Subcortical Vascular Lesions Predict Functional Recovery After Rehabilitation in Patients with L‐Dopa Refractory Parkinsonism
Identifieur interne : 002F40 ( Main/Corpus ); précédent : 002F39; suivant : 002F41Subcortical Vascular Lesions Predict Functional Recovery After Rehabilitation in Patients with L‐Dopa Refractory Parkinsonism
Auteurs : Fabio Guerini ; Giovanni B. Frisoni ; Catherine Bellwald ; Roberta Rossi Psy ; Giuseppe Bellelli ; Marco TrabucchiSource :
- Journal of the American Geriatrics Society [ 0002-8614 ] ; 2004-02.
English descriptors
Abstract
Objectives: To identify predictors of functional recovery after an intensive rehabilitation training in patients with gait disturbances and refractory parkinsonism. Design: Observational study. Setting: A hospital geriatric rehabilitation department (“Ancelle della Carità” hospital of Cremona). Participants: Thirty‐eight subjects (mean age±standard deviation of 78.9±6.5; 66% women) with gait disturbances and L‐dopa refractory parkinsonism consecutively admitted to a rehabilitation unit within 6 months were recruited. Exclusion criteria were obvious musculoskeletal disorders (severe leg arthritis, hemiparesis, recent stroke), recent surgery, delirium, physical impairment from other identifiable causes, and missing computed tomography (CT) scan. All subjects received an intensive standardized rehabilitative program including conventional physical therapy and specific gait training. Measurements: The outcome measure of the rehabilitation training was the gain between admission and discharge on the Unified Parkinson Disease Rating Scale (delta‐UPDRS). The following potential predictors were assessed using comprehensive geriatric assessment: physical health (Charlson Comorbidity Index, number of drugs), cognitive performance (Mini‐Mental State Examination (MMSE)), functional status (Tinetti scale), depressive symptoms (Geriatric Depression Scale), nutritional status (serum albumin and body mass index), and subcortical cerebrovascular load (four classes of increasing severity based on diffuse leukoariosis, patchy lesions of the white matter, and lacunas on CT scan). Multivariate logistic regression with fixed adjustment for age, cognitive performance, and UPDRS on admission and stepwise selection of variables were used to identify independent predictors. Results: Patients were divided into two groups of equal size based on the delta‐UPDRS (high and low functional recovery: delta‐UPDRS >8 and ≤8, respectively). Of all variables, only subcortical cerebrovascular load predicted functional recovery at discharge (odds ratio adjusted for age, MMSE, and UPDRS on admission=2.3, 95% confidence interval=1.0–5.1). The adjusted proportion of patients with high functional recovery decreased with increasing subcortical cerebrovascular load: 83%, 61%, 44%, and 27% (adjusted P for trend=0.047). Conclusion: Subcortical cerebrovascular load is a predicting factor of successful rehabilitation in patients with L‐dopa refractory parkinsonism.
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DOI: 10.1111/j.1532-5415.2004.52064.x
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<record><TEI wicri:istexFullTextTei="biblStruct"><teiHeader><fileDesc><titleStmt><title xml:lang="en">Subcortical Vascular Lesions Predict Functional Recovery After Rehabilitation in Patients with L‐Dopa Refractory Parkinsonism</title><author><name sortKey="Guerini, Fabio" sort="Guerini, Fabio" uniqKey="Guerini F" first="Fabio" last="Guerini">Fabio Guerini</name><affiliation><mods:affiliation>From the*Rehabilitation Unit “Ancelle della Carità” Hospital, Cremona, Italy†Geriatric Research Group, Brescia, Italy‡Laboratory of Epidemiology and Neuroimaging, IRCCS S. Giovanni di Dio Fatabenefratelli, Brescia, Italy§“Tor Vergata” University, Rome, Italy.</mods:affiliation></affiliation></author><author><name sortKey="Frisoni, Giovanni B" sort="Frisoni, Giovanni B" uniqKey="Frisoni G" first="Giovanni B." last="Frisoni">Giovanni B. Frisoni</name><affiliation><mods:affiliation>From the*Rehabilitation Unit “Ancelle della Carità” Hospital, Cremona, Italy†Geriatric Research Group, Brescia, Italy‡Laboratory of Epidemiology and Neuroimaging, IRCCS S. Giovanni di Dio Fatabenefratelli, Brescia, Italy§“Tor Vergata” University, Rome, Italy.</mods:affiliation></affiliation></author><author><name sortKey="Bellwald, Catherine" sort="Bellwald, Catherine" uniqKey="Bellwald C" first="Catherine" last="Bellwald">Catherine Bellwald</name><affiliation><mods:affiliation>From the*Rehabilitation Unit “Ancelle della Carità” Hospital, Cremona, Italy†Geriatric Research Group, Brescia, Italy‡Laboratory of Epidemiology and Neuroimaging, IRCCS S. Giovanni di Dio Fatabenefratelli, Brescia, Italy§“Tor Vergata” University, Rome, Italy.</mods:affiliation></affiliation></author><author><name sortKey="Psy, Roberta Rossi" sort="Psy, Roberta Rossi" uniqKey="Psy R" first="Roberta Rossi" last="Psy">Roberta Rossi Psy</name><affiliation><mods:affiliation>From the*Rehabilitation Unit “Ancelle della Carità” Hospital, Cremona, Italy†Geriatric Research Group, Brescia, Italy‡Laboratory of Epidemiology and Neuroimaging, IRCCS S. Giovanni di Dio Fatabenefratelli, Brescia, Italy§“Tor Vergata” University, Rome, Italy.</mods:affiliation></affiliation></author><author><name sortKey="Bellelli, Giuseppe" sort="Bellelli, Giuseppe" uniqKey="Bellelli G" first="Giuseppe" last="Bellelli">Giuseppe Bellelli</name><affiliation><mods:affiliation>From the*Rehabilitation Unit “Ancelle della Carità” Hospital, Cremona, Italy†Geriatric Research Group, Brescia, Italy‡Laboratory of Epidemiology and Neuroimaging, IRCCS S. Giovanni di Dio Fatabenefratelli, Brescia, Italy§“Tor Vergata” University, Rome, Italy.</mods:affiliation></affiliation></author><author><name sortKey="Trabucchi, Marco" sort="Trabucchi, Marco" uniqKey="Trabucchi M" first="Marco" last="Trabucchi">Marco Trabucchi</name><affiliation><mods:affiliation>From the*Rehabilitation Unit “Ancelle della Carità” Hospital, Cremona, Italy†Geriatric Research Group, Brescia, Italy‡Laboratory of Epidemiology and Neuroimaging, IRCCS S. Giovanni di Dio Fatabenefratelli, Brescia, Italy§“Tor Vergata” University, Rome, Italy.</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:6BAAF5138EB35E869AC3A6ACFACCBA50D53CE9F1</idno><date when="2004" year="2004">2004</date><idno type="doi">10.1111/j.1532-5415.2004.52064.x</idno><idno type="url">https://api.istex.fr/document/6BAAF5138EB35E869AC3A6ACFACCBA50D53CE9F1/fulltext/pdf</idno><idno type="wicri:Area/Main/Corpus">002F40</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a" type="main" xml:lang="en">Subcortical Vascular Lesions Predict Functional Recovery After Rehabilitation in Patients with L‐Dopa Refractory Parkinsonism</title><author><name sortKey="Guerini, Fabio" sort="Guerini, Fabio" uniqKey="Guerini F" first="Fabio" last="Guerini">Fabio Guerini</name><affiliation><mods:affiliation>From the*Rehabilitation Unit “Ancelle della Carità” Hospital, Cremona, Italy†Geriatric Research Group, Brescia, Italy‡Laboratory of Epidemiology and Neuroimaging, IRCCS S. Giovanni di Dio Fatabenefratelli, Brescia, Italy§“Tor Vergata” University, Rome, Italy.</mods:affiliation></affiliation></author><author><name sortKey="Frisoni, Giovanni B" sort="Frisoni, Giovanni B" uniqKey="Frisoni G" first="Giovanni B." last="Frisoni">Giovanni B. Frisoni</name><affiliation><mods:affiliation>From the*Rehabilitation Unit “Ancelle della Carità” Hospital, Cremona, Italy†Geriatric Research Group, Brescia, Italy‡Laboratory of Epidemiology and Neuroimaging, IRCCS S. Giovanni di Dio Fatabenefratelli, Brescia, Italy§“Tor Vergata” University, Rome, Italy.</mods:affiliation></affiliation></author><author><name sortKey="Bellwald, Catherine" sort="Bellwald, Catherine" uniqKey="Bellwald C" first="Catherine" last="Bellwald">Catherine Bellwald</name><affiliation><mods:affiliation>From the*Rehabilitation Unit “Ancelle della Carità” Hospital, Cremona, Italy†Geriatric Research Group, Brescia, Italy‡Laboratory of Epidemiology and Neuroimaging, IRCCS S. Giovanni di Dio Fatabenefratelli, Brescia, Italy§“Tor Vergata” University, Rome, Italy.</mods:affiliation></affiliation></author><author><name sortKey="Psy, Roberta Rossi" sort="Psy, Roberta Rossi" uniqKey="Psy R" first="Roberta Rossi" last="Psy">Roberta Rossi Psy</name><affiliation><mods:affiliation>From the*Rehabilitation Unit “Ancelle della Carità” Hospital, Cremona, Italy†Geriatric Research Group, Brescia, Italy‡Laboratory of Epidemiology and Neuroimaging, IRCCS S. Giovanni di Dio Fatabenefratelli, Brescia, Italy§“Tor Vergata” University, Rome, Italy.</mods:affiliation></affiliation></author><author><name sortKey="Bellelli, Giuseppe" sort="Bellelli, Giuseppe" uniqKey="Bellelli G" first="Giuseppe" last="Bellelli">Giuseppe Bellelli</name><affiliation><mods:affiliation>From the*Rehabilitation Unit “Ancelle della Carità” Hospital, Cremona, Italy†Geriatric Research Group, Brescia, Italy‡Laboratory of Epidemiology and Neuroimaging, IRCCS S. Giovanni di Dio Fatabenefratelli, Brescia, Italy§“Tor Vergata” University, Rome, Italy.</mods:affiliation></affiliation></author><author><name sortKey="Trabucchi, Marco" sort="Trabucchi, Marco" uniqKey="Trabucchi M" first="Marco" last="Trabucchi">Marco Trabucchi</name><affiliation><mods:affiliation>From the*Rehabilitation Unit “Ancelle della Carità” Hospital, Cremona, Italy†Geriatric Research Group, Brescia, Italy‡Laboratory of Epidemiology and Neuroimaging, IRCCS S. Giovanni di Dio Fatabenefratelli, Brescia, Italy§“Tor Vergata” University, Rome, Italy.</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">Journal of the American Geriatrics Society</title><idno type="ISSN">0002-8614</idno><idno type="eISSN">1532-5415</idno><imprint><publisher>Blackwell Science Inc</publisher><pubPlace>Oxford, UK</pubPlace><date type="published" when="2004-02">2004-02</date><biblScope unit="volume">52</biblScope><biblScope unit="issue">2</biblScope><biblScope unit="page" from="252">252</biblScope><biblScope unit="page" to="256">256</biblScope></imprint><idno type="ISSN">0002-8614</idno></series><idno type="istex">6BAAF5138EB35E869AC3A6ACFACCBA50D53CE9F1</idno><idno type="DOI">10.1111/j.1532-5415.2004.52064.x</idno><idno type="ArticleID">JGS52064</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0002-8614</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>functional recovery</term><term>parkinsonism</term><term>rehabilitation</term><term>subcortical vascular lesions</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Objectives: To identify predictors of functional recovery after an intensive rehabilitation training in patients with gait disturbances and refractory parkinsonism. Design: Observational study. Setting: A hospital geriatric rehabilitation department (“Ancelle della Carità” hospital of Cremona). Participants: Thirty‐eight subjects (mean age±standard deviation of 78.9±6.5; 66% women) with gait disturbances and L‐dopa refractory parkinsonism consecutively admitted to a rehabilitation unit within 6 months were recruited. Exclusion criteria were obvious musculoskeletal disorders (severe leg arthritis, hemiparesis, recent stroke), recent surgery, delirium, physical impairment from other identifiable causes, and missing computed tomography (CT) scan. All subjects received an intensive standardized rehabilitative program including conventional physical therapy and specific gait training. Measurements: The outcome measure of the rehabilitation training was the gain between admission and discharge on the Unified Parkinson Disease Rating Scale (delta‐UPDRS). The following potential predictors were assessed using comprehensive geriatric assessment: physical health (Charlson Comorbidity Index, number of drugs), cognitive performance (Mini‐Mental State Examination (MMSE)), functional status (Tinetti scale), depressive symptoms (Geriatric Depression Scale), nutritional status (serum albumin and body mass index), and subcortical cerebrovascular load (four classes of increasing severity based on diffuse leukoariosis, patchy lesions of the white matter, and lacunas on CT scan). Multivariate logistic regression with fixed adjustment for age, cognitive performance, and UPDRS on admission and stepwise selection of variables were used to identify independent predictors. Results: Patients were divided into two groups of equal size based on the delta‐UPDRS (high and low functional recovery: delta‐UPDRS >8 and ≤8, respectively). Of all variables, only subcortical cerebrovascular load predicted functional recovery at discharge (odds ratio adjusted for age, MMSE, and UPDRS on admission=2.3, 95% confidence interval=1.0–5.1). The adjusted proportion of patients with high functional recovery decreased with increasing subcortical cerebrovascular load: 83%, 61%, 44%, and 27% (adjusted P for trend=0.047). Conclusion: Subcortical cerebrovascular load is a predicting factor of successful rehabilitation in patients with L‐dopa refractory parkinsonism.</div></front></TEI><istex><corpusName>wiley</corpusName><author><json:item><name>Fabio Guerini MD</name><affiliations><json:string>From the*Rehabilitation Unit “Ancelle della Carità” Hospital, Cremona, Italy†Geriatric Research Group, Brescia, Italy‡Laboratory of Epidemiology and Neuroimaging, IRCCS S. Giovanni di Dio Fatabenefratelli, Brescia, Italy§“Tor Vergata” University, Rome, Italy.</json:string></affiliations></json:item><json:item><name>Giovanni B. Frisoni MD</name><affiliations><json:string>From the*Rehabilitation Unit “Ancelle della Carità” Hospital, Cremona, Italy†Geriatric Research Group, Brescia, Italy‡Laboratory of Epidemiology and Neuroimaging, IRCCS S. Giovanni di Dio Fatabenefratelli, Brescia, Italy§“Tor Vergata” University, Rome, Italy.</json:string></affiliations></json:item><json:item><name>Catherine Bellwald MD</name><affiliations><json:string>From the*Rehabilitation Unit “Ancelle della Carità” Hospital, Cremona, Italy†Geriatric Research Group, Brescia, Italy‡Laboratory of Epidemiology and Neuroimaging, IRCCS S. Giovanni di Dio Fatabenefratelli, Brescia, Italy§“Tor Vergata” University, Rome, Italy.</json:string></affiliations></json:item><json:item><name>Roberta Rossi Psy</name><affiliations><json:string>From the*Rehabilitation Unit “Ancelle della Carità” Hospital, Cremona, Italy†Geriatric Research Group, Brescia, Italy‡Laboratory of Epidemiology and Neuroimaging, IRCCS S. Giovanni di Dio Fatabenefratelli, Brescia, Italy§“Tor Vergata” University, Rome, Italy.</json:string></affiliations></json:item><json:item><name>Giuseppe Bellelli MD</name><affiliations><json:string>From the*Rehabilitation Unit “Ancelle della Carità” Hospital, Cremona, Italy†Geriatric Research Group, Brescia, Italy‡Laboratory of Epidemiology and Neuroimaging, IRCCS S. Giovanni di Dio Fatabenefratelli, Brescia, Italy§“Tor Vergata” University, Rome, Italy.</json:string></affiliations></json:item><json:item><name>Marco Trabucchi MD</name><affiliations><json:string>From the*Rehabilitation Unit “Ancelle della Carità” Hospital, Cremona, Italy†Geriatric Research Group, Brescia, Italy‡Laboratory of Epidemiology and Neuroimaging, IRCCS S. Giovanni di Dio Fatabenefratelli, Brescia, Italy§“Tor Vergata” University, Rome, Italy.</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>parkinsonism</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>subcortical vascular lesions</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>functional recovery</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>rehabilitation</value></json:item></subject><articleId><json:string>JGS52064</json:string></articleId><language><json:string>eng</json:string></language><abstract>Objectives: To identify predictors of functional recovery after an intensive rehabilitation training in patients with gait disturbances and refractory parkinsonism. Design: Observational study. Setting: A hospital geriatric rehabilitation department (“Ancelle della Carità” hospital of Cremona). Participants: Thirty‐eight subjects (mean age±standard deviation of 78.9±6.5; 66% women) with gait disturbances and L‐dopa refractory parkinsonism consecutively admitted to a rehabilitation unit within 6 months were recruited. Exclusion criteria were obvious musculoskeletal disorders (severe leg arthritis, hemiparesis, recent stroke), recent surgery, delirium, physical impairment from other identifiable causes, and missing computed tomography (CT) scan. All subjects received an intensive standardized rehabilitative program including conventional physical therapy and specific gait training. Measurements: The outcome measure of the rehabilitation training was the gain between admission and discharge on the Unified Parkinson Disease Rating Scale (delta‐UPDRS). The following potential predictors were assessed using comprehensive geriatric assessment: physical health (Charlson Comorbidity Index, number of drugs), cognitive performance (Mini‐Mental State Examination (MMSE)), functional status (Tinetti scale), depressive symptoms (Geriatric Depression Scale), nutritional status (serum albumin and body mass index), and subcortical cerebrovascular load (four classes of increasing severity based on diffuse leukoariosis, patchy lesions of the white matter, and lacunas on CT scan). Multivariate logistic regression with fixed adjustment for age, cognitive performance, and UPDRS on admission and stepwise selection of variables were used to identify independent predictors. Results: Patients were divided into two groups of equal size based on the delta‐UPDRS (high and low functional recovery: delta‐UPDRS >8 and ≤8, respectively). Of all variables, only subcortical cerebrovascular load predicted functional recovery at discharge (odds ratio adjusted for age, MMSE, and UPDRS on admission=2.3, 95% confidence interval=1.0–5.1). The adjusted proportion of patients with high functional recovery decreased with increasing subcortical cerebrovascular load: 83%, 61%, 44%, and 27% (adjusted P for trend=0.047). Conclusion: Subcortical cerebrovascular load is a predicting factor of successful rehabilitation in patients with L‐dopa refractory parkinsonism.</abstract><qualityIndicators><score>6.376</score><pdfVersion>1.3</pdfVersion><pdfPageSize>595 x 782 pts</pdfPageSize><refBibsNative>true</refBibsNative><keywordCount>4</keywordCount><abstractCharCount>2459</abstractCharCount><pdfWordCount>3376</pdfWordCount><pdfCharCount>22889</pdfCharCount><pdfPageCount>5</pdfPageCount><abstractWordCount>309</abstractWordCount></qualityIndicators><title>Subcortical Vascular Lesions Predict Functional Recovery After Rehabilitation in Patients with L‐Dopa Refractory Parkinsonism</title><genre><json:string>brief communication</json:string></genre><host><volume>52</volume><publisherId><json:string>JGS</json:string></publisherId><pages><total>5</total><last>256</last><first>252</first></pages><issn><json:string>0002-8614</json:string></issn><issue>2</issue><genre><json:string>Journal</json:string></genre><language><json:string>unknown</json:string></language><eissn><json:string>1532-5415</json:string></eissn><title>Journal of the American Geriatrics Society</title><doi><json:string>10.1111/(ISSN)1532-5415</json:string></doi></host><publicationDate>2004</publicationDate><copyrightDate>2004</copyrightDate><doi><json:string>10.1111/j.1532-5415.2004.52064.x</json:string></doi><id>6BAAF5138EB35E869AC3A6ACFACCBA50D53CE9F1</id><fulltext><json:item><original>true</original><mimetype>application/pdf</mimetype><extension>pdf</extension><uri>https://api.istex.fr/document/6BAAF5138EB35E869AC3A6ACFACCBA50D53CE9F1/fulltext/pdf</uri></json:item><json:item><original>false</original><mimetype>application/zip</mimetype><extension>zip</extension><uri>https://api.istex.fr/document/6BAAF5138EB35E869AC3A6ACFACCBA50D53CE9F1/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/6BAAF5138EB35E869AC3A6ACFACCBA50D53CE9F1/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a" type="main" xml:lang="en">Subcortical Vascular Lesions Predict Functional Recovery After Rehabilitation in Patients with L‐Dopa Refractory Parkinsonism</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>Blackwell Science Inc</publisher><pubPlace>Oxford, UK</pubPlace><availability><p>WILEY</p></availability><date>2004</date></publicationStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a" type="main" xml:lang="en">Subcortical Vascular Lesions Predict Functional Recovery After Rehabilitation in Patients with L‐Dopa Refractory Parkinsonism</title><author><persName><forename type="first">Fabio</forename><surname>Guerini</surname></persName><roleName type="degree">MD</roleName><affiliation>From the*Rehabilitation Unit “Ancelle della Carità” Hospital, Cremona, Italy†Geriatric Research Group, Brescia, Italy‡Laboratory of Epidemiology and Neuroimaging, IRCCS S. Giovanni di Dio Fatabenefratelli, Brescia, Italy§“Tor Vergata” University, Rome, Italy.</affiliation></author><author><persName><forename type="first">Giovanni B.</forename><surname>Frisoni</surname></persName><roleName type="degree">MD</roleName><affiliation>From the*Rehabilitation Unit “Ancelle della Carità” Hospital, Cremona, Italy†Geriatric Research Group, Brescia, Italy‡Laboratory of Epidemiology and Neuroimaging, IRCCS S. Giovanni di Dio Fatabenefratelli, Brescia, Italy§“Tor Vergata” University, Rome, Italy.</affiliation></author><author><persName><forename type="first">Catherine</forename><surname>Bellwald</surname></persName><roleName type="degree">MD</roleName><affiliation>From the*Rehabilitation Unit “Ancelle della Carità” Hospital, Cremona, Italy†Geriatric Research Group, Brescia, Italy‡Laboratory of Epidemiology and Neuroimaging, IRCCS S. Giovanni di Dio Fatabenefratelli, Brescia, Italy§“Tor Vergata” University, Rome, Italy.</affiliation></author><author><persName><forename type="first">Roberta Rossi</forename><surname>Psy</surname></persName><affiliation>From the*Rehabilitation Unit “Ancelle della Carità” Hospital, Cremona, Italy†Geriatric Research Group, Brescia, Italy‡Laboratory of Epidemiology and Neuroimaging, IRCCS S. Giovanni di Dio Fatabenefratelli, Brescia, Italy§“Tor Vergata” University, Rome, Italy.</affiliation></author><author><persName><forename type="first">Giuseppe</forename><surname>Bellelli</surname></persName><roleName type="degree">MD</roleName><affiliation>From the*Rehabilitation Unit “Ancelle della Carità” Hospital, Cremona, Italy†Geriatric Research Group, Brescia, Italy‡Laboratory of Epidemiology and Neuroimaging, IRCCS S. Giovanni di Dio Fatabenefratelli, Brescia, Italy§“Tor Vergata” University, Rome, Italy.</affiliation></author><author><persName><forename type="first">Marco</forename><surname>Trabucchi</surname></persName><roleName type="degree">MD</roleName><affiliation>From the*Rehabilitation Unit “Ancelle della Carità” Hospital, Cremona, Italy†Geriatric Research Group, Brescia, Italy‡Laboratory of Epidemiology and Neuroimaging, IRCCS S. Giovanni di Dio Fatabenefratelli, Brescia, Italy§“Tor Vergata” University, Rome, Italy.</affiliation></author></analytic><monogr><title level="j">Journal of the American Geriatrics Society</title><idno type="pISSN">0002-8614</idno><idno type="eISSN">1532-5415</idno><idno type="DOI">10.1111/(ISSN)1532-5415</idno><imprint><publisher>Blackwell Science Inc</publisher><pubPlace>Oxford, UK</pubPlace><date type="published" when="2004-02"></date><biblScope unit="volume">52</biblScope><biblScope unit="issue">2</biblScope><biblScope unit="page" from="252">252</biblScope><biblScope unit="page" to="256">256</biblScope></imprint></monogr><idno type="istex">6BAAF5138EB35E869AC3A6ACFACCBA50D53CE9F1</idno><idno type="DOI">10.1111/j.1532-5415.2004.52064.x</idno><idno type="ArticleID">JGS52064</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2004</date></creation><langUsage><language ident="en">en</language></langUsage><abstract xml:lang="en"><p>Objectives: To identify predictors of functional recovery after an intensive rehabilitation training in patients with gait disturbances and refractory parkinsonism. Design: Observational study. Setting: A hospital geriatric rehabilitation department (“Ancelle della Carità” hospital of Cremona). Participants: Thirty‐eight subjects (mean age±standard deviation of 78.9±6.5; 66% women) with gait disturbances and L‐dopa refractory parkinsonism consecutively admitted to a rehabilitation unit within 6 months were recruited. Exclusion criteria were obvious musculoskeletal disorders (severe leg arthritis, hemiparesis, recent stroke), recent surgery, delirium, physical impairment from other identifiable causes, and missing computed tomography (CT) scan. All subjects received an intensive standardized rehabilitative program including conventional physical therapy and specific gait training. Measurements: The outcome measure of the rehabilitation training was the gain between admission and discharge on the Unified Parkinson Disease Rating Scale (delta‐UPDRS). The following potential predictors were assessed using comprehensive geriatric assessment: physical health (Charlson Comorbidity Index, number of drugs), cognitive performance (Mini‐Mental State Examination (MMSE)), functional status (Tinetti scale), depressive symptoms (Geriatric Depression Scale), nutritional status (serum albumin and body mass index), and subcortical cerebrovascular load (four classes of increasing severity based on diffuse leukoariosis, patchy lesions of the white matter, and lacunas on CT scan). Multivariate logistic regression with fixed adjustment for age, cognitive performance, and UPDRS on admission and stepwise selection of variables were used to identify independent predictors. Results: Patients were divided into two groups of equal size based on the delta‐UPDRS (high and low functional recovery: delta‐UPDRS >8 and ≤8, respectively). Of all variables, only subcortical cerebrovascular load predicted functional recovery at discharge (odds ratio adjusted for age, MMSE, and UPDRS on admission=2.3, 95% confidence interval=1.0–5.1). The adjusted proportion of patients with high functional recovery decreased with increasing subcortical cerebrovascular load: 83%, 61%, 44%, and 27% (adjusted P for trend=0.047). Conclusion: Subcortical cerebrovascular load is a predicting factor of successful rehabilitation in patients with L‐dopa refractory parkinsonism.</p></abstract><textClass xml:lang="en"><keywords scheme="keyword"><list><head>Keywords</head><item><term>parkinsonism</term></item><item><term>subcortical vascular lesions</term></item><item><term>functional recovery</term></item><item><term>rehabilitation</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2004-02">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><original>false</original><mimetype>text/plain</mimetype><extension>txt</extension><uri>https://api.istex.fr/document/6BAAF5138EB35E869AC3A6ACFACCBA50D53CE9F1/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Wiley, elements deleted: body"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="yes"</istex:xmlDeclaration><istex:document><component version="2.0" type="serialArticle" xml:lang="en"><header><publicationMeta level="product"><publisherInfo><publisherName>Blackwell Science Inc</publisherName><publisherLoc>Oxford, UK</publisherLoc></publisherInfo><doi origin="wiley" registered="yes">10.1111/(ISSN)1532-5415</doi><issn type="print">0002-8614</issn><issn type="electronic">1532-5415</issn><idGroup><id type="product" value="JGS"></id><id type="publisherDivision" value="ST"></id></idGroup><titleGroup><title type="main" sort="JOURNAL OF AMERICAN GERIATRICS SOCIETY">Journal of the American Geriatrics Society</title></titleGroup></publicationMeta><publicationMeta level="part" position="02002"><doi origin="wiley">10.1111/jgs.2004.52.issue-2</doi><numberingGroup><numbering type="journalVolume" number="52">52</numbering><numbering type="journalIssue" number="2">2</numbering></numberingGroup><coverDate startDate="2004-02">February 2004</coverDate></publicationMeta><publicationMeta level="unit" type="shortCommunication" position="13" status="forIssue"><doi origin="wiley">10.1111/j.1532-5415.2004.52064.x</doi><idGroup><id type="unit" value="JGS52064"></id><id type="supplier" value="52064"></id></idGroup><countGroup><count type="pageTotal" number="5"></count></countGroup><titleGroup><title type="tocHeading1">Brief Reports</title></titleGroup><eventGroup><event type="firstOnline" date="2004-01-22"></event><event type="publishedOnlineFinalForm" date="2004-01-22"></event><event type="xmlConverted" agent="Converter:BPG_TO_WML3G version:2.3.2 mode:FullText source:FullText result:FullText" date="2010-03-10"></event><event type="xmlConverted" agent="Converter:WILEY_ML3G_TO_WILEY_ML3GV2 version:3.8.8" date="2014-01-31"></event><event type="xmlConverted" agent="Converter:WML3G_To_WML3G version:4.1.7 mode:FullText,remove_FC" date="2014-10-30"></event></eventGroup><numberingGroup><numbering type="pageFirst" number="252">252</numbering><numbering type="pageLast" number="256">256</numbering></numberingGroup><correspondenceTo>Address correspondence to Giuseppe Bellelli, MD, Head, Rehabilitation Unit, “Ancelle della Carità” Hospital, 26100, Cremona, Italy. E‐mail: <email normalForm="bellelli-giuseppe@poliambulanza.it">bellelli‐giuseppe@poliambulanza.it</email></correspondenceTo><linkGroup><link type="toTypesetVersion" href="file:JGS.JGS52064.pdf"></link></linkGroup></publicationMeta><contentMeta><countGroup><count type="figureTotal" number="1"></count><count type="tableTotal" number="2"></count><count type="formulaTotal" number="0"></count><count type="referenceTotal" number="30"></count><count type="wordTotal" number="4501"></count><count type="linksCrossRef" number="36"></count></countGroup><titleGroup><title type="main">Subcortical Vascular Lesions Predict Functional Recovery After Rehabilitation in Patients with L‐Dopa Refractory Parkinsonism</title><title type="shortAuthors">GUERINI ET AL.</title><title type="short">SUBCORTICAL VASCULAR LESIONS, FUNCTION, AND PARKINSONISM</title></titleGroup><creators><creator creatorRole="author" xml:id="cr1" affiliationRef="#aff-1-1"><personName><givenNames>Fabio</givenNames><familyName>Guerini</familyName><degrees>MD</degrees></personName></creator><creator creatorRole="author" xml:id="cr2" affiliationRef="#aff-1-1"><personName><givenNames>Giovanni B.</givenNames><familyName>Frisoni</familyName><degrees>MD</degrees></personName></creator><creator creatorRole="author" xml:id="cr3" affiliationRef="#aff-1-1"><personName><givenNames>Catherine</givenNames><familyName>Bellwald</familyName><degrees>MD</degrees></personName></creator><creator creatorRole="author" xml:id="cr4" affiliationRef="#aff-1-1"><personName><givenNames>Roberta Rossi</givenNames><familyName>Psy</familyName></personName></creator><creator creatorRole="author" xml:id="cr5" affiliationRef="#aff-1-1"><personName><givenNames>Giuseppe</givenNames><familyName>Bellelli</familyName><degrees>MD</degrees></personName></creator><creator creatorRole="author" xml:id="cr6" affiliationRef="#aff-1-1"><personName><givenNames>Marco</givenNames><familyName>Trabucchi</familyName><degrees>MD</degrees></personName></creator></creators><affiliationGroup><affiliation xml:id="aff-1-1" countryCode="IT"><unparsedAffiliation>From the <sup>*</sup>Rehabilitation Unit “Ancelle della Carità” Hospital, Cremona, Italy<sup>†</sup>Geriatric Research Group, Brescia, Italy<sup>‡</sup>Laboratory of Epidemiology and Neuroimaging, IRCCS S. Giovanni di Dio Fatabenefratelli, Brescia, Italy<sup>§</sup>“Tor Vergata” University, Rome, Italy.</unparsedAffiliation></affiliation></affiliationGroup><keywordGroup xml:lang="en"><keyword xml:id="k1">parkinsonism</keyword><keyword xml:id="k2">subcortical vascular lesions</keyword><keyword xml:id="k3">functional recovery</keyword><keyword xml:id="k4">rehabilitation</keyword></keywordGroup><abstractGroup><abstract type="main" xml:lang="en"><p><b>Objectives: </b> To identify predictors of functional recovery after an intensive rehabilitation training in patients with gait disturbances and refractory parkinsonism.</p><p><b>Design: </b> Observational study.</p><p><b>Setting: </b> A hospital geriatric rehabilitation department (“Ancelle della Carità” hospital of Cremona).</p><p><b>Participants: </b> Thirty‐eight subjects (mean age±standard deviation of 78.9±6.5; 66% women) with gait disturbances and L‐dopa refractory parkinsonism consecutively admitted to a rehabilitation unit within 6 months were recruited. Exclusion criteria were obvious musculoskeletal disorders (severe leg arthritis, hemiparesis, recent stroke), recent surgery, delirium, physical impairment from other identifiable causes, and missing computed tomography (CT) scan. All subjects received an intensive standardized rehabilitative program including conventional physical therapy and specific gait training.</p><p><b>Measurements: </b> The outcome measure of the rehabilitation training was the gain between admission and discharge on the Unified Parkinson Disease Rating Scale (delta‐UPDRS). The following potential predictors were assessed using comprehensive geriatric assessment: physical health (Charlson Comorbidity Index, number of drugs), cognitive performance (Mini‐Mental State Examination (MMSE)), functional status (Tinetti scale), depressive symptoms (Geriatric Depression Scale), nutritional status (serum albumin and body mass index), and subcortical cerebrovascular load (four classes of increasing severity based on diffuse leukoariosis, patchy lesions of the white matter, and lacunas on CT scan). Multivariate logistic regression with fixed adjustment for age, cognitive performance, and UPDRS on admission and stepwise selection of variables were used to identify independent predictors.</p><p><b>Results: </b> Patients were divided into two groups of equal size based on the delta‐UPDRS (high and low functional recovery: delta‐UPDRS >8 and ≤8, respectively). Of all variables, only subcortical cerebrovascular load predicted functional recovery at discharge (odds ratio adjusted for age, MMSE, and UPDRS on admission=2.3, 95% confidence interval=1.0–5.1). The adjusted proportion of patients with high functional recovery decreased with increasing subcortical cerebrovascular load: 83%, 61%, 44%, and 27% (adjusted <i>P</i> for trend=0.047).</p><p><b>Conclusion: </b> Subcortical cerebrovascular load is a predicting factor of successful rehabilitation in patients with L‐dopa refractory parkinsonism.</p></abstract></abstractGroup></contentMeta></header></component></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Subcortical Vascular Lesions Predict Functional Recovery After Rehabilitation in Patients with L‐Dopa Refractory Parkinsonism</title></titleInfo><titleInfo type="abbreviated"><title>SUBCORTICAL VASCULAR LESIONS, FUNCTION, AND PARKINSONISM</title></titleInfo><titleInfo type="alternative" contentType="CDATA" lang="en"><title>Subcortical Vascular Lesions Predict Functional Recovery After Rehabilitation in Patients with L‐Dopa Refractory Parkinsonism</title></titleInfo><name type="personal"><namePart type="given">Fabio</namePart><namePart type="family">Guerini</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>From the*Rehabilitation Unit “Ancelle della Carità” Hospital, Cremona, Italy†Geriatric Research Group, Brescia, Italy‡Laboratory of Epidemiology and Neuroimaging, IRCCS S. Giovanni di Dio Fatabenefratelli, Brescia, Italy§“Tor Vergata” University, Rome, Italy.</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Giovanni B.</namePart><namePart type="family">Frisoni</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>From the*Rehabilitation Unit “Ancelle della Carità” Hospital, Cremona, Italy†Geriatric Research Group, Brescia, Italy‡Laboratory of Epidemiology and Neuroimaging, IRCCS S. Giovanni di Dio Fatabenefratelli, Brescia, Italy§“Tor Vergata” University, Rome, Italy.</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Catherine</namePart><namePart type="family">Bellwald</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>From the*Rehabilitation Unit “Ancelle della Carità” Hospital, Cremona, Italy†Geriatric Research Group, Brescia, Italy‡Laboratory of Epidemiology and Neuroimaging, IRCCS S. Giovanni di Dio Fatabenefratelli, Brescia, Italy§“Tor Vergata” University, Rome, Italy.</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Roberta Rossi</namePart><namePart type="family">Psy</namePart><affiliation>From the*Rehabilitation Unit “Ancelle della Carità” Hospital, Cremona, Italy†Geriatric Research Group, Brescia, Italy‡Laboratory of Epidemiology and Neuroimaging, IRCCS S. Giovanni di Dio Fatabenefratelli, Brescia, Italy§“Tor Vergata” University, Rome, Italy.</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Giuseppe</namePart><namePart type="family">Bellelli</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>From the*Rehabilitation Unit “Ancelle della Carità” Hospital, Cremona, Italy†Geriatric Research Group, Brescia, Italy‡Laboratory of Epidemiology and Neuroimaging, IRCCS S. Giovanni di Dio Fatabenefratelli, Brescia, Italy§“Tor Vergata” University, Rome, Italy.</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Marco</namePart><namePart type="family">Trabucchi</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>From the*Rehabilitation Unit “Ancelle della Carità” Hospital, Cremona, Italy†Geriatric Research Group, Brescia, Italy‡Laboratory of Epidemiology and Neuroimaging, IRCCS S. Giovanni di Dio Fatabenefratelli, Brescia, Italy§“Tor Vergata” University, Rome, Italy.</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="brief communication" displayLabel="shortCommunication"></genre><originInfo><publisher>Blackwell Science Inc</publisher><place><placeTerm type="text">Oxford, UK</placeTerm></place><dateIssued encoding="w3cdtf">2004-02</dateIssued><copyrightDate encoding="w3cdtf">2004</copyrightDate></originInfo><language><languageTerm type="code" authority="rfc3066">en</languageTerm><languageTerm type="code" authority="iso639-2b">eng</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType><extent unit="figures">1</extent><extent unit="tables">2</extent><extent unit="references">30</extent><extent unit="words">4501</extent></physicalDescription><abstract lang="en">Objectives: To identify predictors of functional recovery after an intensive rehabilitation training in patients with gait disturbances and refractory parkinsonism. Design: Observational study. Setting: A hospital geriatric rehabilitation department (“Ancelle della Carità” hospital of Cremona). Participants: Thirty‐eight subjects (mean age±standard deviation of 78.9±6.5; 66% women) with gait disturbances and L‐dopa refractory parkinsonism consecutively admitted to a rehabilitation unit within 6 months were recruited. Exclusion criteria were obvious musculoskeletal disorders (severe leg arthritis, hemiparesis, recent stroke), recent surgery, delirium, physical impairment from other identifiable causes, and missing computed tomography (CT) scan. All subjects received an intensive standardized rehabilitative program including conventional physical therapy and specific gait training. Measurements: The outcome measure of the rehabilitation training was the gain between admission and discharge on the Unified Parkinson Disease Rating Scale (delta‐UPDRS). The following potential predictors were assessed using comprehensive geriatric assessment: physical health (Charlson Comorbidity Index, number of drugs), cognitive performance (Mini‐Mental State Examination (MMSE)), functional status (Tinetti scale), depressive symptoms (Geriatric Depression Scale), nutritional status (serum albumin and body mass index), and subcortical cerebrovascular load (four classes of increasing severity based on diffuse leukoariosis, patchy lesions of the white matter, and lacunas on CT scan). Multivariate logistic regression with fixed adjustment for age, cognitive performance, and UPDRS on admission and stepwise selection of variables were used to identify independent predictors. Results: Patients were divided into two groups of equal size based on the delta‐UPDRS (high and low functional recovery: delta‐UPDRS >8 and ≤8, respectively). Of all variables, only subcortical cerebrovascular load predicted functional recovery at discharge (odds ratio adjusted for age, MMSE, and UPDRS on admission=2.3, 95% confidence interval=1.0–5.1). The adjusted proportion of patients with high functional recovery decreased with increasing subcortical cerebrovascular load: 83%, 61%, 44%, and 27% (adjusted P for trend=0.047). Conclusion: Subcortical cerebrovascular load is a predicting factor of successful rehabilitation in patients with L‐dopa refractory parkinsonism.</abstract><subject lang="en"><genre>Keywords</genre><topic>parkinsonism</topic><topic>subcortical vascular lesions</topic><topic>functional recovery</topic><topic>rehabilitation</topic></subject><relatedItem type="host"><titleInfo><title>Journal of the American Geriatrics Society</title></titleInfo><genre type="Journal">journal</genre><identifier type="ISSN">0002-8614</identifier><identifier type="eISSN">1532-5415</identifier><identifier type="DOI">10.1111/(ISSN)1532-5415</identifier><identifier type="PublisherID">JGS</identifier><part><date>2004</date><detail type="volume"><caption>vol.</caption><number>52</number></detail><detail type="issue"><caption>no.</caption><number>2</number></detail><extent unit="pages"><start>252</start><end>256</end><total>5</total></extent></part></relatedItem><identifier type="istex">6BAAF5138EB35E869AC3A6ACFACCBA50D53CE9F1</identifier><identifier type="DOI">10.1111/j.1532-5415.2004.52064.x</identifier><identifier type="ArticleID">JGS52064</identifier><recordInfo><recordContentSource>WILEY</recordContentSource><recordOrigin>Blackwell Science Inc</recordOrigin></recordInfo></mods></metadata><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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