Mindup: A Platform for Monitoring and Cognitive Enhancement for Patients with Alzheimer's Disease.

Alzheimer's Disease (AD) is an illness that degenerates an individual's cognitive functions, leaving them unable to take care of themselves. Even without a definitive cure, AD should be treated with remedies and cognitive enhancement. This article presents an application that assists in the cognitive reinforcement of AD patients through games, supports the medical follow-up of patients, and facilitates the daily exchange of information between the caregiver and the doctor.

Idosos com doença de Alzheimer: como vivem e percebem a atenção na estratégia saúde da família / Ancianos con la enfermedad de Alzheimer: cómo vivir y como darse cuenta de atención en la estrategia salud de la família / Elderly with alzheimer’s disease: how they live and notice the attentionin the health strategy of the family

Objective: Understand how seniors live with Alzheimer’s and their perceptions about the actions of the health strategy of the family (FHS). Methods: Exploratory and descriptive study, conducted with ten seniors who agreed to give information. Two forms were used for the evaluation, the index of Katz and the Mini Mental State Examination. Approved by the Research Ethics Committee of the grape with the opinion nº 608,721. Results: The elderly were mostly female, married and illiterate. Had cognitive impairment and some were independent in practice of daily life activities. There are weaknesses in the adaptation of households, but they notice the efforts of their relatives in the space adjustment. The elderly demonstrated satisfaction regarding the attention on ESF. Conclusion: Infer the importance of improving the condition of life, independence and autonomy of the elderly.

Objetivo: Compreender como vivem os idosos com Alzheimer e as suas percepções sobre as ações da Estratégia Saúde da Família (ESF). Métodos: Estudo exploratório-descritivo realizado com dez idosos que concordaram em dar informações. Utilizou-se dois formulários para a avaliação, o Índice de Katz e Mini Exame do Estado Mental. Aprovado pelo Comitê de Ética em Pesquisa da UVA com o parecer nº 608.721. Resultados: Os idosos eram, em sua maioria, do sexo feminino, casados e analfabetos. Apresentavam comprometimento cognitivo e alguns eram independentes na prática das atividades da vida diária. Existem fragilidades na adaptação dos domicílios, porém percebem-se esforços dos familiares no ajuste do espaço. Os idosos demonstraram relativa satisfação quanto à atenção dispensada na ESF. Conclusão: Infere-se a importância de um cuidado que potencialize a melhoria da condição de vida, independência e autonomia do idoso.

Objetivo: Comprender cómo viven los ancianos Alzheimer y sus percepciones sobre las acciones de la Estrategia de Salud de la Familia (ESF). Métodos: Estudio exploratorio descriptivo, realizado con diez ancianos que accedió a dar información. Utiliza dos formas para la evaluación, el Índice de Katz y el Mini Examen del Estado Mental. Aprobado en Comité de Ética con la opinión n° 608.721. Resultados: Los ancianos eran en su mayoría mujeres, casadas y analfabetos. Tenían deterioro cognitivo y eran independientes en la práctica de actividades diarias. Existen deficiencias en la adaptación de los hogares, pero se da cuenta de los esfuerzos de los familiares en el ajuste de espacio. Los ancianos demostraron satisfacción con respecto a la atención en ESF. Conclusión: Inferir la importancia de un cuidado es a influencia para mejorar las condiciones de vida, la independencia y autonomía de las personas mayores.

Location-based technologies for supporting elderly pedestrian in "getting lost" events.

PURPOSE: Localization-based technologies promise to keep older adults with dementia safe and support them and their caregivers during getting lost events. This paper summarizes mainly technological contributions to support the target group in these events. Moreover, important aspects of the getting lost phenomenon such as its concept and ethical issues are also briefly addressed. METHODS: Papers were selected from scientific databases and gray literature. Since the topic is still in its infancy, other terms were used to find contributions associated with getting lost e.g. wandering. RESULTS: Trends of applying localization systems were identified as personal locators, perimeter systems and assistance systems. The first system barely considered the older adult's opinion, while assistance systems may involve context awareness to improve the support for both the elderly and the caregiver. Since few studies report multidisciplinary work with a special focus on getting lost, there is not a strong evidence of the real efficiency of localization systems or guidelines to design systems for the target group. CONCLUSIONS: Further research about getting lost is required to obtain insights for developing customizable systems. Moreover, considering conditions of the older adult might increase the impact of developments that combine localization technologies and artificial intelligence techniques. Implications for Rehabilitation Whilst there is no cure for dementia such as Alzheimer's, it is feasible to take advantage of technological developments to somewhat diminish its negative impact. For instance, location-based systems may provide information to early diagnose the Alzheimer's disease by assessing navigational impairments of older adults. Assessing the latest supportive technologies and methodologies may provide insights to adopt strategies to properly manage getting lost events. More user-centered designs will provide appropriate assistance to older adults. Namely, customizable systems could assist older adults in their daily walks with the aim to increase their self-confidence, independence and autonomy.

Effect of unawareness on rehabilitation outcome in a randomised controlled trial of multicomponent intervention for patients with mild Alzheimer's disease.

Unawareness of deficit has been shown to affect the outcome of targeted cognitive intervention programmes applied to patients with Alzheimer' disease (AD), but the effects on multimodal therapeutic approaches have not yet been explored. This research investigated the efficacy of the Multi-Intervention Programme (MIP) approach on improving cognitive, functional, affective, and behavioural symptoms in people with mild AD. In addition, we examined whether the presence of unawareness influences the MIP outcomes. Sixty-one mild stage AD patients were randomly assigned to either an experimental group which carried out an MIP individually (48 sessions, 16 weeks duration), combining diverse cognitive tasks, training in daily life and recreational activities, or a waiting list group which did not receive any treatment for the same time period. The efficacy of MIP (vs. waiting list) was tested using various standardised neuropsychological, functional, and behavioural outcome measures. Planned analyses were carried out to determine the effect of unawareness versus awareness on such outcomes. The results showed that patients overall benefited from the MIP in terms of both cognitive and non-cognitive symptoms. AD patients with awareness of deficits showed positive effects on all outcome measures in comparison with the waiting list group, while AD patients with unawareness showed improvements in non-cognitive symptoms only. In conclusion, the presence of unawareness reduces the cognitive and functional effects of MIP in patients with mild AD.

What are the Benefits of Exercise for Alzheimer's Disease? A Systematic Review of the Past 10 Years.

To identify and characterize the scientific literature on the effects of exercise on Alzheimer's disease, research was conducted in the following databases: MEDLINE, CINAHL, Web of Science, and Scopus. These MeSH terms--"exercise", "motor activity", "physical fitness", "Alzheimer disease", and its synonyms in English--were used in the initial search to locate studies published between 2003 and 2013. After reading the 12 final articles in their entirety, two additional articles, found by a manual search, were included. Of these, 13 had beneficial results of exercise in Alzheimer's disease. Given the results discussed here, the exercise may be important for the improvement of functionality and performance of daily life activities, neuropsychiatric disturbances, cardiovascular and cardiorespiratory fitness, functional capacity components (flexibility, agility, balance, strength), and improvements in some cognitive components such as sustained attention, visual memory, and frontal cognitive function in patients with AD.

O cuidador familiar do idoso com Alzheimer: percepções e sentimentos / The family caregivers of seniors with Alzheimer's: perceptions and feelings

A Constituição Federal Brasileira defende que o cuidado com o idoso é uma responsabilidade compartilhada entre o Estado, a família e a sociedade. As Políticas públicas voltadas à pessoa idosa vêm corroborar com esse entendimento e apontam o domicílio como um espaço privilegiado para o cuidado do idoso. Isto determina a participação do familiar como cuidador, porém destaca-se a ausência de estratégias de assistência voltadas às necessidades do cuidador familiar que se sente desamparado e desassistido na sua responsabilidade do cuidado com o idoso no domicilio. Nos últimos anos, apesar da busca incessante pela saúde e qualidade de vida, observa-se uma crescente incidência de idosos com doenças demenciais que levam à incapacidade funcional, dentre elas destaca-se a doença de Alzheimer. Essa doença compromete de forma grave e irreversível a cognição, memória e independência do idoso, tornando-o dependente de terceiros para executar atividades básicas da vida diária, por toda sua vida. O presente estudo tem como objetivo conhecer a percepção e os sentimentos dos cuidadores familiares de idosos com Alzheimer sobre o papel de cuidador. Trata-se de um estudo com abordagem qualitativa, realizado com cuidadores familiares de idosos com Alzheimer, vinculados ao grupo de cuidadores do Centro Especializado de Atenção em Saúde do Idoso, localizado em Natal/RN. Por meio de entrevista semiestruturada a pesquisa buscou investigar a percepção dos cuidadores familiares sobre o papel de cuidador, os sentimentos e as mudanças ocorridas na vida do cuidador ao assumir esse papel. Os dados foram organizados em categorias e unidades de análise semântica e analisados pela técnica de análise de conteúdo temática, segundo Bardin. Os relatos originaram três categorias: a percepção do papel do cuidador; sentimentos relacionados ao cuidado e consequências do papel de cuidador. Na percepção dos cuidadores de idosos a exigência proveniente da dedicação ao cuidado gera perdas na vida pessoal e profissional do familiar que assume essa responsabilidade. A falta de suporte, familiar e social, acentua a sobrecarga do cuidado ao idoso dependente. As Políticas públicas de saúde do idoso reconhecem a importância e as necessidades dos familiares cuidadores, porém não disponibilizam apoio e suporte suficiente para atender as necessidades e auxiliá-los em suas limitações. Os resultados da pesquisa demonstraram a urgência na tomada de medidas de assistência aos cuidadores de idosos com Alzheimer, reconhecendo-as como uma ação de promoção da qualidade de vida e saúde do idoso e proteção da saúde do cuidador. (AU)

The Brazilian Constitution maintains that care for elderly people is a responsibility shared by the state, the family and the society. The politics for the elderly corroborate this understanding and treats home as a privileged place for elderly care taking. This determines the participation of the familiar as a caregiver, but highlights the lack of strategic assistance for the needs of the relative caregiver who feels helplessly and unattended in their responsibility for elderly homecare. In recent years , despite the recently pursuit for health and life quality, there is an increasing incidence of elderly patients with dementia diseases that lead to disability, the most common among then is the Alzheimer's disease. This disease affects seriously and irreversibly cognition, memory and independence of the elderly, making it dependent on others to perform basic activities of daily life, for all his life. The present study aims to evaluate the perceptions and feelings of family caregivers of elders with Alzheimer on the role of caregiver. This is a qualitative study conducted with family caregivers of seniors with Alzheimer's, caregivers linked to the group of the Specialized Care Center of the Elderly's Health, located in Natal / RN. Through semi-structured interview research sought to investigate the perceptions of family caregivers on the role of caregiver, the feelings and the changes in the caregiver's life since they assumed this role. The data were organized into categories and units of semantic analysis and analyzed using thematic content analysis by Bardin. The reports originated three categories: the perception of the role of caregiver, feelings related to the caregving and consequences of the caregiver role. Perceptions of caregivers of elderly from the requirement of dedication to the care generates losses in personal and professional life for the familiar who assumes this responsibility. The lack of family and social support, aggravates the burden of care for the dependent elderly. Public health politics for the elderly recognize the importance and needs of family caregivers, but not enough to provide support and meet the needs and assist them in supporting their limitations. The research results show the urgent need to take measures to assist the caregivers of seniors with Alzheimer, recognizing them as an action of promotion quality of life and health of the elderly and protection the health of the caregiver. (AU)

Multimodal exercise intervention improves frontal cognitive functions and gait in Alzheimer's disease: a controlled trial.

AIM: The objective of the present study was to investigate the effect of a multimodal exercise intervention on frontal cognitive functions and kinematic gait parameters in patients with Alzheimer's disease. METHODS: A sample of elderly patients with Alzheimer's disease (n=27) were assigned to a training group (n=14; aged 78.0±7.3 years) and a control group (n=13; aged 77.1±7.4 years). Multimodal exercise intervention includes motor activities and cognitive tasks simultaneously. The participants attended a 1-h session three times a week for 16 weeks, and the control participants maintained their regular daily activities during the same period. The frontal cognitive functions were evaluated using the Frontal Assessment Battery, the Clock Drawing Test and the Symbol Search Subtest. The kinematic parameters of gait-cadence, stride length and stride speed were analyzed under two conditions: (i) free gait (single task); and (ii) gait with frontal cognitive task (walking and counting down from 20--dual task). RESULTS AND DISCUSSION: The patients in the intervention group significantly increased the scores in frontal cognitive variables, Frontal Assessment Battery (P<0.001) and Symbol Search Subtest (P<0.001) after the 16-week period. The control group decreased the scores in the Clock Drawing Test (P=0.001) and increased the number of counting errors during the dual task (P=0.008) after the same period. CONCLUSION: The multimodal exercise intervention improved the frontal cognitive functions in patients with Alzheimer's disease.

A controlled clinical trial on the effects of exercise on neuropsychiatric disorders and instrumental activities in women with Alzheimer's disease / Efeitos do exercício físico sobre distúrbios neuropsiquiátricos e atividades instrumentais da vida diária em mulheres com doença de Alzheimer : um ensaio clínico controlado

OBJECTIVE: To analyze the influence of a six-month exercise program on neuropsychiatric disorders and on the performance of instrumental activities in elderly patients with Alzheimer's disease (AD). METHODS: The study included 20 patients with AD in the mild to moderate stages of the Clinical Dementia Rating (CDR) divided into two groups: the experimental group, composed of 10 women who participated in the six-month exercise program, and the control group, composed of the 10 remaining AD patients who did not take part in an exercise program during the same period. All participants were evaluated using the Mini-Mental State Exam for global cognitive function, the Neuropsychiatric Inventory Questionnaire for neuropsychiatric disorders, and the Pfeffer Functional Activities Questionnaire for the degree of functional impairment. RESULTS: The control group showed functional and neuropsychiatric deterioration in the comparisons between pre- and post-intervention times and between groups. CONCLUSION: The experimental group showed a propensity for less deterioration in neuropsychiatric disorders and performance of instrumental activities compared to the sedentary group.

OBJETIVO: Analisar os efeitos de seis meses de intervenção de um programa de atividade física sobre os distúrbios neuropsiquiátricos e o desempenho nas atividades instrumentais da vida diária de idosos com Doença de Alzheimer (DA). MÉTODOS: Foram recrutados 20 pacientes nos estágios entre leve e moderado da DA. Segundo o escore clínico de demência (CDR), foram distribuídos em dois grupos: o grupo treinamento (GT), composto por dez mulheres que participaram de um program de exercícios físicos por um período de seis meses, e o grupo controle (GC), composto por dez outras participantes que não realizaram nenhum tipo de intervenção motora estruturada durante o mesmo período. Todas as participantes foram avaliadas por meio do Miniexame do Estado Mental, para obtenção da caracterização cognitiva; Inventário Neuropsiquiátrico, para identificação dos distúrbios neuropsiquiátricos mais prevalentes e Questionário de Atividades Instrumentais de Pfeffer, para verificação do grau de comprometimento funcional. RESULTADOS: Os participantes do GC mostraram uma deterioração tanto no desempenho das atividades instrumentais quanto na intensificação dos distúrbios neuropsiquiátricos, quando comparados os momentos pré e pós-intervenção. CONCLUSÃO: O GT demonstrou uma atenuação da intensificação dos distúrbios neuropsiquiátricos e do desempenho funcional em relação ao grupo sedentário.

A controlled clinical trial on the effects of exercise on neuropsychiatric disorders and instrumental activities in women with Alzheimer's disease.

OBJECTIVE: To analyze the influence of a six-month exercise program on neuropsychiatric disorders and on the performance of instrumental activities in elderly patients with Alzheimer's disease (AD). METHODS: The study included 20 patients with AD in the mild to moderate stages of the Clinical Dementia Rating (CDR) divided into two groups: the experimental group, composed of 10 women who participated in the six-month exercise program, and the control group, composed of the 10 remaining AD patients who did not take part in an exercise program during the same period. All participants were evaluated using the Mini-Mental State Exam for global cognitive function, the Neuropsychiatric Inventory Questionnaire for neuropsychiatric disorders, and the Pfeffer Functional Activities Questionnaire for the degree of functional impairment. RESULTS: The control group showed functional and neuropsychiatric deterioration in the comparisons between pre- and post-intervention times and between groups. CONCLUSION: The experimental group showed a propensity for less deterioration in neuropsychiatric disorders and performance of instrumental activities compared to the sedentary group.

Prolonged visual memory enhancement after direct current stimulation in Alzheimer's disease.

BACKGROUND: Immediately after patients with Alzheimer's disease (AD) receive a single anodal transcranial direct current stimulation (tDCS) session their memory performance improves. Whether multiple tDCS sessions improve memory performance in the longer term remains unclear. OBJECTIVE: In this study we aimed to assess memory changes after five consecutive sessions of anodal tDCS applied over the temporal cortex in patients with AD. METHODS: A total of 15 patients were enrolled in two centers. Cognitive functions were evaluated before and after therapeutic tDCS. tDCS was delivered bilaterally through two scalp anodal electrodes placed over the temporal regions and a reference electrode over the right deltoid muscle. The stimulating current was set at 2 mA intensity and was delivered for 30 minutes per day for 5 consecutive days. RESULTS: After patients received tDCS, their performance in a visual recognition memory test significantly improved. We found a main effect of tDCS on memory performance, i.e., anodal stimulation improved it by 8.99% from baseline, whereas sham stimulation decreased it by 2.62%. tDCS failed to influence differentially general cognitive performance measures or a visual attention measure. CONCLUSIONS: Our findings show that after patients with AD receive anodal tDCS over the temporal cerebral cortex in five consecutive daily sessions their visual recognition memory improves and the improvement persists for at least 4 weeks after therapy. These encouraging results provide additional support for continuing to investigate anodal tDCS as an adjuvant treatment for patients with AD.

Attenuation of neuropsychiatric symptoms and caregiver burden in Alzheimer's disease by motor intervention: a controlled trial.

OBJECTIVE: To analyze the effects of motor intervention on the neuropsychiatric symptoms of Alzheimer's disease and on the caregivers' burden. DESIGN: This is a controlled trial evaluating the effects of a motor intervention program on the neuropsychiatric symptoms. SETTING: The intervention was performed on community patients from two university centers specializing in physical exercise for the elderly. SUBJECTS: Patients with Alzheimer's disease were divided into two groups: sixteen received the motor intervention and sixteen controls (five controls were excluded because of clinical intercurrences). INTERVENTIONS: Aerobic exercises (flexibility, strength, and agility) and functional balance exercises were conducted over six months for 60 minutes three times per week. MAIN MEASURES: Psychopathological features of patients were evaluated with the Neuropsychiatric Inventory and Cornell Scale for Depression in Dementia. Caregivers were evaluated using the Neuropsychiatric Inventory-Distress and Burden Interview. A two-way analysis of variance (ANOVA) was applied to observe interactions (pre- vs. post-intervention; participants vs. controls). RESULTS: Patients from the intervention presented a significant reduction in neuropsychiatric conditions when compared to controls (Neuropsychiatric Inventory: F: 11.12; p = 0.01; Cornell Depression scale: F: 11.97; p = 0.01). The burden and stress of caregivers responsible for patients who participated in the intervention significantly decreased when compared to caregivers responsible for controls (Neuropsychiatric Inventory-Distress: F: 9.37; p = 0.01; Burden Interview: F: 11.28; p = 0.01). CONCLUSIONS: Aerobic exercise was associated with a reduction in the neuropsychiatric symptoms and contributed to attenuate the caregivers' burden. However, the researchers were not blinded to the patient's intervention status, which constitutes an important limitation of this study.

Effects of a multidisciplinary cognitive rehabilitation program for patients with mild Alzheimer's disease.

OBJECTIVE: To evaluate the effects of a multidisciplinary rehabilitation program on cognition, quality of life, and neuropsychiatry symptoms in patients with mild Alzheimer's disease. METHOD: The present study was a single-blind, controlled study that was conducted at a university-based day-hospital memory facility. The study included 25 Alzheimer's patients and their caregivers and involved a 12-week stimulation and psychoeducational program. The comparison group consisted of 16 Alzheimer's patients in waiting lists for future intervention. INTERVENTION: Group sessions were provided by a multiprofessional team and included memory training, computer-assisted cognitive stimulation, expressive activities (painting, verbal expression, writing), physiotherapy, and physical training. Treatment was administered twice a week during 6.5-h gatherings. MEASUREMENTS: The assessment battery comprised the following tests: Mini-Mental State Examination, Short Cognitive Test, Quality of Life in Alzheimer's disease, Neuropsychiatric Inventory, and Geriatric Depression Scale. Test scores were evaluated at baseline and the end of the study by raters who were blinded to the group assignments. RESULTS: Measurements of global cognitive function and performance on attention tasks indicated that patients in the experimental group remained stable, whereas controls displayed mild but significant worsening. The intervention was associated with reduced depression symptoms for patients and caregivers and decreased neuropsychiatric symptoms in Alzheimer's subjects. The treatment was also beneficial for the patients' quality of life. CONCLUSION: This multimodal rehabilitation program was associated with cognitive stability and significant improvements in the quality of life for Alzheimer's patients. We also observed a significant decrease in depressive symptoms and caregiver burden. These results support the notion that structured nonpharmacological interventions can yield adjunct and clinically relevant benefits in dementia treatment.

Non-invasive brain stimulation to assess and modulate neuroplasticity in Alzheimer's disease.

Alzheimer's disease (AD) is a neurodegenerative and progressive disease related to a gradual decline in cognitive functions such as memory, attention, perceptual-spatial abilities, language, and executive functions. Recent evidence has suggested that interventions promoting neural plasticity can induce significant cognitive gains especially in subjects at risk of or with mild AD. Transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) are non-invasive techniques that can induce significant and long-lasting changes in focal and non-focal neuroplasticity. In this review, we present initial preliminary evidence that TMS and tDCS can enhance performance in cognitive functions typically impaired in AD. Also, we reviewed the initial six studies on AD that presented early findings showing cognitive gains such as in recognition memory and language associated with TMS and tDCS treatment. In addition, we showed that TMS has also been used to assess neuroplasticity changes in AD supporting the notion that cortical excitability is changed in AD due to the neurodegenerative process. Due to the safe profile, cost of these tools, and initial clinical trials results, further studies are warranted in order to replicate and extend the initial findings of rTMS and tDCS as cognitive enhancers in AD. Further trials should explore different targets of stimulation along with different paradigms of stimulation including combination with behavioural interventions.

Abordagem funcional e centrada no cliente na reabilitação de idoso com demência de Alzheimer avançada - relato de caso / Functional approach and centered-client pratic in rehabilitation of severe Alzheimer disease's older adult - case report

A Doença de Alzheimer (DA) é uma doença cerebral degenerativa que compromete a cognição e a realização das atividades de vida diária (AVDs). Os tratamentos disponíveis apenas minimizam os déficits cognitivos e as alterações de comportamento, sendo necessárias medidas que melhorem a qualidade de vida de pacientes e cuidadores. OBJETIVOS: Apresentar os resultados da intervenção domiciliária de TO usando abordagem funcional e centrada no cliente associada ao tratamento farmacológico em idoso com DA avançada. DESCRIÇÃO DO CASO CLÍNICO: Paciente de 64 anos, sexo masculino, previamente hígido, que, em 2004, apresentou piora progressiva das funções cognitivas, sendo diagnosticado com provável DA. Em 2006, foi avaliado pelo serviço de Terapia Ocupacional (TO) do Hospital Socor/BH, apresentando baixos escores nos testes cognitivos e funcionais (Mini-Mental; Testes de Fluência Verbal e do Relógio; Índice de Katz; Medida Canadense do Desempenho Ocupacional - COPM e Time diary). Observou-se dependência total em AVDs, grande insatisfação da cuidadora relacionados às alterações comportamentais apresentadas pelo paciente (alucinação, perambulação, agitação e inversão do ciclo sono-vigília), interação social reduzida e dependência crescente em AVDs básicas, além da desorganização da rotina ocupacional. Foram realizadas três sessões semanais no domicílio, com duração de 1 hora e acompanhamento pela neurologia e clínica médica. Observou-se melhora nos testes após três meses de tratamento, sustentada por 8 meses, contrapondo-se a evolução descrita na literatura sobre a progressão inexorável da incapacidade funcional. O Índice de Katz, ao contrário da COPM e time diary, não descreveu a melhora qualitativa observada no desempenho das AVDs. CONCLUSÃO: A intervenção domiciliária de TO associada ao tratamento medicamentoso mostrou efeitos significativos no caso apresentado.

Alzheimer's disease (AD) is a degenerative brain disease that affects cognition and perform activities of daily living (ADLs). The treatments available only minimize the cognitive deficits and behavioral changes, being necessary measures to improve the quality of life of patients and caregivers. OBJECTIVES: To present the results of interventions using Ocupational Therapy at home and functional approach focusing on customer conjunction with pharmacological treatment in elderly patients with advanced DA. DESCRIPTION OF THE CASE: A 64 year old male, previously healthy, who in 2004 showed progressive worsening of cognitive function, being diagnosed with probable AD. In 2006 it was assessed by the department of Occupational Therapy (OT), Hospital Socor-BH, showing low scores on cognitive tests and functional (Mini-Mental, Verbal Fluency Test and the Clock; Katz Index, the Canadian Occupational Performance Measure - Time diary and COPM). There is total dependence in ADL, caregiver's great dissatisfaction about the behavioral changes shown and the need for total aid to feed,bath and clothing, plus the disruption of routine occupational. They performed three sessions per week at home, lasting 1 hour and monitored by the neurology and internal medicine. An improvement in the tests after three months of treatment, sustained for 8 months, opposing the developments described in the literature about the inexorable progression of disability. The Katz Index, unlike the time and COPM diary, did not describe the observed qualitative improvement in the performance of ADLs. CONCLUSION: The home of OT intervention related to drug treatment showed significant effects in the case present.

Rehabilitating a brain with Alzheimer's: a proposal.

Alzheimer's disease (AD) is the most common neurodegenerative disorder, originating sporadically in the population aged over 65 years, and advanced age is the principal risk factor leading to AD development. In spite of the large amount of research going on around the globe and all the information now available about AD, there is still no origin or triggering process known so far. Drugs approved for the treatment of AD include tacrine, donepezil, rivastigmine, galantamine, and memantine. These may delay or slow down the degenerative process for a while, but they can neither stop nor reverse its progression. Because that this might be due to a lack of effect of these drugs on degenerating neurons, even when they are able to potentiate the brain in nondegenerative conditions, we propose here an alternative therapy consisting of initial repair of neuronal membranes followed by conventional drug therapies. The rehabilitation of neurons in a degeneration process would enable the drugs to act more effectively on them and improve the effects of treatment in AD patients.

Attenuation of neuropsychiatric symptoms and caregiver burden in Alzheimer's disease by motor intervention: a controlled trial

OBJECTIVE: To analyze the effects of motor intervention on the neuropsychiatric symptoms of Alzheimer's disease and on the caregivers' burden. DESIGN: This is a controlled trial evaluating the effects of a motor intervention program on the neuropsychiatric symptoms. SETTING: The intervention was performed on community patients from two university centers specializing in physical exercise for the elderly. SUBJECTS: Patients with Alzheimer's disease were divided into two groups: sixteen received the motor intervention and sixteen controls (five controls were excluded because of clinical intercurrences). INTERVENTIONS: Aerobic exercises (flexibility, strength, and agility) and functional balance exercises were conducted over six months for 60 minutes three times per week. MAIN MEASURES: Psychopathological features of patients were evaluated with the Neuropsychiatric Inventory and Cornell Scale for Depression in Dementia. Caregivers were evaluated using the Neuropsychiatric Inventory-Distress and Burden Interview. A two-way analysis of variance (ANOVA) was applied to observe interactions (pre- vs. post-intervention; participants vs. controls). RESULTS: Patients from the intervention presented a significant reduction in neuropsychiatric conditions when compared to controls (Neuropsychiatric Inventory: F: 11.12; p = 0.01; Cornell Depression scale: F: 11.97; p = 0.01). The burden and stress of caregivers responsible for patients who participated in the intervention significantly decreased when compared to caregivers responsible for controls (Neuropsychiatric Inventory-Distress: F: 9.37; p = 0.01; Burden Interview: F: 11.28; p = 0.01). CONCLUSIONS: Aerobic exercise was associated with a reduction in the neuropsychiatric symptoms and contributed to attenuate the caregivers' burden. However, the researchers were not blinded to the patient's intervention status, which constitutes an important limitation of this study.

Effects of a multidisciplinar cognitive rehabilitation program for patients with mild Alzheimer's disease

OBJECTIVE: To evaluate the effects of a multidisciplinary rehabilitation program on cognition, quality of life, and neuropsychiatry symptoms in patients with mild Alzheimer's disease. METHOD: The present study was a single-blind, controlled study that was conducted at a university-based day-hospital memory facility. The study included 25 Alzheimer's patients and their caregivers and involved a 12-week stimulation and psychoeducational program. The comparison group consisted of 16 Alzheimer's patients in waiting lists for future intervention. INTERVENTION: Group sessions were provided by a multiprofessional team and included memory training, computer-assisted cognitive stimulation, expressive activities (painting, verbal expression, writing), physiotherapy, and physical training. Treatment was administered twice a week during 6.5-h gatherings. MEASUREMENTS: The assessment battery comprised the following tests: Mini-Mental State Examination, Short Cognitive Test, Quality of Life in Alzheimer's disease, Neuropsychiatric Inventory, and Geriatric Depression Scale. Test scores were evaluated at baseline and the end of the study by raters who were blinded to the group assignments. RESULTS: Measurements of global cognitive function and performance on attention tasks indicated that patients in the experimental group remained stable, whereas controls displayed mild but significant worsening. The intervention was associated with reduced depression symptoms for patients and caregivers and decreased neuropsychiatric symptoms in Alzheimer's subjects. The treatment was also beneficial for the patients' quality of life. CONCLUSION: This multimodal rehabilitation program was associated with cognitive stability and significant improvements in the quality of life for Alzheimer's patients. We also observed a significant decrease in depressive symptoms and caregiver burden. These results support the notion that structured nonpharmacological interventions can yield adjunct and clinically relevant benefits in dementia treatment.

Treadmill training restores spatial cognitive deficits and neurochemical alterations in the hippocampus of rats submitted to an intracerebroventricular administration of streptozotocin.

The intracerebroventricular infusion of streptozotocin (icv-STZ) has been largely used in research to mimic the main characteristics of Alzheimer's disease (AD), including cognitive decline, impairment of cholinergic transmission, oxidative stress and astrogliosis. Moderate physical exercise has a number of beneficial effects on the central nervous system, as demonstrated both in animals and in human studies. This study aimed to evaluate the effect of 5-week treadmill training, in the icv-SZT model of sporadic AD, on cognitive function, oxidative stress (particularly mediated by NO) and on the astrocyte marker proteins, glial fibrillary acidic protein (GFAP) and S100B. Results confirm the spatial cognitive deficit and oxidative stress in this model, as well as astroglial alterations, particularly a decrease in CSF S100B. Physical exercise prevented these alterations, as well as increasing the hippocampal content of glutathione and GFAP per se in the CA1 region. These findings reinforce the potential neuroprotective role of moderate physical exercise. Astroglial changes observed in this dementia model contribute to understanding AD and other diseases that are accompanied by cognitive deficit.

Evaluation of cognitive technologies in geriatric rehabilitation: a case study pilot project.

The aim of this study was to develop and evaluate low-cost technology for cognitive rehabilitation in older individuals with dementia and document changes stemming from a clinical case study using these tools. An activity board, a calendar, a routine organizer and a software program were used and evaluated by specialists (n = 7). A pre-post-case study with an elderly male with dementia was undertaken for four months. All rehabilitation resources were classified as appropriate by the specialists. Post-intervention scores demonstrated improvement in cognitive functioning and daily activities at home. There is a need for further research to assess the therapeutic effects in patients with dementia applying equipment and software to improve cognitive function.

O método Kabat no tratamento fisioterapêutico da doença de Alzheimer / Kabat method in the physiotherapeutic treatment of Alzheimer's disease

A Doença de Alzheimer (DA) é uma doença crônica degenerativa, comum em idosos, caracterizada por uma deterioração gradual da função intelectual. O presente estudo teve como objetivo verificar se o método Kabat, quando aplicado em pacientes com DA, proporciona melhora em sua qualidade de vida. Os resultados indicaram que aplicação do teste em pacientes com DA proporciona, além da funcionalidade e mobilidade, retardo na necessidade de um cuidador.AU

Alzheimer’s Disease (AD) is a chronic degenerative disease, common in the elderly, characterized by a gradual deterioration of the intellectual function. This study aimed to determine whether the Kabat method, when applied to patients with AD, improves their quality of life. This is a descriptive study and a literature review. Results indicated that the application of the test to patients with AD provides functionality and mobility; in addition, it delays the need of having someone to take care of the patient.AU