Fatores que modificam a função congnitiva e motora na doença de Parkinson : um estudo sobre a influência do jogo de dominó

Abstract

Parkinson’s disease (PD) is a chronic illness characterized by the presence of akinesia, rigidity and resting tremor. Clinical fluctuation is a common finding and is probably related to the oscillation of dopaminergic neurotransmission and also to the influence of other neurotransmitters. Obsessive gambling has been described over the years and it has been associated in many cases with the use of dopaminergic agonists. The explanation for these findings might be that dopamine is involved in a reward system at the central nervous system. Games has also been associated with improvement of cognition in the elderly. The aim of this study was to evaluate the acute effect of playing dominoe on working memory, as evaluated by the Stroop test, and motor activity as evaluated by the 14-meter walk and the finger-tap test, on a population with PD. Besides socio-demographic data, patients were evaluated with the Unified Parkinson Disease Rating Scale Part III and with the Beck Depression Inventory (BDI). Experiment consisted on performing a game of dominoe, between 8 and 9 hours A.M. Patients were tested before and after experiment. Control group remained kept without specific activity for the same amount of time as the others. Patients were classified in winners, non-winners and control respectively, after experiment. The study was performed at the University Hospital of Federal University of Ceará. All cases were out patients from a movement disorders clinic. Forty consecutive patients, 27 male (67,5%), age from 48 to 84 years (63,2±8,5), Hoehn &Yahr between I e III were included. Twenty-eight cases (70%) presented depressive symptoms (BDI>10). Control group was made of 13 cases, 14 were winners and 13 were non-winners. Comparison among groups did not show any differences statistics regarding age, disease duration, age at presentation of symptoms, body mass index, alcohol use, smoking habit, family history, depressive symptoms, levodopa dose, and practice of games. One female patient on use of dopaminergic agonist referred compulsion for gambling. In this study, winners presented significantly better results on working memory as evaluated by the Stroop test (p=0,002) and of motor activity as evaluated by the finger-tap test (p= 0,01). Non-winners showed a trend of better performance in the 14-meter walk test. In conclusion, our study shows that in PD, performing a simple dominoe game is associated with improvement of working memory as evaluated by the Stroop Test and of motor activity as evaluated by the finger-tap test. These findings may be explained by a liberation of dopamine that occurs with gaming through the reward system.