Parkinson Hastalığında Kırılganlık ile Fiziksel Fonksiyon Arasındaki İlişki

Year 2022, , 115 - 122, 14.01.2022

Sevim Acaröz Candan Tuba Şaziye Özcan

https://doi.org/10.33631/sabd.1055463

Abstract

Amaç: Bu çalışma, Parkinson hastalığında (PH) kırılganlık ile fiziksel fonksiyon arasındaki ilişkiyi belirlemeyi ve kırılganlık fenotiplerine göre fiziksel fonksiyon durumunu incelemeyi amaçlamaktadır.
Gereç ve yöntemler: Kesitsel tipteki bu çalışmaya PH tanısı almış 68 hasta (21 kadın, 47 erkek) dahil edildi. Kırılganlık FRAİL ölçeği ile, fiziksel fonksiyon ise kısa fiziksel performans bataryası (KFPB) ve dijital el dinamometresi ile değerlendirildi. FRAİL ölçeği puanına göre hastalar kırılgan olmayan, kırılganlık öncesi dönemde olan ve kırılgan olan Parkinson hastaları olmak üzere 3 gruba ayrıldı.
Bulgular: Çalışmaya katılan hastaların yaş ortalaması 70,977,91 yıl idi. Hastaların %69,1’i kırılganlık öncesi dönemde iken, %22,1’inde kırılganlık mevcut, %8,8’inde kırılganlık yoktu. KFPB puanı ve el kavrama kuvveti sırasıyla kırılgan olmayan grupta 10,170,41 ve 18,672,58, kırılganlık öncesi dönemde olan grupta 8,212,34 ve 14,065,97 iken kırılgan olan grupta 5,733,67 ve 12,477,44 idi. Gruplar arasında toplam KFPB puanı ve KFPB alt boyutları açısından fark tespit edildi (p<0,01). Kırılgan olan grupta KFPB puanları daha düşüktü (p<0,01). El kavrama kuvveti gruplar arasında benzerdi (p>0,05). KFPB puanları ile FRAİL ölçeği skoru arasında negatif yönlü ilişki tespit edildi (p<0,05). El kavrama kuvveti ile FRAİL ölçeği skoru arasında ilişki saptanmadı (p>0,05)
Sonuç: Bu çalışma Parkinson hastalarının kırılganlık açısından risk altında olduğunu gösterdi. Parkinson hastalarında kırılganlık durumuna ve şiddetine göre alt ekstremite fonksyionu, denge becerileri ve yürüme hızı azalmakta, üst ekstremite fonksiyonu ise kırılganlık durumuna göre değişmemektedir. PH’nda kırılganlık ile ilişkili olan alt ekstremite fonksiyonu, denge becerileri ve yürüme hızı gibi fiziksel fonksiyon parametrelerine yönelik olan uygulamalar/yaklaşımlar kırılganlığın önlenmesi, geciktirilmesi ve/veya etkilerinin azaltılmasında faydalı olabilir.

Keywords

Parkinson hastalığı, kırılganlık, fiziksel fonksiyonel performans, postural denge, el gücü

The Relationship between Frailty and Physical Function in Parkinson’s Disease

Abstract

Aim: This study aims to determine the relationship between fragility and physical function in Parkinson's disease (PD) and to investigate the physical function status according to the fragilty phenotypes.
Material and methods: In this cross-sectional study, 68 patients (21 females, 47 males) diagnosed with PD were included. Fragility was assessed by the FRAGIL scale, and physical function by the short physical performance battery (SPPB) and digital hand dynamometer. According to the FRAGIL scale score, the patients were divided into three groups: non-fragil, pre-fragil, and fragil patients with PD.
Results: The mean age of the patients in this study was 70.977.91 years. While 69.1% of the patients were in the pre-fragil period, 22.1% of them were fragil, and 8.8% of them were non-fragil. SPPB score and handgrip strength were 10.170.41 and 18.672.58 in the non-fragil group, 8.212.34 and 14.065.97 in the pre-fragil group, while it was 5.733.67 and 12.477.44 in the fragil group, respectively. There was a difference between the groups in terms of total SPPB score and SPPB sub-dimensions (p <0.01). SPPB scores were lower in the fragil group (p <0.01). Handgrip strength was similar between the groups (p> 0.05). A negative correlation was found between SPPB scores and the FRAGIL scale score (p <0.05). There was no relationship between handgrip strength and FRAGIL scale score (p> 0.05).
Conclusion: This study showed that patients with PD were at risk for fragility. The lower extremity function, balance skills, and walking speed decrease in patients with PD according to the fragility status and severity of their fragility, while the upper extremity function does not change according to their fragilty status. Interventions/approaches related to physical function parameters such as lower extremity function, balance skills, and gait speed, which are associated with fragilty in PD may be useful in preventing, delaying, and/or reducing the effects of fragilty.

Keywords

parkinson disease, fragility, physical functional performance, postural balance, hand strength

References

• Rodriguez-Manas L, Feart C, Mann G, Vina J, Chatterji S, Chodzko-Zajko W, et al. Searching for an operational definition of fragilty: A Delphi method based consensus statement: The fragilty operative definition-consensus conference project. J Gerontol A Biol Sci Med Sci. 2012; 68(1): 62-7.
• Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Fragilty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001; 56(3): 146-56.
• Espinoza S, Walston JD. Fragilty in older adults: Insights and interventions. Cleve Clin J Med. 2005; 72(12): 1105-12.
• Chen X, Mao G, Leng SX. Fragilty syndrome: An overview. Clin Interv Aging. 2014; 9: 433-41.
• Collard RM, Boter H, Schoevers RA, Oude Voshaar RC. Prevalence of fragilty in community-dwelling older persons: a systematic review. J Am Geriatr Soc. 2012; 60(8): 1487-92.
• Lally F, Crome P. Understanding fragilty. Postgrad Med J. 2007; 83(975): 16-20.
• Smith N, Brennan L, Gaunt DM, Ben-Shlomo Y, Henderson E. Fragilty in Parkinson's disease: A systematic review. J Parkinsons Dis. 2019; 9(3): 517‐24.
• Roland K, Jakobi J, Jones G, Powell C. Quality of life as a determinant of fragilty phenotype in community-dwelling persons with Parkinson’s disease. J Am Geriatr Soc. 2012; 60(3): 590-2.
• Ahmed NN, Sherman SJ, Vanwyck D. Fragilty in Parkinson’s disease and its clinical implications. Parkinsonism Relat Disord. 2008; 14(4): 334–7.
• Fırat Özer F, Akın S, Gültekin M, Ertürk-Zararsız G, Ekinci-Soylu A. Fragilty in patients with Parkinson’s disease: Associations with disability and timed up and go. Arch Neuropsychiatry. 2019. https://doi.org/10.29399/npa.23444 (in press).
• Hughes AJ, Daniel SE, Kilfor L, Lees AJ. Accuracy of clinical diagnosis of idiopathic Parkinson’s disease: a clinicopathological study of 100 cases. J Neurol Neurosurg Psychiatry. 1992; 55(3): 181-4.
• Hoehn MM, Yahr MD. Parkinsonism: onset,progression, and mortality. Neurology. 1967; 17(5): 427-42.
• Hymabaccus Muradi, Ben Azir Begum. Yaşlılarda kırılganlığı ölçmeye yönelik FRAGIL ölçeğinin Türkçe geçerlik ve güvenirlik çalışması [Uzmanlık Tezi]. Ankara: Hacettepe Üniversitesi; 2017.
• Morley JE, Malmstrom TK, Miller DK. A simple fragilty questionnaire (FRAGİL) predicts outcomes in middle aged African Americans. J Nutr Health Aging. 2012; 16(7): 601-8.
• Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, et al. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol Med Sci. 1994; 49(2): 85-94.
• Fisher S, Ottenbacher KJ, Goodwin JS, Graham JE, Ostir GV. Short Physical Performance Battery in hospitalized older adults. Aging Clin Exp Res. 2009; 21(6): 445-52.
• Fess E. Grip strength. In Casanova JS editor. Clinical assessment recommendations. 2nd ed. Chicago: American Society of Hand Therapists; 1992. p. 41-5.
• Roberts HC, Denison HJ, Martin HJ, Patel HP, Syddall H, Cooper C, et al. A review of the measurement of grip strength in clinical and epidemiological studies: towards a standardised approach. Age Ageing. 2011; 40(4): 423‐9.
• Lin WC, Huang YC, Leong CP, Chen MH, Chen HL, Tsai NW, et al. Associations between cognitive functions and physical fragilty in patients with Parkinson's disease. Front Aging Neurosci. 2019; 11: 283.
• Roland K, Cornett K, Theou O, Jakobi J, Jones G. Physical activity across fragilty phenotypes in females with Parkinson’s disease. J Aging Res. 2012: 468156.
• Roland K, Cornett K, Theou O, Jakobi J, Jones G. Concurrence of fragilty and Parkinson’s disease. J Fragilty Aging. 2012; 1(3): 123-7.
• Tan AH, Hew YC, Lim SY, Ramli NM, Kamaruzzaman SB, Tan MP, et al. Altered body composition, sarcopenia, fragilty, and their clinico-biological correlates, in Parkinson’s disease. Parkinsonism Relat. Disord. 2018; 56: 58–64.
• Hoogendijk EO, Abellan van Kan G, Guyonnet S, Vellas B, Cesari M. Components of the fragilty phenotype in relation to the fragilty index: results from the Toulouse Fragilty Platform. J Am Med Dir Assoc. 2015; 16(10): 855-9.
• Auyeung TW, Lee JS, Leung J, Kwok T, Woo J. The selection of a screening test for fragilty identification in community-dwelling older adults. J Nutr Health Aging. 2014; 18(2): 199-203.
• Peball M, Mahlknecht P, Werkmann M, Marini K, Murr F, Herzmann H, et al. Prevalence and associated factors of sarcopenia and fragilty in Parkinson's disease: A cross-sectional study. Gerontology. 2019; 65(3): 216-28.