Young-onset Alzheimer dementia: a comparison of Brazilian and Norwegian carers' experiences and needs for assistance.

OBJECTIVES: Although dementia typically occurs in older people, it can also emerge in people aged younger than 65 years in the form of young-onset dementia, the most common type of which is Alzheimer's disease (AD). However, few studies have examined the needs of persons with young-onset AD (YO-AD) and their families, and cross-cultural research on the topic is even scarcer. In response, we investigated the situations, experiences and needs for assistance of carers of persons with YO-AD in Brazil and Norway. METHODS: As part of our qualitative study, we formed a convenience sample of Brazilian (n = 9; 7 women) and Norwegian carers (n = 11; 6 women) in 2014 and 2015, respectively, and analysed data in light of a modified version of grounded theory. RESULTS: Carers' narratives from both countries revealed five common themes in terms of how YO-AD affected carers' psychological and emotional well-being, physical well-being, professional and financial well-being, social lives and need for support services. CONCLUSIONS: The infrequent differences between carers of persons with YO-AD in Brazil and Norway indicate that carers' problems are highly similar regardless of cultural differences and public services provided. Copyright © 2017 John Wiley & Sons, Ltd.

d-serine levels in Alzheimer's disease: implications for novel biomarker development.

Alzheimer's disease (AD) is a severe neurodegenerative disorder still in search of effective methods of diagnosis. Altered levels of the NMDA receptor co-agonist, d-serine, have been associated with neurological disorders, including schizophrenia and epilepsy. However, whether d-serine levels are deregulated in AD remains elusive. Here, we first measured D-serine levels in post-mortem hippocampal and cortical samples from nondemented subjects (n=8) and AD patients (n=14). We next determined d-serine levels in experimental models of AD, including wild-type rats and mice that received intracerebroventricular injections of amyloid-ß oligomers, and APP/PS1 transgenic mice. Finally, we assessed d-serine levels in the cerebrospinal fluid (CSF) of 21 patients with a diagnosis of probable AD, as compared with patients with normal pressure hydrocephalus (n=9), major depression (n=9) and healthy controls (n=10), and results were contrasted with CSF amyloid-ß/tau AD biomarkers. d-serine levels were higher in the hippocampus and parietal cortex of AD patients than in control subjects. Levels of both d-serine and serine racemase, the enzyme responsible for d-serine production, were elevated in experimental models of AD. Significantly, d-serine levels were higher in the CSF of probable AD patients than in non-cognitively impaired subject groups. Combining d-serine levels to the amyloid/tau index remarkably increased the sensitivity and specificity of diagnosis of probable AD in our cohort. Our results show that increased brain and CSF d-serine levels are associated with AD. CSF d-serine levels discriminated between nondemented and AD patients in our cohort and might constitute a novel candidate biomarker for early AD diagnosis.

Effect of aerobic training on EEG alpha asymmetry and depressive symptoms in the elderly: a 1-year follow-up study

The effect of physical exercise on the treatment of depressive elderly adults has not been investigated thus far in terms of changes in cortical hemispheric activity. The objective of the present study was to identify changes in depressive symptoms, quality of life, and cortical asymmetry produced by aerobic activity. Elderly subjects with a diagnosis of major depressive disorder (DSM-IV) were included. Twenty patients (70 percent females, 71 ± 3 years) were divided into an exercise group (pharmacological treatment plus aerobic training) and a control group (undergoing pharmacological treatment) in a quasi-experimental design. Pharmacological treatment was maintained stable throughout the study (antidepressants and anxiolytics). Subjects were evaluated by depression scales (Beck Depression Inventory, Hamilton Depression Rating Scale, Montgomery-Asberg Depression Rating Scale) and the Short Form Health Survey-36, and electroencephalographic measurements (frontal and parietal alpha asymmetry) before and after 1 year of treatment. After 1 year, the control group showed a decrease in cortical activity on the right hemisphere (increase of alpha power), which was not observed in the exercise group. The exercise group showed a significant decrease of depressive symptoms, which was not observed in the control group. This result was also accompanied by improved treatment response and remission rate after 1 year of aerobic exercise associated with treatment. This study provides support for the effect of aerobic training on alpha activity and on depressive symptoms in elderly patients. Exercise facilitates the treatment of depressive elderly adults, leading to clinical and physical improvement and protecting against a decrease in cortical activity.

Effect of aerobic training on EEG alpha asymmetry and depressive symptoms in the elderly: a 1-year follow-up study.

The effect of physical exercise on the treatment of depressive elderly adults has not been investigated thus far in terms of changes in cortical hemispheric activity. The objective of the present study was to identify changes in depressive symptoms, quality of life, and cortical asymmetry produced by aerobic activity. Elderly subjects with a diagnosis of major depressive disorder (DSM-IV) were included. Twenty patients (70% females, 71 +/- 3 years) were divided into an exercise group (pharmacological treatment plus aerobic training) and a control group (undergoing pharmacological treatment) in a quasi-experimental design. Pharmacological treatment was maintained stable throughout the study (antidepressants and anxiolytics). Subjects were evaluated by depression scales (Beck Depression Inventory, Hamilton Depression Rating Scale, Montgomery-Asberg Depression Rating Scale) and the Short Form Health Survey-36, and electroencephalographic measurements (frontal and parietal alpha asymmetry) before and after 1 year of treatment. After 1 year, the control group showed a decrease in cortical activity on the right hemisphere (increase of alpha power), which was not observed in the exercise group. The exercise group showed a significant decrease of depressive symptoms, which was not observed in the control group. This result was also accompanied by improved treatment response and remission rate after 1 year of aerobic exercise associated with treatment. This study provides support for the effect of aerobic training on alpha activity and on depressive symptoms in elderly patients. Exercise facilitates the treatment of depressive elderly adults, leading to clinical and physical improvement and protecting against a decrease in cortical activity.

Anti-alpha-glucose-based glycan IgM antibodies predict relapse activity in multiple sclerosis after the first neurological event.

BACKGROUND: There is no specific serum-based biomarker for the diagnosis or prognosis of relapsing-remitting multiple sclerosis (RRMS). OBJECTIVE: We investigated whether levels of IgM antibodies to Glc(alpha1,4)Glc(alpha) (GAGA4) or to a panel of four glucose-based glycans could differentiate MS from other neurological diseases (OND) or predict risk of early relapse following first presentation (FP) of RRMS. METHODS: Retrospective analysis of 440 sera samples of three cohorts: A) FP-RRMS (n = 44), OND (n = 44); B) FP-RRMS (n = 167), OND (n = 85); and C) FP (n = 100). Anti-GAGA4 IgM levels were measured by enzyme immunoassay in cohort-A and cohort-B. Cohort-C IgM antibodies to glucose-based glycan panel were measured by immunofluorescence. RESULTS: FP-RRMS had higher levels of anti-GAGA4 IgM than OND patients (cohort-A, P = 0.01; cohort-B, P = 0.0001). Sensitivity and specificity were 27% and 97% for cohort-A; and 26% and 90% for cohort-B, respectively. In cohort-C, 58 patients experienced early relapse (<24 months), 31 had late relapse (> or =24 months), and 11 did not experience second attack during follow-up. Kaplan-Meier curves demonstrated decrease in time to next relapse for patients positive for the antibody panel (P = 0.02, log rank). CONCLUSIONS: Serum anti-GAGA4 IgM discerns FP-RRMS patients from OND patients. Higher levels of serum anti-alpha-glucose IgM in FP patients predict imminent early relapse.

A doença de Alzheimer e o impacto nos cuidadores / Alzheimer's diseases and the impact on the caregivers

A doença de Alzheimer (DA) caracteriza-se por um declínio progressivo e inexorável cognitivo, funcional e comportamental dos pacientes atingidos. À medida que o comprometimento ocorre surge a demanda de ajuda, que aumenta com a progressão da doença. Os cuidadores (parentes ou profissionais) vêm para prover os cuidados necessários. Estes desempenham um papel essencial no manejo da vida diária de pacientes com DA, envolvendo-se em praticamente todos os aspectos que dizem respeito aos cuidados da demência. O declínio dos pacientes (cognitivo, dependência nas atividades de vida diária e transtornos de comportamento) e suas demandas representam importantes estressores para os cuidadores levando a tensões como conflitos familiares e problemas econômicos. A carga gerada pela administração de cuidados expressa-se de maneiras mútiplas (emocionais, sociais, econômicas e físicas), que frequentemente se manifestam por altos níveis de problemas de saúde psicológica (ansiedade, depressão, insônia) e física (hipertensão arterial, propensão a infecções). Assim a carga de administrar cuidados é um conceito que integra o nível dos cuidados que o paciente requer com os sentimentos e as dificuldades dos cuidadores em provê-los. Algumas opções terapêuticas atuais para pacientes com DA mostram sucesso, principalmente a utilização de estratégias colinérgica e glutamatérgica, com indicação e utilidade que variam com o estágio da doença, com benefício (melhora, estabilização ou lentificação do declínio) em relação à cognição, função e comportamento. A eficácia do tratamento se relaciona com estabilização ou redução da carga dos cuidadores, oferecendo-lhes a possibilidade de uma melhora de qualidade de vida.

Alzheimer's disease (AD) is characterized by a progressive and relentless cognitive, functional and behavioral decline of the affected patients. As the impairment occurs a demand for help arises, and increases with the progression of the disease. The caregivers (relatives or professionals) come to participative in order to provide the needed assistance or care. They play an essential role in managing the daily life of AD patients under treatment, and are involved in virtually every aspect of dementia care. The patients' decline (cognitive, dependence in activities of daily living and behavioral disturbances) and their demands represent important stressors to the caregivers leading to strains like family conflicts and economic problems. The burden generated by caregiving is expressed in multiple ways (emotional, social, economical and physical), which frequently manifest themselves by high rates of psychological (anxiety, depression, insomnia) and physical (arterial hypertension, propensity to infections) health problems. Thus, caregiving burden is a concept that integrates the level of care the patients require with the caregivers's subjective and objective difficulties about providing it. Several present therapeutic options for patients with AD show some success, mainly the use of cholinergic and glutamatergic strategies, the indciation and utility depending on the stage of the disease, with benefit (improvement, stabilization or slowing of the decline) in relation to cognition, function and behavior. The efficacy of the treatment is related to stabilization or reduction of the burden, offering the caregivers the possibility of a better quality of life.

O mini-exame do estado mental-mais que um instrumento de triagem: uma análise neuropsicológica e neuroanatômica funcional / The mini-mental state examination - more than a screening tool: a neuropsychological and functional neuroanatomic analysis

O Mini-Exame do Estado Mental (MEEM) tem sido amplamente utilizado como instrumento de triagem cognitiva em ambiente de ambulatório e em situação de pesquisa. A obtenção de um ponto de corte para definir se o paciente examinado é suspeito de ser um 'caso' de comprometimento cognitivo / demência é geralmente o objetivo básico. Entretanto, do ponto de vista qualitativo, o MEEM encerra um potencial muito maior do que aparece à primeira vista, permitindo avaliar com relativo detalhe um número apreciável de domínios cognitivos, como atenção, memória, linguagem, gnosia, praxia, esquema corporal, função executiva e outras funções pré-frontais, pensamento. As redes neurais subjacentes a cada domínio são diversas e complexas, envolvendo grande número de áreas / regiões cerebrais, além de conexões hemisféricas e inter-hemisféricas. Dessa maneira o MEEM permite obter muito mais que um simples escore e um ponto de corte dentro de uma avaliação de triagem, mas sim, um mapa de comprometimento de diversos domínios cognitivos relacionados a diversos sistemas funcionais/redes neurais integrando regiões cerebrais determinadas.

Efficacy and safety of risperidone oral solution in agitation associated with dementia in the elderly.

BACKGROUND: Behavioral and psychological symptoms in dementia (BPSD) contribute to caregiver burden and institutionalization of elderly. Neuroleptics are prescribed to control agitation. Side effects of typical neuroleptics are harmful, making atypical neuroleptics an indication. OBJECTIVES: To evaluate efficacy and tolerability of risperidone oral solution (ROS) given once daily to demented elderly outpatients with BPSD (agitation). METHOD: Patients (n=26), 76.35+/-8.63 years, Diagnostic and Statistical Manual of Mental Disorders 4th ed. (DSM-IV) criteria for dementia. RSO was given, starting dose of 0.25 mg and increments of 0.25 mg every week. Mini-Mental State Examination (MMSE) assessed cognitive status, Behavioral and Emotional Activities Manifested in Dementia (BEAM-D) and Clinical Global Impression (CGI) measured BPSD, Extrapiramidal Symptom Rating Scale (ESRS) evaluated extrapyramidal symptoms. Cardiovascular side effects were evaluated clinically. RESULTS: There was a 26% reduction in agitation and no cardiovascular side effects in the range from 1.0 to 1.25 mg. Side effects were more prevalent above 2.5 mg. CONCLUSION: Risperidone oral solution improved agitation with good tolerability from 0.5 to 1.25 mg. A single dose with increments of 0.25 mg may be more acceptable to patients and caregivers.

[Alzheimer's disease and magnetic resonance spectroscopy of the hippocampus]. / Doença de Alzheimer e espectroscopia por ressonância magnética do hipocampo.

OBJECTIVE: Acquisition of data of magnetic resonance metabolite spectrum of the hippocampal formation (hippocampus-hc) in the elderly, normal and with Alzheimer's disease (AD). METHOD: Subjects matched for age: a. normal sample (n=20), CDR=0, and b. AD sample (n=40), CDR 1 and 2. TECHNIQUE: Signa Horizon LX-GE, 1.5T, 1H-MRS with automated software PROBE/SV, VOI: hc (right and left); single voxel (2x2x2cm); TR 1500ms/TE 50ms; PRESS; metabolites: N-acetylaspartate (Naa), choline (Cho), creatine (Cr), myo-inositol (mI). RESULTS: The present data relate to the ratios of Naa, Cho and mI, with Cr taken as reference, and the mI/Naa ratio. The study showed reduction of Naa, increase of mI and of the mI/Naa ratio, and not consistent results for Cho. The results of the whole sample of AD patients compared to the pooled normal mean +/- sd were significant for Naa, mI and mI/Naa (p<0.01). Accuracy in relation to the individual values of both samples showed satisfactory levels of sensitivity, specificity and positive predictive value. CONCLUSION: The present results can be used as a helpful tool to detect pathologic changes of the hippocampus in AD, and allowing greater accuracy and an earlier diagnosis of this disease.

Ultraviolet radiation-induced decreases in tension and phosphorylase a formation in rat aorta.

Helical strips of rat aorta contracted with norepinephrine (10 nM) respond to ultraviolet (UV) radiation (340-360 nm) with a transient decrease in tension. The UV radiation-dependent relaxation is completely reversible and endothelial cell-independent. Although decreased tension is associated with a rise in tissue cGMP content, the cAMP level is unchanged after UV radiation. A significant inhibition of phosphorylase a formation which occurs coincidently with the rise in cGMP and decline in tension is observed with UV radiation. The effects of UV radiation on cGMP, phosphorylase a formation and tension were blocked by methylene blue. Relaxation and inhibition of phosphorylase a formation in response to UV radiation were also partially reversed with higher concentrations of norepinephrine (100 nM). Our results suggest that cGMP may mediate UV radiation-dependent reactions by reducing cytoplasmic Ca2+.

A psicofarmacoterapia do paciente idoso. / The psychopharmacotherapy in the elderly

Este e um trabalho de revisao do comportamento dos principais orgaos e sistemas em relacao ao processo de envelhecimento.Fez-se um levantamento da interacao entre os dados fisiologicos na velhice e a farmacocinetica dos medicamentos, em especial os psicofarmacos. Procura-se, de posse das informacoes coletadas, orientar o planejamento do tratamento dos idosos, ja que a iatrogenia nessa faixa etaria e muito comum

A psicoterapia behaviorista. / Behavior psychotherapy

A psicoterapia behaviorista tem alcancado grande aceitacao nos Estados Unidos e na Europa, enquanto e vista com reservas e preconceitos em nosso meio. No Brasil poucos tecnicos seguem os principios behavioristas de tratamento psicoterapico e impera um desconhecimento quase que generalizado sobre seus pressupostos e indicacoes.O objetivo deste trabalho e o de fazer um apanhado geral dos principios que regem essa forma de psicoterapia, ver que criticas os proprios behavioristas fazem as suas tecnicas e que perspectivas veem para os impasses que enfrentam. Alem disso descrevem-se aqui duas tecnicas de tratamento para a frigidez na mulher e do estado fobico-ansioso para exemplificar os metodos do behaviorismo

O conceito de borderline. / The borderline concept

A sindrome borderline, embora muito estudada quanto ao tratamento, nao tem conceituacao uniformemente aceita. Apos revisao das quatro principais descricoes de borderline tenta-se colocar as dificuldades atuais e as possiveis perspectivas da pesquisa nesse campo. Discute-se as dificuldades metodologicas envolvidas na tipificacao de uma fronteira

Consciente e inconsciente - mundo ambiente e mundo interno. / Conscious and unconscious - ambient world and inner world

Define-se consciencia, segundo a fenomenologia, estabelecendo-se pontos em comum e de diferenca com o inconsciente dinamico de Freud. O tempo e o espaco sao discutidos em sua relacao com a consciencia e o inconsciente. Critica-se tambem a dicotomia mundo ambiente versus mundo interno colocando-se em evidencia a importancia do ser-no-mundo

Demencia como diagnostico: sua validade como sindrome irreversivel. / Dementia as diagnosis: its validity as an irreversible syndrome

O termo demencia foi mantido na nova classificacao de doencas psiquiatricas. Discute-se sua validade como diagnostico de doenca e se faz a diferenca entre demencia-sindrome e demencia-doenca. Ilustra-se com caso a questao da "reversibilidade da sindrome demencial"

Acute hemodilution: its effect of hemodynamics and oxygen transport in anesthetized man.

The effects of acute normovolemic hemodilution on hemodynamics, oxygen transport, tissue perfusion and blood volume were studied. The subjects were four patients undergoing total hip replacement with prebleeding and hemodilution under fluoroxene and nitrous oxide anesthesia. The hematocrit was reduced to 29% and 21% by bleeding in two steps with simultaneous infusion of plasmanate and lactated Ringer's solution. The major compensation was a rise in CO to 123% and 136%. Systemic oxygen transport (COX arterial O(2) content) was only slightly reduced and the arteriovenous oxygen difference decreased. Tissue perfusion remained excellent. Blood volume was slightly expanded. The procedure was well tolerated by this group of selected patients, and homologous blood utilization was markedly reduced.