Neuropsychological rehabilitation of memory deficits and activities of daily living in patients with Alzheimer's disease: a pilot study

Patients with Alzheimer's disease (AD) gradually lose their cognitive competence, particularly memory, and the ability to perform daily life tasks. Neuropsychological rehabilitation is used to improve cognitive functions by facilitating memory performance through the use of external aids and internal strategies. The effect of neuropsychological rehabilitation through memory training - motor movements, verbal association, and categorization - and activities of daily living (ADL) training was tested in a sample of 5 elderly out-patients (mean age: 77.4 ± 2.88 years), with mild AD (Mini-Mental State Examination score: 22.20 ± 2.17) and their caregivers. All patients had been taking rivastigmine (6-12 mg/day) for at least 3 months before being assigned to the rehabilitation sessions, and they continued to take the medication during the whole program. Just before and after the 14-week neuropsychological rehabilitation program all patients were assessed by interviewers that did not participate in the cognitive training, using the Mini-Mental State Examination, Montgomery-Alsberg Depression Rating Scale, Hamilton Anxiety Scale, Interview to Determine Deterioration in Functioning in Dementia, Functional Test, Memory Questionnaire of Daily Living for patient and caregiver, Quality of Life Questionnaire for patient and caregiver, and a neuropsychological battery. The results showed a statistically significant improvement in ADL measured by Functional Test (P = 0.04), and only a small improvement in memory and psychiatric symptoms. Our results support the view that weekly stimulation of memory and training of ADL is believed to be of great value in AD treatment, not only delaying the progress of the disease, but also improving some cognitive functions and ADL, even though AD is a progressively degenerative disease.

Operacao cesariana em Recife em 1979: incidencia e mortalidade materna. / Cesarean section in Recife during 1979: incidence and maternal death rate

Em 19 maternidades da cidade do Recife (Pernambuco, Brasil), em 1979, houve um total de 12 156 cesarianas (incidencia de 28,1%) e 30 953 partos vaginais. A mortalidade materna na operacao cesariana, foi de 3,3 por 1 000.Nas pacientes indigentes, foram realizadas 2 327 cesarianas (incidencia de 11,2%) e 18 414 partos vaginais. A mortalidade materna na operacao cesariana foi de 9 por 1 000. Nas pacientes do INAMPS, foram realizadas 5621 cesarianas (incidencia de 35,4%) e 10226 partos vaginais. A mortalidade materna na operacao cesariana foi de 3 por 1000. Nas pacientes previdenciarias estaduais e militares, foram realizadas 444 cesarianas (incidencia de 42,6%) e 596 partos vaginais. A mortalidade materna na operacao cesariana foi de 2,2 por 1 000. Nas pacientes de clinica particular, foram realizadas 3 764 cesarianas (incidencia de 67,7%) e 1 717 partos vaginais A mortalidade materna na operacao cesariana foi de 0,5 por 1 000. As causas mais frequentes de mortalidade materna foram: hemorragia, eclampsia, infeccao e embolia amniotica. No global, a mortalidade materna na operacao cesariana foi 6,13 vezes maior do que no parto vaginal