Atividade física e sintomas depressivos em cuidadores de idosos com demência de Alzheimer

The Alzheimer's dementia (AD) is a chronic, neurodegenerative and progressive disorder, characterized by cognitive decline, affecting brain functions like memory, reasoning and communication, occurrence of behavioral disturbances and difficulty in performing activities of daily living (ADLs). These conditions lead to patient’s dependence, which can cause depressive symptoms in caregivers, due to physical and mental burden caused by of the difficulties of the act of caring. Whereupon, it became necessary to find strategies to improve the caregivers’ quality of life. An interesting hypothesis is that physical activity can be considered a non-pharmacological alternative in reducing depressive symptoms, being an important factor for maintaining the physical and mental well-being of the general population, especially on positive changes in mood and social interaction. This study aimed to analyze the effects of a physical activity protocol on depressive symptoms and burden of caregivers of patients with AD. This experimental study, of longitudinal character, comprised a sample of 19 caregivers, of both genders, divided into two groups: a) intervention group – IG (10 caregivers who participated in a physical activity protocol) and b) control group – CG (9 caregivers who didn’t participate in the physical activity protocol). This protocol, which worked the components of functional ability and social interaction of participants, was held three times a week, being 48 sessions of 60 minutes each, for 16 weeks. Data collect was performed at pre and post-intervention for both groups. The assessment instruments used were: a) Zarit Burden Interview, b) Hospital Anxiety and Depression Scale (HAD) and c) battery of motor tests of the American Alliance for Health Physical Education Recreation and Dance (AAHPERD). Nonparametric statistics was used, with intra-group comparison by Wilcoxon test... (Complete abstract click electronic access below)

Equilíbrio, funções executivas e quedas de idosos com demência de Alzheimer: um estudo longitudinal

Falls among older people is a major clinical problem due to its high incidence, with consequent implications for the health and care costs. Elderly patients with dementia of Alzheimer type (AD) are more susceptible to falls due to the impairment of executive functions and gait, with the risk of falls 3 times higher than non-demented elderly. This study used a longitudinal design and aimed to analyze the effects of a regular and systematized physical activity program on the frequency of falls in patients with AD. Additionally, we aimed to correlate the frequency of falls with the executive functions and equilibrium, after and before the physical activity program. The study included 21 patients with clinical diagnosis of AD, divided into two groups: control group (CG), composed of 11 subjects not engaged in any systematized physical activity and training group (TG): 10 seniors who participated in the Cinesioterapia Functional and Cognitive in Elderly with Alzheimer's disease program (PRO-CDA). The physical activity program lasted four months, with weekly frequency of three times, with each session lasting 60 minutes. Were administered the Mini-Mental State Examination (MMSE) to assess cognitive functioning and global score of the Clinical Dementia Rating (CDR) to classify the severity of dementia. For the evaluation of executive functions were used the Clock Drawing Test (TDR) and Frontal Assessment Battery (FAB). In addition, we used the Functional Balance Scale, Berg test (EEFB) and Timed Up-and-Go (TUG) to assess the equilibrium and risk of falls. Falls were recorded by means of a questionnaire, which included the number of falls in the last four months. Analyzing the results, it was observed that TG obtained significant improvements in equilibrium and in executive functions, highlighting the beneficial effects of physical activity in these variables... (Complete abstract click electronic access below)

Efeito do treinamento com pesos nos distúrbios do sono e na qualidade de vida de pacientes com demência de Alzheimer

The Alzheimer's dementia (AD) is the most prevalent form of dementia in the elderly. Among the harmful changes arising from the DA, there may be sleep disturbance and impaired quality of life. Physical activity is an important non-pharmacological feature that would provide positive effects for the treatment of disease. However, there are still few studies that clarify the effects of resistance training in this population. Thus, the present study has as objective analyzes the effects of the resistance training in sleep disturbance and quality of life of patients with AD. Participated in this study 22 patients with clinical diagnosis of AD divided into two groups: Training Group (TG) and Social Interaction Group (SIG). The subjects of TG underwent a resistance training protocol, appropriate to the individual conditions, during three days no consecutive in the week, with duration of 60 minutes each session, for 16 weeks. The SIG won't participate in any systematized physical activity, but they realized other activities, such as reading, poetry, hiking and painting, among others. This protocol also was realized three times in week for 16 weeks, with duration of 60 minutes each session. Both groups were assessed at the beginning of the program and after 16 weeks. For the assessment of sleep disturbance was used the Mini Sleep Questionnaire and to assess of quality of life was used the Scale for Assessment of Quality of Life in Alzheimer's disease (QL), versions: patient, caregiver, family and the final score. Due to the scalar nature of the data and small sample, all variables were analyzed by nonparametric statistics. The U-Mann Whitney test, Wilcoxon test and Spearman correlation test was used, except for the Modified Baecke... (Complete abstract click electronic access below)

Structural and vibrational study of 8-hydroxyquinoline-2-carboxaldehyde isonicotinoyl hydrazone: a potential metal-protein attenuating compound (MPAC) for the treatment of Alzheimer's disease

A comprehensive structural and vibrational study of the potential metal-protein attenuating compound 8-hydroxyquinoline-2-carboxaldehyde isonicotinoyl hydrazone is reported. X-ray diffraction data, as well as FT-IR and Raman frequencies, were compared with the respective theoretical values obtained from DFT calculations. Theory agrees well with experiment. In this context, an attempt of total assignment concerning the FT-IR and Raman spectra of the title compound was performed, shedding new light on previous partial assignments published elsewhere.

Intervenção das estruturas residenciais no diagnóstico e acompanhamento de doentes de alzheimer

O envelhecimento traz consigo alguns défices cognitivos que podem levar á demência. Um dos tipos de demência mais comum é a doença de Alzheimer e, atualmente, as Estruturas Residenciais (ER) são um tipo de resposta social para acolher este tipo de utentes. O objetivo da investigação foi compreender a intervenção das Estruturas Residenciais no diagnóstico e acompanhamento de doentes de Alzheimer. Para tal, através de uma metodologia qualitativa, foram selecionadas por conveniência quatro Estruturas Residenciais do distrito de Leiria e realizou-se uma entrevista com guião semi-estruturado e um inquérito por questionário às suas diretoras técnicas. Conclui-se que, apesar das adaptações realizadas ao longo dos anos, o ambiente físico das instituições em estudo não está adaptado a utentes com este tipo de patologia. No que concerne aos recursos humanos, existe a necessidade de mais técnicos especializados e, apesar do rácio das Auxiliares de Ação Direta (AAD) estar de acordo com o exigido pela Segurança Social, existe falta de formação das mesmas. Notou-se que são realizadas fichas de avaliação diagnóstica inicial no entanto, ainda há evidentes dificuldades no cumprimento dos Planos Individuais (PI). As atividades de estimulação/ocupação não são planeadas em específicos para utentes com a doença de Alzheimer e apesar da falta de formação/informação das famílias em relação à patologia evidencia-se que estão cada vez mais presentes. Perspetiva-se para o futuro a existência de instituições mais adaptadas para acolher este tipo de utentes.

A Sobrecarga do Cuidador Informal do Doente de Alzheimer

Atualmente, é fundamental refletirmos sobre o impacto da doença de Alzheimer, dado que se trata de uma patologia neurodegenerativa com grande repercussõesquer nas funções intelectuais dos doentes e que afeta o seu dia-a-dia,quer na dinâmica do seu núcleo familiar. Deste modo, a rede de suporte formal e informal é crucial no que diz respeito à prestação de cuidados. São os familiares que se responsabilizam por essa tarefa que face ao caráter ininterrupto pode causar desgaste da saúde física e psicológica do cuidador. A sobrecarga carateriza-se pela soma dos problemas psicológicos, físicos e emocionais, sociais e financeiros, todos eles inerentes à prestação informal de cuidados. Este trabalho que tem como objetivo principal a avaliação do benefício/impacto físico, emocional, social e da saúde mental de um programa de grupo de suporte em cuidadores informais de doentes portadores da doença de Alzheimer.É crucial acompanhar o progresso do grupo de suporte, a evolução dos cuidadores informais e a sua capacidade de se manterem satisfeitos neste gruponos dois papéis: cuidador e pessoa. Os métodos utilizados para recolher estes dados foram um questionário sociodemográfico, a SCL-90-R para avaliar a sintomatologia e o Questionário de Avaliação de Sobrecarga do Cuidador Informal. Os resultados sugerem que o programa grupo de suporte altera a vida dos cuidadores informais, uma vez que estes, após o frequentarem, sentem menor sobrecarga nos aspetos da vida pessoal. No entanto, apesar dos progressosna vida pessoal dos cuidadores,estes não se sentem satisfeitos com a tarefa de cuidar. A sobrecarga de trabalho e suas exigências tornam o cuidador mais insatisfeito com as tarefas que está a exercer, uma vez queestas são vistas de forma negativa pelo mesmo. Pretende-se que o cuidador se sinta satisfeito, na medida do possível,nos dois papéis: no seu papel de cuidador e familiar.Este último motiva-o para a responsabilização social e pessoal, uma vez que sendo uma obrigação, esta pode ser feita de forma conformada.

Diminuição da expressão dos genes APP e CP em doentes de Alzheimer sugere alteração da exportação de ferro celular nesta demência

Recentemente tem-se assistido a um acumular de evidência sugerindo a implicação de uma desregulação do metabolismo do ferro (Fe) na fisiopatologia da doença de Alzheimer (DA). Neste trabalho, pretendemos esclarecer melhor os mecanismos moleculares subjacentes à homeostasia deste metal na DA, particularmente ao nível do efluxo celular. Assim, mediu-se em células mononucleares do sangue periférico de 73 doentes com DA e 74 controlos a expressão de genes diretamente envolvidos na regulação e exportação celular de Fe, utilizando a técnica de PCR quantitativo. Os resultados mostraram uma diminuição significativa na expressão dos genes aconitase (ACO1; P=0,007); ceruloplasmina (CP; P<0,001) e proteína precursora de beta amilóide (APP; P=0,006) em doentes com DA comparativamente com os voluntários saudáveis. Estas observações apontam para uma diminuição significativa da expressão dos genes associados com a exportação de Fe celular mediada pela ferroportina na DA. Assim, o presente estudo reforça resultados anteriores que mostram alterações no metabolismo do Fe e podem estar na origem da retenção intracelular deste metal e aumento de stress oxidativo caraterísticos desta patologia.

A doença de Parkinson e as suas implicações na saúde oral

Dissertação para obtenção do grau de Mestre no Instituto Superior de Ciências da Saúde Egas Moniz

Estudos de vias sintéticas catalíticas para benzociclo-alcanois e análogos: potenciais fármacos para doença de Alzhjeimer

A doença de Alzheimer constitui uma ameaça significativa a nível mundial. Estima-se que, mundialmente existam cerca de 35 milhões de pessoas afetadas por este tipo de demência. Os compostos contendo um esqueleto benzocicloalcanol (que incluem benzofuranos e di-hidrobenzofuranóis) mostram atividades biológicas significativas e possuem muito potencial no tratamento das doenças neurodegenerativas. Nos últimos anos têm havido avanços significativos no campo das reações catalisadas por metais. As reações de adição nucleófila intramolecular e a de Heck intramolecular constituem metodologias importantes para a síntese de benzocicloalcanóis. No âmbito deste trabalho, pretendia-se sintetizar uma biblioteca de compostos contendo um esqueleto benzocicloalcanol. A estratégia adotada para a síntese de dihidrobenzofuranóis envolveu um método de ciclização catalítica de cetonas aril-éteres e para a síntese de benzofuranos, um método de ciclização catalítico de enoatos e enamidas (amidas de Weinreb). Várias condições foram estudadas; Abstract: Studies on Synthetic Catalytic Pathways to Benzocycloalkanols and Derivatives – Potential Drugs for Alzheimer’s Disease Alzheimer's disease constitutes a significant threat worldwide. It is estimated that are about 35 million people worldwide suffering from this type of dementia. The compounds containing a benzocycloalkanol scaffold (including benzofurans and dihydrobenzofurans) show significant biological activity and have great potential in the treatment of neurodegenerative diseases. In recent years there have been many advances in the field of catalyzed reactions by transition-metals. The intramolecular nucleophilic addition and the intramolecular Heck reactions constitute important methods for the synthesis of benzocycloalkanols. Within this work, the main goal was to synthesize a library of compounds containing a benzocycloalkanol scaffold. The adopted strategy for the synthesis of dihydrobenzofurans was the catalytic cyclization of aryl ether ketones and for the synthesis of benzofurans, the catalytic cyclization of enoates and enamides (Weinreb amides). Several conditions were studied

Como melhorar as práticas de alimentação para o paciente com demência de Alzheimer

A Doença de Alzheimer é uma enfermidade que se agrava ao longo do tempo. O comprometimento mais marcante é uma acentuada perda de peso, que normalmente vem acompanhada de desidratação e resulta freqüentemente em um quadro de subnutrição. Avaliação e reavaliação nutricional periódica com dados laboratoriais, anamnese alimentar e a avaliação do estágio da doença são importantes para a melhoria na estratégia da alimentação do idoso.

Plano de ação para o cuidado ao portador de Alzheimer e seu familiar/cuidador - desafio da Estratégia Saúde da Família Novo Tempo São Geraldo - MG

Embora se estime que a proporção de idosos duplicará até 2050, alcançando 15% do total da população, as doenças crônico degenerativas e distúrbios mentais já têm determinado, atualmente, maciça utilização dos serviços de saúde (CHAIMOWICZ, 1997). Este estudo foi realizado a partir do diagnóstico situacional realizado pela Equipe da Estratégia de Saúde da Família Novo Tempo do município de São Geraldo - MG que revelou esta realidade, em especial à pessoa idosa com doença de Alzheimer. Para fundamentar o plano de ação proposto, recorreu-se à literatura disponível nas bases de dados Medline, SciELO e Lilacs no período de 1997 à 2013 visando agregar evidências para o desenvolvimento do projeto de intervenção a ser implantado pela equipe. Embora não atinja todos os problemas diagnosticados, este plano pretende ser um instrumento de ação proporcionando mudanças consideráveis no cuidado à pessoa idosa com doença de Alzheimer, oferecendo uma resposta progressiva às suas necessidades e contribuir na qualidade da assistência e nas orientações prestadas ao seu familiar/cuidador.

Structural Connectivity Of The Default Mode Network And Cognition In Alzheimer׳s Disease.

Disconnectivity between the Default Mode Network (DMN) nodes can cause clinical symptoms and cognitive deficits in Alzheimer׳s disease (AD). We aimed to examine the structural connectivity between DMN nodes, to verify the extent in which white matter disconnection affects cognitive performance. MRI data of 76 subjects (25 mild AD, 21 amnestic Mild Cognitive Impairment subjects and 30 controls) were acquired on a 3.0T scanner. ExploreDTI software (fractional Anisotropy threshold=0.25 and the angular threshold=60°) calculated axial, radial, and mean diffusivities, fractional anisotropy and streamline count. AD patients showed lower fractional anisotropy (P=0.01) and streamline count (P=0.029), and higher radial diffusivity (P=0.014) than controls in the cingulum. After correction for white matter atrophy, only fractional anisotropy and radial diffusivity remained significantly lower in AD compared to controls (P=0.003 and P=0.05). In the parahippocampal bundle, AD patients had lower mean and radial diffusivities (P=0.048 and P=0.013) compared to controls, from which only radial diffusivity survived for white matter adjustment (P=0.05). Regression models revealed that cognitive performance is also accounted for by white matter microstructural values. Structural connectivity within the DMN is important to the execution of high-complexity tasks, probably due to its relevant role in the integration of the network.

Whole Cortical And Default Mode Network Mean Functional Connectivity As Potential Biomarkers For Mild Alzheimer's Disease.

The search for an Alzheimer's disease (AD) biomarker is one of the most relevant contemporary research topics due to the high prevalence and social costs of the disease. Functional connectivity (FC) of the default mode network (DMN) is a plausible candidate for such a biomarker. We evaluated 22 patients with mild AD and 26 age- and gender-matched healthy controls. All subjects underwent resting functional magnetic resonance imaging (fMRI) in a 3.0 T scanner. To identify the DMN, seed-based FC of the posterior cingulate was calculated. We also measured the sensitivity/specificity of the method, and verified a correlation with cognitive performance. We found a significant difference between patients with mild AD and controls in average z-scores: DMN, whole cortical positive (WCP) and absolute values. DMN individual values showed a sensitivity of 77.3% and specificity of 70%. DMN and WCP values were correlated to global cognition and episodic memory performance. We showed that individual measures of DMN connectivity could be considered a promising method to differentiate AD, even at an early phase, from normal aging. Further studies with larger numbers of participants, as well as validation of normal values, are needed for more definitive conclusions.

Obstacle Crossing With Dual Tasking Is A Danger For Individuals With Alzheimer's Disease And For Healthy Older People.

The aim of this study was to analyze the effects of dual tasking on obstacle crossing during walking by individuals with Alzheimer's disease (AD) and by healthy older people. Thirty four elderly individuals (16 healthy subjects and 18 individuals with AD) were recruited to participate in this study. Three AD individuals and one control participant were excluded due to exclusion criteria. The participants were instructed to walk barefoot at their own speed along an 8 m long pathway. Each participant performed five trials for each condition (unobstructed walking, unobstructed walking with dual tasking, and obstacle crossing during walking with dual tasking). The trials were completely randomized for each participant. The mid-pathway stride was measured in the unobstructed walking trials and the stride that occurred during the obstacle avoidance was measured in the trials that involved obstacle crossing. The behavior of the healthy elderly subjects and individuals with AD was similar for obstacle crossing during walking with dual tasking. Both groups used the posture first strategy to prioritize stability and showed decreased attention to executive tasking while walking. Additionally, AD had a strong influence on the modifications that are made by the elderly while walking under different walking conditions.

Plastias de estenoses de intestino delgado na doença de Crohn: resultados imediatos e tardios

BACKGROUND: Strictureplasty is an alternative surgical procedure for Crohn?s disease, particulary in patients with previous resections or many intestinal stenosis. AIM: To analyze surgical complications and clinical follow-up in patients submitted to strictureplasty secondary to Crohn?s disease. METHODS: Twenty-eight patients (57.1% male, mean age 33.3 years, range 16-54 years) with Crohn?s disease and intestinal stenosis (small bowel, ileocecal region and ileocolic anastomosis) were submitted to strictureplasty, at one institution, between September 1991 and May 2004. Thirteen patients had previous intestinal resections. The mean follow-up was 58.1 months. A total of 116 strictureplasties were done (94 Heineke-Mikulicz - 81%, 15 Finney - 13%, seven side-to-side ileocolic strictureplasty - 6%). Three patients were submitted to strictureplasty at two different surgical procedures and two in three procedures. RESULTS: Regarding to strictureplasty, postoperative complication rate was 25% and mortality was 3.6%. Early local complication rate was 57.1%, with three suture leaks (10.7%) and late complication was present in two patients, both with incisional hernial and enterocutaneous fistulas (28.6%). Patients remained hospitalized during a medium time of 12.4 days. Clinical and surgical recurrence rates were 63% and 41%, respectively. Among the patients submitted to another surgery, two patients had two more operations and one had three. Recurrence rate at strictureplasty site was observed in 3.5%, being Finney technique the commonest one. Presently, 19 patients had been asymptomatic with the majority of them under medical therapy. CONCLUSION: Strictureplasties have low complication rates, in spite of having been done at compromised site, with long term pain relief. Considering the clinical course of Crohn?s disease, with many patients being submitted to intestinal resections, strictureplasties should be considered as an effective surgical treatment to spare long intestinal resections.