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1.
J Alzheimers Dis ; 68(2): 669-678, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30856109

RESUMO

BACKGROUND: Behavioral and psychological symptoms (BPSD) can be a prodrome of dementia, and the Neuropsychiatric Inventory (NPI) is widely used for BPSD evaluation. OBJECTIVE: To compare the prevalence of BPSD according to cognitive status, and to determine NPI cutoffs that best discern individuals with mild cognitive impairment (MCI) and dementia from those without dementia. METHODS: We included 1,565 participants (mean age = 72.7±12.2 years, 48% male). BPSD and cognitive status were assessed with the NPI and the Clinical Dementia Rating (CDR). We used multivariable logistic regression models to investigate the association of BPSD with cognitive status. The area under the curve (AUC) was used to assess model discrimination, and to determine the best NPI cutoff for MCI and dementia. RESULTS: Participants were cognitively normal (CDR = 0; n = 1,062), MCI (CDR = 0.5; n = 145), or dementia (CDR≥1.0, n = 358). NPI symptoms were more frequent in dementia and MCI when compared to cognitively normal. Higher odds for delusions, hallucinations, disinhibition, and psychomotor alterations were found among participants with dementia and MCI than in those who were cognitively normal. The best NPI cutoff to discern participants with dementia from those cognitively normal was 11 (AUC = 0.755). Poor discrimination (AUC = 0.563) was found for the comparison of MCI and those cognitively normal. CONCLUSIONS: We found an increase in BPSD frequencies across the continuum of cognitive impairment. BPSD severity and frequency in MCI was more similar to individuals cognitively normal than with dementia. NPI scores≥to 11 in individuals with no diagnosis of dementia can support the decision for further investigation of dementia.

2.
J Affect Disord ; 241: 176-181, 2018 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-30125821

RESUMO

BACKGROUND: Disturbances in peripheral brain-derived neurotrophic factor (BDNF) have been reported in major depressive disorder (MDD). However, there are no studies measuring BDNF levels directly in post-mortem brains of older subjects with MDD and dementia. We aimed to verify if brain BDNF levels were lower in older adults with lifetime history of MDD with and without dementia. METHODS: BDNF levels of post-mortem brains from 80 community-dwelling older individuals with lifetime MDD with and without dementia were compared with levels from 80 controls without lifetime MDD. Participants with no reliable close informant, or with prolonged agonal state were excluded. Lifetime MDD was defined as at least one previous episode according to the Structured Clinical Interview for DSM (SCID). RESULTS: BDNF levels were lower in the MDD group with dementia than in participants with dementia and without MDD as confirmed by multivariate analysis adjusted for clinical and cardiovascular risk factors (ß = -0.106, 95%CI = -0.204; -0.009, p = 0.034). No difference was found in the group with MDD without dementia compared with their controls. LIMITATIONS: The retrospective assessment of a lifetime history of depression may be subject to information bias and this study only establishes a cross-sectional association between lifetime history of MDD and lower levels of BDNF in patients with dementia. CONCLUSIONS: In this community sample of older individuals, lower brain BDNF levels were found in cases with both lifetime MDD and dementia. Low BDNF levels could be a moderator to accelerated brain aging observed in MDD with dementia.

3.
Int J Geriatr Psychiatry ; 33(1): 14-20, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28055136

RESUMO

OBJECTIVE: We examined brain volume and atrophy in individuals with major depressive disorder (MDD) without dementia that were referred to a large autopsy service. We also examined potential risk factors for brain atrophy, including demographics and clinical variables. METHODS: In this study, 1373 participants (787 male) aged 50 years or older who died from natural causes were included. Participants with no reliable informant, with cognitive impairment or dementia, with a medical history of severe chronic disease, or with prolonged agonal state were excluded. Presence of MDD at least once in their lifetime was defined according to the Structured Clinical Interview for DSM. Brain volume was measured immediately after removal from the skull. RESULTS: Mean age at death was 68.6 ± 11.6, and MDD was present in 185 (14%) individuals. Smaller brain volume was associated with older age (p < 0.001), lower education (years; p < 0.001), hypertension (p = 0.001), diabetes (p = 0.006), and female gender (p < 0.001). In the multivariate analysis adjusted for sociodemographics and cardiovascular risk factors, smaller brain volume was not associated with major depression (ß = -0.86, 95% CI = -26.50 to 24.77, p = 0.95). CONCLUSIONS: In this large autopsy study of older adults, MDD was not associated with smaller brain volumes. Regardless of the presence of MDD, in this sample of older adults without dementia, we found that smaller brain volumes were associated with risk factors for brain neurodegeneration such as older age, diabetes, hypertension, and lower education. Copyright © 2017 John Wiley & Sons, Ltd.


Assuntos
Encéfalo/patologia , Transtorno Depressivo Maior/patologia , Idoso , Envelhecimento/patologia , Atrofia/patologia , Autopsia , Estudos Transversais , Diabetes Mellitus/patologia , Escolaridade , Feminino , Humanos , Hipertensão/patologia , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Tamanho do Órgão , Fatores de Risco
4.
Arq Neuropsiquiatr ; 74(7): 549-54, 2016 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-27487375

RESUMO

Mild impairment in activities of daily living (ADL) can occur in Mild Cognitive Impairment (MCI), but the nature and extent of these difficulties need to be further explored. The Canadian occupational performance measure (COPM) is one of the few individualized scales designed to identify self-perceived difficulties in ADL. The present study investigated impairments in ADL using the COPM in elderly with MCI. A total of 58 MCI patients were submitted to the COPM for studies of its validity and reliability. The COPM proved a valid and consistent instrument for evaluating ADL in elderly MCI patients. A total of 74.6% of the MCI patients reported difficulties in ADL. Of these problems, 41.2% involved self-care, 31.4% productivity and 27.4% leisure. This data further corroborates recent reports of possible functional impairment in complex ADL in MCI.


Assuntos
Atividades Cotidianas/psicologia , Disfunção Cognitiva/fisiopatologia , Avaliação da Deficiência , Idoso , Brasil , Feminino , Humanos , Atividades de Lazer/psicologia , Masculino , Terapia Ocupacional/métodos , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Reprodutibilidade dos Testes , Autorrelato , Estatísticas não Paramétricas , Análise e Desempenho de Tarefas
5.
Arq. neuropsiquiatr ; 74(7): 549-554, tab
Artigo em Inglês | LILACS-Express | ID: lil-787365

RESUMO

ABSTRACT Mild impairment in activities of daily living (ADL) can occur in Mild Cognitive Impairment (MCI), but the nature and extent of these difficulties need to be further explored. The Canadian occupational performance measure (COPM) is one of the few individualized scales designed to identify self-perceived difficulties in ADL. The present study investigated impairments in ADL using the COPM in elderly with MCI. A total of 58 MCI patients were submitted to the COPM for studies of its validity and reliability. The COPM proved a valid and consistent instrument for evaluating ADL in elderly MCI patients. A total of 74.6% of the MCI patients reported difficulties in ADL. Of these problems, 41.2% involved self-care, 31.4% productivity and 27.4% leisure. This data further corroborates recent reports of possible functional impairment in complex ADL in MCI.


RESUMO A presença de dificuldades leves no desempenho de atividades da vida diária (AVD) pode estar presente no comprometimento cognitivo leve (CCL), mas sua natureza e extensão devem ser melhor exploradas. A medida canadense de desempenho ocupacional (COPM) é uma das poucas escalas individualizadas de autorrelato destinadas a identificar dificuldades no desempenho de AVDs. Este estudo investigou as dificuldades em AVDs através da COPM em idosos com CCL. 58 idosos com CCL foram submetidos à validação da COPM. A COPM se mostrou um instrumento válido e consistente para avaliar desempenho de AVDs em idosos com CCL. 74,6% dos idosos relatou alguma dificuldade no desempenho de AVDs, sendo 41,2% em auto-cuidado, 31,4% na produtividade e de 27,4% no lazer. Estes dados acrescentam evidências à recente literatura em que afirma que há comprometimento nas AVDs em CCL.

6.
Artigo em Inglês | MEDLINE | ID: mdl-26780170

RESUMO

Major depression (MDD) is a chronic psychiatric condition in which patients often show increasing cognitive impairment with recurring episodes. Neurodegeneration may play an important component in the pathogenesis of MDD associated with cognitive complaints. In agreement with this, patients with MDD show decreased brain volumes in areas implicated in emotional regulation and cognition, neuronal and glial cell death as well as activation of various pathways that can contribute to cell death. Therefore, the aim of this review is to provide an integrative overview of potential contributing factors to neurodegeneration in MDD. Studies have reported increased neuronal and glial cell death in the frontal cortex, amygdala, and hippocampus of patients with MDD. This may be due to decreased neurogenesis from lower levels of brain-derived neurotrophic factor (BDNF), excitotoxicity from increased glutamate signaling, and lower levels of gamma-aminobutyric acid (GABA) signaling. In addition, mitochondrial dysfunction and oxidative stress are found in similar brain areas where evidence of excitotoxicity has been reported. Also, levels of antioxidant enzymes were reported to be increased in patients with MDD. Inflammation may also be a contributing factor, as levels of inflammatory cytokines were reported to be increased in the prefrontal cortex of patients with MDD. While preliminary, studies have also reported neuropathological alterations in patients with MDD. Together, these studies suggest that lower BDNF levels, mitochondrial dysfunction, oxidative stress, inflammation and excitotoxicity may be contributing to neuronal and glial cell death in MDD, leading to decreased brain volume and cognitive dysfunction with multiple recurrent episodes. This highlights the need to identify specific pathways involved in neurodegeneration in MDD, which may elucidate targets that can be treated to ameliorate the effects of disease progression in this disorder.


Assuntos
Encéfalo/patologia , Demência/patologia , Transtorno Depressivo Maior/patologia , Modelos Teóricos , Encéfalo/metabolismo , Humanos
7.
Rev. psiquiatr. clín. (São Paulo) ; 42(6): 153-156, Nov.-Dec. 2015. tab
Artigo em Inglês | LILACS-Express | ID: lil-767838

RESUMO

Abstract Background Non-pharmalogical interventions represent an important complement to standard pharmalogical treatment in dementia. Objective This study aims to evaluate the effects of a multidisciplinary rehabilitation program on cognitive ability, quality of life and depression symptoms in patients with Alzheimer’s disease (AD) and cognitive impairment without dementia (CIND). Methods Ninety-seven older adults were recruited to the present study. Of these, 70 patients had mild AD and were allocated into experimental (n = 54) or control (n = 16) groups. Two additional active comparison groups were constituted with patients with moderate AD (n = 13) or with CIND (n = 14) who also received the intervention. The multidisciplinary rehabilitation program lasted for 12 weeks and was composed by sessions of memory training, recreational activities, verbal expression and writing, physical therapy and physical training, delivered in two weekly 6-hour sessions. Results As compared to controls, mild AD patients who received the intervention had improvements in cognition (p = 0.021) and quality of life (p = 0.003), along with a reduction in depressive symptoms (p < 0.001). As compared to baseline, CIND patients displayed at the end of the intervention improvements in cognition (p = 0.005) and depressive symptoms (p = 0.011). No such benefits were found among patients with moderate AD.Discussion: This multidisciplinary rehabilitation program was beneficial for patients with mild AD and CIND. However, patients with moderate dementia did not benefit from the intervention.

8.
Arq Neuropsiquiatr ; 72(12): 913-8, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25465779

RESUMO

There is limited data regarding the cognitive profile from screening tests of older adults with bipolar disorder (BD) with dementia. Objective To investigate the Clock Drawing Test (CDT) among older adults with BD with and without Alzheimer's disease (AD). Method 209 older adults (79 with BD without dementia and 70 controls; 60 with AD, being 27 with BD) were included to evaluate the performance of three CDT scoring scales, beyond the Mini-Mental State Examination (MMSE) and verbal fluency (VFT). Results Patients with BD without dementia presented with lower scores in MMSE, VF and one CDT scoring scale than controls. Patients with BD and AD presented with lower scores in VF and CDT scoring scales than patients with only AD. All CDT scales presented similar sensitivity and specificity for BD and non-BD groups. Conclusion Elderly subjects with BD showed greater impairment in CDT in both groups of normal cognition and AD.


Assuntos
Doença de Alzheimer/fisiopatologia , Transtorno Bipolar/fisiopatologia , Cognição/fisiologia , Testes Neuropsicológicos , Idoso , Transtornos Cognitivos/fisiopatologia , Estudos Transversais , Escolaridade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valores de Referência , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Estatísticas não Paramétricas
9.
Arq. neuropsiquiatr ; 72(12): 913-918, 02/12/2014. tab
Artigo em Inglês | LILACS | ID: lil-731037

RESUMO

There is limited data regarding the cognitive profile from screening tests of older adults with bipolar disorder (BD) with dementia. Objective To investigate the Clock Drawing Test (CDT) among older adults with BD with and without Alzheimer’s disease (AD). Method 209 older adults (79 with BD without dementia and 70 controls; 60 with AD, being 27 with BD) were included to evaluate the performance of three CDT scoring scales, beyond the Mini-Mental State Examination (MMSE) and verbal fluency (VFT). Results Patients with BD without dementia presented with lower scores in MMSE, VF and one CDT scoring scale than controls. Patients with BD and AD presented with lower scores in VF and CDT scoring scales than patients with only AD. All CDT scales presented similar sensitivity and specificity for BD and non-BD groups. Conclusion Elderly subjects with BD showed greater impairment in CDT in both groups of normal cognition and AD. .


Há dados limitados sobre o perfil cognitivo de idosos com transtorno bipolar (TAB) e demência. Previamente, testes de rastreio cognitivo comuns foram pouco estudados. Objetivo Investigar o Teste do Desenho do Relógio (CDT) entre idosos com TAB com e sem doença de Alzheimer (DA). Método Foram incluídos 209 idosos (79 pacientes com TAB sem demência e 70 controles; 60 indivíduos com DA leve, sendo 27 com TAB) para avaliar três escalas de pontuação do TDR, além do Mini-Mental State Examination (MMSE) e fluência verbal (FV). Resultados Pacientes com TAB sem demência apresentaram menores escores no MMSE, FV e uma escala de TDR que controles. Pacientes com TAB e DA apresentaram escores mais baixos na FV e em todos os TDR comparados aos apenas com DA. As escalas de CDT apresentaram sensibilidade e especificidade semelhantes para os grupos com e sem TAB. Conclusão Idosos com TAB apresentaram maior comprometimento no TDR em ambos grupos com cognição normal e DA. .


Assuntos
Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Alzheimer/fisiopatologia , Transtorno Bipolar/fisiopatologia , Cognição/fisiologia , Testes Neuropsicológicos , Estudos Transversais , Transtornos Cognitivos/fisiopatologia , Escolaridade , Valores de Referência , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Estatísticas não Paramétricas
10.
Braz J Psychiatr ; 35(3): 274-8, 2013 Jul-Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24142090

RESUMO

OBJECTIVE: It has been postulated that mood stabilizers inhibit glycogen synthase kinase 3-beta (Gsk3ß) activity, mainly through its phosphorylation on serine-9 (Ser9). However, in vivo studies addressing Gsk3ß activity in patients with bipolar disorder are scarce. Here, we compare Gsk3ß inactivation (as indicated by Ser9-phosphorylation) in platelets of elderly patients with bipolar disorder undergoing clinical treatment and healthy elderly adults not taking medication. METHODS: Platelet samples were obtained from 37 elderly adults (bipolar disorder = 19, controls = 18). Relative changes in Gsk3ß inactivation was estimated by comparing the ratios of phosphorylated Gsk3ß to total Gsk3ß (p-Gsk3ß Ser9/Gsk3ß) between the disease and control groups. RESULTS: Phosphorylated-Gsk3ß (p < 0.001) and the p-Gsk3ß Ser9/Gsk3ß ratio (p = 0.006) were elevated in bipolar patients. In the bipolar disorder group, p-Gsk3ß Ser9/Gsk3ß was positively correlated with serum lithium levels (r = 0.478, p = 0.039). CONCLUSIONS: Gsk3ß inactivation is higher in this group of elderly adults undergoing treatment for bipolar disorder. However, whether the treatment or the disease causes Gsk3ß inactivation was confounded by the lack of an unmedicated, bipolar control group and the non-uniform treatment regimens of the bipolar disorder group. Thus, further studies should help distinguish whether Gsk3ß inactivation is an effect of drug treatment or an intrinsic characteristic of bipolar disorder.


Assuntos
Transtorno Bipolar/enzimologia , Plaquetas/enzimologia , Quinase 3 da Glicogênio Sintase/sangue , Idoso , Idoso de 80 Anos ou mais , Transtorno Bipolar/tratamento farmacológico , Estudos de Casos e Controles , Feminino , Glicogênio Sintase Quinase 3 beta , Humanos , Masculino , Pessoa de Meia-Idade , Fosforilação , Psicotrópicos/uso terapêutico
11.
J Affect Disord ; 150(2): 691-4, 2013 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-23764386

RESUMO

BACKGROUND: There is increasing evidence that bipolar disorder is also associated with neuropsychological impairments persisting during euthymia, thus representing a trait-like feature of the disease. Language and speech abnormalities are also present in bipolar disorder, especially in verbal fluency and verbal memory. However, there is a lack of studies in the literature investigating different levels of linguistic processing (phonological, syntactical, and semantic) in a single cohort of euthymic bipolar patients. Based on previous findings of pervasive language impairment in euthymic elderly bipolar patients, the aim of this study was to comprise a more thorough investigation on the subject. METHODS: We studied 19 euthymic bipolar patients aged 60 and above, and 20 cognitively healthy subjects using the Arizona Battery for Communication Disorders of Dementia (ABCD) and the Test for Reception of Grammar Version 2 (TROG-2) in order to assess the phonological, syntactic, and semantic domains of language. RESULTS: Bipolar patients performed poorer than controls in Linguistic Expression (p=0.011), in Linguistic Comprehension (Following Commands; p=0.025 and Reading Comprehension of Sentences; p=0.007), and in the TROG-2 (p=0.006). LIMITATIONS: The small sample comprising only elderly patients; the lack of statistical power to analyze the potential effect of individual medications on the cognitive performance. CONCLUSIONS: Our data demonstrate that linguistic impairment is present in euthymic bipolar patients, affecting mostly syntactic and lexical-semantic abilities, both in comprehension and production of language. These deficits are interrelated with other cognitive skills also known to be affected in bipolar disorder, such as executive functions and episodic memory.


Assuntos
Transtorno Bipolar/complicações , Transtorno Bipolar/fisiopatologia , Transtornos Cognitivos/complicações , Transtornos da Linguagem/complicações , Idoso , Estudos de Casos e Controles , Compreensão , Função Executiva , Feminino , Humanos , Masculino , Memória , Pessoa de Meia-Idade , Testes Neuropsicológicos
12.
Dement. neuropsychol ; 5(3): 226-237, Sept. 2011.
Artigo em Inglês | LILACS-Express | ID: biblio-952992

RESUMO

Abstract Psychoeducational activities are a way of promoting help for caregivers of patients with Alzheimer's disease, representing a forum for knowledge sharing, and in which the primary focus is on psychological themes aimed at carers developing coping skills and strategies. Objective: The main objective of this study was to gauge perceptions about care and its impact among family caregivers of patients with AD participating in a psychoeducational group intervention, as well as the possible positive and negative aspects associated with this role. The subjective impact of AD on the lives of these caregivers was assessed on each of the dimensions of the Caregiver Burden Scale using a semi-directed interview on perceptions about care. Methods: This was a prospective study, in which information was collected twice, before and after, psychoeducational intervention. Through the application of the scale, benefits were evident for all dimensions assessed in the instrument (general strain, isolation, disappointment, emotional involvement and environment). Results: The results showed that after the psychoeducational intervention, caregivers felt less burdened by care compared to pre-intervention. Conclusion: These findings confirm that expanded implementation of psychoeducational interventions for caregivers of patients with AD can be beneficial for both caregivers and patients.


Resumo Atividades psicoeducacionais constitui um meio de promover auxílio a cuidadores de acientes com Alzheimer's disease (DA), representam um espaço para o compartilhamento de conhecimentos que tem como foco primário temas dirigidos a estratégias e habilidades de enfretamento. Objetivo: O objetivo do presente estudo foi levantar as percepções sobre o cuidar e seu impacto entre cuidadores familiares de portadores de DA, participantes de um Grupo de Intervenção Psicoeducativa. Visou-se também detectar possíveis impactos em variáveis objetivas e subjetivas, pré e pós intervenção psicoeducacional. Métodos: Esta pesquisa tratou-se de um estudo prospectivo, no qual foram coletadas informações em dois momentos distintos, antes e após a intervenção psicoeducativa. Através da aplicação da Escala perceberam-se benefícios em todas as dimensões envolvidas nesta (tensão geral, isolamento, decepção, envolvimento emocional e ambiente). Resultados: Os resultados demonstraram que após a intervenção psicoeducativa, os cuidadores apresentaram menor sobrecarga em relação ao cuidado, do que comparado ao início da intervenção. Conclusão: Esses achados confirmam que as intervenções psicoeducacionais implementadas de modo expandido podem ser benéficas para cuidadores e pacientes com DA.

13.
Int J Geriatr Psychiatry ; 26(4): 403-8, 2011 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-20658476

RESUMO

OBJECTIVE: To identify the CAMCOG sub-items that best contribute for the identification of patients with mild cognitive impairment (MCI) and incipient Alzheimer's disease (AD) in clinical practice. METHODS: Cross-sectional assessment of 272 older adults (98 MCI, 82 AD, and 92 controls) with a standardized neuropsychological battery and the CAMCOG schedule. Backward logistic regression analysis with diagnosis (MCI and controls) as dependent variable and the sub-items of the CAMCOG as independent variable was carried out to determine the CAMCOG sub-items that predicted the diagnosis of MCI. RESULTS: Lower scores on Language, Memory, Praxis, and Calculation CAMCOG sub-items were significantly associated with the diagnosis of MCI. A composite score obtained by the sum of these scores significantly discriminated MCI patients from comparison groups. This reduced version of the CAMCOG showed similar diagnostic accuracy than the original schedule for the identification of patients with MCI as compared to controls (AUC = 0.80 ± 0.03 for the reduced CAMCOG; AUC = 0.79 ± 0.03 for the original CAMCOG). CONCLUSION: This reduced version of the CAMCOG had similar diagnostic properties as the original CAMCOG and was faster and easier to administer, rendering it more suitable for the screening of subtle cognitive deficits in general clinical practice.


Assuntos
Transtornos Cognitivos/diagnóstico , Demência/diagnóstico , Testes Neuropsicológicos , Atividades Cotidianas , Idoso , Análise de Variância , Área Sob a Curva , Estudos Transversais , Diagnóstico Precoce , Feminino , Humanos , Modelos Logísticos , Masculino , Programas de Rastreamento/instrumentação , Pessoa de Meia-Idade , Testes Neuropsicológicos/normas , Escalas de Graduação Psiquiátrica , Sensibilidade e Especificidade
14.
Dement Neuropsychol ; 5(3): 226-237, 2011 Jul-Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29213748

RESUMO

Psychoeducational activities are a way of promoting help for caregivers of patients with Alzheimer's disease, representing a forum for knowledge sharing, and in which the primary focus is on psychological themes aimed at carers developing coping skills and strategies. Objective: The main objective of this study was to gauge perceptions about care and its impact among family caregivers of patients with AD participating in a psychoeducational group intervention, as well as the possible positive and negative aspects associated with this role. The subjective impact of AD on the lives of these caregivers was assessed on each of the dimensions of the Caregiver Burden Scale using a semi-directed interview on perceptions about care. Methods: This was a prospective study, in which information was collected twice, before and after, psychoeducational intervention. Through the application of the scale, benefits were evident for all dimensions assessed in the instrument (general strain, isolation, disappointment, emotional involvement and environment). Results: The results showed that after the psychoeducational intervention, caregivers felt less burdened by care compared to pre-intervention. Conclusion: These findings confirm that expanded implementation of psychoeducational interventions for caregivers of patients with AD can be beneficial for both caregivers and patients.

15.
Rev. ter. ocup ; 21(3): 240-246, set.-dez. 2010.
Artigo em Português | LILACS | ID: lil-657265

RESUMO

A produção científica relativa às intervenções e avaliações em Terapia Ocupacional têm avançado. Instrumentos de avaliação são cada vez mais utilizados para avaliar resultados de intervenções nos Estados Unidos, Canadá, Austrália e em países da Europa. No Brasil, entretanto, instrumentos traduzidos e validados ainda são pouco utilizados e difundidos entre terapeutas ocupacionais. Diante disso, o objetivo desta revisão de literatura é conhecer os instrumentos e escalas de avaliação em Terapia Ocupacional que estão validados para língua portuguesa e disponíveis para o uso no Brasil. Para a pesquisa foi utilizada a base de dados da Biblioteca Virtual em Saúde (BVS) a partir de 1969 e trabalhos disponíveis na biblioteca do Serviço de Terapia Ocupacional do Instituto de Psiquiatria da Faculdade de Medicina da Universidade de São Paulo. Apenas sete instrumentos de avaliação foram encontrados, um indicativo de que no Brasil há poucos instrumentos validados para o uso em Terapia Ocupacional. O uso de instrumentos de avaliação possibilita o estabelecimento de objetivos terapêuticos e a mensuração dos resultados obtidos em terapia, sendo muito importantes para o reconhecimento clínico e científico da Terapia Ocupacional, além de possibilitar a produção de conhecimento específico na área. Desta forma, se faz necessário o aumento e ampliação da discussão das formas de sistematização das avaliações em Terapia Ocupacional no Brasil.


The scientific literature of interventions and evaluations in Occupational Therapy has advanced. Assessment instruments are increasingly used to evaluate outcomes of interventions in the U.S.A., Canada, Australia and European countries. However, in Brazil, instruments translated and validated are not much used and known among occupational therapists. Therefore, the objective of this review of the literature is to know which instruments and rating scales in Occupational Therapy are validated for portuguese language and available for use in Brazil. The database of the Virtual Health Library (BVS) from 1969 was used as well as studies available in the library of the Occupational Therapy Service of the Psychiatry Institute, University of Sao Paulo. Only seven assessments instruments were found what denotes there are few validated instruments for use in Occupational Therapy in Brazil. The use of assessment tools allows the establishment of therapeutic goals and measurement of results in therapy which are very important for the clinical and scientific recognition of the Occupational Therapy and through this is possible the production of specific knowledge in the area. Thus, it is necessary to increase and expand of the discussion of the systematic ways to evaluate in Occupational Therapy in Brazil.


Assuntos
Estudos de Avaliação , Terapia Ocupacional , Literatura de Revisão como Assunto , Pesos e Medidas , Indicadores de Produção Científica
16.
Int Psychogeriatr ; 22(6): 1003-11, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-20598195

RESUMO

BACKGROUND: The Rivermead Behavioural Memory Test (RBMT) assesses everyday memory by means of tasks which mimic daily challenges. The objective was to examine the validity of the Brazilian version of the RBMT to detect cognitive decline. METHODS: 195 older adults were diagnosed as normal controls (NC) or with mild cognitive impairment (MCI) or Alzheimer's disease (AD) by a multidisciplinary team, after participants completed clinical and neuropsychological protocols. RESULTS: Cronbach's alpha was high for the total sample for the RBMT profile (PS) and screening scores (SS) (PS = 0.91, SS = 0.87) and for the AD group (PS = 0.84, SS = 0.85), and moderate for the MCI (PS = 0.62, SS = 0.55) and NC (PS = 0.62, SS = 0.60) groups. RBMT total scores, Appointment, Pictures, Immediate and Delayed Story, Immediate and Delayed Route, Delayed Message and Date contributed to differentiate NC from MCI. ROC curve analyses indicated high accuracy to differentiate NC from AD patients, and, moderate accuracy to differentiate NC from MCI. CONCLUSIONS: The Brazilian version of the RBMT seems to be an appropriate instrument to identify memory decline in Brazilian older adults.


Assuntos
Atividades Cotidianas/psicologia , Doença de Alzheimer/diagnóstico , Transtornos Cognitivos/diagnóstico , Comparação Transcultural , Testes Neuropsicológicos/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Brasil , Transtornos Cognitivos/psicologia , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Equipe de Assistência ao Paciente , Psicometria/estatística & dados numéricos , Valores de Referência , Reprodutibilidade dos Testes
17.
Int Psychogeriatr ; 21(6): 1088-95, 2009 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-19691909

RESUMO

BACKGROUND: At least for a subset of patients, the clinical diagnosis of mild cognitive impairment (MCI) may represent an intermediate stage between normal aging and dementia. Nevertheless, the patterns of transition of cognitive states between normal cognitive aging and MCI to dementia are not well established. In this study we address the pattern of transitions between cognitive states in patients with MCI and healthy controls, prior to the conversion to dementia. METHODS: 139 subjects (78% women, mean age, 68.5 +/- 6.1 years; mean educational level, 11.7 +/- 5.4 years) were consecutively assessed in a memory clinic with a standardized clinical and neuropsychological protocol, and classified as cognitively healthy (normal controls) or with MCI (including subtypes) at baseline. These subjects underwent annual reassessments (mean duration of follow-up: 2.7 +/- 1.1 years), in which cognitive state was ascertained independently of prior diagnoses. The pattern of transitions of the cognitive state was determined by Markov chain analysis. RESULTS: The transitions from one cognitive state to another varied substantially between MCI subtypes. Single-domain MCI (amnestic and non-amnestic) more frequently returned to normal cognitive state upon follow-up (22.5% and 21%, respectively). Among subjects who progressed to Alzheimer's disease (AD), the most common diagnosis immediately prior conversion was multiple-domain MCI (85%). CONCLUSION: The clinical diagnosis of MCI and its subtypes yields groups of patients with heterogeneous patterns of transitions between one given cognitive state to another. The presence of more severe and widespread cognitive deficits, as indicated by the group of multiple-domain amnestic MCI may be a better predictor of AD than single-domain amnestic or non-amnestic deficits. These higher-risk individuals could probably be the best candidates for the development of preventive strategies and early treatment for the disease.


Assuntos
Doença de Alzheimer/diagnóstico , Transtornos Cognitivos/diagnóstico , Idoso , Doença de Alzheimer/classificação , Doença de Alzheimer/psicologia , Transtornos Cognitivos/classificação , Transtornos Cognitivos/psicologia , Estudos de Coortes , Progressão da Doença , Feminino , Seguimentos , Humanos , Masculino , Cadeias de Markov , Pessoa de Meia-Idade , Testes Neuropsicológicos/estatística & dados numéricos , Psicometria
18.
Curr Opin Psychiatry ; 22(6): 527-31, 2009 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-19633557

RESUMO

PURPOSE OF REVIEW: To identify and discuss recent research studies that propose innovative psychosocial interventions in old age psychiatry. RECENT FINDINGS: Studies have shown that cognitive training research for healthy elderly has advanced in several ways, particularly in the refinement of study design and methodology. Studies have included larger samples and longer training protocols. Interestingly, new research has shown changes in biological markers associated with learning and memory after cognitive training. Among mild cognitive impairment patients, results have demonstrated that they benefit from interventions displaying cognitive plasticity.Rehabilitation studies involving dementia patients have suggested the efficacy of combined treatment approaches, and light and music therapies have shown promising effects. For psychiatric disorders, innovations have included improvements in well known techniques such as cognitive behavior therapy, studies in subpopulations with comorbidities, as well as the use of new computer-aided resources. SUMMARY: Research evidence on innovative interventions in old age psychiatry suggests that this exciting field is moving forward by means of methodological refinements and testing of creative new ideas.


Assuntos
Psiquiatria Geriátrica/métodos , Transtornos Mentais/terapia , Psicoterapia/métodos , Idoso , Pesquisa Biomédica/métodos , Transtornos Cognitivos/reabilitação , Transtornos Cognitivos/terapia , Terapia Cognitivo-Comportamental/métodos , Demência/reabilitação , Demência/terapia , Humanos , Transtornos Mentais/reabilitação , Musicoterapia/métodos , Fototerapia/métodos , Terapia Assistida por Computador/métodos
19.
Dement Geriatr Cogn Disord ; 27(3): 224-31, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19225236

RESUMO

BACKGROUND/AIMS: The diagnostic stability of mild cognitive impairment (MCI) on short-term follow-up is a key issue in the characterization of this clinical syndrome. We aim to determine the cognitive outcome after 1 year of follow-up in a cohort of older adults. METHODS: Baseline clinical and neuropsychological assessments were carried out in older subjects recruited at a tertiary memory clinic. The subjects were reassessed after 1 year of follow-up with the same clinical and neuropsychological protocol. RESULTS: A total of 115 older adults, including MCI (n = 54) and controls (n = 61), underwent baseline and follow-up evaluation. Ten subjects classified as MCI at baseline (23%) resumed normal cognitive function and 13 controls (21%) progressed to MCI upon follow-up (chi(2) = 0.015, d.f. = 1, p = 0.90). The subjects diagnosed as having MCI on both assessments were older (p = 0.002) and had a worse global cognitive performance according to the Cambridge Cognitive Test (p = 0.014). CONCLUSION: The subjects who maintain the MCI status are older and have a worse baseline cognitive performance as well as multiple cognitive deficits.


Assuntos
Transtornos Cognitivos/diagnóstico , Idoso , Transtornos Cognitivos/psicologia , Progressão da Doença , Feminino , Humanos , Masculino , Testes Neuropsicológicos , Valor Preditivo dos Testes , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Risco , Fatores Socioeconômicos
20.
Rev. bras. psiquiatr ; 30(4): 316-321, Dec. 2008. graf, tab
Artigo em Inglês | LILACS | ID: lil-501861

RESUMO

OBJECTIVE: To describe the neuropsychological profile of mild cognitive impairment subtypes (amnestic, non-amnestic and multiple-domain) of a clinical sample. We further address the diagnostic properties of the Mini-Mental State Examination and the Cambridge Cognitive Examination for the identification of the different mild cognitive impairment subtypes in clinical practice. METHOD: Cross-sectional clinical and neuropsychological evaluation of 249 elderly patients attending a memory clinic at a university hospital in Sao Paulo, Brazil. RESULTS: The performance of patients with mild cognitive impairment was heterogeneous across the different subtests of the neuropsychological battery, with a trend towards an overall worse performance for amnestic (particularly multiple domain) mild cognitive impairment as compared to non-amnestic subtypes. Screening tests for dementia (Mini-Mental State Examination and Cambridge Cognitive Examination) adequately discriminated cases of mild Alzheimer's disease from controls, but they were not accurate to discriminate patients with mild cognitive impairment (all subtypes) from control subjects. CONCLUSIONS: The discrimination of mild cognitive impairment subtypes was possible only with the aid of a comprehensive neuropsychological assessment. It is necessary to develop new strategies for mild cognitive impairment screening in clinical practice.


OBJETIVO: Descrever o perfil neuropsicológico dos subtipos de comprometimento cognitivo leve, amnéstico, não-amnéstico e múltiplos domínios, de uma amostra clínica. Além disto, avaliou-se as propriedades diagnósticas do Mini-exame do Estado Mental e do Cambridge Cognitive Examination na identificação dos diferentes subtipos de comprometimento cognitivo leve na prática clínica. MÉTODO: Avaliação clínica e neuropsicológica transversal de 249 idosos em uma clínica de memória de um hospital universitário em São Paulo, Brasil. RESULTADOS: Testes de rastreio para demência (Mini-exame do Estado Mental e Cambridge Cognitive Examination) identificam corretamente casos de doença de Alzheimer leve, mas não apresentam boa acurácia para diferenciar os diversos subtipos de comprometimento cognitivo leve. A performance dos sujeitos portadores de comprometimento cognitivo leve foi heterogênea nos diferentes testes da bateria neuropsicológica, com uma tendência a uma pior performance global nos pacientes com o subtipo amnéstico (especialmente os com envolvimento de múltiplos domínios cognitivos) em relação ao comprometimento cognitivo leve não-amnéstico. CONCLUSÕES: A discriminação dos diferentes subtipos de comprometimento cognitivo leve foi possível somente a partir de uma avaliação neuropsicológica detalhada. Desta maneira, é necessário o desenvolvimento de novas estratégias de rastreio para esta condição na prática clínica.


Assuntos
Idoso , Feminino , Humanos , Masculino , Doença de Alzheimer/diagnóstico , Amnésia/diagnóstico , Transtornos Cognitivos/diagnóstico , Testes Neuropsicológicos , Estudos de Casos e Controles , Avaliação Geriátrica/métodos , Entrevista Psiquiátrica Padronizada , Análise Multivariada , Reprodutibilidade dos Testes
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