Apraxia da marcha em paciente com demência: prevalência, características motoras e fatores associados
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2013-10-01
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Universidade Federal de Goiás
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Introduction: Gait apraxia is an alteration of the gait characterized by a deficiency in the integration
of the sensorial, motor and cerebellar functions necessary for rambling. The patients with this
compromise have difficulty initiating and there is a congelation of the gait, mainly when turning ove
their own axle. It is frequently associated with a cognitive dysfunction, an emotional instability, a
urinary bladder dysfunction and behavioral abnormalities.
Objectives: To evaluate the gait apraxia in patients with dementia, its prevalence and association
with other types of apraxia as well as observing what phase of the disease in which it appears.
Methods: Gait apraxia has been researched in a universe of patients with dementia consecutively
assisted in the HC-UFG Dementia Ambulatory. The tests applied were the Mini-Mental State
Examination and Clinical Dementia Rating Scale (CDR) to evaluate the cognitive functions, Pfeffer's
Questionnaire for the functional evaluation of the activities of the daily life, the Scale of Berg's
Functional Balance (BERG) and the Timed Up and Go Test (TUG) for the balance mensuration,
besides the evaluation of the gait and the posture of the trunk.
Results: A total of fifteen patients with gait apraxia were included in the study and all had some
other associated apraxia. Regarding the CDR showed that 33.3% of patients were mild stage of the
disease, 46.7% in the moderate and 20% in the severe. In Pfeffer Questionnaire patients had an
average of 28.6 ± 1.40. There balance and coordination deficit in all patients, since the scores of the
tests BERG and TUG showed inferior results. On the scale of BERG total score obtained average
11.07 ± 8.06 and varying between 2 and 24 points. The TUG test was performed above 20 seconds
for all the patients. In the assessment of gait and postural trunk (AWS) the average score was 14.00
± 6.88 ranging between 7 and 27 points. The correlation between AWS and scale BERG was
significant (p = 0.001). Apraxia dynamics (90.9 %), ideatory (72.2 %) and kinetic members (63.6 %)
were more frequent among patients. Forms of dementia who had gait apraxia were corticbasal
degeneration (53.3 %), frontotemporal dementia (13.3%), Alzheimer's disease (6.6%), dementia with
chronic subdural hematoma (6.6%), normal pressure hydrocephalus (6.6%), dementia in Parkinson's
disease (6.6%) and multiple system atrophy (6.6%). The prevalence of patients with dementia and
apraxia of gait was 9.37%.
Conclusion: Gait apraxia is little prevalent in the universe of dementia and it is always
associated with cortic-cortical dementia. Other forms of apraxia frequently follow gait apraxia. The
corticbasal degeneration is the type of dementia most associated with the gait apraxia.
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RESENDE, L. D. Apraxia da marcha em paciente com demência: prevalência, características motoras e fatores associados. 2013. 103 f. Dissertação (Mestrado em Ciências da Saúde) - Universidade Federal de Goiás, Goiânia, 2013.