OBSTRUCTIVE AND RESTRICTIVE PULMONARY DYSFUNCTION INCREASES DISABILITY IN PARKINSON DISEASE

Objective: The purpose of this study was to determine in Parkinson dis ease the impact of pulmonary dysfunction on daily living activities (D LA). Patients: Extrapyramidal motor impairment, pulmonary dysfunction, and DLA disabilities were studied in 58 Parkinson patients consecutiv ely enrolled in a rehabilitation service at a university hospital. Mai n Outcome Measures: Extrapyramidal motor impairments were assessed by the Unified Parkinson's Disease Rating Scale (UPDRS) and the DLA disab ilities by the UPDRS, Hoehn-Yahr, and Schwab-England scales. The pulmo nary dysfunctions were assessed by spirometry with flow-volume loops, body plethysmography with lung volumes computation, and maximal inspir atory and expiratory static mouth pressures. Results: Parkinson patien ts showed important modifications of pulmonary function with a decreas e in forced vital capacity, forced expiratory volume in the first minu te, and arterial Pot and an increase in residual volume and total airw ay resistance (RAW). In addition, they showed a high incidence of airw ay ventilatory obstructions and restrictive dysfunction. The impact of lung disease on daily living activities in Parkinson disease patients was higher in subjects with restrictive pulmonary dysfunctions (Schwa b-England test and turning in bed and adjusting bedclothes, walking, f alling, and freezing when walking items of UPDRS) and airway obstructi ons (handling utensils, dressing and hygiene items of UPDRS). Conclusi ons: Airway obstructions or restrictive pulmonary dysfunctions present a high prevalence in Parkinson disease, contributing as a main factor for DLA dysfunctions. The evaluation and rehabilitation of respirator y disturbances should be systematically included in the management of these patients. (C) 1996 by the American Congress of Rehabilitation Me dicine and the American Academy of Physical Medicine and Rehabilitatio n