Atividade cortical durante o andar usual e com obstáculos em idosos com doença de Parkinson: efeito do subtipo da doença, da terapia medicamentosa e do exercício físico agudo
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Data
2020-02-10
Autores
Orcioli-Silva, Diego
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Universidade Estadual Paulista (Unesp)
Resumo
Estudos sugerem que o córtex cerebral é ativo durante o andar, principalmente em idosos com doença de Parkinson (DP). Embora os recentes avanços científicos mostrem alterações na atividade cortical durante o andar de idosos com DP, algumas lacunas ainda permanecem, como quais são os efeitos de diferentes terapias (medicamentosa e exercício físico) na atividade cortical e no andar de idosos com DP e se há diferença entre os subtipos da DP. Para investigar estas lacunas, três estudos foram desenvolvidos. O Estudo #1 teve como objetivo investigar o efeito da terapia medicamentosa na atividade cortical durante o andar usual e adaptativo em idosos com DP. Vinte e três idosos com DP foram avaliados no estado “OFF” (no mínimo 12 horas após a última ingestão do medicamento) e “ON” (aproximadamente 1h após a última dose do medicamento) da medicação específica da DP. O Estudo #2 comparou a atividade cortical durante o andar de acordo com os subtipos da DP (Tremor Dominante - TD, n=19; Instabilidade Postural/Dificuldades no Andar - IPDA, n=17). O Estudo #3 teve como objetivo analisar o efeito de uma sessão de exercício aeróbio na atividade cortical durante o andar de idosos com DP. Trinta e quatro idosos com DP foram distribuídos em dois grupos: grupo experimental e grupo controle. A mesma avaliação do andar foi aplicada nos três estudos. Os participantes andaram em um circuito de 26,8 m de comprimento, em duas condições: (i) andar usual e (ii) andar adaptativo – com ultrapassagem de obstáculos. Cinco tentativas para cada condição experimental foram realizadas. Cada tentativa teve duração de 60 segundos. Um carpete com sensores de pressão foi utilizado para o registro dos parâmetros do andar. Os sistemas portáteis de eletroencefalografia e espectroscopia funcional de luz próxima ao infravermelho foram posicionados na cabeça do participante para registro da atividade cortical. No Estudo #3, o grupo experimental realizou uma sessão aguda de exercício físico aeróbio, em bicicleta ergométrica, com duração de 40 min e intensidade entre 65 e 70% da frequência cardíaca (FC) máxima. O grupo controle também realizou o exercício em bicicleta, porém, a FC durante os 40 min foi mantida dentro de 5% da FC de repouso. A análise do andar e da atividade cortical dos idosos foram realizadas nos momentos Pré e Pós-exercício. O Estudo #1 demonstrou que o medicamento dopaminérgico facilitou o recrutamento de áreas cognitivas adicionais durante tarefas mais desafiadoras, como ultrapassar obstáculos. Ainda, além de melhorar o andar, a ingestão de medicamento também melhorou a integração sensório-motora durante o andar. O Estudo #2 indicou que os idosos do subtipo IPDA necessitaram de maior recrutamento do córtex pré-frontal para andar e que os idosos do subtipo TD apresentaram mudanças na atividade dos córtices motor e sensório-motor durante a ultrapassagem de obstáculos. O Estudo #3 demonstrou que o exercício aeróbio não alterou a atividade do córtex pré-frontal e o desempenho do andar. Contudo, os parâmetros eletrocorticais foram alterados pelo exercício, aumentando a banda alfa nos canais FCz, Cz e CPz, o que pode indicar estado de fadiga e menor atividade cortical durante o andar. Sendo assim, a conclusão desta tese é que fatores como medicamento, subtipo da DP e exercício aeróbio influenciam a atividade cortical durante o andar de idosos com DP. Portanto, futuros estudos devem considerar estes fatores para ter um melhor entendimento dos comprometimentos da DP.
Studies have suggested that the cerebral cortex is active during walking, mainly in people with Parkinson's disease (PD). Although recent scientific advances have shown changes in cortical activity during walking in people with PD, some gaps remain open, such as what are the effects of different kinds of intervention (medication and exercise) on the cortical activity and on the gait in people with PD and whether there are differences between PD subtypes. To investigate these gaps, three studies were developed. Study #1 aimed to investigate the effects of dopaminergic medication on brain activity during unobstructed walking and obstacle avoidance in people with PD. Twenty-three people with PD were evaluated in the “OFF” (at least 12 hours after their last intake of dopaminergic medications) and “ON” (approximately 1 hour after taking medications) state of PD medication. Study # 2 aimed to compare cortical activity during walking according to PD subtypes (Tremor dominant - TD, n = 19; Postural instability gait difficulty - PIGD, n = 17). Study # 3 aimed to analyze the effects of an aerobic exercise session on cortical activity during walking in people with PD. Thirty-four people with PD were split into two groups: the experimental group and the control group. The same gait assessment was applied in the three studies. Participants walked in a 26.8 m long circuit under two conditions: (i) unobstructed walking and (ii) obstacle avoidance. Five trials for each experimental condition were performed. Each trial lasted 60 seconds. A carpet using pressure sensors was used to record the gait parameters. Portable electroencephalography and functional near-infrared spectroscopy systems were positioned on the participant's head to record cortical activity. In Study # 3, the experimental group performed an acute aerobic exercise session on a cycle ergometer for 40 min and at 65-70% of maximum heart rate (HR). The control group also performed a cycle ergometer, but the HR for 40 min was maintained within 5% of the resting HR. The gait and cortical activity analyses were performed in the pre- and post-exercise moments. Study # 1 demonstrated that dopaminergic medication facilitated the recruitment of additional cognitive areas during more challenging tasks, such as obstacle avoidance. In addition, after medication intake, people with PD improved both gait parameters and sensorimotor integration during walking. Study # 2 indicated that PIGD patients needed to recruit additional PFC resources for walking and that TD patients changed the activation of motor/sensorimotor areas during obstacle avoidance. Study # 3 demonstrated that aerobic exercise did not alter prefrontal cortex activity and gait performance. However, the electrocortical parameters were altered by exercise, increasing the alpha band in the FCz, Cz and CPz channels, which may indicate a fatigued state and lower cortical activity during walking. Thus, this thesis concludes that factors such as medication, PD subtype, and aerobic exercise influence cortical activity during walking in people with PD. Therefore, future studies should consider these factors to have a better understanding of PD impairments.
Studies have suggested that the cerebral cortex is active during walking, mainly in people with Parkinson's disease (PD). Although recent scientific advances have shown changes in cortical activity during walking in people with PD, some gaps remain open, such as what are the effects of different kinds of intervention (medication and exercise) on the cortical activity and on the gait in people with PD and whether there are differences between PD subtypes. To investigate these gaps, three studies were developed. Study #1 aimed to investigate the effects of dopaminergic medication on brain activity during unobstructed walking and obstacle avoidance in people with PD. Twenty-three people with PD were evaluated in the “OFF” (at least 12 hours after their last intake of dopaminergic medications) and “ON” (approximately 1 hour after taking medications) state of PD medication. Study # 2 aimed to compare cortical activity during walking according to PD subtypes (Tremor dominant - TD, n = 19; Postural instability gait difficulty - PIGD, n = 17). Study # 3 aimed to analyze the effects of an aerobic exercise session on cortical activity during walking in people with PD. Thirty-four people with PD were split into two groups: the experimental group and the control group. The same gait assessment was applied in the three studies. Participants walked in a 26.8 m long circuit under two conditions: (i) unobstructed walking and (ii) obstacle avoidance. Five trials for each experimental condition were performed. Each trial lasted 60 seconds. A carpet using pressure sensors was used to record the gait parameters. Portable electroencephalography and functional near-infrared spectroscopy systems were positioned on the participant's head to record cortical activity. In Study # 3, the experimental group performed an acute aerobic exercise session on a cycle ergometer for 40 min and at 65-70% of maximum heart rate (HR). The control group also performed a cycle ergometer, but the HR for 40 min was maintained within 5% of the resting HR. The gait and cortical activity analyses were performed in the pre- and post-exercise moments. Study # 1 demonstrated that dopaminergic medication facilitated the recruitment of additional cognitive areas during more challenging tasks, such as obstacle avoidance. In addition, after medication intake, people with PD improved both gait parameters and sensorimotor integration during walking. Study # 2 indicated that PIGD patients needed to recruit additional PFC resources for walking and that TD patients changed the activation of motor/sensorimotor areas during obstacle avoidance. Study # 3 demonstrated that aerobic exercise did not alter prefrontal cortex activity and gait performance. However, the electrocortical parameters were altered by exercise, increasing the alpha band in the FCz, Cz and CPz channels, which may indicate a fatigued state and lower cortical activity during walking. Thus, this thesis concludes that factors such as medication, PD subtype, and aerobic exercise influence cortical activity during walking in people with PD. Therefore, future studies should consider these factors to have a better understanding of PD impairments.
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Palavras-chave
Desordens do movimento, Locomoção, EEG, fNIRS, Intervenção, Movement disorders, Locomotion, Intervention