Asociación entre periodontitis, enfermedad cerebrovascular y demencia. Informe científico del Grupo de Trabajo de la Sociedad Española de Periodoncia y la Sociedad Española de Neurología / The association between periodontitis, cerebrovascular disease, and dementia. Scientific report of the Working Group of the Spanish Society of Periodontology and the Spanish Society of Neurology

Objetivo: Revisar la evidencia científica disponible sobre la relación entre la periodontitis y las enfermedades neurológicas, en particular la enfermedad cerebrovascular y la demencia. Además, se facilitan una serie de recomendaciones en relación con la prevención y el manejo de la periodontitis y estas enfermedades neurológicas desde las consultas dentales y las unidades de neurología. Desarrollo: Se realizó una búsqueda bibliográfica sin restricción en cuanto al diseño del estudio para identificar aquellos artículos más relevantes sobre la asociación entre periodontitis, enfermedad cerebrovascular y demencia desde un punto de vista epidemiológico, de intervención, así como de mecanismos biológicos involucrados en estas relaciones, y así responder a diferentes preguntas planteadas por los miembros del Grupo de Trabajo SEPA-SEN. Conclusiones: La periodontitis aumenta el riesgo de ictus isquémico y demencia de tipo Alzheimer. Bacteriemias recurrentes con aumento de un estado inflamatorio sistémico de bajo grado parecen ser posibles mecanismos biológicos que explicarían esta asociación. Una evidencia limitada apunta a que diferentes intervenciones de salud oral pueden reducir el riesgo futuro de padecer enfermedad cerebrovascular y demencia.(AU)

Objective: This article reviews the scientific evidence on the relationship between periodontitis and neurological disease, and particularly cerebrovascular disease and dementia. We also issue a series of recommendations regarding the prevention and management of periodontitis and these neurological diseases at dental clinics and neurology units. Development: In response to a series of questions proposed by the SEPA-SEN Working Group, a literature search was performed, with no restrictions on study design, to identify the most relevant articles on the association between periodontitis and cerebrovascular disease and dementia from the perspectives of epidemiology, treatment, and the biological mechanisms involved in these associations. Conclusions: Periodontitis increases the risk of ischaemic stroke and Alzheimer dementia. Recurrent bacterial infections and increased low-grade systemic inflammation seem to be possible biological mechanisms underlying this association. Limited evidence suggests that various oral health interventions can reduce the future risk of cerebrovascular disease and dementia.(AU)

El arte gráfico como medio de comunicación y cuidados en personas con demencia temprana y Alzhéimer / A arte gráfica como meio de comunicação e cuidado em pessoas com demência precoce e Alzheimer / Graphic art as a means of communication and care in people with early dementia and Alzheimer’s

El presente trabajo analiza la repercusión de la técnica de grabadono tóxica Collagraph, en personas con Demencia tempranatipo Alzhéimer, en el programa de educación artística “Retalesde una vida”. El objetivo es conectar a los participantes conprogramas de carácter cultural para fomentar la comunicacióne interacción entre participantes. La experiencia se llevó a caboen el Centro de Referencia Estatal para personas con Alzheimery otras Demencias de Salamanca (CREA). Una vez adaptadala metodología del taller a las características personales y desalud de las personas enfermas de Alzheimer, se considera lautilización del grabado genera importantes beneficios en losparticipantes, relacionados con el incremento de la inteligenciacristalizada, la conducta prosocial y la valoración positiva desí mismos, favoreciendo la inclusión social y familiar.Asimismo, el empleo del grabado puede ofrecer un soporte deayuda terapéutica individual y cooperativa a los participantes,desarrollar habilidades funcionales, sociales y cognitivas, ampliandosus recursos emocionales y disfrutar de la experiencia. A suvez fortalecen su autoestima y seguridad ante su capacidady valía. Por último, planteamos una serie de pautas para laplanificación e implementación de este proceso artístico paraque sirva de referente a profesionales de la salud.(AU)

The present work analyzes the repercussion of the non-toxic engraving technique Collagraph, in people with EarlyAlzheimer’s Dementia, in the artistic education program “Retalesde una vida”. The objective is to connect the participants withprograms of a cultural nature to encourage communication and interaction between participants. The experience wascarried out at the State Reference Center for people withAlzheimer’s and other Dementias of Salamanca (CREA). Oncethe methodology of the workshop has been adapted to thepersonal and health characteristics of people with Alzheimer'sdisease, it is considered that the use of engraving generatesimportant benefits in the participants, related to the increasein crystallized intelligence, prosocial behavior and positiveassessment. of themselves, favoring social and family inclusion.Likewise, the use of engraving can offer support for individualand cooperative therapeutic help to the participants, developfunctional, social and cognitive skills, expanding theiremotional resources and enjoying the experience. In turn,they strengthen their self-esteem and security in the faceof their ability and worth. Finally, we propose a series ofguidelines for the planning and implementation of this artisticprocess so that it serves as a reference for health professionals.(AU)

O presente trabalho analisa a repercussão da técnica degravura atóxica Collagraph, em pessoas com DemênciaInicial de Alzheimer, no programa de educação artística“Retales de una vida”. O objetivo é conectar os participantes aprogramas de cunho cultural para estimular a comunicação ea interação entre os participantes. A experiência foi realizadano Centro Estadual de Referência para Pessoas com Alzheimere outras Demências de Salamanca (CREA). Uma vez quea metodologia da oficina foi adaptada às característicaspessoais e de saúde das pessoas com doença de Alzheimer,considerase que o uso da gravura gera importantes benefíciosnos participantes, relacionados ao aumento da inteligênciacristalizada, comportamento prósocial e avaliação positivade si mesmos, favorecendo a inclusão social e familiar.Da mesma forma, o uso da gravura pode oferecer suporte paraajuda terapêutica individual e cooperativa aos participantes,desenvolver habilidades funcionais, sociais e cognitivas, ampliandoseus recursos emocionais e desfrutando da experiência. Porsua vez, fortalecem sua auto-estima e segurança diante de suacapacidade e valor. Por fim, propomos uma série de diretrizespara o planejamento e implementação desse processo artísticopara que sirva de referência para os profissionais de saúde.(AU)

Effects of training Community Health Agents on dementia: a quasi-experimental study.

OBJECTIVES: to evaluate the knowledge of Community Health Agents about dementia before and after the training workshop for detecting signs of the disease. METHODS: a quasi-experimental study with 33 community agents, in which sociodemographic information and knowledge about dementia were collected and assessed using the Alzheimer's Disease Knowledge Scale before and after the workshop. There were 10 weekly, online, synchronous meetings. The Student's t-test for related samples was used, and the effect size was calculated. RESULTS: while the average score on the initial assessment, using the measurement instrument, was 16.3, it was 21.24 in the final assessment. An increase in the scale score was observed after participating in the workshop, with a value of 4.94. CONCLUSIONS: it is urgent to invest in the ongoing education of these professionals for greater awareness in the timely detection of dementia cases in primary care and awareness of potentially modifiable factors.

Miastenia gravis y enfermedad de Alzheimer: una asociación a estudio / Association between myasthenia gravis and Alzheimer’s disease

Introducción La miastenia gravis (MG) y la enfermedad de Alzheimer (EA) son dos de las enfermedades neurológicas en cuya fisiopatología interviene la acetilcolina en distintos niveles. En la primera, la alteración de este neurotransmisor se produce en la unión neuromuscular, y en la segunda, en el sistema nervioso central. Objetivo Analizar la posible relación entre dichas patologías estudiando la prevalencia y la odds ratio de la EA dentro de los pacientes diagnosticados de MG con respecto a la prevalencia de EA en la población general. Pacientes y métodos Se han examinado datos de las historias clínicas electrónicas del sistema de salud de Castilla-La Mancha utilizando el procesamiento de lenguaje natural a través de la plataforma clínica de inteligencia artificial Savana Manager?. Resultados Se ha identificado a 970.503 pacientes mayores de 60 años, de los que 1.028 tenían diagnóstico de MG. La proporción de pacientes con diagnóstico de EA dentro de este grupo (4,28%) es mayor que en el resto de la población (2,82%; p = 0,0047), con una odds ratio de 1,54 (intervalo de confianza al 95%: 1,13-2,08; p = 0,0051), sin que se encuentren diferencias significativas en el análisis bivariante del resto de los factores de riesgo para EA más importantes conocidos hasta ahora. Conclusiones Nuestros resultados sugieren que podría existir un aumento de la prevalencia de EA en pacientes con MG. (AU)

INTRODUCTION Myasthenia gravis (MG) and Alzheimer’s disease (AD) are two of the most important diseases where the dysregulation of acetylcholine activity plays a crucial role. In the first, this dysregulation happens at the level of the neu­romuscular junction and in the second, in the central nervous system (CNS). AIM To analyze the possible relationship between these two pathologies, analyzing the prevalence and the odds ratio of AD within patients previously diagnosed with MG. We will compare these data with respect to the prevalence of AD in the general population. PATIENTS AND METHODS We examined the data obtained by the electronic medical records of patients in the health care system of Castilla La Mancha using the Natural Language Process provided by a clinical platform of artificial intelligence known as the Savana Manager?. RESULTS We identified 970,503 patients over the age of 60 years, of which 1,028 were diagnosed with MG. The proportion of the patients diagnosed with AD within this group (4.28%) was greater than the rest of the population (2.82%) (p = 0,0047) with an odds ratio of 1.54 (confidence interval at 95% 1.13-2.08; p = 0.0051) without finding significant differences in the bivariate analysis for the rest of the most important actual known risk factors for AD. CONCLUSION. Our results suggest that there might be an increase in the prevalence of AD in patients previously diagnosed with MG. (AU)

Association between myasthenia gravis and Alzheimer's disease. / Miastenia gravis y enfermedad de Alzheimer: una asociación a estudio.

INTRODUCTION: Myasthenia gravis (MG) and Alzheimer's disease (AD) are two of the most important diseases where the dysregulation of acetylcholine activity plays a crucial role. In the first, this dysregulation happens at the level of the neu-romuscular junction and in the second, in the central nervous system (CNS). AIM: To analyze the possible relationship between these two pathologies, analyzing the prevalence and the odds ratio of AD within patients previously diagnosed with MG. We will compare these data with respect to the prevalence of AD in the general population. PATIENTS AND METHODS: We examined the data obtained by the electronic medical records of patients in the health care system of Castilla La Mancha using the Natural Language Process provided by a clinical platform of artificial intelligence known as the Savana Manager?. RESULTS: We identified 970,503 patients over the age of 60 years, of which 1,028 were diagnosed with MG. The proportion of the patients diagnosed with AD within this group (4.28%) was greater than the rest of the population (2.82%) (p = 0,0047) with an odds ratio of 1.54 (confidence interval at 95% 1.13-2.08; p = 0.0051) without finding significant differences in the bivariate analysis for the rest of the most important actual known risk factors for AD. CONCLUSION: Our results suggest that there might be an increase in the prevalence of AD in patients previously diagnosed with MG.

TITLE: Miastenia gravis y enfermedad de Alzheimer: una asociación a estudio.Introducción. La miastenia gravis (MG) y la enfermedad de Alzheimer (EA) son dos de las enfermedades neurológicas en cuya fisiopatología interviene la acetilcolina en distintos niveles. En la primera, la alteración de este neurotransmisor se produce en la unión neuromuscular, y en la segunda, en el sistema nervioso central. Objetivo. Analizar la posible relación entre dichas patologías estudiando la prevalencia y la odds ratio de la EA dentro de los pacientes diagnosticados de MG con respecto a la prevalencia de EA en la población general. Pacientes y métodos. Se han examinado datos de las historias clínicas electrónicas del sistema de salud de Castilla-La Mancha utilizando el procesamiento de lenguaje natural a través de la plataforma clínica de inteligencia artificial Savana Manager?. Resultados. Se ha identificado a 970.503 pacientes mayores de 60 años, de los que 1.028 tenían diagnóstico de MG. La proporción de pacientes con diagnóstico de EA dentro de este grupo (4,28%) es mayor que en el resto de la población (2,82%; p = 0,0047), con una odds ratio de 1,54 (intervalo de confianza al 95%: 1,13-2,08; p = 0,0051), sin que se encuentren diferencias significativas en el análisis bivariante del resto de los factores de riesgo para EA más importantes conocidos hasta ahora. Conclusiones. Nuestros resultados sugieren que podría existir un aumento de la prevalencia de EA en pacientes con MG.

[Neuropsychological differences in Alzheimer's disease depending on the age of onset]. / Diferencias neuropsicológicas en la enfermedad de Alzheimer en función de la edad de presentación.

INTRODUCTION: Early-onset Alzheimer's disease (EOAD) has been defined as a dementia due to AD presenting before the arbitrarily established age of 65 (as opposed to late-onset Alzheimer's disease or LOAD). There is still little research about other age sub-groups, the use of so-called senile dementia has been banished, usually including it within the late-onset Alzheimer's dementia. To the extent of our knowledge, there are no studies comparing the neuropsychological features of very-late-onset patients with early and late-onset ones. METHODS: We retrospectively selected 359 patients with a diagnosis of probable AD dementia. We subdivided patients into three groups attending to the age of onset of the disease: early-onset AD (EOAD; younger than 65 years old), late-onset AD (LOAD; between 65 and 80) and very-late-onset AD (VLOAD; defined here as onset age older than 80), and then we compared their neuropsychological results. RESULTS: AD patients with a younger age at onset scored worse on attention, executive function and visuospatial skills, while older-onset patients scored worse in memory tasks and language. Patients with a very-late-onset differed from the late-onset ones in a greater impairment of semantic fluency and naming. CONCLUSION: Although the point of separation between EOAD and later-onset forms of EA at the age of 65 is an arbitrary one, our study shows that there are significant differences between these groups from a neuropsychological point of view. However, these differences do seem to follow a linear trend with age, rather than representing fundamentally distinct clinical pictures.

Publicações científicas sobre direção veicular por pessoas idosas: revisão de escopo / Scientific publications on driving by older adults: scope review

Resumo Objetivo Mapear evidências científicas nacionais e internacionais sobre a condução veicular por pessoas idosas. Método Revisão de escopo baseada no manual proposto pelo Joanna Briggs Institute. Para as buscas foram acessadas as bases MEDLINE, Web of Science, Scopus, SciELO e a literatura cinzenta, por meio do Google Scholar. Resultados Dos 1.194 estudos encontrados, selecionaram-se 189 artigos submetidos aos critérios de elegibilidade. Os países precursores nas publicações foram Austrália e Estados Unidos, e o ápice das pesquisas ocorreu entre 2013 e 2014. Os participantes dos estudos eram pessoas idosas saudáveis, 63,49% (120); seguidos de 17,46% (33) com doença de Alzheimer; 11,11% (21) com Transtorno Neurocognitivo Leve; 6,88% (13) com doença de Parkinson; e 19,58% (37) com outras comorbidades. Diferentes tipos de intervenções foram identificadas nos estudos, destas, 94,02% (178) avaliaram a eficácia de instrumentos que mensuram a aptidão do motorista idoso. Conclusão Houve predominância de estudos na busca de instrumentos de avaliação que mensurassem a funcionalidade do condutor idoso. Esse fato ratifica a importância de avaliação padronizada, validada e economicamente viável que colabore na identificação do motorista em risco. Evidenciou-se a necessidade de intervenções para a prática da geriatria e gerontologia, por meio de ações para formação de equipe multidisciplinar especializada em condução veicular, de modo a adequar as diretrizes de licenciamento a fim de atender às especificidades dos condutores idosos, considerando os aspectos sociais, econômicos, políticos e educacionais, especialmente nos departamentos de trânsito brasileiro.

Abstract Objective To map national and international scientific evidence regarding driving by older adults. Method Scope review based on the manual proposed by the Joanna Briggs Institute. Searches were conducted in the MEDLINE, Web of Science, Scopus, SciELO databases, and grey literature through Google Scholar. Results Out of 1,194 studies identified, 189 papers meeting eligibility criteria were selected. Pioneering countries in publications were Australia and the United States, with the peak of research occurring between 2013 and 2014. Study participants included healthy older adults (63.49%, 120), followed by those with Alzheimer's disease (17.46%, 33), Mild Neurocognitive Disorder (11.11%, 21), Parkinson's disease (6.88%, 13), and other comorbidities (19.58%, 37). Various interventions were identified, with 94.02% (178) assessing the effectiveness of instruments measuring the fitness of older drivers. Conclusion There was a prevalence of studies aimed at identifying assessment tools to measure the functionality of older drivers. This underscores the importance of standardized, validated, and economically viable assessments that contribute to identifying at-risk drivers. The need for interventions in geriatrics and gerontology was evident, emphasizing the necessity for actions to establish a specialized multidisciplinary team in vehicular driving. This approach seeks to align licensing guidelines with the specific needs of older drivers, taking into account social, economic, political, and educational aspects, particularly within the Brazilian traffic departments.

Condiciones de salud bucodental en personas adultas mayores con enfermedad de Alzheimer: Scoping Review

Introducción: El aumento de la longevidad de las personas ha generado en la última etapa de vida la aparición de enfermedades de tipo multifactorial y relacionadas con el estilo de vida, aumentando la prevalencia de patologías mentales y enfermedades orales. Objetivo: Identificar las condiciones de salud oral en personas adultas mayores con enfermedad de Alzheimer. Métodos: Se planteó una revisión de la literatura tipo Scoping Review, determinando una estrategia de búsqueda para tres bases de datos (Pubmed, EbscoHost y LILACS). Fueron incluidos artículos con diseño de corte transversal, cohorte y casos y controles en idioma español, inglés y portugués entre 2011 y 2021. Se realizó la extracción y evaluación del riesgo de sesgo teniendo en cuenta los criterios de elegibilidad. Resultados: Se seleccionaron 32 artículos para revisión de texto completo y síntesis cualitativa de la información. Alemania y Estados Unidos presentan mayor cantidad de publicaciones, el sexo femenino predominó como población de estudio. Se observó menor frecuencia de cepillado, mayor cantidad de ausencias dentales en pacientes con demencia por Alzheimer y consecuentemente un mayor uso de prótesis en dicha población. Conclusiones: Es importante fortalecer la relación sistémico-oral de los adultos mayores mediante un manejo interdisciplinario entre el geriatra y el odontólogo.

Introduction. The increase in the longevity of individuals has led to the emergence of multifactorial diseases related to lifestyle during the later stages of life, thereby increasing the prevalence of mental disorders and oral diseases. Objective: To identify oral health conditions in older adults with Alzheimer's disease. Methods: A Scoping Review literature review was conducted, outlining a search strategy for three databases (Pubmed, EbscoHost, and LILACS). Articles with a cross-sectional, cohort, or case-control design published in Spanish, English, or Portuguese between 2011 and 2021 were included. Extraction and bias risk assessments were performed based on eligibility criteria. Results: Thirty-two articles were selected for full-text review and qualitative synthesis of information. Germany and the United States had the highest number of publications, with females predominating as the study population. A lower frequency of brushing, a higher number of missing teeth in Alzheimer's patients, and consequently higher use of prosthetics were observed in this population. Conclusions: It is essential to strengthening the systemic-oral relationship in older adults through interdisciplinary management involving geriatricians and dentists.

Introdução: O aumento da longevidade das pessoas tem gerado na última fase da vida o aparecimento de doenças multifatoriais e relacionadas ao estilo de vida, aumentando a prevalência de patologias mentais e doenças bucais. Objetivo: identificar as condições de saúde bucal em idosos com doença de Alzheimer. Métodos: foi realizada uma revisão de escopo da literatura, determinando uma estratégia de busca em três bancos de dados (Pubmed, EbscoHost e LILACS). Foram incluídos artigos com desenho transversal, de coorte e de caso-controle em espanhol, inglês e português entre 2011 e 2021. A extração e a avaliação do risco de viés foram realizadas levando-se em conta os critérios de elegibilidade. Resultados: Trinta e dois artigos foram selecionados para revisão do texto completo e síntese qualitativa das informações. A Alemanha e os Estados Unidos tiveram o maior número de publicações, e a população do estudo era predominantemente feminina. Observou-se menor frequência de escovação, maior número de ausencias odontológicas em pacientes com demência de Alzheimer e, consequentemente, maior uso de dentaduras nessa população. Conclusões: É importante fortalecer a relação sistêmico-oral dos idosos por meio do gerenciamento interdisciplinar entre o geriatra e o dentista.

Qualidade de vida do cuidador informal de idosos com doença de alzheimer na pandemia COVID-19 / Quality of life of informal caregivers of aged people with alzheimer's disease during the COVID-19 pandemic

Objetivo: Desvelar sobre a qualidade de vida dos cuidadores informais de idosos com Doença de Alzheimer em tempos de pandemia da COVID-19. Método: Estudo descritivo, qualitativo, por meio de entrevista semiestruturada com 12 cuidadores informais de idosos, selecionados por conveniência. O processamento dos dados foi realizado pelo software IraMuTeQ e análise das classes pelo método de Strauss e Corbin, da qual emergiram 4 classes: rede social e mudança na rotina dos cuidadores informais no período da pandemia da COVID-19; fatores que interferem na QV do cuidador informal; vivenciando o diagnóstico de Alzheimer pelo cuidador informal e sentimentos despertados pela sobrecarga dos cuidadores informais de idosos com DA. Resultados: O perfil feminino se sobressaiu, com destaque para cuidadores com idade entre 40 a 49 anos, casados, ensino médio incompleto, desempenhando esta função por mais de cinco anos e em tempo integral. Os fatores que interferem na qualidade de vida são a falta de tempo, sobrecarga do cuidado, falta de lazer, baixas atividades sociais e sentimentos de tristeza, ansiedade, nervosismo, depressão e desespero. Conclusão: Constatou-se que os aspectos encontrados foram impactados ainda mais durante o período da pandemia da COVID-19, que reconfigurou a rotina do idoso com Alzheimer e do cuidador informal. Descritores: Doença de Alzheimer; Cuidadores. Idosos; Coronavírus; Qualidade de Vida.

Objective:To reveal the quality of life of informal caregivers of aged people with Alzheimer's disease in times of the COVID-19 pandemic. Method:Adescriptive and qualitative study conducted through semi-structured interviews with 12 informal caregivers of older adults, selected by convenience. Data processing was performed using the IraMuTeQ software and class analysis using the Strauss and Corbin method, from which 4 classes emerged, namely: Social network and change in the routine of informal caregivers during theCOVID-19 pandemic period; Factors that interfere with the QoL of informal caregivers; How informal caregivers experience the Alzheimer's disease diagnosis; and Feelings awakened by the burden of informal caregivers of aged people with AD. Results:The female profile stood out, with emphasis on caregivers aged from 40 to 49 years old, married, incomplete High School, and performing this role for more than five years and full-time. The factors that interfere with quality of life are lack of time, care burden, lack of leisure, few social activities and feelings of sadness, anxiety, nervousness, depression and despair. Conclusion:It was verified that the aspects found were impacted even more during the COVID-19 pandemic period, which reconfigured the routine of older adults with Alzheimer's and of informal caregivers. Descriptors: Alzheimer Disease; Caregivers; Aged; Coronavirus; Quality of Life.

Participación de rafts en enfermedades neurológicas / Role of rafts in neurological disorders

Introducción: Los rafts constituyen nano-dominios estructurales de naturaleza lipoproteica que propician la eficiente transducción de señales y la modulación de procesos fisiológicos asociados a la membrana plasmática. En el sistema nervioso, la alteración de estos dominios se ha asociado con el desarrollo de diversos padecimientos. Desarrollo: En el presente artículo se revisa el concepto de rafts, los procesos del sistema nervioso en los cuales están involucrados y su papel en distintas afectaciones, entre las que se destacan las enfermedades de Parkinson, Alzheimer y Huntington. Conclusiones: Dadas las evidencias de su participación en diversas neuropatologías, la preservación y/o reconstitución de los rafts se vislumbran como una atractiva estrategia terapéutica.(AU)

Introduction: Rafts are function-structural cell membrane nano-domains. They contribute to explain the efficiency of signal transduction at the low physiological membrane concentrations of the signaling partners by their clustering inside specialized signaling domains. Development: In this article, we review the current model of the membrane rafts and their physio-pathological relevance in the nervous system, including their role in Parkinson, Alzheimer, and Huntington diseases. Conclusions: Rafts disruption/dysfunction has been shown to relate diverse neurological diseases. Therefore, it has been suggested that preservation of membrane rafts may represent a strategy to prevent or delay neuronal dysfunctions in several diseases.(AU)

La nueva era de las enfermedades neurodegenerativas. La base de los nuevos abordajes / The new age of neurodegenerative diseases. The basis of the new approaches

La detección por biomarcadores de los procesos fisiopatológicos y moleculares implicados en las enfermedades cerebrales por plegamiento anormal de proteínas está permitiendo delinear la historia natural de estos procesos. La gran mayoría de ellos tiene una fase preclínica prolongada, en la que los cambios biológicos son patentes. Las manifestaciones clínicas (fenotipos) no tienen una correspondencia unívoca con la patología subyacente, a pesar de que se han utilizado los epónimos anatomopatológicos para la descripción de los síndromes clínicos, lo que ha favorecido la imprecisión diagnóstica. Para realizar un adecuado manejo clínico debemos conocer los tres planos que definen actualmente los procesos neurodegenerativos más frecuentes. La precisión diagnóstica será un prerrequisito para las nuevas terapias dirigidas a modificar el curso de las enfermedades por plegamiento proteico cerebrales. (AU)

The detection by biomarkers of the pathophysiological and molecular processes involved in misfolding protein diseases making it possible to delineate the natural history of these processes. The great majority of protein misfolding diseases have a prolonged preclinical phase, in which the biological changes are patent. The clinical manifestations (i.e., phenotypes) do not have a univocal correspondence with the underlying pathology, despite the fact that pathological eponyms have been used for the description of the clinical syndromes, which has favored diagnostic inaccuracy. In order to perform an adequate clinical management, we must know the 3 planes that currently define the most common neurodegenerative processes. Diagnostic accuracy will be a prerequisite for new therapies aimed at modifying the course of brain protein misfolding diseases. (AU)

La grave incongruencia existente entre el nuevo sistema de apoyo y la emisión del consentimiento informado por las personas con discapacidad / The Serious Inconsistency Between the New Support System and the Is-suance of Informed Consent by People with Disabilities

Recientemente, el Tribunal Constitucional ha dictado una sentencia por la que se confirmaba la constitucionalidad de dos resoluciones judiciales que habían ordenado la vacunación de una persona con discapacidad en contra de la voluntad de su tutor. El objeto de este artículo es analizar qué hubiera ocurrido de haberse producido esos hechos en la actualidad, tras la entrada en vigor de la Ley 8/2021 que regula un nuevo sistema de apoyo a la capacidad jurídica en favor de las personas con discapacidad. Tras analizar las nuevas medidas de apoyo que se han incorporado al Código Civil, se concluye informando de la existencia de un grave desajuste entre el Código Civil y la Ley 41/2002. (AU)

Recently, the Constitutional Court issued a ruling confirming the constitutiona-lity of two court resolutions that had ordered the vaccination of a person with disabilities against the will of their legal guardian. The purpose of this article is to analyze what would have happened if these events had occurred today, after the entry into force of Law 8/2021, which regulates a new system of support for legal capacity in favor of people with disabilities. After analyzing the new support measures that have been incorporated into the Civil Code, it is concluded that there is a serious mismatch between the Civil Code and Law 41/2002. (AU)

Consumption of drugs for Alzheimer's disease on the Brazilian private market.

OBJECTIVE: To analyze the consumption of drugs for Alzheimer's disease on the Brazilian private market and its geographical distribution from 2014 to 2020. METHODS: National data from the Brazilian National System of Controlled Product Management were used, regarding sales of donepezil, galantamine, rivastigmine, and memantine from January 2014 to December 2020. Sales data were used as a proxy for drug consumption and expressed as defined daily dose/1,000 inhabitants/year at national, regional, federative unit and microregion levels. RESULTS: Drug consumption went from 5,000 defined daily doses/1,000 inhabitants, in 2014, to more than 16,000/1,000 inhabitants, in 2020, and all federative units showed positive variation. The Brazilian Northeast had the highest cumulative consumption in the period but displayed microregional disparities while the North region had the lowest consumption. Donepezil and memantine were the most consumed drugs, with the highest growth in consumption from 2014 to 2020. CONCLUSION: The consumption of medicines indicated to treat Alzheimer's disease tripled in Brazil between 2014 and 2020, which may relate to the increase in the prevalence of the disease in the country, greater access to health services, and inappropriate use. This challenges managers and healthcare providers due to population aging and the increased prevalence of chronic-degenerative diseases.

[Alzheimer's disease. Current evidence on the preventive role of nutrition]. / Enfermedad de Alzheimer. Evidencia actual sobre el papel preventivo de la nutrición.

Introduction: Introduction: in the last decades, a significant increase in the incidence of Alzheimer's disease (AD) has been observed. Currently, there are no effective pharmacological treatments available, which makes preventive measures particularly important. Objective: to analyze the available scientific evidence on nutritional and dietary factors and their association with AD prevention. Methods: a review of nutritional and dietary factors related to the prevention of AD was conducted. Results: several dietary components have been positively associated with AD prevention, including intake of complex carbohydrates, fiber, omega-3, plant-based proteins, vitamins (folates, choline, vitamin D, C, B6 and B9), zinc, some bioactive compounds such as flavonols and probiotics. Following the Mediterranean, Dietary Approaches to Stop Hypertension (DASH) y Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diets has been associated with a lower risk of developing the disease. Conclusion: nutrition may have a protective role against AD, although further studies are needed in this regard.

Introducción: Introducción: en las últimas décadas, se ha observado un incremento significativo en la incidencia de la enfermedad de Alzheimer (EA). En la actualidad, no se dispone de tratamientos farmacológicos efectivos, lo que hace que las medidas preventivas sean particularmente importantes. Objetivo: analizar la evidencia científica disponible sobre factores nutricionales y dietéticos y su asociación con la prevención de la EA. Métodos: se llevó a cabo una revisión de la literatura científica sobre factores nutricionales y dietéticos relacionados con la prevención de la EA. Resultados: diversos componentes de la dieta se han asociado positivamente con la prevención de la EA. Estos incluyen hidratos de carbono complejos, fibra, omega-3, proteínas de origen vegetal, vitaminas (folatos, colina, vitamina D, C, B6 y B9), zinc y algunos compuestos bioactivos como los flavonoles, y los probióticos. El seguimiento de las dietas mediterránea, Dietary Approaches to Stop Hypertension (DASH) y Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) se ha asociado con un menor de riesgo de desarrollar la enfermedad. Conclusión: la nutrición podría tener un papel protector frente a la EA, aunque se requieren más estudios al respecto.

La neurodegeneración desde un punto de vista holístico / A holistic insight into neurodegeneration

Las enfermedades neurodegenerativas se caracterizan por un deterioro neuronal progresivo e irreversible. Aunque constituyen un grupo de patologías muy heterogéneo, la mayoría comparten un origen multifactorial y una estrecha relación con el envejecimiento. El aumento de la esperanza de vida a nivel mundial ha convertido a estas patologías en una amenaza para los sistemas sanitarios y de cuidados, pues su prevalencia crece de forma paralela al envejecimiento de la población. Destacan entre ellas, por su elevada prevalencia o por el impacto sanitario que tienen, las enfermedades de Alzheimer, Parkinson y Huntington; y la esclerosis lateral amiotrófica. El conocimiento sobre el origen de estas enfermedades es generalmente muy limitado, lo que condiciona la extrema dificultad de su manejo clínico. No existen métodos fiables para su diagnóstico temprano, por lo que su detección se suele producir cuando el deterioro clínico es ya irreversible. Por otra parte, los tratamientos disponibles hoy en día son meramente paliativos, ya que el desconocimiento sobre las causas primarias de la enfermedad y su diagnóstico tardío impiden el desarrollo de tratamientos capaces de detener o revertir el deterioro estructural y funcional. En los últimos años se han identificado varios fenómenos patológicos que podrían constituir las verdaderas causas primigenias de estas enfermedades, destacando el estrés oxidativo, las alteraciones de la proteostasis y la neuroinflamación: en las conexiones entre ellos y en su capacidad para retroalimentarse podrían estar algunas de las respuestas necesarias para avanzar hacia un abordaje clínico efectivo de los procesos neurodegenerativos.(AU)

Neurodegenerative diseases are defined by a progressive and irreversible impairment of neurons. Despite being a very heterogeneous group of pathologies, they share some common features, such as their multifactorial origin and their close correlation with ageing. As worldwide life expectancy increases, these diseases have become a tough challenge for healthcare systems as their prevalence is raising in the same way. The most important neurodegenerative disorders, because of their prevalence or their health impact, are Alzheimer´s, Parkinson´s and Huntington´s diseases; and amyotrophic lateral sclerosis. The knowledge about their origin is still very poor, so their clinical management is far from being adequate. There are not reliable methods for early diagnosis, so these diseases are usually detected when tissue damage is irreparable. Furthermore, current available therapies are intended only for symptomatic relief, since the misunderstanding about the real causes of these diseases and their delayed diagnosis hinder the development of new treatments being able to stop or even reverse the structural and functional decline. In the last few years, some pathological events have been identified as potential key factors to understand the origin of neurodegeneration. Among them, we shall mention oxidative stress, impaired proteostasis and neuroinflammation: a deeper knowledge about their interconnections and their ability to feedback each other could provide valuable information to progress towards an effective clinical management of neurodegenerative disorders.(AU)

Diagnostic criteria in dementing illness. What's new? / Criterios diagnósticos en la enfermedad demencial ¿Qué hay de nuevo?

The spectrum of neurodegenerative diseases that primarily affect cognition and behaviorspreads from asymptomatic preclinical disease to very mild cognitive impairment to frank dementia. Alzheimer's disease (AD) is the most common cause of a decline in cognitive ability. Also, it is a devastating condition that affects patients and their entirefamilies of caregivers, exacting tremendous financial hardships. Diagnosis may be complicated by other forms of dementia that have symptoms and pathologies similar to AD. Knowing the key features and pathology of each type of dementia can help in the accurate diagnosis of patients, so they will receive the treatment and support services appropriate for their condition and maintain the highest possible functioning in daily life and quality of life. Differentiate, based on clinical criteria, neuropathology, and biomarkers, AD and its atypical variants from other common dementias including Dementia with Lewy Bodies, Vascular Cognitive Impairment, Frontotemporal Degeneration, and less frequent cognitive disorders. The importance of getting an accurate and early diagnosis of dementiais now increasingly significant to make important decisions about treatment, support, and care. Nonpharmacological as well as pharmacological interventions should be initiated once the diagnosis is obtained. Biochemical markers to identify Alzheimer's disease play a central role in the new diagnostic criteria for the disease and in the recent biological definition of AD. This review article presents up-to-date data regarding the recent diagnostic criteria of Alzheimer´s disease and related disorders, emphasizing its usefulness in routine clinical practice.

El espectro de enfermedades neurodegenerativas que afectan principalmente a la cognición y el comportamiento abarca desde la enfermedad preclínica asintomática hasta el deterioro cognitivo muy leve y la demencia franca. La enfermedad de Alzheimer (EA) es la causa más común de deterioro de la capacidad cognitiva. Es una enfermedad devastadora que afecta a los pacientes y a toda su familia de cuidadores, lo que supone enormes dificultades socioeconómicas y psicoemocionales. El diagnóstico puede complicarse debido a otras formas de demencia que presentan síntomas y patologías similares a la EA. Los marcadores bioquímicos para identificar la enfermedad de Alzheimer desempeñan un papel central en los nuevos criterios diagnósticos de la enfermedad y en la reciente definición biológica de la EA. Conocer las características claves y la patología de cada tipo de demencia puede ayudar en el diagnóstico preciso de los pacientes, a fin de que reciban el tratamiento y los servicios de apoyo adecuados a su condición y mantengan el mayor funcionamiento posible en la vida diaria y la calidad de vida. Por lo tanto es prioritario diferenciar, basándose en criterios clínicos, neuropatología y biomarcadores, la EA y sus variantes atípicas de otras demencias comunes como el Deterioro Cognitivo Vascular, la Degeneración Fronto- temporal entre otras, y los trastornos cognitivos menos frecuentes. Este artículo de revisión presenta datos actualizados relativos a los recientes criterios diagnósticos de algunas formas de demencia haciendo hincapié en su utilidad en la práctica clínica habitual. Se exponen los criterios de EA, de Demencia Vascular (DV), de la demencia Fronto-temporal (DFT) y de una forma rara de demencia, descripta en los últimos años, que se evidencia en pacientes muy añosos con un perfil similar a la EA. Se trata de la encefalopatía predominantemente límbica por tdp- 43 relacionada a la edad (LATE).

Spanish translation, retranslation, and content validation of the Quality of Life in Alzheimer's Disease scale in patients with Alzheimer's dementia. / Traducción al español, retraducción y validación de contenido de la escala Quality of Life in Alzheimer's Disease en pacientes con demencia Alzheimer.

Introduction: It is estimated that by the year 2050, persons over 60 will account for 22% of the world population. Consequently, the incidence and prevalence of Alzheimer's disease will increase correspondingly. One of the pillars of the treatment of this condition is to improve the quality of life. In this sense, questionnaires such as the Quality of Life in Alzheimer's Disease allow us to measure the quality of life in patients and caregivers. Objective: To translate into Chilean Spanish and carry out the content validation of the Quality of Life in Alzheimer's Disease scale in patients with Alzheimer's dementia at the Guillermo Grant Benavente Hospital in Concepción, Chile. Methods: Translation, back-translation and content validity were carried out by expert judgment, using Lawshe analysis, pre-test and semantic validation using the respondent debriefing strategy. Results: The translated and retranslated versions were compared with each other and with the original version. Lawshe indicates that a Content Validity Ratio equal 0.49 is adequate to consider the item valid when 15 experts participated in the content validation process, as in our study. The analysis yielded a content validity ratio greater than 0.49 in 11 of the 13 items on the scale. Of these, 8 obtained a value greater than 0.8 and 3 between 0.49 and 0.79. In semantic validation using the respondent debriefing strategy, the scale was applied to five people with Alzheimer's and their respective caregivers. With the data obtained, modifications were generated in those items that obtained a content validity ratio of less than 0.49. Conclusions: The version obtained in Spanish of the Quality of Life in Alzheimer's Disease scale is valid from the point of view of its content and equivalent to its original version.

Introducción: Se estima que para el año 2050 los mayores de 60 años corresponderán al 22% de la población mundial y con ello aumente la incidencia y prevalencia de enfermedad de Alzheimer. Uno de los pilares del tratamiento de esta condición es mejorar la calidad de vida, en este sentido surgen herramientas como la Quality of Life in Alzheimer's Disease Scale que permite medir calidad de vida en pacientes y sus cuidadores. Objetivo: Realizar la traducción al español chileno y validación de contenido de la Quality of Life in Alzheimer's Disease Scale en pacientes con demencia por Alzheimer del Hospital Guillermo Grant Benavente de Concepción, Chile. Métodos: Se llevó a cabo la traducción, retraducción y validez de contenido por juicio experto, utilizando el análisis Lawshe, pre-test y validación semántica usando la estrategia de respondent debriefing. Resultados: Las versiones traducidas y retraducidas fueron comparadas entre ellas y con la versión original. Lawshe indica que una razón de validez de contenido de 0,49 es adecuado para considerar aceptable el ítem cuando en el proceso de validación de contenido han participado 15 expertos como en este estudio. El análisis arrojó una razón de validez de contenido mayor a 0,49 en 11 de los 13 ítems de la escala. De estos, ocho obtuvieron un valor superior a 0,8 y tres entre 0,49 y 0,79. En la validación semántica mediante la estrategia de se aplicó la escala a cinco personas con enfermedad de Alzheimer y a sus respectivos cuidadores. Con los datos obtenidos, se generaron modificaciones en aquellos ítems que obtuvieron una razón de validez de contenido menor a 0,49. Conclusión: La versión obtenida en español de la resulta ser válida desde el punto de vista de su contenido y equivalente a su versión original.

Lecanemab (Leqembi™) en enfermedad de Alzheimer / Lecanemab (Leqembi™) in Alzheimer's disease

INTRODUCCIÓN: La demencia es un término general para un conjunto de síntomas causados por trastornos que afectan el cerebro y tienen un impacto en la memoria, el pensamiento, el comportamiento y las emociones.1 La enfermedad de Alzheimer es la causa más común de demencia y es una enfermedad cerebral degenerativa mortal caracterizada por la pérdida progresiva de habilidades cognitivas como la memoria, el lenguaje, la navegación y la resolución de problemas, y la función física. Los cambios neuropatológicos característicos de la enfermedad de Alzheimer son la aparición de placas difusas y neuríticas, marcadas por depósito extracelular de Aß y ovillos neurofibrilares, compuestos por la acumulación intracelular de proteína tau hiperfosforilada (p-tau), que se supone que conducen al daño y, finalmente, a la muerte de las neuronas. TECNOLOGÍA: Lecanemab (Leqembi™, Lecanemab-irmb) es un anticuerpo monoclonal de inmunoglobulina gamma 1 (IgG1) humanizado dirigido contra formas solubles e insolubles agregadas de Aß. 10 La acumulación de placas de Aß en el cerebro es una característica fisiopatológica definitoria de la enfermedad de Alzheimer, donde la utilización de este fármaco reduciría las placas de Aß. ¬¬¬¬¬¬ OBJETIVO: El objetivo del presente informe es evaluar rápidamente los parámetros de eficacia, seguridad, costos y recomendaciones disponibles acerca del empleo del uso de lecanemab (Leqembi™) en enfermedad de Alzheimer. MÉTODOS: Se realizó una búsqueda bibliográfica en las principales bases de datos tales como PUBMED, LILACS, BRISA, COCHRANE, SCIELO, EMBASE, TRIPDATABASE como así también en sociedades científicas, agencias reguladoras, financiadores de salud y agencias de evaluación de tecnologías sanitarias. Se priorizó la inclusión de revisiones sistemáticas, ensayos clínicos controlados aleatorizados, evaluación de tecnología sanitaria y guías de práctica clínica de alta calidad metodológica. RECOMENDACIONES: No se hallaron recomendaciones para Argentina y la región. El Instituto Nacional para la Excelencia en Salud y Atención (NICE, su sigla del inglés National Institute for Health and Care Excellence) de Reino Unido actualmente está desarrollando su evaluación sobre la tecnología en la indicación mencionada. 20 El panel de expertos del ICER de los Estados Unidos destacó la incertidumbre sobre los beneficios clínicos reales de la tecnología y su valor comparativo respecto a otros tratamiento, y recomendó a aquellos que decidan financiaciar el fármaco diseñar una política clara de precios, acceso e investigación futura. CONCLUSIONES: La evidencia que sustenta la aprobación de comercialización acelerada por parte de los Estados Unidos de lecanemab para el tratamiento de personas con enfermedad de Alzheimer, con deterioro cognitivo leve o en la etapa de demencia leve de la enfermedad, se basa en un solo ensayo clínico aleatorizado de fase III. Este estudio mostró que su utilización, comparado con el uso de placebo, podría mejorar al mediano plazo algunas puntuaciones para la estadificación de la demencia y la disminuir las placas de Aß. No se halló evidencia sobre el real beneficio clínico que implicarían estas mejoras y si éstas se mantienen al largo plazo, como tampoco de beneficios sobre otros desenlaces clínicos relevantes para la patología. El tratamiento presentó reacciones adversas sustancialmente mayores respecto a placebo, relacionadas a la infusión y a anomalías en las imágenes por el amiloide con desenlaces serios en personas homocigotas para el alelo APOE ε4. Es importante señalar que las personas incluidas en el estudios de fase III debían tener de 50 a 90 años de edad, diagnóstico deterioro cognitivo leve debido a la enfermedad de Alzheimer con probabilidad intermedia (cumplir con los criterios clínicos básicos del NIA-AA; tener una CDR de 0,5 y una puntuación de CDR Memory Box de 0,5 o más al inicio del estudio; e informar un historial de disminución de la memoria subjetiva con inicio gradual y progresión lenta durante el último año antes de la selección) y demencia leve de la enfermedad de Alzheimer (cumplir con los criterios clínicos básicos de NIA-AA para la demencia probable de la enfermedad de Alzheimer; y tener una puntuación de CDR global de 0,5 a 1,0 y una puntuación de cuadro de memoria de CDR de 0,5 o más al inicio del estudio). No se hallaron evaluaciones económicas y recomendaciones para Argentina y la región. A un a un precio de adquisición anual por persona tratada de USD 26.100 (ARS 7.438.500), un estudio de costo-efectividad determinó que financiar el tratamiento para los Estados Unidos resultaría en valores superiores a los umbrales usualmente utilizados por ese país; mientras que un estudio para 27 países europeos estimó que financiar el tratamiento supondría consumir más de la mitad de los gastos farmacéuticos anuales totales de la Unión Europea.

Internação hospitalar de idosos por Doença de Alzheimer no Brasil, e custo associado: estudo ecológico / Hospitalization of the elderly for Alzheimer's Disease in Brazil, and associated costs: an ecological study

A alta prevalência de demências, onde a população goza de uma maior longevidade, torna-se importante a necessidade de realizar pesquisas relacionadas à doença de alzheimer, assim objetivou-se analisar a tendência temporal de internação hospitalar de idosos por doença de alzheimer no brasil, e custo associado, entre 2008-2020. Estudo ecológico de séries temporais, utilizando registros do sistema de informação hospitalar. Identificou-se que a taxa geral (ß= 0,203; p= 0,009), em ambos os sexos (p≤0,05), na faixa etária de 80 anos ou mais (ß= 1,081; p= 0,002) e em todas as regiões do brasil (p≤ 0,05) apresentou tendência crescente. O custo total de internação foi de r$ 27.617.699,74 e o custo médio de r$ 2.124.438,44. Conclui-se que a tendência temporal de internação hospitalar de idosos por doença de alzheimer está crescente no brasil entre 2008-2020, e os custos associados são consideráveis.

The high prevalence of dementias, where the population enjoys greater longevity, makes the need to conduct research related to alzheimer's disease important, thus we aimed to analyze the temporal trend of hospital admissions of the elderly for alzheimer's disease in brazil, and associated cost, between 2008-2020. Ecological study of analysis of time series, using records from the hospital information system. It was identified that the overall rate (ß= 0.203; p= 0.009), in both sexes (p≤ 0.05), in the age group 80 years and older (ß= 1.081; p= 0.002) and in all regions of brazil (p≤ 0.05) showed an increasing trend. The total cost of hospitalization was r$ 27,617,699.74 and the average cost was r$ 2,124,438.44. it is concluded that the time trend of hospitalization of the elderly for alzheimer's disease is increasing in brazil between 2008-2020, and the associated costs are considerable.

Fatores relacionados com a resiliência no cuidador familiar com doença de Alzheimer: Relatório de estágio em enfermagem de cuidados de saúde à família em contexto de USF / Factors related to resilience in family carers with Alzheimer's disease: Report of an internship in family health care nursing in a USF context

Em Portugal, o envelhecimento demográfico associado ao aumento da esperança de vida, veio a aumentar as doenças, e consequente situação de dependência, relacionadas como o envelhecimento, no qual se destaca a demência de Alzheimer. Perante a situação de dependência dum familiar, as famílias são obrigadas a restruturar o seu funcionamento para incluir um novo papel- o de cuidador. Esta situação é um forte teste a resiliência familiar, que consiste na habilidade desta para desenvolver funcionalidade nas relações entre os seus membros perante uma crise (Wash, 2005), e compete ao enfermeiro de saúde familiar a capacitação da família para melhor responder a crises, pelo que importa conhecer os fatores relacionados com a resiliência do cuidador familiar. A resiliência, quer psicológica quer familiar, é um fator influente importante na adaptação de famílias de doentes com DA. Destaca-se o processo de comunicação dentro da família, que interage com o seu sistema de crença e padrão organizacional, funcionando como um fator benéfico ou crítico para a adaptação familiar. Neste contexto encerra o legado funcional do enfermeiro de saúde familiar, pois para além de ocupar posição privilegiada, que com a sua intervenção poderá capacitar o cuidador/família para a prestação de cuidados mais efetiva, alicerçando a nas forças da família e não nas vulnerabilidades da mesma. Sendo que, um forte sistema de crenças, a utilização dos recursos familiares e uma melhoria do padrão de organização podem traduzir uma maior estabilidade e coerência familiar, que leva a fortalecer a resiliência familiar. Isto pode, por sua vez, facilitar uma comunicação mais clara e mais aberta e melhorar a resolução de problemas, proporcionando às famílias a força para obterem uma adaptação positiva. Também o apoio social formal tem um impacto positivo na resiliência (onde os enfermeiros de família se destacam), pois os cuidadores que receberam forte apoio social tinham maior probabilidade de serem altamente resilientes. Pelo que, uma maior perceção sobre a resiliência do cuidador e seus fatores determinantes poderá facilitar a identificação precoce e precisa de cuidadores com níveis mais baixos de resiliência. Esta avaliação permitirá a implementação de intervenções numa abordagem sistémica e colaborativa, para ajudar os cuidadores/famílias a melhorar seu bem-estar e qualidade de vida.

In Portugal, demographic ageing associated with increased life expectancy has led to an increase in age-related illnesses and consequent dependency, particularly Alzheimer's dementia. Faced with the situation of dependency of a family member, families are forced to restructure their functioning to include a new role - that of carer. This situation is a strong test of family resilience, which consists of the family's ability to develop functionality in the relationships between its members in the face of a crisis (Wash, 2005), and it is up to the family health nurse to enable the family to better respond to crises, so it is important to know the factors related to family carer resilience. Resilience, both psychological and familial, is an important influencing factor in the adaptation of families of patients with AD. Of particular note is the communication process within the family, which interacts with its belief system and organisational pattern, acting as a beneficial or critical factor for family adaptation. In this context, the functional legacy of the family health nurse comes to an end, since, in addition to occupying a privileged position, their intervention can empower the carer/family to provide more effective care, building on the family's strengths rather than its vulnerabilities. positive adaptation. Formal social support also has a positive impact on resilience (where family nurses stand out), as carers who received strong social support were more likely to be highly resilient. Therefore, greater insight into carer resilience and its determining factors could facilitate the early and accurate identification of carers with lower levels of resilience. This assessment will allow interventions to be implemented using a systemic and collaborative approach to help carers/families improve their well-being and quality of life.