Effects of the Staff Training for Assisted Living Residences protocol for caregivers of older adults with dementia: A pilot study in the Brazilian population.

AIM: To investigate the effects of the Staff Training for Assisted Living Residences administered to formal caregivers of older adults with behavioral and psychological symptoms of dementia in the institutional environment. METHODS: The project was developed in two long-term care institutions in Belo Horizonte, Brazil, with 25 formal caregivers and 46 older adults with dementia. The training was carried out over 6 weeks. Evaluations were carried out with the caregivers and the elderly residents, using specific instruments to evaluate different domains (demographic data, etiological diagnoses of dementia, severity of dementia, global cognition, functional performance, quality of life, behavior, burden of caregiver, depression and anxiety). The total time for data collection was 6 months. RESULTS: A significant improvement in behavioral and psychological symptoms of dementia, as assessed by the Neuropsychiatric Inventory, was observed (P < 0.008), with no changes in the other indexes. No significant changes were observed in parameters related to caregivers. CONCLUSIONS: The Staff Training for Assisted Living Residences protocol was effective in reducing neuropsychiatric symptoms in dementia patients, and might be a feasible and positive strategy to train formal caregivers in long-term care institutions in Brazil. Geriatr Gerontol Int 2017; 17: 449-455.

Analysis of the posterior cingulate cortex with [ 18 F]FDG-PET and Naa/mI in mild cognitive impairment and Alzheimer's disease: Correlations and differences between the two methods / Análise do giro do cíngulo posterior com [ 18 f]FDG-PET e relação Naa/mI no comprometimento leve e na doença de Alzheimer: correlações e diferenças entre os métodos

ABSTRACT Reduction of regional brain glucose metabolism (rBGM) measured by [18F]FDG-PET in the posterior cingulate cortex (PCC) has been associated with a higher conversion rate from mild cognitive impairment (MCI) to Alzheimer's disease (AD). Magnetic Resonance Spectroscopy (MRS) is a potential biomarker that has disclosed Naa/mI reductions within the PCC in both MCI and AD. Studies investigating the relationships between the two modalities are scarce. OBJECTIVE To evaluate differences and possible correlations between the findings of rBGM and NAA/mI in the PCC of individuals with AD, MCI and of cognitively normal volunteers. METHODS Patients diagnosed with AD (N=32) or MCI (N=27) and cognitively normal older adults (CG, N=28), were submitted to [18F]FDG-PET and MRS to analyze the PCC. The two methods were compared and possible correlations between the modalities were investigated. RESULTS The AD group exhibited rBGM reduction in the PCC when compared to the CG but not in the MCI group. MRS revealed lower NAA/mI values in the AD group compared to the CG but not in the MCI group. A positive correlation between rBGM and NAA/mI in the PCC was found. NAA/mI reduction in the PCC differentiated AD patients from control subjects with an area under the ROC curve of 0.70, while [18F]FDG-PET yielded a value of 0.93. CONCLUSION rBGM and Naa/mI in the PCC were positively correlated in patients with MCI and AD. [18F]FDG-PET had greater accuracy than MRS for discriminating AD patients from controls.

RESUMO Redução do metabolismo cerebral regional glicolítico (MRG) medido pela PET-18FDG no giro do cíngulo posterior (GCP) está relacionada a maior conversão para doença de Alzheimer (DA) em sujeitos com comprometimento cognitivo leve (CCL). Espectroscopia por ressonância magnética (MRS), um biomarcador promissor, demonstra redução de Naa/mI no GCP na DA. Raros estudos avaliam relações entre Naa/mI e MRG. OBJETIVO Avaliar diferenças e possíveis correlações entre MRG com PET-18FDG e Naa/mI por MRS no GCP de sujeitos com DA, CCL e voluntários normais. MÉTODOS Sujeitos com DA (N=32), CCL amnéstico (N=27) e voluntários idosos normais (GC, N=28), foram submetidos a PET-18FDG e análise de Naa/mI no GCP. A performance de ambos os métodos foi então comparada e verificou-se a existência de correlações entre os achados da PET e da MRS. RESULTADOS Observou-se hipometabolismo glicolítico nos pacientes com DA no GCP em relação ao GC, porém não no CCL. A MRS demonstrou valores menores de Naa/mI no CP do grupo DA em relação ao GC, porém também sem diferenças entre CCL e GC. A área sob a curva ROC demonstrou valor de 0,70 para MRS e 0,93 para o MRG no GCP para diferenciar DA do GC. Houve correlação positiva entre o MRG e o Naa/mI no GCP. CONCLUSÃO Os valores de metabolismo de glicose à PET e de Naa/mI à MRS no giro do cíngulo posterior apresentaram correlação positiva estatisticamente significante na presente amostra. Houve ainda superioridade da PET-18FDG para diferenciar DA do GC.

Bereavement and behavioral changes as risk factors for cognitive decline in adults with Down syndrome.

BACKGROUND: Cognitive decline and Alzheimer's disease often affect older adults with Down syndrome (DS) much earlier than those in the general population. There is also growing evidence of the effects of negative life events on the mental health and behavior of individuals with intellectual disability. However, to our knowledge, this is the first study investigating objective cognitive decline following bereavement in aging individuals with DS. OBJECTIVE: The objective of this study was to determine whether cognitive decline correlates with bereavement following the recent loss of a caregiver or with behavioral changes in a sample of adult individuals with DS who do not meet the criteria for dementia or depression, using the longitudinal assessment of the Cambridge Cognitive Examination (CAMCOG), together with the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). METHODS: We evaluated 18 subjects at baseline and over a follow-up period of 14-22 months, attempting to determine whether cognitive decline correlates with bereavement following the recent loss of the main caregiver or with behavioral changes (as assessed with the Neuropsychiatric Inventory). RESULTS: The mean rate of change in CAMCOG was -1.83 (standard deviation 4.51). Behavioral changes had a significant direct influence on cognitive decline. When bereavement was accompanied by behavioral changes, the probability of cognitive decline was 87% (odds ratio 3.82). CONCLUSION: The occurrence of behavioral changes attributed to bereavement following the loss of the primary caregiver significantly increases the probability of cognitive decline in individuals with DS. Longitudinal comparison of the CAMCOG and use of the IQCODE appear to enrich the analysis of cognitive decline in individuals with DS. Further studies involving larger samples are needed in order to corroborate and expand upon our findings, which can have implications for the clinical management of older adults with DS.

Depressive morbidity among elderly individuals who are hospitalized, reside at long-term care facilities, and are under outpatient care in Brazil: a meta-analysis

Objectives: i) To investigate studies published between 1991 and 2010 on the prevalence of depressive morbidity (major depressive disorder [MDD], dysthymia and clinically significant depressive symptoms [CSDS]) among elderly Brazilians assisted at healthcare facilities; ii) to establish the prevalence of depression and identify its related factors; and iii) to conduct a meta-analysis to assess the prevalence of depressive syndrome among elderly individuals assisted or hospitalized at healthcare facilities. Methods: Studies were selected from articles dated between January 1991 and June 2010 and extracted from the MEDLINE, LILACS, and SciELO databases. Results: The final analysis consisted of 15 studies, distributed as follows: i) four sampled hospitalized patients, totaling 299 individuals, and found a prevalence of CSDS varying between 20 and 56%; ii) four sampled outpatients, totaling 1,454 individuals; the prevalence of CSDS varied between 11 and 65%, and the prevalence of MDD varied between 23 and 42%; and iii) seven sampled elderly individuals residing in long-term care facilities (LTCF), totaling 839 individuals, and the prevalence of CSDS varied between 11 and 65%. Conclusion: The present review indicated a higher prevalence of both MDD and CSDS among elderly Brazilians assisted at healthcare facilities. .

Diagnóstico diferencial entredemência e transtornos psiquiátricos: critérios diagnósticos e exames complementares / Differential diagnosis between dementia and psychiatric disorders: Diagnostic criteria and further tests

Em 2005, o Departamento Científico de Neurologia Cognitiva e do Envelhecimento da ABN publicou as Recomendações para o Diagnóstico da Doença de Alzheimer. Essas recomendações foram revisadas através de buscas em bases de dados PUBMED, SCIELO e LILACS, buscando evidências nacionais e internacionais sobre esses temas. Este artigo de revisão tem como objetivos: (1) apresentar as evidências encontradas em bases de dados brasileiras (LILACS, SCIELO) e internacionais (MEDLINE), até maio de 2011, sobre o diagnóstico diferencial desses transtornos psiquiátricos com demência, tendo como foco especial a demência de Alzheimer (DA) e a demência vascular (DV), incluindo os exames complementares que podem auxiliar neste processo diagnóstico; e (2) propor recomendações que podem ser úteis a clínicos e pesquisadores envolvidos com o diagnóstico de pacientes com demência. O diagnóstico diferencial entre demência e outros transtornos neuropsiquiátricos deve sempre incluir a avaliação de depressão, delirium, e o uso de substâncias psicoativas, tais como benzodiazepínicos, antiepilépticos e o padrão de consumo de bebidas alcoólicas. Os critérios diagnósticos atuais para demência exigem a exclusão de outros transtornos neuropsiquiátricos maiores, porém não estão disponíveis exames complementares que possam, com segurança, auxiliar de maneira definitiva nesse diagnóstico diferencial. A avaliação clínica cuidadosa e a utilização de instrumentos de rastreio já validados no Brasil podem melhorar a efetividade do clínico e do pesquisador no diagnóstico diferencial de demência e outros transtornos psiquiátricos.