result, tremor develops at rest, muscle stiffness and bradykinesia. Although PD also causes non-motor symptoms related to the main causes of death in these individuals, scientific research mainly addresses neuromotor symptoms. Objective: To analyze the risk of dysphagia, respiratory muscle strength (FMR) and maximal phonation time (MPT) in elderly patients with Parkinson's disease in the initial stages. Method: an observational study in the elderly with PD in the initial stages (Hoen & Yahr modified 0-3), enrolled in the Comprehensive Attention Centers of the Best Age - CAIMIS Dr. Paulo Lima and Dr. André Araújo - in Manaus, Amazonas, Brazil. We evaluated the risk of dysphagia with the Eating Assessment Tool (EAT-10) questionnaire; FMR by manovacuometry and vocal behavior by TMF (sustained fricatives / s / and / z / e of its s / z ratio). The absolute and relative absolute frequencies for the categorical data were presented. For the quantitative data, when the normality hypothesis was accepted using the Shapiro-Wilk test, the mean and the standard deviation were calculated. When the normality hypothesis was rejected, the median and the interquartile range (IIQ) were calculated. In the comparison of means in relation to categorical variables, the t-student test was applied. The Mann-Whitney test was used to compare the medians. In the analysis of the quantitative data the Pearson's Correlation Coefficient and the t-student test were calculated to verify if the Coefficient was nonzero. The software used was Minitab® version 17 for Windows®. The level of significance was 5%. Results: In the elderly with PD in the early stages there was a higher risk of dysphagia, lower FMR and association of respiratory and phonological components. FMR worsened within 3 years of follow-up, and as PEmáx decreased, the risk of dysphagia increased. Conclusion: In the elderly with PD, there was alteration of respiratory and phonatory variables, even at the beginning of the disease, demonstrating that the evaluation of these variables should be a propaedeutic and, if altered, therapeutic target, not awaiting respiratory, swallowing and / or phonatory symptoms.