Investigation of anti-Alzheimer's activity of aqueous extract of areca nuts (Areca catechu L): in vitro and in vivo studies / Investigación de la actividad anti-Alzheimer del extracto acuoso de nueces de areca (Areca catechu L): estudios in vitro e in vivo

Alzheimer's disease (AD) is an age-related neurodegenerative disorder. Sever cognitive and memory impairments, huge increase in the prevalence of the disease, and lacking definite cure have absorbed worldwide efforts to develop therapeutic approaches. Since many drugs have failed in the clinical trials due to multifactorial nature of AD, symptomatic treatments are still in the center attention and now, nootropic medicinal plants have been found as versatile ameliorators to reverse memory disorders. In this work, anti-Alzheimer's activity of aqueous extract of areca nuts (Areca catechu L.) was investigated via in vitro and in vivo studies. It depicted good amyloid ß (Aß) aggregation inhibitory activity, 82% at 100 µg/mL. In addition, it inhibited beta-secretase 1 (BACE1) with IC50 value of 19.03 µg/mL. Evaluation of neuroprotectivity of the aqueous extract of the plant against H2O2-induced cell death in PC12 neurons revealed 84.5% protection at 1 µg/mL. It should be noted that according to our results obtained from Morris Water Maze (MWM) test, the extract reversed scopolamine-induced memory deficit in rats at concentrations of 1.5 and 3 mg/kg.

La enfermedad de Alzheimer (EA) es un trastorno neurodegenerativo relacionado con la edad. Los severos deterioros cognitivos y de la memoria, el enorme aumento de la prevalencia de la enfermedad y la falta de una cura definitiva han absorbido los esfuerzos mundiales para desarrollar enfoques terapéuticos. Dado que muchos fármacos han fallado en los ensayos clínicos debido a la naturaleza multifactorial de la EA, los tratamientos sintomáticos siguen siendo el centro de atención y ahora, las plantas medicinales nootrópicas se han encontrado como mejoradores versátiles para revertir los trastornos de la memoria. En este trabajo, se investigó la actividad anti-Alzheimer del extracto acuoso de nueces de areca (Areca catechu L.) mediante estudios in vitro e in vivo. Representaba una buena actividad inhibidora de la agregación de amiloide ß (Aß), 82% a 100 µg/mL. Además, inhibió la beta-secretasa 1 (BACE1) con un valor de CI50 de 19,03 µg/mL. La evaluación de la neuroprotección del extracto acuoso de la planta contra la muerte celular inducida por H2O2 en neuronas PC12 reveló una protección del 84,5% a 1 µg/mL. Cabe señalar que, de acuerdo con nuestros resultados obtenidos de la prueba Morris Water Maze (MWM), el extracto revirtió el déficit de memoria inducido por escopolamina en ratas a concentraciones de 1,5 y 3 mg/kg.

Protective effect of CD73 inhibitor α, ß-methylene ADP against amyloid-ß-induced cognitive impairment by inhibiting adenosine production in hippocampus

BACKGROUND: Alzheimer's disease (AD) is a chronic, progressive neurodegenerative disease. Recent studies have reported the close association between cognitive function in AD and purinergic receptors in the central nervous system. In the current study, we investigated the effect of CD73 inhibitor α, ß-methylene ADP (APCP) on cognitive impairment of AD in mice, and to explore the potential underlying mechanisms. RESULTS: We found that acute administration of Aß1­42 (i.c.v.) resulted in a significant increase in adenosine release by using microdialysis study. Chronic administration of APCP (10, 30 mg/kg) for 20 d obviously mitigated the spatial working memory impairment of Aß1­42-treated mice in both Morris water maze (MWM) test and Y-maze test. In addition, the extracellular adenosine production in the hippocampus was inhibited by APCP in Aß-treated mice. Further analyses indicated expression of acetyltransferase (ChAT) in hippocampus of mice of was significantly reduced, while acetylcholinesterase (AChE) expression increased, which compared to model group. We observed that APCP did not significantly alter the NLRP3 inflammasome activity in hippocampus, indicating that anti-central inflammation seems not to be involved in APCP effect. CONCLUSIONS: In conclusion, we report for the first time that inhibition of CD73 by APCP was able to protect against memory loss induced by Aß1­42 in mice, which may be due to the decrease of CD73-driven adenosine production in hippocampus. Enhancement of central cholinergic function of the central nervous system may also be involved in the effects of APCP.

Factores de riesgo asociados a pacientes con enfermedad de Alzheimer y sus cuidadores principales / Risk Factors Associated to Patients with Alzheimer's Disease and their Main Caregivers

Introducción: La demencia es una enfermedad crónica, y la enfermedad de Alzheimer su causa más frecuente, ambas asociadas a factores genéticos y ambientales. La enfermedad de Alzheimer es un trastorno exclusivo del sistema nervioso central en el que se produce una lenta destrucción y atrofia de la corteza cerebral. Objetivo: Caracterizar los principales factores de riesgo asociados a los pacientes con enfermedad de Alzheimer y a sus cuidadores principales. Métodos: Se realizó un trabajo de revisión bibliográfica, que se llevó a cabo en la Facultad de Ciencias Médicas General Calixto García, entre mayo y junio del 2019, para lo cual se tuvieron en cuenta criterios de inclusión que delimitaron la búsqueda en relación a la enfermedad de Alzheimer. La pesquisa se inició a través de las plataformas virtuales (Scielo, Medline y Google Schrome). Se seleccionaron 31 artículos, de ellos, 18 artículos originales, 11 trabajos de revisión, una carta al editor y un debate. Los artículos fueron publicados en idioma español y/o en portugués. Conclusiones: Es de gran importancia el conocimiento de los factores de riesgo que están asociados a la enfermedad de Alzheimer y sus cuidadores, lo que permitirá evitarlos mediante acciones de salud que promuevan estilos de vida saludables y así intentar prevenir y controlar la evolución de esta enfermedad que cada día afecta de forma dramática a más personas(AU)

Introduction: Dementia is a chronic disease, and Alzheimer's disease is its most frequent cause, both associated with genetic and environmental factors. Alzheimer's disease is a disorder only manifested in the central nervous system and in which a slow destruction and atrophy of the cerebral cortex appears. Objective: To characterize the main risk factors associated with patients with Alzheimer's disease and their main caregivers. Methods: A literature review was carried out in General Calixto García School of Medical Sciences, between May and June 2019, and for which inclusion criteria were taken into account that delimited the search in relation to Alzheimer's disease. The research began through virtual platforms (SciELO, Medline, and Google Scholar). 31 articles were selected, of which 18 were original articles, 11 were review papers, there was one letter to the editor, and one debate. The articles were published in Spanish or Portuguese. Conclusions: Knowledge about the risk factors associated with Alzheimer's disease and its caregivers is of great importance, which will allow avoiding them by means of health actions that promote healthy lifestyles and thus trying to prevent and controlling the evolution of this disease, which dramatically affects more people every day(AU)

Nutrição e doença de alzheimer no idoso: uma revisão / Nutrition and alzheimer's disease in older adults: a review

Objetivo: verificar se a alimentação e a nutrição podem contribuir para a prevenção ou retardo da progressão da doença de Alzheimer. Métodos: pesquisa de revisão integrativa cujos artigos foram encontrados nas bases de dados: Lilacs, Medline, Periódicos Capes e National Center of Biotechnology Information, entre o período de 2006 e 2016. Resultados: 20 artigos compuseram o produto final da seleção, sendo 14 artigos de revisão, dois estudos transversais, três estudos de corte e um estudo caso-controle. De modo geral, os padrões alimentares associados à prevenção da Doença de Alzheimer são a Dieta Mediterrânea, Dietary Approaches to Stop Hypertension, Dieta Mediterranean/Dietary Approaches to Stop Hypertension. Também há evidências acerca do retardo da progressão do Alzheimer através de vitaminas antioxidantes. Discussão: entre os fatores alimentares de risco para o desenvolvimento da patologia, estão o elevado consumo de ácidos graxos saturados e trans, carnes vermelhas em excesso e álcool. Conclusão: ficou evidente o papel protetor contra o desenvolvimento da DA através de uma dieta saudável. Alguns nutrientes parecem ser promissores na prevenção e redução da progressão da DA, como as vitaminas C e E e selênio, vitaminas B9 e B12, especialmente quando oriundos de fontes dietéticas e parte de um padrão alimentar saudável.

Objective: To verify if nourishment and nutrition can contribute to the prevention or retardation of the progression of Alzheimer's disease. Methods: An integrative review was carried out in the databases: Lilacs, Medline, Capes Periodicals and National Center of Biotechnology Information between the period 2006 and 2016. Results: 20 articles composed the final product of the selection, 14 articles of 2 cross-sectional studies, 3 cohort studies and 1 case-control study. In general, the dietary patterns associated with Alzheimer's disease prevention are the Mediterranean diet, Dietary Approaches to Stop Hypertension, Mediterranean Diet/Approach to Stop Hypertension. There is also evidence of delayed Alzheimer's proration through antioxidant vitamins. Discussion: Among the dietary risk factors for the development of the pathology are the high consumption of saturated and trans fatty acids, excess red meat and alcohol. Conclusion: The protective role against the development of AD through a healthy diet became evident. Some nutrients appear to be promising in preventing and reducing the progression of AD, such as vitamins C and E and selenium, vitamins B9 and B12, especially when derived from dietary sources and part of a healthy eating pattern.

Chlorella sorokiniana and Chlorella minutissima exhibit antioxidant potentials, inhibit cholinesterases and modulate disaggregation of ß-amyloid fibrils

BACKGROUND: Microalgae are aquatic chlorophyll-containing organisms comprising unicellular microscopic forms, and their biomasses are potential sources of bioactive compounds, biofuels and food-based products. However, the neuroprotective effects of microalgal biomass have not been fully explored. In this study, biomass from two Chlorella species was characterized, and their antioxidant, anticholinesterase and anti-amyloidogenic activities were investigated. RESULTS: GC­MS analysis of the extracts revealed the presence of some phenols, sterols, steroids, fatty acids and terpenes. Ethanol extract of Chlorella sorokiniana (14.21 mg GAE/g) and dichloromethane extract of Chlorella minutissima (20.65 mg QE/g) had the highest total phenol and flavonoid contents, respectively. All the extracts scavenged 2,2-diphenyl-1-picrylhydrazyl, 2,2-azinobis (3-ethylbenzothiazoline-6-sulfonate) and hydroxyl radicals. The highest metal chelating activity of the extracts was observed in the ethanol extracts of C. minutissima (102.60 µg/mL) and C. sorokiniana (107.84 µg/mL). Furthermore, the cholinesterase inhibitory activities of the extracts showed that ethanol extract of C. sorokiniana (13.34 µg/mL) exhibited the highest acetylcholinesterase inhibitory activity, while dichloromethane extract of C. minutissima (11.78 µg/mL) showed the highest butyrylcholinesterase inhibitory activity. Incubation of the ß-amyloid protein increased the aggregation of amyloid fibrils after 96 h. However, ethanol extract of C. sorokiniana and C. minutissima inhibited further aggregation of Aß1­42 and caused disaggregation of matured protein fibrils compared to the control. This study reveals the modulatory effects of C. sorokiniana and C. minutissima extracts on some mediators of Alzheimer's disease and provides insights into their potential benefits as functional food, nutraceutics or therapeutic agent for the management of this neurodegenerative disease.

Políticas públicas para os idosos portadores do mal de Alzheimer / Public policies for the older carriers of Alzheimer's evil / Políticas públicas para los ancianos portadores del mal de Alzheimer

Objetivo: Conocer y analizar la producción científica en el período de 2011 a 2016 sobre las políticas públicas para los ancianos portadores del mal de Alzheimer. Método: El estudio se caracteriza como una investigación exploratoria, descriptiva con enfoque cuantitativo, realizado a través del método de la revisión integrativa. Resultados: Aunque la DA es una enfermedad progresiva e incurable, mucho se ha avanzado en beneficio del anciano portador, como la creación de instrumentos de evaluación y de criterios diagnósticos más claros, medicamentos que mejoran la cognición y disminuyen la incidencia de cambios conductuales y la la creación de leyes y decretos gubernamentales que disponen específicamente de los derechos de la persona de edad avanzada con la enfermedad de Alzheimer. Conclusión: El conocimiento acerca de los derechos de los pacientes portadores de la enfermedad de Alzheimer es de suma importancia para la promoción de la salud y el mantenimiento de la vida de esas personas

Objective: To know and analyze the scientific production in the period from 2011 to 2016 on public policies for elderly people with Alzheimer's disease. Method: The study is characterized as exploratory, descriptive research with a quantitative approach, performed through the integrative review method. Results: Although AD is a progressive and incurable disease, much has already been advanced for the benefit of the elderly patient, such as the creation of clearer diagnostic tools and criteria, medications that improve cognition and reduce the incidence of behavioral changes, and creating laws and government ordinances that specifically govern the rights of the elderly with Alzheimer's Disease. Conclusion: Knowledge about the rights of patients with Alzheimer's disease is of paramount importance for the promotion of health and maintenance of their lives

Objetivo: Conhecer e analisar a produção científica no período de 2011 a2016 sobre as políticas públicas para os idosos portadores do mal de Alzheimer. Método: O estudo caracteriza-se como pesquisa exploratória, descritiva com abordagem quantitativa, realizado por meio do método da revisão integrativa. Resultados: Embora a DA seja uma doença progressiva e incurável, muito já se avançou em benefício do idoso portador, como a criação de instrumentos de avaliação e de critérios diagnósticos mais claros, medicações que melhoram a cognição e diminuem a incidência de mudanças comportamentais e a criação de leis e portarias governamentais que dispõem especificamente dos direitos da pessoa idosa com a Doença de Alzheimer. Conclusão: O conhecimento acerca dos direitos dos pacientes portadores da Doença de Alzheimer é de suma importância para promoção da saúde e manutenção da vida dessas pessoas

Knowledge about Alzheimer's disease in the Brazilian population / Conhecimento sobre a doença de Alzheimer na população brasileira)

ABSTRACT Dementia is a very common disease, but the general population's knowledge about its main etiology, Alzheimer's disease (AD), is still poor, leading to delayed seeking of healthcare services, less prevention of disease by lifestyle changes and more difficulty in managing the care of the demented. Objective: To measure knowledge about AD in a Brazilian sample, taking into account some demographic variables. Methods: A link to a self-administered online questionnaire was sent by email and via other social media to anyone older than 18 years old. Our questionnaire contained sociodemographic questions and the Alzheimer's Disease Knowledge Scale (ADKS), a well-established scale comprising 30 "true or false" questions about AD. Results: 1,414 people (1,076 females), with a mean age of 42.3 years (SD ± 14.1), and 87.4% having more than 11 years of schooling, answered the online questionnaire. The mean total score for the ADKS was 21.6 out of 30 points (SD ± 3.73); however when we excluded health professionals (36.4% of the sample), it dropped to 20.5/30 (SD ± 3.51). The scores were positively influenced by educational level, professional skills (better for health professionals, mainly physicians) and by age (younger than 65 years). Being a caregiver or family member did not influence the knowledge about disease. Discussion: Despite the high prevalence of AD, few studies have been conducted in Brazil regarding the population's knowledge about the disease. Our study revealed a lack of information about AD in our country, even in relatives and caregivers of demented patients.

RESUMO Apesar da alta e crescente prevalência de demência em nosso meio, o conhecimento da população sobre sua principal causa - a Doença de Alzheimer (DA) - é insuficiente, levando à menor procura por serviços de saúde, menor prevenção da doença por meio de mudanças no estilo de vida e maior dificuldade no cuidado aos pacientes com demência. Objetivo: Mensurar o conhecimento sobre DA em uma amostra da população brasileira, levando em conta algumas variáveis demográficas. Métodos: Um link para um questionário online auto-aplicável foi enviado por email e por meio de outras mídias sociais para pessoas com mais de 18 anos de idade. O questionário era composto por ítens sociodemográficos e pela "Alzheimer's Disease Knowledge Scale" (ADKS), uma escala bem estabelecida composta por 30 questões relacionadas à DA, no formato "verdadeiro ou falso". Resultados: 1414 pessoas (1076 mulheres), com idade média de 42,3 anos (DP ± 14,1) e mais de onze anos de escolaridade em 87.4%, responderam o questionário online. A pontuação média na escala ADKS foi de 21,6 em 30 pontos possíveis (DP ± 3,73). Contudo, excluindo profissionais de saúde (36,4% da amostra), a pontuação média caiu para 20,5 (DP ± 3,51). Os resultados foram influenciados positivamente pela escolaridade, profissão (profissionais de saúde, principalmente médicos, tiveram melhor desempenho) e idade inferior a 65 anos. Cuidadores e familiares de pessoas com demência não tiveram melhor desempenho que os demais. Discussão: Apesar da alta prevalência da DA, poucos estudos brasileiros avaliaram o conhecimento da população sobre esta doença. O nosso estudo revelou falta de informação da população brasileira em relação a este tema, mesmo entre familiares e cuidadores de pessoas com demência.

Protocolo del Sistema Nacional de Vigilancia Epidemiológica: enfermedades no transmitibles (ENT) diabetes, cardiovasculares y cáncer. No. 11 / Protocolo del Sistema Nacional de Vigilancia Epidemiológica: enfermedades no transmitibles (ENT) diabetes, cardiovasculares y cáncer. No. 11

Estos protocolos están dirigido a personal médico, paramédico y otros profesionales que realizan acciones gerenciales y operativas de vigilancia epidemiológica en los servicios de salud del país, y están divididos en varios tomos para dar a conocer y actualizar la identificación y medidas de control para diversos padecimientos a fin de continuar con el mejoramiento de las capacidades técnicas de los trabajadores de salud, que permita planificar la prestación de servicios con decisiones partiendo de un enfoque epidemiológico comprobado, para responder a los cambios de tendencias epidemiológicas y con ello contribuir al fortalecimiento de prácticas asertivas de la salud pública de nuestro país.

Dieta mediterránea y sus efectos benéficos en la prevención de la enfermedad de Alzheimer / Role of Mediterranean diet on the prevention of Alzheimer disease

Type 2 diabetes and obesity are possible risk factors for Alzheimer’s disease and these can be modified by physical activity and changes in dietary patterns, such as switching to a Mediterranean diet. This diet includes fruits, vegetables, olive oil, fish and moderate wine intake. These foods provide vitamins, polyphenols and unsaturated fatty acids. This diet should be able to reduce oxidative stress. The inflammatory response is also reduced by unsaturated fatty acids, resulting in a lower expression and a lower production of pro-inflammatory cytokines. The Cardiovascular protection is related to the actions of polyphenols and unsaturated fatty acids on the vascular endothelium. The Mediterranean diet also can improve cardiovascular risk factors such as dyslipidemia, hypertension and metabolic syndrome. These beneficial effects of the Mediterranean diet should have a role in Alzheimer’s disease prevention.

Enduring amnesia induced by ICV scopolamine is reversed by sesame oil in male rats

ABSTRACT PURPOSE: To evaluated the long-term effect of scopolamine and sesame oil on spatial memory. METHODS: Memory impairment induced by Intracerebroventricular (ICV) injection of scopolamine hydrochloride (10 μg/ rat). Animals were gavaged for 4 weeks with saline, sesame oil (0.5, 1, or 2 mL/kg/day), or 3 weeks with memantine (30 mg/kg/day) in advance to induction of amnesia. Morris water maze (MWM) test was conducted 6 days after microinjection of scopolamine. Then, blood and brain samples were collected and evaluated for the malondialdehyde (MDA) levels, superoxide dismutase (SOD) and glutathione peroxidase (GPX) activities, and total antioxidant status (TAS) and ferric reducing ability of plasma (FRAP). RESULTS: Scopolamine significantly decreased traveled distance and time spent in target quadrant in probe test. Pretreatment of rats with sesame oil (0.5 mg/kg) mitigated scopolamine-induced behavioral alterations. Measurement of MDA, SOD, and GPX in brain tissue, and FRAP and TAS in blood showed little changes in animals which had received scopolamine or sesame oil. CONCLUSIONS: Intracerebroventricular injection of scopolamine has a residual effect on memory after six days. Sesame oil has an improving effect on spatial memory; however this effect is possibly mediated by mechanisms other than antioxidant effect of sesame oil.

Effects of aerobic physical exercise on cognition / Efeitos da atividade física aeróbica na cognição

INTRODUCTION: The increasing prevalence of cognitive impairment in older adults is a major concern nowadays. Interventions able to change the natural history of the most common cause of cognitive impairment in older adults, Alzheimer's disease (AD), are needed. Physical inactivity is considered one of the most important modifiable risk factors for AD. OBJECTIVE: To review recent evidence on the role of physical exercise (PE) in the older adults cognition. METHOD: The authors reviewed recent papers about PE and cognition in older adults. CONCLUSION: Current data indicate that PE is a promising intervention to decrease the risk of cognitive impairment in cognitively normal older subjects and in those with Mild Cognitive Impairment. Controversy still remains about the effect of PE in demented patients, but more recent data is pointing towards a positive effect.

INTRODUÇÃO: A prevalência crescente de comprometimento cognitivo em adultos mais idosos é uma grande preocupação atual. Intervenções capazes de alterar a história natural da causa mais frequente de comprometimento cognitivo em adultos mais idosos, a doença de Alzheimer (DA), são necessárias. A inatividade física é considerada um dos fatores de risco modificáveis mais importantes na DA. OBJETIVO: Rever evidências recentes no papel do exercício físico (EF) na cognição de adultos mais idosos. MÉTODO: Os autores fizeram uma revisão dos artigos recentes sobre EF e cognição em adultos mais idosos. CONCLUSÃO: Dados correntes indicam que o EF é uma intervenção promissora para diminuir o risco de comprometimento cognitivo em indivíduos mais idosos cognitivamente normais e naqueles com Comprometimento Cognitivo Leve. Ainda permanecem controvérsias quanto ao efeito do EF em pacientes demenciados, porém dados mais recentes apontam para um efeito positivo.

Una encuesta sobre biomarcadores y diagnóstico precoz de la enfermedad de Alzheimer / A survey on biomarkers and early diagnosis in Alzheimer's disease

Ante el uso potencial de biomarcadores para el diagnóstico temprano de la enfermedad de Alzheimer (EA), nuevos dilemas éticos y de comunicación aparecen en la práctica clínica cotidiana. El objetivo de este trabajo fue conocer la opinión de profesionales de la salud (PS) y del público en general (PG) sobre la realización de técnicas diagnósticas tempranas en la EA utilizando marcadores biológicos, aun a sabiendas que hasta ahora la enfermedad es incurable. Se confeccionó una encuesta en Internet con respuesta múltiple en dos versiones: una para PS y otra para el PG. Se invitó a participar a los encuestados a través de un sistema legal de envíos masivos de correo electrónico, utilizando direcciones recolectadas en la base de datos del CEMIC. Se analizaron 1503 respuestas: 807 grupo PS y 696 grupo PG. La mayoría de los encuestados (84.7%) prefirió la opción de realizar el diagnóstico temprano de la EA aun conociendo la falta de tratamiento curativo. El 45.1% del grupo PG vs. el 26.8% del grupo PS respondió que no cree que se genere un dilema de comunicación ni ético en los médicos al informar el diagnóstico de la enfermedad. El grupo PS mostró mayor divergencia en las opiniones que el PG. Estos resultados podrían indicar una nueva dinámica en la relación médico-paciente, mostrando al PG con una posición activa y favorable frente al uso de los biomarcadores para el diagnóstico temprano de la EA.

Given the potential use of biomarkers in the diagnosis of Alzheimer’s disease (AD) in early stages, new ethical and communication dilemmas appear in everyday clinical practice. The aim of this study was to know the opinion of health professionals (HP) and general public (GP) on the implementation of early diagnostic techniques in AD and the use of biomarkers for this purpose. A survey with multiple choice answers was elaborated in two versions: one for HP and the other for GP. Respondents were invited to participate through a system of mass mailing e-mail; e-mail addresses were collected from CEMIC database. A total of 1503 answers were analyzed: 807 HP and 696 GP. Most respondents, 84.7%, preferred the option of early diagnosis of AD even knowing the lack of curative treatment. Forty five percent of GP and 26.8% of HP replied that there is no ethical dilemma in the use of biomarkers and that no communication or ethical dilemma is generated to physicians when informing the diagnosis of the disease. The HP group showed more divergence in the views than the GP group. These results may indicate a change in the physician-patient relationship, showing the GP group with an active and supportive position towards the use of biomarkers for early diagnosis of AD.

Estrategia y plan de acción sobre demências en las personas mayores / Strategy and action plan on dementia in the elderly

Una estrategia y plan de acción sobre las demencias en personas mayores que busca mejorar y ampliar la atención a los adultos mayores con demencias, prevenir o retrasar su deterioro funcional y dependencia, y aumentar la investigación.

La ocupación como factor protector de la demencia por enfermedad de alzheimer / Occupation as a protective factor for alzheimer's disease dementia

La demencia es un síndrome de alteración predominantemente cognitiva que de la mano con el progresivo envejecimiento poblacional ha experimentado un aumento en su frecuencia, con el consecuente impacto en costos en salud y por sobre todo, en las vidas de las personas mayores que la presentan, sus cuidadores y familia. La enfermedad de Alzheimer es la principal causa de demencia en la población de 60 años y más. Actualmente el tratamiento de la demencia por enfermedad de Alzheimer tiene por objetivo retardar o minimizar el impacto en las esferas funcionales, sociales y cognitivas de la persona. No obstante, existe investigación creciente con un enfoque desde la prevención primaria, que busca establecer causalidad a partir de factores protectores o factores de riesgo vinculados por ejemplo, a los estilos de vida, considerables como agentes preventivos de la demencia por enfermedad de Alzheimer. Por medio de este trabajo, se busca realizar un análisis a partir de la evidencia sobre prevención de la demencia por enfermedad de Alzheimer, y desde una perspectiva teórica, reflexionar sobre el rol que tiene la ocupación de los sujetos como factor protector a partir de una intervención preventiva.

Dementia is a syndrome that affects predominantly the individual’s cognitive condition. Related to an aging population dementia has increased in terms of prevalence and incidence, with the consequent impact on health costs and above all, a high impact on the lives of people with dementia, their caregivers and their families. Alzheimer’s disease is the leading cause of dementia in the population aged 60 years and over. Currently the treatment of dementia of the Alzheimer’s type aims to slow or minimize the impact on functional, social and cognitive areas. However there is growing research that focuses in primary prevention that seeks to establish causality from protective or risk factors related for example, to lifestyles, identifying prevention agents for dementia of the Alzheimer’s type. This work seeks to make an analysis considering data from the evidence on the prevention of dementia of the Alzheimer’s type, as well as to reflect on the role that the occupation of the subject as a protective factor from a preventive intervention.

Demencias y enfermedad de Alzheimer en América Latina y el Caribe / Dementias and Alzheimer's disease in Latin America and the Caribbean

La demencia es la primera causa de discapacidad en adultos mayores y la mayor contribuyente de dependencia, sobrecarga económica y estrés psicológico en el cuidador, sin embargo, aún no recibe la misma prioridad que otras enfermedades crónicas no trasmisibles, como las enfermedades cardiovasculares y el cáncer, que tienen un mayor impacto en la mortalidad. Se abordan aspectos relacionados con la prevalencia y el incremento del número de personas con demencia en América Latina y el Caribe para el 2030, su impacto y cómo la prevención de los factores de riesgo, con una perspectiva del curso de la vida desde la concepción y la vida intrauterina hasta la edad tardía y además, un enfoque multifactorial, pudieran potencialmente conducir a una reducción del número de enfermos. Un mayor énfasis en la prevención y un amplio acceso a la educación, mejores condiciones socioeconómicas, estilos de vida saludables y control de los factores de riesgo cardiovasculares, es una alternativa viable y sostenible para reducir el impacto creciente de las demencias en la sociedad(AU)

Although dementia is the leading cause of disability and the main causative factor of dependence in the elderly, and of economic burden and psychological stress in the caregiver, it has not yet been prioritized in the same degree as other non-communicable chronic diseases, such as cardiovascular disease and cancer, which have a greater impact on mortality. Some aspects related to the prevalence and the rise of number of people with dementia in Latin America and the Caribbean for 2030 were discussed in this paper. The impact of dementia as well as the knowledge about and control of its risk factors were also addressed, using perspective course of life from the conception and intrauterine life to the late age and the multifactoral approach, all of which could potentially lead to a reduction in the number of patients with dementia. Greater emphasis on prevention, broad access to education, better socioeconomic conditions, healthy lifestyles and control of cardiovascular risk factors to reduce the growing impact of dementia in the society are sustainable viable alternatives for the reduction of growing impact of dementias on the society(AU)

In vitro evaluation of anti-Alzheimer effects of dry ginger (Zingiber officinale Roscoe) extract.

As the disease modifying therapies against Alzheimer’s disease (AD) continue to exist as a major challenge of this century, the search for newer drug leads with lesser side effects is on the rise. A large number of plant extracts and phytocompounds are being actively pursued for their anti-Alzheimer effects. In the present study, the antioxidant activity, cholinesterase inhibition, anti-amyloidogenic potential and neuroprotective properties of methanolic extract of dry ginger (GE) have been evaluated. The extract contained 18±0.6 mg/g gallic acid equivalents of total phenolic content and 4.18±0.69 mg quercetin equivalents/g of dry material. GE expressed high antioxidant activity with an IC50 value of 70±0.304 µg/mL in DPPH assay and 845.4±56.62 μM Fe(II) equivalents/g dry weight in FRAP assay respectively. In Ellman’s assay for the cholinesterase inhibitory activity, GE had an IC50 value of 41±1.2 µg/mL and 52±2 µg/mL for inhibition of acetyl- and butyrylcholinesterase respectively. Also, GE increased the cell survival against amyloid β (Aβ) induced toxicity in primary adult rat hippocampal cell culture. Aggregation experiments with the thioflavin T binding studies showed that GE effectively prevented the formation of Aβ oligomers and dissociated the preformed oligomers. These findings suggest that methanolic GE influences multiple therapeutic molecular targets of AD and can be considered as an effective nontoxic neutraceutical supplement for AD.

Refletindo acerca da doença de alzheimer no contexto familiar do idoso: implicações para a enfermagem / Reflejo acerca de la enfermedad del alzheimer en lo contexto familiar del anciano: implicaciones para a enfermagem / Reflecting about alzheimer disease in the context of elderly family: nursing implications

Objetivou-se refletir acerca das dificuldades geradas pela doença de Alzheimer no contexto familiar doidoso. Para tal,realizou-se em dezembro de 2012 a busca de materiais impressos e artigos científicosonlinenas bases de dadosLiteraturaLatino Americana em Ciências da Saúde(LILACS) eScientific Eletronic Library Online(SCIELO), utilizando os descritores:Doença de Alzheimer, Idoso, Família e Enfermagem. Após procedeu-se a leitura e análise crítica-reflexiva do materialselecionado emergindo duas categorias: Vivenciandosentimentos de toda ordem; Dificuldades no cuidadoprestado por umúnico familiar. Pode-se perceber que o cuidado ao idoso com Alzheimer, desencadeia inúmeros sentimentos/atitudes nofamiliar cuidador, tais como: emoções, raiva, dificuldades de convívio, desgaste físico/emocional, certezas/incertezas,mas, sobretudo dedicação. Devido a dificuldade de articulação com outros familiares, o cuidado fica namaioria das vezessob responsabilidade de um único familiar, gerandosobrecarga fica e emocional, facilitando o surgimento de possíveispatologias no familiar. Desta forma, torna-se necessário que os profissionais de saúde, em especial osda enfermagem, porserem os que permanecem mais tempo junto aos indivíduos/famílias possuam abordagens integradoras e capazes deincluir a família nas estratégias de cuidado, possibilitando dividir as responsabilidades entre os familiares cuidadores,evitando a sobrecarga física/emocional.

This study has as objective to reflect about the difficulties that are generated from Alzheimer in thefamiliar context ofelderly. For such, a search for printed and onlinescientific articles in December 2012 was carried out onLiteratura LatinoAmericana em Ciências da Saúde(LILACS) andScientific Eletronic Library Online(SCIELO) databases. The key-words usedfor such search wereAlzheimer disease, Elderly,familyandnursing. After proceeded to read and critically-reflectiveanalysis of the selected material emerging two categories: Experiencing all-types of feelings and Difficulties in care takenby only one family member. It can be perceived thattaking care of an elderly with Alzheimer triggersseveral feelings andattitudes in the family member, such as various emotions, anger, living together difficulties, physical and mental strains,certainties and doubts, but especially, dedication.Due to difficulties in arranging with other familymembers, the care ismostly under only one family member’s responsibility, leading to physical and mental overburden, facilitating possiblepathologies in the caregiver. This way, it is necessary for the health professionals – especially nurses, for being togetherwith the individuals and families most of the time– to have integrative approaches, able to include family in care.

El objetivo era reflexionar sobre las dificultadescausadas por la enfermedad de Alzheimer en el contexto familiar delanciano. Con este fin, se celebró en diciembre de 2012 la busca de los materiales impresos y artículos científicos enbases de datos Literatura Latinoamericana en Cienciasde la Salud (LILACS) y Scientific Electronic LibraryOnline (SciELO),utilizando los siguientes descriptores: Enfermedadde Alzheimer, Anciano, familia y Enfermería. Después procedió a lalectura y el análisis crítico reflectante del material seleccionado surgieron dos categorías: Experimentar sensaciones detodo tipo, las dificultades en la atención proporcionada por un solo familiar. Se puede observar que el cuidado de losancianos con enfermedad de Alzheimer, desencadenannumerosos sentimientos/actitudes en lo familiar cuidador, comolas emociones, la ira, dificultades de socialización, el estrés físico/mentales, certezas/incertidumbres, pero sobre tododedicación. Debido La dificultad de articulación conotros miembros de la familia, el cuidado es en sumayoría laresponsabilidad de un solo familiar, causando sobrecarga física y mental facilitando la aparición de posibles patologías enlo familiar. Por lo tanto, se hace necesario que los profesionales de la salud, especialmente los de enfermería, siendo losque se quedan más tiempo con las personas/familiastienen enfoques integradores y capaz de incluir a la familia en lasestrategias de atención, lo que permite dividir lasresponsabilidades entre los cuidadores familiares,evitando lasobrecarga física/emocional.

Dual task and postural control in Alzheimer's and Parkinson's disease / Tarefa dupla e controle da postura na doença de Alzheimer e na doença de Parkinson / Doble tarea y el control postural en la enfermedad de Alzheimer y la enfermedad de Parkinson

Patients with neurodegenerative diseases are required to use cognitive resources while maintaining postural control. The aim of this study was to investigate the effects of a frontal cognitive task on postural control in patients with Alzheimer, Parkinson and controls. Thirty-eight participants were instructed to stand upright on a force platform in two experimental conditions: single and dual task. Participants with Parkinson's disease presented an increase in the coefficient of variation greater than 100% in the dual task as compared to the single task for center of pressure (COP) area and COP path. In addition, patients with Parkinson's and Alzheimer's disease had a higher number of errors during the execution of the cognitive task when compared to the group of elderly without neurodegenerative diseases. The motor cortex, which is engaged in postural control, does not seem to compete with frontal brain regions in the performance of the cognitive task. However, patients with Parkinson's and Alzheimer's disease presented worsened performance in cognitive task.

Pacientes com doenças neurodegenerativas utilizam recursos cognitivos para manutenção do controle postural. O objetivo deste estudo foi investigar os efeitos de uma tarefa cognitiva frontal no controle postural em pacientes com Alzheimer, com Parkinson e idosos sem doenças neurodegenerativas. Trinta e oito participantes foram instruídos a ficar em pé sobre uma plataforma de força em duas condições experimentais: tarefa simples e tarefa dupla com uma tarefa cognitiva frontal. Foi observado aumento no coeficiente de variação superior a 100% na área e na trajetória do centro de pressão (COP) em condição de tarefa dupla em pacientes com Parkinson. Foi observada também, diferença significativa na comparação entre grupos, mostrando que pacientes com Parkinson e Alzheimer tiveram maior número de erros durante a execução da tarefa cognitiva, quando comparado ao grupo de idosos sem doenças neurodegenerativas. O córtex motor envolvido na manutenção do controle postural parece não competir com regiões frontais cerebrais no desempenho desse tipo de tarefa cognitiva, no entanto, os pacientes com doença de Parkinson e doença de Alzheimer apresentaram pior desempenho durante a execução de uma tarefa cognitiva frontal.

Pacientes con enfermedades neurodegenerativas utilizan de recursos cognitivos para el mantenimiento del control postural. El objetivo de este estudio fue investigar los efectos de una tarea cognitiva frontal en el control postural de pacientes con enfermedad de Alzheimer, enfermedad de Parkinson y ancianos sin enfermedades neurodegenerativas. Treinta y ocho participantes fueron instruidos para mantenerse en pie sobre una plataforma de fuerza en dos condiciones experimentales: tarea simple y doble tarea con una tarea cognitiva frontal. Hubo un aumento en el coeficiente de variación superior a 100% en el área y en la trayectoria del centro de presión (CP) en condiciones de doble tarea en los pacientes con Parkinson. También fue observada diferencia significativa entre los grupos, revelando que los pacientes con Parkinson y Alzheimer tuvieron un número de errores más grande durante la realización de la tarea cognitiva en comparación con el grupo de sujetos sin enfermedades neurodegenerativas. La corteza motora que participa en el mantenimiento del control postural parece no competir con las regiones frontales del cerebro en el rendimiento de este tipo de tarea cognitiva, sin embargo, los pacientes con enfermedad de Parkinson y la enfermedad de Alzheimer presentaron peor rendimiento durante la ejecución de una tarea cognitiva frontal.

Estudo de biodisponibilidade relativa/bioequivalência de duas formulações de cloridrato de donepezila em voluntários sadios de ambos os sexos / Study of relative bioavailability/bioequivalence of two formulations of donepezil hydrochloride in healthy volunteers for both sexes

O estudo foi realizado para comparar a biodisponibilidade de duas formulações de cloridrato de donepezila 10 mg comprimido revestido (cloridrato de donepezila do Aché Laboratórios Farmacêuticos S/A formulação teste e Eranz® da Wyeth Whitehall Ltda. formulação referência, Brasil) em 30 voluntários de ambos os sexos. O estudo foi aberto, aleatorizado, 2-sequências, 2-períodos, cruzado, dose única com 2 tratamentos, nos quais um grupo de voluntários receberam a formulação teste e outro a formulação referência. As amostras de sangue foram obtidas ao longo de um intervalo de 96 horas. As concentrações de donepezila foram determinadas através de espectrometria de massa (UPLC-MS-MS), utilizando loratadina como padrão interno. A partir dos dados obtidos se calcularam os seguintes parâmetros farmacocinéticos: ASC0-t, ASC0-¥ e Cmax. A média geométrica de cloridrato de donepezila/Eranz® 10 mg foi de 99,79 % para ASC0-t, 101,44 % para ASC0-¥ e 91,19% para Cmax. Os intervalos de confiança de 90% foram de 94,91% - 104,9%, 94,12% - 109,31% e 84,03% - 98,97%, respectivamente. Uma vez que os intervalos de confiança de 90% para Cmax e ASC0-t estiveram dentro da faixa de 80%-125% proposta pelo FDA e pela ANVISA (Agência Nacional de Vigilância Sanitária do Brasil), conclui-se que a comprimido revestido de cloridrato de donepezila de 10 mg foi bioequivalente ao comprimido revestido de Eranz® de 10 mg e, dessa forma, o produto teste pode ser considerado intercambiável na prática médica...