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3.
Phys Rev Lett ; 125(12): 128102, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-33016724

RESUMO

Neurodegenerative diseases, such as Alzheimer's or Parkinson's disease, show characteristic degradation of structural brain networks. This degradation eventually leads to changes in the network dynamics and degradation of cognitive functions. Here, we model the progression in terms of coupled physical processes: The accumulation of toxic proteins, given by a nonlinear reaction-diffusion transport process, yields an evolving brain connectome characterized by weighted edges on which a neuronal-mass model evolves. The progression of the brain functions can be tested by simulating the resting-state activity on the evolving brain network. We show that while the evolution of edge weights plays a minor role in the overall progression of the disease, dynamic biomarkers predict a transition over a period of 10 years associated with strong cognitive decline.


Assuntos
Demência/patologia , Modelos Neurológicos , Doenças Neurodegenerativas/patologia , Animais , Relógios Biológicos , Encéfalo/patologia , Encéfalo/fisiopatologia , Morte Celular/fisiologia , Disfunção Cognitiva/patologia , Disfunção Cognitiva/fisiopatologia , Conectoma/métodos , Demência/fisiopatologia , Humanos , Camundongos , Doenças Neurodegenerativas/fisiopatologia , Neurônios/patologia
6.
Isr J Health Policy Res ; 9(1): 50, 2020 10 06.
Artigo em Inglês | MEDLINE | ID: mdl-33023673

RESUMO

Alzheimer's disease and Alzheimer's disease-related dementias (AD/ADRD) constitute a worldwide public health crisis. In light of the AD/ADRD epidemic now existing within the global COVID-19 pandemic, the need for global action to improve dementia care is greater than ever. The article collection "Dementia- an Interdisciplinary Approach," in the Israeli Journal of Health Policy and Research (IJHPR) highlights the need for interprofessional approaches to improving outcomes for people living with dementia and their care partners, as well as the complexities of conducting dementia care research.


Assuntos
Demência/terapia , Política de Saúde , Pesquisa sobre Serviços de Saúde , Publicações Periódicas como Assunto , Demência/epidemiologia , Humanos , Israel/epidemiologia
7.
Artigo em Russo | MEDLINE | ID: mdl-32929941

RESUMO

Cognitive impairment is one of the most common consequences of brain dysfunction. Nowadays, there is an increasing interest in the diagnosis and treatment of cognitive impairment without dementia, as a stage of cognitive deficit spectrum that could be controlled. The article discusses the current approaches to the management of patients with mild cognitive impairment including non-pharmacological strategies as well as medical antioxidant treatment.


Assuntos
Transtornos Cognitivos , Disfunção Cognitiva , Demência , Humanos
8.
Pflege ; 33(5): 309-317, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32996861

RESUMO

Immediate reactions of people with dementia to individualized music - Analysis of behavioral observations in a nursing home Abstract. Background: Due to the increasing prevalence of dementia, there is an urgent need for effective non-pharmacological interventions to improve the quality of life of people with dementia (PwD) and to relieve their carers. Studies show evidence for the benefits of individualized music. However, the immediate reactions to individualized music have not yet been adequately investigated. AIM: The research objective of the study was the investigation of the immediate effects of an individualized music intervention in a nursing home using a newly developed systematic behavioral observation rating scale. METHODS: In 153 behavioral observations of 20 PwD, 32 different experiences and behaviors pertaining to 11 categories such as emotional and motor changes which indicate immediate reactions to listening to music were rated. RESULTS: Participants showed significantly more positive reactions (e. g. joy or relaxation) and less negative reactions immediately after listening to the music compared to before. Moreover, in the course of listening to music, participants showed significantly more positive reactions, most often smiles, movements to music, attentive listening, relaxation and general vigilance / interest / social contact. CONCLUSIONS: The systematic behavioral observation rating scale proved to be a suitable method for rating the experiences and behaviors of people with dementia. Listening to individualized music seems to be a helpful intervention for PwD in institutional care settings.


Assuntos
Demência/psicologia , Demência/terapia , Musicoterapia/métodos , Idoso , Técnicas de Observação do Comportamento , Humanos , Casas de Saúde , Resultado do Tratamento
9.
Tijdschr Gerontol Geriatr ; 51(3)2020 Apr 23.
Artigo em Holandês | MEDLINE | ID: mdl-32951401

RESUMO

Long-term care for older adults is highly affect by the COVID-19 outbreak. The objective of this rapid review is to understand what we can learn from previous crises or disasters worldwide to optimize the care for older adults in long term care facilities during the outbreak of COVID-19. We searched five electronic databases to identify potentially relevant articles. In total, 23 articles were included in this study.Based on the articles, it appeared that nursing homes benefit from preparing for the situation as best as they can. For instance, by having proper protocols and clear division of tasks and collaboration within the organization. In addition, it is helpful for nursing homes to collaborate closely with other healthcare organizations, general practitioners, informal caregivers and local authorities. It is recommended that nursing homes pay attention to capacity and employability of staff and that they support or relieve staff where possible. With regard to care for the older adults, it is important that staff tries to find a new daily routine in the care for residents as soon as possible. Some practical tips were found on how to communicate with people who have dementia. Furthermore, behavior of people with dementia may change during a crisis. We found tips for staff how to respond and act upon behavior change. After the COVID-19 outbreak, aftercare for staff, residents, and informal caregivers is essential to timely detect psychosocial problems.The consideration between, on the one hand, acute safety and risk reduction (e.g. by closing residential care facilities and isolating residents), and on the other hand, the psychosocial consequences for residents and staff, were discussed in case of other disasters. Furthermore, the search of how to provide good (palliative) care and to maintain quality of life for older adults who suffer from COVID-19 is also of concern to nursing home organizations. In the included articles, the perspective of older adults, informal caregivers and staff is often lacking. Especially the experiences of older adults, informal caregivers, and nursing home staff with the care for older adults in the current situation, are important in formulating lessons about how to act before, during and after the coronacrisis. This may further enhance person-centered care, even in times of crisis. Therefore, we recommend to study these experiences in future research.


Assuntos
Infecções por Coronavirus/epidemiologia , Assistência à Saúde/métodos , Instituição de Longa Permanência para Idosos/organização & administração , Casas de Saúde/organização & administração , Pneumonia Viral/epidemiologia , Idoso , Betacoronavirus , Comunicação , Demência , Desastres , Humanos , Pandemias , Qualidade de Vida
10.
Aging Clin Exp Res ; 32(10): 2133-2140, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32918696

RESUMO

BACKGROUND: COVID-19 outbreak has led to severe health burden in the elderly. Age, morbidity and dementia have been associated with adverse outcome. AIMS: To evaluate the impact of COVID-19 on health status in home-dwelling patients. METHODS: 848 home-dwelling outpatients with dementia contacted from April 27 to 30 and evaluated by a semi-structured interview to evaluate possible health complication due to COVID-19 from February 21 to April 30. Age, sex, education, clinical characteristics (including diagnosis of dementia) and flu vaccination history were obtained from previous medical records. Items regarding change in health status and outcome since the onset of the outbreak were collected. COVID-19 was diagnosed in patients who developed symptoms according to WHO criteria or tested positive at nasal/throat swab if hospitalized. Unplanned hospitalization, institutionalization and mortality were recorded. RESULTS: Patients were 79.7 years old (SD 7.1) and 63.1% were females. Ninety-five (11.2%) patients developed COVID-19-like symptoms. Non COVID-19 and COVID-19 patients differed for frequency of diabetes (18.5% vs. 37.9%, p < 0.001), COPD (7.3% vs. 18.9%, p < 0.001), and previous flu vaccination (56.7% vs. 37.9%, p < 0.001). Diabetes and COPD were positively associated with COVID-19, whereas higher dementia severity and flu vaccination showed an inverse association. Among COVID-19 patients, 42 (44.2%) were hospitalized while 32 (33.7%) died. Non COVID-19 patients' hospitalization and mortality rate were 1.9% and 1.2%, respectively. COVID-19 and COPD were significantly associated with the rate of mortality. DISCUSSION/CONCLUSIONS: A high proportion of adverse outcome related to COVID-19 was observed in home-dwelling elderly patients with dementia. Active monitoring though telehealth programs would be useful particularly for those at highest risk of developing COVID-19 and its adverse outcomes.


Assuntos
Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/mortalidade , Demência/epidemiologia , Demência/mortalidade , Nível de Saúde , Pneumonia Viral/epidemiologia , Pneumonia Viral/mortalidade , Idoso , Betacoronavirus , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Itália/epidemiologia , Masculino , Pandemias
12.
Medicine (Baltimore) ; 99(33): e21711, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32872049

RESUMO

BACKGROUND: This study will investigate the effects of Spore Powder of Ganoderma Lucidum (SPGL) on CaSR and apoptosis-related proteins (ARP) in hippocampus tissue of epilepsy following dementia. METHODS: This study will retrieve all potential studies from both electronic databases (Cochrane Library, EMBASE, MEDLINE, CINAHL, AMED, and CNKI) and other literature sources to assess the effects of SPGL on CaSR and ARP in hippocampus tissue of epilepsy following dementia. We will search all literature sources from the inception to the present. All eligible case-control studies will be included in this study. Two authors will independently carry out literature selection, data collection, and study quality evaluation. Any divergence will be resolved by another author through discussion. RevMan 5.3 software will be employed for data analysis. RESULTS: This study will summarize existing evidence to assess the effects of SPGL on CaSR and ARP in hippocampus tissue of epilepsy following dementia. CONCLUSIONS: The findings of this study may provide helpful evidence of SPGL on CaSR and ARP in hippocampus tissue of epilepsy following dementia. SYSTEMATIC REVIEW REGISTRATION: INPLASY202070041.


Assuntos
Demência/tratamento farmacológico , Medicamentos de Ervas Chinesas/uso terapêutico , Epilepsia/tratamento farmacológico , Hipocampo/efeitos dos fármacos , Reishi , Animais , Demência/complicações , Medicamentos de Ervas Chinesas/farmacologia , Epilepsia/etiologia , Hipocampo/metabolismo , Receptores de Detecção de Cálcio/metabolismo , Revisões Sistemáticas como Assunto
13.
Medicine (Baltimore) ; 99(36): e22141, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899101

RESUMO

The aim of this case-control study was to evaluate the association between chronic rhinosinusitis (CRS) and neurodegenerative dementia in a large representative Korean population. The ≥ 50-year-old population was selected from the Korean Health Insurance Review and Assessment Service - National Sample Cohort from 2002 to 2015. A total of 17,634 neurodegenerative dementia patients were matched in a 1:4 ratio with 70,536 control participants for age, sex, income, and region of residence. Neurodegenerative dementia was defined using the ICD-10 codes G30 and F00. CRS was identified based on the ICD-10 code J32. Among the cohort, we selected participants who were treated ≥ 2 times and those who underwent head and neck computed tomography. The odds ratio (OR) for CRS in patients with dementia was analyzed using a conditional logistic regression model. Subgroup analyses were conducted according to age and sex. There was no difference in the prevalence of CRS with/without nasal polyps between the dementia (1.1%) and control (1.2%) groups (P = .825). CRS with/without nasal polyps was not significantly associated with dementia (adjusted OR = 0.96, 95% CI = 0.82-1.13, P = .653). In the subgroup analyses according to age and sex, the adjusted ORs for CRS with/without nasal polyps were not higher in the dementia group than in the control group. Previous CRS was not associated with neurodegenerative dementia in the Korean population.


Assuntos
Doença de Alzheimer/epidemiologia , Pólipos Nasais/epidemiologia , Sinusite/epidemiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Doença Crônica , Demência/epidemiologia , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , República da Coreia/epidemiologia , Características de Residência , Fatores de Risco , Fatores Sexuais
14.
BMC Geriatr ; 20(1): 333, 2020 09 09.
Artigo em Inglês | MEDLINE | ID: mdl-32900360

RESUMO

BACKGROUND: The lockdown imposed in the UK on the 23rd of March and associated public health measures of social distancing are likely to have had a great impact on care provision. The aim of this study was to explore the decision-making processes of continued paid home care support for dementia in the time of COVID-19. METHODS: Unpaid carers caring for a person living with dementia (PLWD) who were accessing paid home care before COVID-19 and residing in the UK were eligible to take part. Participants were interviewed over the phone and asked about their experiences of using paid home care services before and since COVID-19, and their decision-making processes of accessing paid home care since the outbreak and public health restrictions. RESULTS: Fifteen unpaid carers, who were also accessing paid care support for the PLWD before COVID-19, were included in the analysis. Thematic analysis identified three overarching themes: (1) Risk; (2) Making difficult choices and risk management; and (3) Implications for unpaid carers. Many unpaid carers decided to discontinue paid carers entering the home due to the risk of infection, resulting in unpaid carers having to pick up the care hours to support the person living with dementia. CONCLUSIONS: This is the first study to report on the impact of COVID-19 on paid home care changes in dementia. Findings raise implications for providing better Personal Protective Equipment for paid carers, and to support unpaid carers better in their roles, with the pandemic likely to stay in place for the foreseeable future.


Assuntos
Betacoronavirus , Cuidadores/psicologia , Infecções por Coronavirus/epidemiologia , Demência/terapia , Acesso aos Serviços de Saúde , Serviços de Assistência Domiciliar/economia , Pneumonia Viral/epidemiologia , Idoso , Cuidadores/economia , Demência/economia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pesquisa Qualitativa
15.
N Z Med J ; 133(1522): 18-29, 2020 09 25.
Artigo em Inglês | MEDLINE | ID: mdl-32994613

RESUMO

AIMS: To evaluate how New Zealand newsprint media shapes discourse about dementia through its framing of the causes, effects and solutions, and who bears responsibility for the disease. METHODS: Using New Zealand's three largest daily newspapers, we examined i) the coverage of dementia between 2012-2016, ii) the framing of causes and effects of dementia, and iii) the most frequent associations of causes and effects of dementia. We integrated the findings to assess the moral evaluation of dementia in New Zealand newsprint media. RESULTS: Of the 361 articles extracted all presented effects of dementia, 35% discussed causes and 7% mentioned solutions for dementia. Medical causes dominated over health behavioural and societal causes, and effects were mostly the negative impact on the individual, family and society. Modifiable medical causes were more likely to be associated with adverse outcomes for society whereas non-modifiable medical causes were more likely to be associated with adverse outcomes for the individual and/or their family. CONCLUSIONS: Between 2012-16 New Zealand newsprint media largely portrayed dementia from a 'powerless victim' frame. Further research is required to assess whether, since 2016, there has been a shift towards media framing of dementia as potentially preventable and a social justice issue.


Assuntos
Demência/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Meios de Comunicação de Massa , Opinião Pública , Humanos , Princípios Morais , Nova Zelândia , Estigma Social
16.
N Z Med J ; 133(1522): 112-127, 2020 09 25.
Artigo em Inglês | MEDLINE | ID: mdl-32994621

RESUMO

Dementia is recognised to be one of the most challenging diseases facing society, both now and in the future, with its prevalence estimated to increase substantially by 2050. The potential contributions of age-related sensory deficits have attracted little attention until recently, when a landmark study suggested that hearing loss could be a greater risk factor for dementia than hypertension, obesity, smoking, depression, physical inactivity or social isolation. Over the last decade, evidence has been gradually accumulating to suggest that the other part of the inner ear, the balance organs or 'vestibular system', might also be important in the development of cognitive dysfunction and dementia. Increasing evidence suggests that dizziness associated with vestibular dysfunction, a common reason for patients consulting their GPs, increases the risk of cognitive dysfunction, including dementia, and our understanding of the basic neurobiology of this sensory system supports this view. This paper aims to review and critically evaluate the relevant evidence.


Assuntos
Disfunção Cognitiva , Demência , Tontura , Idoso , Idoso de 80 Anos ou mais , Disfunção Cognitiva/complicações , Disfunção Cognitiva/epidemiologia , Disfunção Cognitiva/fisiopatologia , Demência/complicações , Demência/epidemiologia , Demência/fisiopatologia , Tontura/complicações , Tontura/epidemiologia , Tontura/fisiopatologia , Perda Auditiva , Humanos , Fatores de Risco , Doenças Vestibulares
17.
SEMERGEN, Soc. Esp. Med. Rural Gen. (Ed. Impr.) ; 46(supl.1): 33-41, ago. 2020. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-193115

RESUMO

Las residencias de ancianos han sido especialmente golpeadas durante la crisis por la actual pandemia por COVID-19. En el momento de redactar este artículo son más de 17.500 los ancianos que fallecieron por coronavirus y que vivían en residencias, más de un 66% de las defunciones. Las tasas de contagio y letalidad en la población institucionalizada son altas por la avanzada edad y deficitario sistema inmune, la presencia de comorbilidades, porque se trata de personas frágiles, porque conviven con otros residentes y cuidadores en una institución cerrada y la transmisibilidad es fácil en un contexto de alta contagiosidad y virulencia del virus. Las personas de edad avanzada presentan con mayor frecuencia las formas más graves de la enfermedad. Las presentaciones atípicas son más frecuentes en ancianos y pueden retrasar el diagnóstico. La prueba de reacción en cadena de la polimerasa (PCR) en los primeros 7 días para la detección de RNA viral del SARS-CoV-2 se considera el gold standard. Los criterios de derivación a un centro hospitalario desde los centros residenciales deberían tener en cuenta una valoración de la comorbilidad, la gravedad, la presencia de deterioro cognitivo grave y la dependencia o la necesidad de soporte ventilatorio en pacientes graves. Los centros sociosanitarios deben disponer de planes de contingencia para ofrecer una respuesta ante la aparición de casos de COVID-19. El aislamiento durante las pandemias puede tener importantes consecuencias físicas y psicosociales en los residentes. Se hace necesario reflexionar y reivindicar un nuevo modelo residencial desde un enfoque de atención centrada en la persona que procure la integración de los servicios sanitarios y sociales


Rest homes for the elderly have been particularly hit during the crisis due the current COVID-19 pandemic. At the time of writing this article, more than 17,500 elderly people that lived in Care Homes have died due to coronavirus, more than 66% of the deaths. The infection and mortality rates in the institutionalised population are high. This is due to the advanced age, immune system deficit, and the presence of comorbidities, as well as because there are frail, because they live with other residents and carers in a closed institution, and transmission is easy in the context of a highly contagious and virulent virus. The elderly often have more severe forms of the disease. Atypical presentations are more frequent in the elderly and can delay the diagnosis. The Polymer Chain Reaction (PCR) test in the first 7 days for the detection of SARS-CoV-2 viral RNA is considered the test of reference ('Gold standard'). The criteria for referring to a hospital site from Care Homes should take into account an assessment of comorbidity, the severity, the presence of severe cognitive impairment, and the dependency or necessity of ventilatory support in seriously ill patients. The social-health centres should have contingency plans available in order to offer a response when cases of COVID-19 appear. Isolation during pandemics may have important physical and psychosocial consequences in the residents. It is necessary to reflect and claim a new residential model from a person-centered care approach that seeks the integration of health and social services


Assuntos
Humanos , Idoso , Atenção Primária à Saúde/organização & administração , Instituição de Longa Permanência para Idosos/estatística & dados numéricos , Fragilidade/epidemiologia , Infecções por Coronavirus/epidemiologia , Respiração Artificial/estatística & dados numéricos , Síndrome Respiratória Aguda Grave/diagnóstico por imagem , Pandemias/estatística & dados numéricos , Vírus da SARS/isolamento & purificação , Indicadores de Morbimortalidade , Idoso Fragilizado/estatística & dados numéricos , Controle de Doenças Transmissíveis/métodos , Demência/epidemiologia , Reação em Cadeia da Polimerase/estatística & dados numéricos , Síndrome Respiratória Aguda Grave/epidemiologia
18.
Actas esp. psiquiatr ; 48(4): 169-180, jul.-ago. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-193805

RESUMO

OBJETIVO: Realizar un meta-análisis actualizado de estudios prospectivos que evalúen la asociación entre la depresión y el riesgo de demencia. METODOLOGÍA: Se realizó una búsqueda bibliográfica en Pubmed para identificar estudios publicados desde enero de 2014 hasta marzo del 2019. Se seleccionaron estudios prospectivos con seguimiento mínimo de 1 año; evaluación de la depresión y ausencia de demencia y deterioro cognitivo leve (DCL) al inicio del estudio. Calculamos el riesgo relativo combinado (RR) mediante un modelo de efectos aleatorios, y la fracción de demencia poblacional atribuible (FAP) a la depresión. RESULTADOS: Ocho cohortes fueron incluidas. Obtuvimos una asociación estadísticamente significativa entre la depresión y el riesgo de demencia, con un RR global de 1,63 (IC 95%: 1,30-2,04), y una FAP de 9,0% (IC 95%: 4,5%-14,1%). CONCLUSIONES: La depresión se asocia con un aumento de riesgo de demencia en este meta-análisis


BACKGROUND. Our primary aim was to conduct an up-date meta-analysis of prospective studies investigating the association between depression and dementia risk. METHODS: We searched Pubmed database to identify all relevant papers published from January 2014 to March 2019. Prospective studies with a minimum follow-up period of 1 year, baseline depression assessment, absence of dementia or mild cognitive impairment at baseline were selected. We calculated pooled relative risks (RR), with a random effect model, as well as compute population attributable fraction (PAF) of dementia due to depression. RESULTS. Eight cohorts were included. A statistically significant association between depression and dementia risk, with a pooled RR of 1.63 (95% CI: 1.30-2.04), and a PAF of 9.0% (95% CI: 4.5%-14.1%), were found. CONCLUSIONS: Depression is associated with an increased risk of dementia in this meta-analysis


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Depressão/psicologia , Demência/psicologia , Estudos Prospectivos , Fatores de Risco
19.
Medicine (Baltimore) ; 99(31): e21412, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756140

RESUMO

We examine the relationship between dementia and psychiatric disorder diagnoses among long-term care residents in nursing homes across the state of Rhode Island (RI), USA.Observational clinical study.Two hundred fifty-five residents with and without the diagnosis of dementia were included in this study.Prevalence analysis was used to elucidate information on psychiatric disorders in the overall cohort, and among residents with dementia. Questions from the quality of life questionnaire (EQ-5D-3L) that provides information on self-care, anxiety/depression, and resident's view of how healthy they are, were used to evaluate their association with dementia and psychiatric disorders. A logistic regression analysis was conducted to understand the relationship between dementia and mental illness diagnoses in long-term care facilities. Finally, a subgroup logistic regression analysis was performed for residents with Alzheimer disease.65.1% of all residents suffered from at least 1 psychiatric disorder. Anxiety was the most common diagnosis (36.5%), followed by depression (28.6%), and insomnia (14.9%). There was a positive and statistically significant association between any mental illness diagnosis and dementia (adjusted OR: 3.73; 95% CI: 1.34-10.41). Bipolar disorder and insomnia were negatively and statistically significantly associated with dementia (adjusted OR: 0.17; 95% CI: 0.03-0.89 AND adjusted OR: 0.39; 95% CI: 0.16-0.96 respectively). Age and COPD were also statistically associated with dementia (adjusted OR: 1.07; 95% CI: 1.03-1.11 AND adjusted OR: 0.28, 95% CI: 0.12-0.66). Alzheimer disease was positively and significantly associated with the diagnosis of any mental illness (adjusted OR: 3.77; 95% CI: 1.17-12.20).We studied the relationship between dementia and diagnoses of psychiatric disorders present in long-term care residents. We found that residents with a diagnosis of dementia were more likely to suffer from at least 1 psychiatric disorder. Further work is needed to establish the neuropathophysiological relationship between psychiatric disorders and dementia.


Assuntos
Demência/psicologia , Transtorno Depressivo/psicologia , Assistência de Longa Duração , Idoso , Idoso de 80 Anos ou mais , Demência/complicações , Transtorno Depressivo/complicações , Feminino , Humanos , Masculino , Psicometria , Rhode Island , Inquéritos e Questionários
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