La ment forma part de la teva vida, apr��n a cuidar-la!

L���objectiu d���aquest estudi ��s crear un programa de prevenci�� de la dem��ncia a partir d���activitats i ocupacions significatives. S���utilitzar�� la metodologia quantitativa i es realitzar�� un estudi experimental i seq��encial. L���estudi es realitzar�� al medi rural, concretament a Ripoll (Sant Bernab��). Per tal de poder obtenir la els participants per la realitzaci�� de l���estudi s���utilitzar�� el mostreig aleatori estratificat amb el qual s���obtindr�� dos grups de 16 persones de 50 a 55 anys. Els instruments que s���utilitzaran per tal de poder obtenir les dades de l���estudi s��n el ���Q��estionari internacional d���activitat f��sica��� (2002), la bateria neuropsicol��gica anomenada ���Test de Barcelona abreviat��� (1997), ���L���escala de qualitat de vida��� (2008), i per acabar s���utilitzar�� el ���Test KIMED��� (2004). Una primera limitaci�� pot ser que l���ajuntament no ens faciliti les dades per tal de poder realitzar el mostreig aleatori estratificat per tal de poder aconseguir la mostra. Tamb�� pot ser que l���ajuntament no cedeixi el lloc per tal de poder realitzar la intervenci��. Un altre possible limitaci�� pot ser el temps atmosf��ric. I per acabar tamb�� ens podem torbar amb l���abandonament del programa per part d���un o m��s participants.

Un programa psicosocial: programa psicoestimulatiu integral (P.P.I.) amb persones afectades de malaltia d' Alzheimer

L'any 2011 la malaltia d'Alzheimer es situava com la quarta causa de mort m��s freq��ent amb un augment de fins a 11.907, m��s del doble de morts que l'any 2000 (INE). Aquestes dades demostren l'augment del n��mero de persones que pateixen una dem��ncia a mesura que envelleixen i una de les explicacions ��s l'augment de l'esperan��a de vida. Per aquest motiu l'estudi de la qualitat de vida ha adquirit una gran import��ncia des de la d��cada dels 90. La qualitat de vida ��s un concepte especialment subjectiu pel fet que cada persona la viu segons la pr��pia percepci�� de salut i benestar i el grau d'adaptaci�� a l'entorn que l'envolta. Per aquest motiu es planteja un programa de psicoestimulaci�� integral (PPI) centrat en les individualitats de cada persona: valors, interessos, hist��ria ocupacional..., des de la filosofia de la Ter��pia Ocupacional. El projecte est�� elaborat mitjan��ant la metodologia qualitativa utilitzant l'enquesta en profunditat semi-estructurada per a realitzar les entrevistes i obtenir la informaci�� principal a l'inici i al final del programa juntament amb tota la informaci�� que s'obtingui de l'observaci�� participant del dia a dia de cada un dels professionals per tal d'estudiar fins a quin punt aquesta atenci�� centrada en la persona contribueix a millorar la qualitat de vida de les persones afectades de Malaltia d'Alzheimer que reben tractaments no farmacol��gics com el proposat en aquest projecte. Com a tot estudi es poden trobar alguns factors condicionants com pot ser l'evoluci�� pr��pia de la malaltia amb les conseq����ncies negatives que aix�� comporta i/o el n��mero de participants que formen la mostra.

On Automatic Diagnosis of Alzheimer's Disease based on Spontaneous Speech Analysis and Emotional Temperature

Alzheimer's disease is the most prevalent form of progressive degenerative dementia; it has a high socio-economic impact in Western countries. Therefore it is one of the most active research areas today. Alzheimer's is sometimes diagnosed by excluding other dementias, and definitive confirmation is only obtained through a post-mortem study of the brain tissue of the patient. The work presented here is part of a larger study that aims to identify novel technologies and biomarkers for early Alzheimer's disease detection, and it focuses on evaluating the suitability of a new approach for early diagnosis of Alzheimer���s disease by non-invasive methods. The purpose is to examine, in a pilot study, the potential of applying Machine Learning algorithms to speech features obtained from suspected Alzheimer sufferers in order help diagnose this disease and determine its degree of severity. Two human capabilities relevant in communication have been analyzed for feature selection: Spontaneous Speech and Emotional Response. The experimental results obtained were very satisfactory and promising for the early diagnosis and classification of Alzheimer���s disease patients.

Alzheimer disease diagnosis based on automatic spontaneous speech analysis

Alzheimer���s disease (AD) is the most prevalent form of progressive degenerative dementia and it has a high socio-economic impact in Western countries, therefore is one of the most active research areas today. Its diagnosis is sometimes made by excluding other dementias, and definitive confirmation must be done trough a post-mortem study of the brain tissue of the patient. The purpose of this paper is to contribute to im-provement of early diagnosis of AD and its degree of severity, from an automatic analysis performed by non-invasive intelligent methods. The methods selected in this case are Automatic Spontaneous Speech Analysis (ASSA) and Emotional Temperature (ET), that have the great advantage of being non invasive, low cost and without any side effects.

Anticonvulsants in the treatment of aggression in the demented elderly: an update

Complex psychopathological and behavioral symptoms, such as delusions and aggression against care providers, are often the primary cause of acute hospital admissions of elderly patients to emergency units and psychiatric departments. This issue resembles an interdisciplinary clinically highly relevant diagnostic and therapeutic challenge across many medical subjects and general practice. At least 50% of the dramatically growing number of patients with dementia exerts aggressive and agitated symptoms during the course of clinical progression, particularly at moderate clinical severity. METHODS: Commonly used rating scales for agitation and aggression are reviewed and discussed. Furthermore, we focus in this article on benefits and limitations of all available data of anticonvulsants published in this specific indication, such as valproate, carbamazepine, oxcarbazepine, lamotrigine, gabapentin and topiramate. RESULTS: To date, most positive and robust data are available for carbamazepine, however, pharmacokinetic interactions with secondary enzyme induction limit its use. Controlled data of valproate do not seem to support the use in this population. For oxcarbazepine only one controlled but negative trial is available. Positive small series and case reports have been reported for lamotrigine, gabapentin and topiramate. CONCLUSION: So far, data of anticonvulsants in demented patients with behavioral disturbances are not convincing. Controlled clinical trials using specific, valid and psychometrically sound instruments of newer anticonvulsants with a better tolerability profile are mandatory to verify whether they can contribute as treatment option in this indication.

Anticonvulsants in the treatment of aggression in the demented elderly: an update

Complex psychopathological and behavioral symptoms, such as delusions and aggression against care providers, are often the primary cause of acute hospital admissions of elderly patients to emergency units and psychiatric departments. This issue resembles an interdisciplinary clinically highly relevant diagnostic and therapeutic challenge across many medical subjects and general practice. At least 50% of the dramatically growing number of patients with dementia exerts aggressive and agitated symptoms during the course of clinical progression, particularly at moderate clinical severity. METHODS: Commonly used rating scales for agitation and aggression are reviewed and discussed. Furthermore, we focus in this article on benefits and limitations of all available data of anticonvulsants published in this specific indication, such as valproate, carbamazepine, oxcarbazepine, lamotrigine, gabapentin and topiramate. RESULTS: To date, most positive and robust data are available for carbamazepine, however, pharmacokinetic interactions with secondary enzyme induction limit its use. Controlled data of valproate do not seem to support the use in this population. For oxcarbazepine only one controlled but negative trial is available. Positive small series and case reports have been reported for lamotrigine, gabapentin and topiramate. CONCLUSION: So far, data of anticonvulsants in demented patients with behavioral disturbances are not convincing. Controlled clinical trials using specific, valid and psychometrically sound instruments of newer anticonvulsants with a better tolerability profile are mandatory to verify whether they can contribute as treatment option in this indication.

Factores de riesgo psicosocial y personalidad prem��rbida en enfermos con demencia: un estudio de casos y controles

Objetivos: Explorar los factores de riesgo no-biol��gicos para las demencias, plantear probables perfiles de riesgo para la enfermedad de Alzheimer y sugerir elementos para un posible desarrollo de intervenciones preventivas. Metodolog��a: Se administr�� un cuestionario sobre eventos vitales y factores de personalidad, elaborado espec��ficamente, a un grupo de enfermos (108 personas con demencia) y un grupo control (49 personas mayores sin demencia), identificando las diferencias significativas con un nivel alfa de 0.05 para todas las pruebas estad��sticas. Resultados: Como probables factores de riesgo para la enfermedad de Alzheimer se��alar: 1) Aspectos ps��quicos: mayor n��mero de trastornos ps��quicos familiares graves y mayor respuesta psicosom��tica personal; 2) Aspectos familiares: mayor n��mero de muertes precoces del padre y estilo educativo m��s dominante; 3) Educaci��n y trabajo: menor nivel educativo y menor cualificaci��n en el trabajo; 4) Eventos vitales: mayor problem��tica familiar; 5) Factores de personalidad seg��n el criterio de los cinco grandes: Energ��a (Evitaci��n, dependencia general y de relaci��n e inhibici��n), Afabilidad (Introversi��n), Estabilidad emocional (Afectaci��n, pesimismo e impulsividad), Apertura mental (Indiferencia y rigidez). Conclusiones: Destacar la relevancia del porcentaje de muertes precoces del padre y el d��ficit de personalidad en el factor I (Energ��a): Imitaci��n, evitaci��n y dependencia. Como posibles medidas de prevenci��n se sugieren intervenciones que potencien la autonom��a personal, la capacidad de afrontamiento y la relaci��n social. Palabras clave: Alzheimer, Demencia, Factores de riesgo, Personalidad prem��rbida, Psicosocial

EEG Windowed statitical wavelet deviation for estimation of muscular artifacts

Electroencephalographic (EEG) recordings are, most of the times, corrupted by spurious artifacts, which should be rejected or cleaned by the practitioner. As human scalp EEG screening is error-prone, automatic artifact detection is an issue of capital importance, to ensure objective and reliable results. In this paper we propose a new approach for discrimination of muscular activity in the human scalp quantitative EEG (QEEG), based on the time-frequency shape analysis. The impact of the muscular activity on the EEG can be evaluated from this methodology. We present an application of this scoring as a preprocessing step for EEG signal analysis, in order to evaluate the amount of muscular activity for two set of EEG recordings for dementia patients with early stage of Alzheimer���s disease and control age-matched subjects.

Alzheimer Disease Diagnosis based on Automatic Spontaneous Speech Analysis

Alzheimer���s disease (AD) is the most prevalent form of progressive degenerative dementia and it has a high socio-economic impact in Western countries, therefore is one of the most active research areas today. Its diagnosis is sometimes made by excluding other dementias, and definitive confirmation must be done trough a post-mortem study of the brain tissue of the patient. The purpose of this paper is to contribute to improvement of early diagnosis of AD and its degree of severity, from an automatic analysis performed by non-invasive intelligent methods. The methods selected in this case are Automatic Spontaneous Speech Analysis (ASSA) and Emotional Temperature (ET), that have the great advantage of being non invasive, low cost and without any side effects.

Calidad de vida global en personas con demencia

Objetivo: Evaluar la calidad de vida (CV) global en personas con demencia e investigar las variables asociadas con la percepci��n subjetiva de la CV. Pacientes y m��todos: Se llev�� a cabo un estudio transversal en seis centros de Barcelona y Tarragona. Un total de 99 personas con demencia leve-moderada que viv��an en casa con un cuidador conocido completaron una entrevista cara-cara que inclu��a informaci��n sociodemogr��fica, percepci��n del estado de salud, un listado de problemas cr��nicos de salud, sintomatolog��a depresiva, estado funcional, aspectos positivos, sentido de la vida y satisfacci��n con las relaciones personales. La CV global se evalu�� con la pregunta global del World Health Organization Quality of Life-BREF. Resultados: El 40,6% de los entrevistados consider�� su CV como buena/muy buena. Los an��lisis univariados de regresi��n log��stica ordinal y binaria no mostraron asociaci��n entre CV con datos sociodemogr��ficos, gravedad de la demencia ni estado funcional, pero s�� con las otras variables de estudio. Los an��lisis multivariados de la regresi��n log��stica ordinal y binaria mostraron que una mejor percepci��n de salud y mayor satisfacci��n con las relaciones personales se asociaban con mejor CV. Asimismo, en el an��lisis multivariado de regresi��n log��stica ordinal, mejor CV se asoci�� con un menor n��mero de s��ntomas depresivos, y en el an��lisis de regresi��n log��stica binaria, con disfrutar de la vida y menor gravedad de la demencia. Conclusiones: Personas con demencia leve-moderada pueden informar sobre su CV y estados subjetivos. Adem��s de los aspectos relacionados con la salud, aspectos positivos y las relaciones personales deber��an evaluarse sistem��ticamente en esta poblaci��n.

Atenci�� a l'ictus agut: comparaci�� del sistema catal�� amb el sistema finland��s

L���ictus ��s un problema de salut p��blica on les malalties cerebrovasculars representen la tercera causa de mort del nostre pa��s, la primera causa de discapacitat f��sica en adults i la segona de dem��ncia. Segons la OMS es preveu que la malaltia cerebrovascular s��� incrementi un 27% en relaci�� a l���envelliment de la poblaci�� entre els anys 2000 i 2025Objectius: Con��ixer i comparar l���atenci�� i la organitzaci�� de les persones afectades per ictus a Catalunya i a Finl��ndia, espec��ficament a l���Hospital Universitari Doctor Josep Trueta (Girona) i a l���Hospital Universitari de Kuopio (Finl��ndia) Metodologia: Estudi observacional quantitatiu i qualitatiu que compara les diferents atencions a la fase pre-hospital��ria, hospital��ria i sub-aguda a Girona (Catalunya) i a Kuopio (Finl��ndia). S���han estudiat variables relacionades amb l���atenci�� pre-hospital��ria, hospital��ria i post-hospital��ria espec��ficament, s���han estudiat variables relacionades amb cures d���infermeria. S���han realitzat t��cniques qualitatives utilitzant la observaci�� directa en els dos centres estudiats, i t��cniques quantitatives mitjan��ant un q��estionari als responsables d���infermeria

Feature selection for automatic analysis of emotional response based on nonlinear speech modeling suitable for diagnosis of Alzheimer��s disease

Alzheimer��s disease (AD) is the most common type of dementia among the elderly. This work is part of a larger study that aims to identify novel technologies and biomarkers or features for the early detection of AD and its degree of severity. The diagnosis is made by analyzing several biomarkers and conducting a variety of tests (although only a post-mortem examination of the patients��� brain tissue is considered to provide definitive confirmation). Non-invasive intelligent diagnosis techniques would be a very valuable diagnostic aid. This paper concerns the Automatic Analysis of Emotional Response (AAER) in spontaneous speech based on classical and new emotional speech features: Emotional Temperature (ET) and fractal dimension (FD). This is a pre-clinical study aiming to validate tests and biomarkers for future diagnostic use. The method has the great advantage of being non-invasive, low cost, and without any side effects. The AAER shows very promising results for the definition of features useful in the early diagnosis of AD.

El modelo de la Atenci��n Centrada en la Persona: An��lisis descriptivo de una muestra de personas mayores con demencia en centros residenciales

Este an��lisis descriptivo tiene el objetivo de evaluar la calidad asistencial de una muestra de personas con demencia institucionalizadas usando el Dementia Care Mapping (DCM) como metodolog��a de observaci��n sistem��tica y de examinar la presencia de pautas asociadas a la psicolog��a social maligna en las residencias observadas. Participaron en el estudio 73 personas con demencia ingresadas en residencias a largo plazo. Los resultados m��s relevantes apuntan a la presencia de una cultura de cuidados donde predomina la psicolog��a social maligna y el DCM como un instrumento que permite analizar el comportamiento de las personas con demencia, aportando nuevas variables como el bienestar emocional, la diversidad ocupacional y la calidad de la interacci��n social. Se concluye que la implementaci��n de un modelo de atenci��n centrado en la persona puede incidir postivamente en el bienestar de las personas con demencia.

Hipertensi��n arterial y enfermedad de Alzheimer

Hypertension (HT) is the most prevalent cardiovascular risk factor associated with dementia and Alzheimer disease (AD). The evidence about the association within hight blood pressure (BP) level in the middle age and dementia and Alzheimer���s disease incidence in the advanced age has increased. Longitudinal studies show that in the previous years of onset AD, BP is similar or lower in the patients who develop AD with regard to those who not develop. When patients has developed AD the case is the same that the previous one. Most studies show that BP reduction is beneficious to prevent cognitive impairment, dementia and AD. Is spite of some discordant studies, health authorities recommend to treat isolated systolic HT with an ���A��� evidence degree, level 1, to prevent AD. Animal experimentation prove different ways to act of antihypertensive drugs in the AD prevention and has established the pathophysiological bases in this relation, until now only showed through various clinical studies

Experi��ncia dels cuidadors i les cuidadores principals informals que tenen cura d'un familiar vell amb dem��ncia des de fa m��s de quatre anys

El treball que es presenta vol respondre la pregunta de quina ��s l���experi��ncia dels cuidadors i les cuidadores principals informals que tenen cura d���un familiar vell amb dem��ncia des de fa m��s de 4 anys. Despr��s de plantejar les hip��tesis de partida, es defineixen els objectius generals i espec��fics i s���expliquen l���inter��s, la justificaci��, la rellev��ncia i l���aportaci�� d���aquest estudi. En l���apartat corresponent a l���estat de la q��esti�� i la fonamentaci�� conceptual, despr��s de fer una revisi�� bibliogr��fica, es descriuen els elements que formen part d���aquesta tem��tica: perfils dels receptors de cures i de les cuidadores, significat de tenir cura, vida quotidiana i qualitat de vida i descripci�� del model conceptual de Virginia Henderson. En el cap��tol seg��ent s���exposen la metodologia, el paradigma i el m��tode d���investigaci�� utilitzats en aquest treball, aix�� com les matrius d���an��lisi del contingut i del discurs. A partir d���aqu�� s���exposen els resultats en funci�� dels objectius plantejats. En la discussi��, s���analitzen i s���interpreten les dades obtingudes i es contraposen amb altres estudis, a m��s de fer-se una reflexi�� personal sobre els aprenentatges adquirits i una proposta de l��nies de treball futures. A continuaci�� s���exposen unes conclusions per resumir la informaci�� obtinguda. En la secci�� de refer��ncies bibliogr��fiques es detallen les fonts consultades, i en els annexos hi consten els models d���entrevista i de matriu per a l���an��lisi de dades, el full de consentiment informat, aix�� com el buidatge i l���an��lisi de les entrevistes.