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OBJECTIVE: Depression in later life is associated with a two-fold increased risk of dementia. It is not clear to what extent potentially modifiable risk factors account for this association. METHOD: Older adults (age 50 + ) with objective health measures (n = 14,014) from the Canadian Longitudinal Study on Aging were followed for a mean duration of 35 months. Linear regression analyses were used to determine if clinically significant depression (Centre for Epidemiologic Studies Depression scale score (CESD) ≥ 10) was associated with global cognitive decline, assessed with a neuropsychological battery during follow-up, and if modifiable risk factors mediated this association. RESULTS: Depression was associated with an excess of risk factors for cognitive decline including: vascular disease, hypertension, diabetes, apnoea during sleep, higher body mass index, smoking, physical inactivity and lack of social participation. In regression analyses depression remained independently associated with cognitive decline over time (beta -0.060, P = 0.038) as did cerebrovascular disease (beta -0.197, P < 0.001), HbA1C (beta -0.059, P < 0.001), visual impairment (beta -0.070, P = 0.007), hearing impairment (beta -0.098, P < 0.001) and physical inactivity (beta -0.075, P = 0.014). In mediation analyses, we found that cerebrovascular disease (z = -3.525, P < 0.001), HbA1C (z = -4.976, P < 0.001) and physical inactivity (z = -3.998, P < 0.001) partially mediated the association between depression and cognitive decline. CONCLUSIONS: In this large sample of Canadian older adults incorporating several objective health measures, older adults with depression were at increased risk of cognitive decline and had an excess of potentially modifiable risk factors. Clinicians should pay particular attention to control of diabetes, physical inactivity and risk factors for cerebrovascular disease in older adults presenting with depression as they can contribute to accelerated cognitive decline and may be addressed during routine clinical care.
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BACKGROUND: People living with dementia (PLWD) may want to participate in research, but the guidelines and processes enacted across various contexts may prohibit this from happening. OBJECTIVE: Understanding the experiences of people with lived experiences of dementia requires meaningful inclusion in research, as is consistent with rights-based perspectives. Currently, the inclusion of PLWD in Canadian research is complex, and guidelines and conceptual frameworks have not been fully developed. METHODS: This research note outlines a three-year proof-of-concept grant on the inclusion and consent of PLWD in research. FINDINGS: It presents a brief report on some of the contradictions and challenges that exist in legislation, research guidelines, and research practices and raises a series of questions as part of an agenda on rights and inclusion of PLWD in research. DISCUSSION: It suggests conceptual, legal, and policy issues that need to be addressed and invites Canadian researchers to re-envision research practices and to advocate for law and policy reform that enables dementia research to align and respect the rights and personhood of PLWD.
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The relationship between alcohol consumption and cognition is still controversial. This is a cross-sectional population-based study conducted in Caeté (MG), Brazil, where 602 individuals aged 75+ years, 63.6% female, and with a mean education of 2.68 years, were submitted to thorough clinical assessments and categorized according to the number of alcoholic beverages consumed weekly. The prevalence rates of previous and current alcohol consumption were 34.6% and 12.3%, respectively. No association emerged between cognitive diagnoses and current/previous alcohol consumption categories. Considering current alcohol intake as a dichotomous variable, the absence of alcohol consumption was associated with dementia (OR = 2.34; 95%CI: 1.39-3.90) and worse functionality (p = 0.001). Previous consumption of cachaça (sugar cane liquor) increased the risk of dementia by 2.52 (95%CI: 1.25-5.04). The association between the consumption of cachaça and dementia diagnosis has not been described before.
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This study aimed to explore the prevalence of suicidal thoughts and potential associations (i.e., strength and direction) with caregiver characteristics or factors. A targeted survey was distributed to dementia caregivers aged 55+ years. Questions concerning psychological distress, suicidal thoughts while caregiving and antecedents of suicidal behaviours were administered. A sample of 71 French-speaking Canadian caregivers completed the survey between May and October 2019. Among them, 52.1 per cent (n = 37) reported suicidal ideation while providing care to a relative or a friend living with dementia. Caregivers who presented suicidal ideation reported more abusive behaviour toward the care recipient. Caregivers who reported suicidal thoughts were significantly more distressed than caregivers without them on measures of burden, depression, and anxiety. Suicidal thoughts in caregivers are important evaluation targets, primarily for the prevention of suicide, but also because caregivers who report suicidal thoughts also present a heightened risk for abusing the care recipient.
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Worldwide, over 55-million people have dementia, and the number will triple by 2050. Persons living with dementia are exposed to risks secondary to cognitive challenges including getting lost. The adverse outcomes of going missing include injuries, death, and premature institutionalization. In this scoping review, we investigate risk factors associated with going missing among persons living with dementia. We searched and screened studies from four electronic databases (Medline, CINAHL, Embase, and Scopus), and extracted relevant data. We identified 3,376 articles, of which 73 met the inclusion criteria. Most studies used quantitative research methods. We identified 27 variables grouped into three risk factor domains: (a) demographics and personal characteristics, (b) health conditions and symptoms, and (c) environmental and contextual antecedents. Identification of risk factors associated with getting lost helps to anticipate missing incidents. Risk factors can be paired with proactive strategies to prevent incidents and inform policies to create safer communities.
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Resumo A demência é uma síndrome de curso lento, progressivo e de natureza crônica, sendo o subtipo doença de Alzheimer (DA) a mais comum. Muitos estudos são realizados a partir das demandas da pessoa com demência, porém na perspectiva do cuidador eles são escassos. A pesquisa qualitativa teve como objetivo conhecer aspectos singulares da experiência do cuidar na perspectiva de cuidadoras familiares de idosos com DA, a partir de abordagem qualitativa. Foi utilizado o método fenomenológico proposto por Giorgi e Sousa. Participaram nove cuidadoras familiares (quatro esposas e cinco filhas) que cuidam de seus familiares. Esta pesquisa acompanhou o cuidar na fase inicial, moderada, avançada, em diferentes estágios da doença e no pós-óbito. A partir da questão central: "Como é para você a experiência de acompanhar seu familiar com a doença de Alzheimer?", emergiram treze unidades temáticas que foram associadas às fases da doença. Os resultados apontaram as necessidades dos cuidadores, que vão desde o diagnóstico em fases iniciais até a criação de espaço para escuta e acolhimento diante das perdas graduais vivenciadas ao longo do processo de cuidar. Assim, é urgente o investimento em formação de profissionais em todas as áreas envolvidas no cuidar para promover qualidade de vida e bem-estar aos cuidadores. bem como a necessidade de equipes interdisciplinares para a experiência singular do cuidado em demência.
Abstract Dementia is a slow-progressing chronic syndrome with the subtype of Alzheimer's disease being the most commom (Burlá, 2015). This study verified the experience of care from the perspective of family caregivers of older adults with AD from the qualitative approach. The phenomenological method proposed by Giorgi and Sousa (2010) was adopted. Nine family caregivers (4 wives and 5 daughters) participated during different stages of the disease and after death. From the main question "How is your experience of caring for your relative with Alzheimer's disease?" emerged 13 thematic units associated with each stage of the disease. The findings raise the need of caregivers, which include initial diagnosis and goes through the creation of a space for listening and care, given the gradual loss experienced throughout the caring process. Thus, there must be investments in forming professionals of all fields related to healthcare in order to promote quality of life and well-being for caregivers, as well as the need for interdisciplinary teams for the unique experience of dementia care.
Résumé La démence est un syndrome à évolution lente et progressive, de nature chronique, et son sous-type la maladie d'Alzheimer étant le plus fréquent (Burlá, 2015). De nombreuses études sont réalisées en fonction des demandes du patient, mais du côté de l'aidant familial, elles sont rares. Cette recherche a eu pour objectif connaître l'expérience des soins du point de vue des aidants familiaux des personnes âgées atteints de la MA à travers une abordage qualitative. En ce qui concerne la méthodologie, nous avons choisi l'approche phénoménologique proposée par Giorgi et Sousa (2010). Y ont participé neuf membres familiaux (4 épouses et 5 filles) qui ont pris part aux soins à différents stades de la maladie et après le décès de leur proche. De la question centrale : « Comment est l'expérience d'accompagner un membre de sa famille avec la maladie d'Alzheimer ? ¼, sont émergé 13 thématiques qui ont été associés aux stades de la maladie. Les résultats ont indiqué le besoin signaler par ces aidants de se faire soutenir à partir de l'accès au diagnostic, en ayant un espace de parole que les soient dédié tout au long du processus de l'accompagnement des soins. Ainsi, il s'avère l'importance d'investissement dans la formation de tous les métiers concernant, pour la qualité de vie et le bien-être des aidants et le besoin d'une équipe interdisciplinaire capable de soutenir l'expérience singulière vécue par le membre de la famille qui s'occupe des soins au patient que souffre de démence.
Resumen La demencia es un síndrome de curso lento y progresivo, de naturaleza crónica, en la cual se destaca como subtipo más común la enfermedad de Alzheimer -EA- (Burlá, 2015). Se han realizado muchos estudios acerca de las demandas del individuo con demencia, pero son pocos desde la perspectiva del cuidador. A partir de un abordaje cualitativo, la investigación tuvo como objetivo conocer la experiencia del cuidado en la perspectiva de cuidadoras familiares de ancianos con EA. Se utilizó el método fenomenológico propuesto por Giorgi y Sousa (2010). Participaron nueve cuidadoras familiares (4 esposas y 5 hijas). El estudio acompañó el proceso del cuidado en las etapas inicial, intermedia y avanzada, en diferentes fases de la enfermedad y en el postóbito. Desde la cuestión central: "Cómo es para usted la experiencia de acompañar a su familiar con la enfermedad de Alzheimer?", emergieron trece unidades temáticas que se asociaron a las fases de la enfermedad. Los hallazgos apuntan las necesidades de los cuidadores, desde el diagnóstico en la etapa inicial hasta la creación de un espacio para la escucha y el acogimiento en el proceso vivenciado a lo largo del cuidado. Es imprescindible invertir en la formación de profesionales de todas las áreas asociadas al cuidado para promover la calidad de vida y el bienestar de los cuidadores, así como son necesarios equipos interdisciplinarios para la experiencia singular del cuidado en demencia.
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Humanos , Femenino , Anciano , Cuidadores/psicología , Enfermedad de Alzheimer/psicología , Estudios de Evaluación como AsuntoRESUMEN
O artigo propõe articular o fenômeno da repetição, em uma perspectiva psicanalítica, ao discurso repetitivo característico dos pacientes com doença de Alzheimer (DA), considerando os correlatos neurocognitivos desse processo. Trata-se de um estudo teórico exploratório. Metodologicamente, realizou-se uma busca de artigos nas bases de dados PsycINFO (APA), SciELO e PePSIC com os seguintes descritores: Alzheimer e Psicanálise; Alzheimer e Psicodinâmica; Alzheimer e repetição à compulsão; e também em inglês (Alzheimer and psychoanalysis; Alzheimer and pychodynamic; e Alzheimer and repetition compulsion). Encontrou-se apenas sete artigos que se aproximaram do tema deste trabalho dentro dos critérios de inclusão: artigos disponibilizados na íntegra e gratuitamente na base de dados, e artigos escritos nos idiomas português ou inglês. Não foram encontrados artigos em português. Foram ainda consultadas obras consagradas da Psicanálise, especialmente da corrente teórica freudiana. Uma interlocução entre a Psicanálise e as Neurociências é proposta, a fim de considerar a relação que o sujeito estabelece com sua doença, sem com isso negligenciar os aspectos fisiológicos e cognitivos caros ao processo de demenciação na DA. Entende-se que o discurso repetitivo do idoso pode servir-lhe como uma tentativa de manutenção da identidade subjetiva ao longo do tempo. Impõe-se o desafio da sustentação de uma escuta que favoreça a preservação do sujeito demenciado nas funções socializante e libertadora da linguagem. A restrição de estudos específicos sobre o fenômeno da repetição vinculada à discussão psicanalítica sobre o envelhecimento humano foi uma limitação para este estudo. Aponta-se a necessidade de elaborações teóricas mais profundas, ancoradas em ensaios clínicos mais amplos acerca do tema.
The article proposes to articulate the phenomenon of repetition, in a psychoanalytic perspective, to the characteristic repetitive discourse of patients with Alzheimer's Disease (AD), considering the neurocognitive correlates of this process. This is an exploratory theoretical study. Methodologically, a search of articles in the databases PsycINFO (APA), SciELO and PePSIC with the following descriptors: in Portuguese: Alzheimer e Psicanálise; Alzheimer e Psicodinâmica; Alzheimer e Repetição à compulsão; and in English Alzheimer and psychoanalysis; Alzheimer and psychodynamic; and Alzheimer's and repetition compulsion. There were only seven articles that approached the theme of this work, within the criteria of inclusion: articles available in full and free of charge in the database, and articles written in Portuguese or English. No articles were found in Portuguese. Also consecrated works of Psychoanalysis were consulted, especially the current Freudian theoretical. An interlocution between Psychoanalysis and Neurosciences is proposed in order to consider the relationship that the subject establishes with his illness, without neglecting the physiological and cognitive aspects that are dear to the process of dementia in AD. It is understood that the repetitive discourse of the elderly can serve as an attempt to maintain subjective identity over time. The challenge of sustaining a listening that favors the preservation of the demented subject in the socializing and liberating functions of language. The restriction of specific studies on the phenomenon of repetition linked to a psychoanalytic discussion about human aging was a limitation of this study. The need for deeper theoretical elaborations, anchored in broader clinical trials on the subject, is pointed out.
El artículo propone articular el fenómeno de la repetición, en una perspectiva psicoanalítica, al discurso repetitivo característico de los pacientes con Alzheimer (DA), considerando los correlatos neurocognitivos de este proceso. Se refiere a una investigación teórico-exploratoria. Metodológicamente fue realizada una búsqueda de artículos en las bases de datos PsycINFO (APA), SciELO y PePSIC con los siguiente descriptores: Alzheimer y Psicoanálisis; Alzheimer y Psicodinámica; Alzheimer y Repetición a la compulsión; y en inglés Alzheimer and psychoanalysis; Alzheimer and pychodynamic; y Alzheimer and repetition compulsion. Fue encontrado solo siete artículos que se acercaron al tema de este trabajo, dentro de los criterios de inclusión: artículos disponibles en la íntegra y gratis en las bases de datos, y artículos escritos en los idiomas portugués o inglés. Artículos en portugués no fueron encontrados. Fueron consultadas aún obras importantes del psicoanálisis, especialmente de la corriente freudiana. Es propuesta una interlocución entre el Psicoanálisis y las Neurociencias con la finalidad de considerar la relación que el sujeto establece con su enfermedad, sin que se pase por alto los aspectos fisiológicos y cognitivos caros al proceso de demencia en la DA. Se entiende que el discurso repetitivo del anciano puede servirle como intento de manutención de la identidad subjetiva a lo largo del tiempo. Se impone el reto del apoyo de una escucha que favorezca la preservación del sujeto demenciado en las funciones socializante y libertadora del lenguaje. La restricción de investigaciones específicas sobre el fenómeno de la repetición relacionada a una discusión psicoanalítica sobre el envejecimiento humano fue una limitación para este trabajo. Se indica la necesidad de elaborar teorías más profundas, ancladas en ensayos clínicos más amplios a cerca del tema.
L'article propose articuler le phénomène de la répétition, dans une perspective de la psychanalyse, avec le discours répétitif caractéristique des patients atteint de la maladie d'Alzheimer (MA), en considérant les correlations neurocognitives de ce processus. Il s'agit d'une étude théorique exploratoire. Sur le plan méthodologique, il y a eu une recherche d'articles dans les bases de données PsycINFO (APA), SciELO et PePSIC avec les mots clés suivants : Alzheimer et psychanalyse; Alzheimer et psychodynamique; Alzheimer et la compulsion de répétition; et en anglais: Alzheimer and psychoanalysis; Alzheimer and psychodynamic; et Alzheimer and repetition compulsion . Nous avons trouvé seulement sept articles qui abordent le thème de ce travail, dans les critères d'inclusion: articles disponibles dans son intégralité et gratuitement dans la base de données et des articles rédigés en langues portugaise ou anglaise. Nous n'avons pas trouvés des articles en Portugais. Des oeuvres consacrées de la psychanalyse ont été consultées, surtout de la théorique freudienne. Un dialogue entre la psychanalyse et les neurosciences est proposé, afin d'examiner la relation que le sujet établit avec sa maladie, sans pour autant négliger les aspects physiologiques et cognitives, chères au processus de demence chez la MA. Il est entendu que le discours répétitif des personnes âgées peut servir comme une tentative de maintenir l'identité subjective au fil du temps. S'impose le défi de la sustentation d'une écoute qui favorise la préservation du sujet dément chez les fonctions de socialisation et de libération langagièr. La restriction des études spécifiques sur le phénomène de la répétition liée à une discussion psychanalytique sur le vieillissement humain a été un frein à cette étude. Il faut souligner la nécessité d'élaborations théoriques plus profondes, ancrées dans des essais cliniques plus vastes sur le sujet.
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Humanos , Demencia/psicología , Enfermedad de Alzheimer , PsicoanálisisRESUMEN
Introducción: las demencias son enfermedades degenerativas que afectan a 35.6 millones de personas en el mundo y a más de 100 000 en Cuba; constituyen un acontecimiento vital estresante y hacen al anciano muy dependiente de otros y, por tanto, presa fácil de violencia. Objetivo: caracterizar los pacientes con demencia, según grupos de edades, sexo y nivel educacional, manifestaciones clínicas e identificar las conductas violentas, ejercidas sobre ellos, en la consulta de demencia y de terreno durante marzo a agosto de 2010. Material y Método: se realizó un estudio descriptivo desde el 1ero de marzo al 31 de agosto de 2010, en la consulta de demencia y/o en terreno pertenecientes al Policlínico Cristóbal Labra. La información se obtuvo mediante la aplicación de los siguientes instrumentos: Miniexamen del estado mental del anciano, criterios del DSM-IV, la escala de Zarit, Yasavage y la aplicación de una encuesta creada por la autora. Se utilizaron variables cuantitativas y cualitativas; los datos se recogieron en una planilla previamente diseñada y se procesaron de forma automatizada. Los resultados se mostraron en tablas y/o gráficos, y se calcularon medidas de resumen (frecuencias absolutas y porcentajes). Resultados: la demencia se relacionó con aumento de la edad, sexo femenino y menor grado de escolaridad. Los principales síntomas que generaron violencia fueron la pérdida de memoria e insomnio, predominó la Violencia Psicológica; las hijas fueron las principales maltratadoras. Conclusión: la demencia en adultos mayores constituyó un factor estresante generador de violencia en los cuidadores.
Introduction: the violence against the older persons is not a recent, it has been producing since many time ago, it real number is unknow. The dementia is a neurodegenerative disorders, already 35.6 millones of persons in the world and more of 100 000 en Cuba are afected by this pathology. The dementias are an important cause of violence because it produced a big uncapacity physical and intellectual. Objetives: caractherize pacient with dementia, by age, educacional level and sex, know mainly symptoms that produce violence in their mainly parent, diferents types of violences, principle clinical symptoms of psicologycal violence, persons responsible of injuries. Material and Methods: we made a descriptive estudies, since march 1er to agust 31, 2010 about the behavior of the violence on this kind of pacients and it relation with their parent. We used Minimental de Folstein, DSM-IV, Zarit, Yasavage test. Also we used the National Aging Resource Center of violence and the test made for the author. Results: dementias be increased in old patients, women were more afected, it incressed in patient with low educational level, symptoms more frequently found were: memory loss e insomny. The psychological violence was the principal type of violence found, the daughters had more violence behavior. Conclusion: the dementia on old persons produce a lot stress in persons that take care them.
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Aqui publicamos a tradução brasileira (1905) do capítulo sobre a paranoia, extraído da sétima edição alemã (1904) do tratado (Lehrbuch) de psiquiatria de Emil Kraepelin. O autor discute o diagnóstico da paranoia e, particularmente, faz a distinção entre a paranoia e a demência precoce.
This is the Brazilian translation (1905) of the chapter on paranoia, in seventh German edition (1904) of Emil Kraepelin's Textbook (Lehrbuch). In it he discusses the diagnosis of paranoia and, especially, makes a distinction between it and dementia praecox.
Ce qui suit est la traduction brésilienne (1905) du chapitre sur la paranoïa, extrait de la septième édition allemande (1904), du traité (Lehrbuch) de psychiatrie d'Emil Kraepelin. L'auteur discute le diagnostic de la paranoïa et, en particulier, la distinction entre la paranoïa et la démence précoce.
Aquí publicamos la traducción brasileña (1905) del capítulo relativo a la paranoia, extraído de la séptima edición alemana (1904) del tratado (Lehrbuch) de psiquiatría de Emil Kraepelin. El autor discute el diagnóstico de paranoia y, en particular, distingue entre la paranoia y la demencia precoz.