Sleep disturbances in Alzheimer's disease are associated with neuropsychiatric symptoms and antidementia treatment.

Sleep disturbances (SDs) in Alzheimer's disease (AD) may significantly affect the behavioral, functional, and cognitive capacities of patients to the point of becoming a major determinant of caregiver burden. We conducted a cross-sectional study in 125 patients with probable AD to assess the association of SDs with neuropsychiatric symptoms, cognitive and functional status of patients, and severity and duration of dementia and to ascertain the role of antidementia drugs in the treatment of SD. SDs were assessed using the questionnaire on sleep disorders in the Neuropsychiatric Inventory. The prevalence of SDs in this sample was 36%. SDs in patients with AD are significantly associated with depression (Wald's test, 3.983; p < 0.05), disinhibition (Wald's test, 5.522; p < 0.05), and aberrant motor behavior (Wald's test, 7.430; p < 0.01). The patients treated with memantine presented lower mean SDs scores (t = 2.76; p < 0.001). These results highlight the need for a standardized and validated approach to the assessment of SDs in AD.

The experience of caregiving: the influence of coping strategies on behavioral and psychological symptoms in patients with Alzheimer's disease.

OBJECTIVES: To determine whether caregiver coping strategies are independently associated with behavioral and psychological symptoms (BPS) in Alzheimer's disease (AD) after accounting for patient characteristics. METHODS: Cross-sectional data analysis of 80 patients with AD and their primary caregivers. The presence of BPS was recorded using the Neuropsychiatric Inventory (NPI). The relationship between caregiver characteristics and BPS was assessed through one-way analysis of variance, two-tailed student t-tests or correlation coefficients. Multivariate linear regression was used to determine the combined effect of all caregiver factors that were significant on bivariate analysis regarding coping and BPS controlling for patient characteristics. RESULTS: Caregivers were on average 62 years old, 77% female, and most were the children or the spouse of the patient. Over 50% had significant depression or anxiety. Patients were on average 77 years old and 62% were female, and most had moderate to severe dementia. After adjusting for patient characteristics, patients cared for by more depressed, more burdened, or those using more disengagement coping strategies showed higher NPI mean composite scores. CONCLUSION: Coping strategies are associated with BPS regardeless of patient characteristics. Interventions to reduce BPS should focus on which psychological coping strategies caregivers use. Understanding how coping strategies influence BPS may help tailor specific interventions for caregivers.

Anxiety and depression are associated with coping strategies in caregivers of Alzheimer's disease patients: results from the MÁLAGA-AD study.

BACKGROUND: Caregiving for people with Alzheimer's disease (AD) is highly stressful and has significant negative consequences, such as anxiety and depression. Previous research offers conflicting findings as to whether coping strategies are associated with greater psychological distress or not. We conducted this study with a view to obtaining new data regarding the association of coping strategies and psychological distress in AD caregivers. METHODS: Eighty people with AD and their primary caregivers living in the community were recruited from local health services. Purposive recruitment was carried out to ensure that the sample was representative of people living with dementia in terms of dementia severity, gender, and care setting. We used the State-Trait Anxiety Inventory to measure anxiety, the Beck Depression Inventory to measure depression, and the Coping Strategies Inventory to measure coping strategies. RESULTS: Most caregivers reported higher anxiety and depression levels. Use of disengagement coping strategies (Wald = 3.35, p = 0.01) and higher caregiver burden (Wald = 4.83, p = 0.02) predicted anxiety on logistic regression. In turn, use of disengagement coping strategies (Wald = 12.48, p = 0.001) and higher caregiver burden (Wald = 6.91, p = 0.009) predicted depression on logistic regression. CONCLUSION: These results may be useful for designing treatment interventions that aim to modify the use of coping strategies and thus reduces caregiver anxiety and depression.

Disengagement coping partially mediates the relationship between caregiver burden and anxiety and depression in caregivers of people with Alzheimer's disease. Results from the MÁLAGA-AD study.

BACKGROUND: Caring for people with Alzheimer's disease can be considered stressful and demand adjustment strategies. While various variables have been associated with caregiver anxiety and depression, a possible mediator role of coping strategies adopted by caregivers between caregiver burden and anxiety and depression is still unclear. We hypothesized that caregivers with clinically significant anxiety and depression were more likely to use disengagement coping strategies that non-anxious and non-depressed caregivers. METHODS: This study involved 80 Alzheimer disease patients and their primary caregivers. Patients were evaluated using the Mini Mental State Examination, the Bayer Activities of Daily Living Scale, the Global Deterioration Scale and the Neuropsychiatric Inventory. Caregivers were evaluated with the Caregiver Burden Interview, the Beck Depression Inventory, the State-Trait Anxiety Inventory and the Coping Strategies Inventory. We conducted a series of multiple linear regressions to determine the relationship between caregiver burden and caregiver anxiety and depression, and if the coping strategies mediated this relationship. RESULTS: Using more disengagement (ß=0.270, p<0.001) and less engagement coping (ß=-0.310, p<0.001) were predictors for anxiety scores. Using more disengagement (ß=0.250, p<0.001) and less engagement coping (ß=-0.261, p<0.001) were predictors for depression scores. LIMITATIONS: This study was a cross-sectional design, so the direction of causality should be strengthened by a longitudinal study. CONCLUSIONS: Most caregivers reported higher anxiety and depression levels and this was partially mediated by their dysfunctional coping strategies.

Can impairment in memory, language and executive functions predict neuropsychiatric symptoms in Alzheimer's disease (AD)? Findings from a cross-sectional study.

The authors performed a cross-sectional study to examine the relationship between specific cognitive domains and behavioral and psychological symptoms in dementia (BPSD) in 125 patients with probable AD. Cognitive deficits were evaluated with the mini mental state examination (MMSE), trail-making test (TMT), Rey auditory verbal learning test (RAVLT), and semantic fluency test (SFT) and phonemic fluency test (PhFT), whereas the neuropsychiatric inventory (NPI) was used to rate BPSD. Patients' performance in cognitive tests significantly correlated with total NPI scores (p<0.0001). After controlling for demographic and clinical characteristics, cognitive impairments in memory, executive function, and language (RAVLT, TMT, PhFT, SFT) importantly estimated total NPI scores (p<0.001, multivariate regression models). These findings suggest that the evaluation of cognitive domains may have a predictive value for the occurrence of BPSD.

Calidad de atención y relaciones familiares en la asistencia a los controles del servicio de consulta externa / Quality of care and family relations in assisting controls outpatient service

Para recolectar la información se realizaron 100 visitas domiciliarias; se aplicaron 2 instrumentos para c/u, (calidad de atención y apgar familiar); para la tabulación, se utilizaron tablas de contingencia; la información se presento a razón de disparidad, determinando la fuerza de asociación entre los factores de riesgo estudiados, de acuerdo con las hipótesis planteadas. Se pudo determinar que la insatisfacción de los usuarios para la calidad de los servicios ofertados por el H.M.R.S. es un factor predisponente para inasistencia a los controles por consulta externa. Se identificó que no hay evidencia estadísticamente, que el presentar insatisfacción, representa un factor asociado para la inasistencia a tratamiento por consulta externa. Para la funcionalidad familiar, se demostró que el 96.7% de cada 100 casos presentan disfuncionalidad familiar, y un 89.7% de cada 100 controles también presentan disfunción familiar, demostrando que esta variable es una característica principal de los pacientes mentales en general. Para concluir, la calidad de atención como la funcionalidad familiar, representan un factor predisponente a presentar inasistencia, pero no son la principal causa por la cual los usuarios del Hospital Mental Rudesindo Soto ( HMRS) no acuden a los controles programados por consulta externa de acuerdo a lo investigado.

For the harvesting of the information 100 domiciliary visits were realised; 2 instruments for c/u were applied, (quality of attention and to apgar familiar); for the tabulation, contingency tables were used, and the information I appear at the rate of disparity, determining the force of association between the studied factors of risk, in agreement with the raised hypotheses. With the investigation it was possible to be determined that the dissatisfaction of the users for the quality of the services supplied by the H.M.R.S is a factor prearranger for inasistencia to the controls by external consultation. I identify myself that there is no evidence statistically, that presenting/displaying dissatisfaction, represents a factor associated for the inasistencia treatment by external consultation. For the familiar functionality, one demonstrated that the 96,7% of each 100 cases present/display familiar disfunctionality, and 89,7% of each 100 controls also present/display familiar dysfunction, demonstrating that this variable is a basic characteristics of the mental patients generally. In order to conclude, the quality of attention like the familiar functionality, represents a factor prearranger to present/display inasistencia, but they are not the main cause by which the users of the HMRS do not go to the controls.

[New perspectives in the diagnosis and evolution of the consumption of tobacco: markers of susceptibility and damage]. / Nuevas perspectivas en el diagnóstico y la evolución del consumo de tabaco: marcadores de susceptibilidad y lesión.

The smoking represents a serious problem of public health. It is in and of itself high-priority to describe the genetic bases of the addiction, the susceptibility to begin the consumption, to be smoking and to develop pathologies related with the tobacco. Markers of susceptibility (I begin, consolidation, modulation and ceasing of the habit), of damage potential -chronic obstructive pulmonary disease (COPD), lung carcinoma-, and of valuation of the adverse goods of the exhibition. Dependence markers, motivation, depression, anxiety and stress are reviewed. As well as tests to value syndrome of abstinence, breathing analytic and functional parameters and quality of life.