Conhecimento e intervenção do cuidador na doença de Alzheimer: uma revisão da literatura / Knowledge and caregivers? intervention in Alzheimer?s disease: a literature review

Objetivo: Analisar de forma sistemática o conhecimento da doença de Alzheimer (DA) e as estratégias adotadas pelo cuidador para lidar com os sintomas apresentados pelo idoso com DA. Métodos: Levantamento de estudos publicados nas bases de dados PubMed, MedLine, Lilacs e SciELO, utilizando os seguintes descritores e termos livres para estratégia de busca, de acordo com suas definições no DeCS e no MeSH: “cuidadores” or “educação em saúde” or “treinamento” or “cuidadores de idosos” and “doença de Alzheimer”; “elderly caregiving” or “training” or “health education” or “caregivers” and “Alzheimer disease”; “cuidadores de personas mayores” or “formación” or “educación en salud” or “cuidadores” and “enfermedad de Alzheimer”. Resultados: Foram eleitos 12 artigos para análise e leitura na íntegra. Os artigos foram classificados em três categorias: 1) Conhecimento acerca do declínio cognitivo e funcional da doença de Alzheimer; 2) Conhecimento acerca dos sintomas psicológicos e comportamentais da demência (SPCD); 3) Conhecimento acerca do comprometimento da linguagem. Na maioria dos estudos, verificou-se que a orientação a respeito do que é a enfermidade e a sua evolução pode interferir na maneira como o cuidador planeja e executa as ações de cuidado. Conclusão: É extremamente necessário criar oportunidades para que os cuidadores familiares e profissionais conheçam a doença para compreender o paciente e, consequentemente, as possibilidades de atuação (seguras e eficazes) nesse paciente. Isso é possível mediante implementação de programas psicoeducativos ...

Objective: To analyze systematically the knowledge of Alzheimer’s disease (AD) and the strategies used by the caregiver to act on the symptoms presented by the elderly with AD. Methods: Search of articles at PubMed, MedLine, Lilacs and SciELO, using the following keywords and free terms to search strategy, according to their definitions in DeCS and MeSH: “cuidadores” or “educação em saúde” or “treinamento” or “cuidadores de idosos” and “doença de Alzheimer”; “elderly caregiving” or “training” or “health education” or “caregivers” and “Alzheimer disease”; “cuidadores de personas mayores” or “formación” or “educación en salud” or “cuidadores” and “enfermedad de Alzheimer”. Results: We found 12 articles to analyze and reading in full. The articles were classified into three categories: 1) Knowledge about the cognitive and functional decline of Alzheimer’s disease; 2) Knowledge about the behavioral and psychological symptoms of dementia (BPSD); 3) Knowledge about language impairment. In most studies, it was found that the orientation about the disease and its evolution can interfere with how the caregiver plans and executes the actions of care. Conclusion: It is extremely necessary to create opportunities for family caregivers and professionals know the disease to understand the patient and the possibilities for action (safe and effective) with him. It is possible through implementing psychoeducational programs that provide information and practical guidance to improve the care provided by caregivers of patients with AD. .

Magnetic resonance imaging study cannot individually distinguish individuals with mild cognitive impairment, mild Alzheimer's disease, and normal aging.

OBJECTIVE: To evaluate the volumetric and spectroscopy aspects of hippocampus in patients with mild Alzheimer's disease (AD) and mild cognitive impairment (MCI). METHODS: A series of patients older than 65 years and with memory deficit were studied. RESULTS: The evocation of words test presented a significant reduction in the number of words recalled by the patients with MCI and mild AD as compared with the control group. Bilateral reduction of the hippocampus volume in the AD group was observed when compared to the control group. There were no statistical differences in the values of NAA/Cr, mI/Cr, Cho/Cr and mI/NAA between the groups. CONCLUSIONS: Magnetic resonance imaging study failed to individually distinguish patients with MCI, mild AD and normal aging. However, patients with mild AD presented loss of asymmetry between the right and left hippocampus, and a reduction in hippocampus volume.

Magnetic resonance imaging study cannot individually distinguish individuals with mild cognitive impairment, mild Alzheimer's disease, and normal aging / Estudo por ressonância magnética não pode diferenciar individualmente os indivíduos com declínio cognitivo leve, doença de Alzheimer leve e envelhecimento normal

Objective: To evaluate the volumetric and spectroscopy aspects of hippocampus in patients with mild Alzheimer's disease (AD) and mild cognitive impairment (MCI). Methods: A series of patients older than 65 years and with memory deficit were studied. Results: The evocation of words test presented a significant reduction in the number of words recalled by the patients with MCI and mild AD as compared with the control group. Bilateral reduction of the hippocampus volume in the AD group was observed when compared to the control group. There were no statistical differences in the values of NAA/Cr, mI/Cr, Cho/Cr and mI/NAA between the groups. Conclusions: Magnetic resonance imaging study failed to individually distinguish patients with MCI, mild AD and normal aging. However, patients with mild AD presented loss of asymmetry between the right and left hippocampus, and a reduction in hippocampus volume. .

Objetivo: Avaliar volume e espectroscopia do hipocampo em pacientes com doença de Alzheimer leve e declínio cognitivo leve. Métodos: Foi estudada uma série de pacientes com 65 anos de idade ou mais, com déficit de memória. Resultados: O teste de evocação de palavras mostrou redução significativa no número de palavras lembradas pelos pacientes com declínio cognitivo leve e doença de Alzheimer leve, em comparação com o grupo controle. Foi observada redução bilateral do volume do hipocampo no grupo com doença de Alzheimer quando comparado com o grupo controle. Não houve diferença estatística nos valores de NAA/Cr, mI/Cr, Cho/Cr e mI/NAA entre os grupos. Conclusão: Estudo pela ressonância magnética não diferencia individualmente os pacientes com declínio cognitivo leve, doença de Alzheimer leve e envelhecimento normal. No entanto, pacientes com quadro leve de doença de Alzheimer apresentam perda de assimetria entre os hipocampos direito e esquerdo e redução no volume do hipocampo. .

Preliminary data on a mnemonic instrument with proverbs for tracking Alzheimer's disease.

In the differential diagnosis between Alzheimer's disease (AD) and normal aging, tests evaluating memory and executive functions are frequently used. The addition of abstraction tests may enhance the effectiveness of screening tests for AD. OBJECTIVES: The aim of this study was to compare initial data of a new instrument - The Screening Test for Alzheimer's Disease with Proverbs (STADP) - against other screening tests used in AD diagnosis. METHODS: Sixty elderly individuals (46 controls and 14 AD subjects with CDR=1), aged =60 years, with at least one year of schooling, were evaluated using the STADP at outpatient clinic. The STADP assesses short-term memory, episodic memory, executive functions and language, in addition to proverb recognition. The performance of the participants on the Mini-Mental State Examination (MMSE), semantic Verbal Fluency (VF) and Clock Drawing Test (CDT) were evaluated and the habit of reading, writing and sociodemographic data were also taken into account. RESULTS: There were significant correlations between STADP and the performance on the MMSE (r=0.64), CDT (r=0.50) and VF (r=0.56). Age influenced all sub-items of the STADP, specifically episodic memory (r= -0.54), whereas schooling mainly influenced executive functions and language (r=0.46). The total score, stages A and C and the "proverb recognition" of STADP (p<0.001), as well as the MMSE (p<0.001), CDT (p=0.016), VF (p<0.001) were significantly different in AD versus control groups. CONCLUSIONS: The findings point to the potential use of the STADP in AD, warranting the conducting of further studies.

No diagnóstico diferencial entre a doença de Alzheimer (DA) e envelhecimento normal testes que avaliam memória e função executiva são freqüentemente utilizados. A adição de testes de abstração ao de rastreio pode ampliar ainda mais a eficácia de testes de rastreio para DA. OBJETIVOS: O objetivo deste trabalho foi comparar dados iniciais do novo instrumento ­ Teste de Rastreio de Doença de Alzheimer com Provérbios (TRDAP) ­ com testes padronizados para diagnóstico de DA. MÉTODOS: Sessenta idosos (46 controles e 14 DA com CDR=1), escolaridade mínima de um ano, a partir de 60 anos, atendidos em ambulatórios foram avaliados com o TRDAP. O TRDAP avalia memória de curto prazo, memória episódica e funções executivas e linguagem, além do reconhecimento de provérbios. Foram usados o Mini-Exame Mental (MEEM), a Fluência Verbal semântica (FV), o Teste do Desenho do Relógio (TDR) e observados hábitos de leitura, escrita e dados sócio-demográficos. RESULTADOS: Houve significativa correlação entre: TRDAP e MEEM (r=0,64), TDR (r=0,50) e FV (r=0,56). Idade influenciou os três testes, especificamente memória episódica do TRDAP (r= ­0,54); escolaridade, em funções executivas e linguagem (r=0,46). Na comparação entre pacientes com DA e controles o escore total e as etapas A e C do TRDAP e o reconhecimento dos provérbios (p<0,001), assim como o MEEM (p<0,001), o TDR (p=0,016) e FV (p<0,001). CONCLUSÕES: Os achados apontam para utilidade potencial do TRDAP na DA, indicando que mais estudos devem ser realizados.

Computed tomography scan of the head in patients with migraine or tension-type headache.

A retrospective study was performed in order to evaluate the frequency of abnormalities found by computed tomography (CT) scan of the head in 78 patients with migraine or tension-type headache. In the present study CT scan was normal in 61.5% of the patients with migraine or tension-type headache. A number of abnormalities were encountered in more than one third of the patients studied, including inflammatory sinus disease (19.2%), cysticercosis (3.9%), unruptured cerebral aneurysm (2.6%), basilar impression (2.6%), intracranial lipoma (2.6%), arachnoid cyst (2.6%), empty sella (2.6%), intracranial neoplasm (2.6%), and others (2.6%). None of these lesions were symptomatic or responsible by the headache picture, therefore, considered incidental findings. In conclusion, the fortuitous encounter of some abnormalities on CT scan of the head is often higher than what we could predict in patients suffering migraine or tension-type headache. We briefly discuss clinical, epidemiologic, and practical management of some of the abnormalities detected by CT scan as well as the indication to request a neuroimaging investigation.

Computed tomography scan of the head in patients with migraine or tension-type headache

A retrospective study was performed in order to evaluate the frequency of abnormalities found by computed tomography (CT) scan of the head in 78 patients with migraine or tension-type headache. In the present study CT scan was normal in 61.5 percent of the patients with migraine or tension-type headache. A number of abnormalities were encountered in more than one third of the patients studied, including inflammatory sinus disease (19.2 percent), cysticercosis (3.9 percent), unruptuted cerebral aneurysm (2.6 percent), basilar impression (2.6 percent), intracranial lipoma (2.6 percent), arachnoid cyst (2.6 percent), empty sella (2.6 percent), intracranial neoplasm (2.6 percent), and others (2.6 percent). None of these lesions were symptomatic or responsible by the headache picture, therefore, considered incidental findings. In conclusion, the fortuitous encounter of some abnormalities on CT scan of the head is often higher than what we could predict in patients suffering migraine or tension-type headache. We briefly discuss clinical, epidemiologic, and practical management of some of the abnormalities detected by CT scan as well as the indication to request a neuroimaging investigation