The literature suggests that informed consent documents (ICDs) are not well understood by research participants. The patient decision aid model may suggest improvements for the informed consent process, particularly in the critical care setting (ICU) because of patient capacity issues. Our goal was to evaluate the extent to which existing ICDs used in ICU research adhere to standards and recommendations for high quality informed consent. Eighteen items from recommendations specific to ICU trials were added to a previously developed ICD evaluation tool. A sample of ICU trials was identified from clinicaltrials.gov database and the investigators contacted for their trial ICD. Conformity to the recommendations was variable. Some information are found routinely in consent documents for critical care research and some are not. Efforts should aim to establish tools for measuring decision quality in the ICU with the goal of facilitating and helping patients and surrogates work through trial participation decisions.

Indiana University-Purdue University Indianapolis (IUPUI) / Down syndrome (DS) and Fetal Alcohol Syndrome (FAS) are two leading causes of birth defects with phenotypes ranging from cognitive impairment to craniofacial abnormalities. While DS originates from the trisomy of human chromosome 21 and FAS from prenatal alcohol consumption, many of the defining characteristics for these two disorders are stunningly similar. A survey of the literature revealed over 20 similar craniofacial and structural deficits in both human and mouse models of DS and FAS. We hypothesized that the similar phenotypes observed are caused by disruptions in common molecular or cellular pathways during development. To test our hypothesis, we examined morphometric, genetic, and cellular phenotypes during development of our DS and FAS mouse models at embryonic days 9.5-10.5. Our preliminary evidence indicates that during early development, dysregulation of Dyrk1a and Rcan1, cardinal genes affecting craniofacial and neurological precursors of DS, are also dysregulated in embryonic FAS models. Furthermore, Caspase 3 was also found to have similar expression in DS and FAS craniofacial neural crest derived tissues such as the first branchial arch (BA1) and regions of the brain. This may explain a developmental deficit by means of apoptosis. We have also investigated the expression of pAkt, a protein shown to be affected in FAS models, in cells located within the craniofacial precursor of Ts65Dn. Recent research shows that Ttc3, a gene that is triplicated and shown to be overexpressed in the BA1 and neural tube of Ts65Dn, targets pAkt in the nucleus affecting important transcription factors regulating cell cycle and cell survival. While Akt has been shown to play a role in neuronal development, we hypothesize that it also affects similar cellular properties in craniofacial precursors during development. By comparing common genotypes and phenotypes of DS and FAS we may provide common mechanisms to target for potential treatments of both disorders. One of the least understood phenotypes of DS is their deficient immune system. Many individuals with DS have varying serious illnesses ranging from coeliac disease to respiratory infections that are a direct result of this immunodeficiency. Proteasomes are an integral part of a competent and efficient immune system. It has been observed that mice lacking immunoproteasomes present deficiencies in providing MHC class I peptides, proteins essential in identifying infections. A gene, Psmg1 (Dscr2), triplicated in both humans and in Ts65Dn mice, is known to act as a proteasome assembly chaperone for the 20S proteasome. We hypothesized that a dysregulation in this gene promotes a proteasome assembly aberration, impacting the efficiency of the DS immune system. To test this hypothesis we performed western blot analysis on specific precursor and processed β-subunits of the 20S proteasome in thymic tissue of adult Ts65Dn. While the β-subunits tested displayed no significant differences between trisomic and euploid mice we have provided further insight to the origins of immunodeficiency in DS.

Indiana University-Purdue University Indianapolis (IUPUI) / Methamphetamine (MA) is a widely abused psychostimulant that has been shown to evoke an array of neurobiological abnormalities and cognitive deficits in humans and in rodent models (Marshall & O'Dell, 2012). Alterations in cognitive function after repeated drug use may lead to impaired decision-making, a lack of behavioral control, and ultimately the inability to abstain from drug use. Human studies have shown that alterations in neurobiology resulting from prolonged MA use may lead to a number of cognitive deficits, including impairments in executive function, learning, memory, and impulsivity. These impairments, specifically those that engage the prefrontal cortex (PFC) or hippocampus (HC), may persist or recover based on the duration of abstinence. In rodents, repeated intermittent injections of MA yield protracted changes in neurobiology and behavior, which have been shown to effectively model a number of the biological and cognitive abnormalities observed in addiction. In order to assess the temporal evolution of impaired cognitive function throughout abstinence, sensitization was first induced in rats (7 x 5.0 mg/kg MA over 14 days). MA-treated rats initially exhibited a robust increase in locomotion that transitioned to stereotypy as the induction phase progressed. Then, the effects of MA sensitization on social interaction (SI), temporal order recognition (TOR) and novel object recognition (NOR) was assessed at one-day and 30-days post induction. No differences were observed in SI in either group or after a single injection of MA. However, an acute injection of 5.0 mg/kg of MA 30-minutes prior to testing dramatically reduced SI time. Impairments in TOR and NOR were observed in MA-treated rats after one day of abstinence, and impairments in TOR, but not NOR, were observed on day 30 of abstinence. No differences in TOR and NOR after a single injection of MA or saline were observed. These data establish that after 30 days of abstinence from a sensitizing regimen of MA, the ability to recall the temporal sequence that two stimuli were encountered was impaired and that was not attributable to impaired novelty detection. These data also suggest that at least some of the neurocognitive abnormalities caused by chronic MA administration may normalize after prolonged abstinence, since the ability to detect novelty recovered after 30 days of abstinence. These data provide compelling support that, since MA-sensitization caused temporal deficits in memory, PFC and HC function may be differentially impaired throughout the time course of abstinence.

Text in Afrikaans / Depression as disorder is an ever-increasing phenomenon. Especially, during the adolescent years, depression seems to be on the increase. The developmental phase of adolescence, characterised by a fragile self-esteem, places high demands on the adolescent. The depressed adolescent frequently has a negative self-esteem manifesting from the adolescent's belief that the demands of this phase are inadequately met. It would appear as if the depressed individual constantly tends to see himself in a negative light. In this study the focus is on the negative thought processes (cognitive distortions) demonstrated by the depressed adolescent. The purpose of this study is to evaluate the effect of cognitive therapy on the self-esteem of the adolescent and interplay thereof with depression. Beck's psychotherapeutic model is evaluated in the light of a single case study / Educational Studies / M.Ed.

Introdução: A deglutição e suas características principais ainda são desconhecidas na demência frontotemporal. Objetivos: Caracterizar a deglutição e o comportamento alimentar de pacientes com diagnóstico de demência frontotemporal que apresentam a variante comportamental (DFTvc) e a afasia progressiva primária (APP). Caracterizar os pacientes com DFT e seus cuidadores. Descrever aspectos cognitivos e comportamentais, funcionalidade global, comunicação funcional, e a funcionalidade da deglutição na DFT. Descrever os problemas de deglutição e do comportamento alimentar na DFTvc e APP. Correlacionar os aspectos cognitivos e comportamentais, funcionalidade global e a comunicação com as características da deglutição. Identificar fatores preditivos da piora da funcionalidade da deglutição e do comportamento alimentar na DFT. Avaliar o comportamento dos instrumentos empregados. Desenvolver a versão reduzida do Questionário de Habilidades de Alimentação e Deglutição nas Demências e do Questionário de Comunicação Funcional na Afasia. Método: Este estudo incluiu 46 indivíduos com DFT nas fases leve, moderada e grave, e seus 46 cuidadores. O Mini exame do estado mental (MEEM) e o Mini exame do estado mental grave (MEEM-g) foram usados para avaliar os aspectos cognitivos. A Escala de estadiamento da demência (CDR-DLFT) foi usada para confirmar a fase da doença. O Inventário Neuropsiquiátrico (INP) foi aplicado para investigar os problemas comportamentais. A Bateria de Avaliação Frontal (BAF) investigou as funções executivas. O Índice das Atividades de Vida Diária (Katz), Questionário para Avaliação da Comunicação Funcional na Afasia (QACFA) e a Escala de funcionalidade da deglutição (EFD) avaliaram as habilidades funcionais. O Questionário de Habilidades de Alimentação e Deglutição nas Demências (QHADD) avaliou as dificuldades na deglutição e alimentação. Resultados: Os grupos DFTvc e APP não mostraram diferença estatisticamente significante no MEEM, CDR e BAF. Os cuidadores dos pacientes com DFTvc apresentaram mais horas de cuidado por dia em comparação aos pacientes com APP (p<0,05). Os grupos diferiram na EFD (p < 0,05). As características comportamentais que foram significantes na comparação entre os grupos DFTvc e APP foram: delírio, desinibição, comportamento motor aberrante e distúrbios do sono(p < 0,05) e alucinação (p=0,01). Os pacientes com DFTvc tiveram mais problemas de deglutição do que os pacientes com APP, tais como: tosse e engasgos, dificuldade com alguma consistência alimentar e dificuldade com alimento específico. Os problemas de deglutição na DFTvc se correlacionaram com a funcionalidade, aspectos cognitivos (p < 0,05), com a função executiva e com o comportamento (p < 0,01). Na APP, o subtipo semântico apresentou mais problemas de deglutição, tais como: escape de saliva e comida da boca, múltiplas deglutições, atraso na iniciação da deglutição e engasgos, estas características se correlacionaram com a ansiedade (p < 0,01), apatia e comportamento motor aberrante (p=0,01). Os problemas do comportamento alimentar foram mais frequentes no subtipo logopênico e se correlacionaram com dificuldades de comunicação. Os principais fatores preditivos da piora da funcionalidade da deglutição foram: declínio funcional, alterações comportamentais e o comprometimento da comunicação. Os problemas de deglutição foram observados em todas as fases da demência. A BAF foi o único instrumento que não apresentou uma boa confiabilidade interna. Conclusão: Problemas na deglutição foram observados nas duas variantes desde os estágios iniciais da demência. As alterações comportamentais, cognitivas e funcionais, e dificuldades na comunicação comprometeram as fases antecipatória e preparatória oral da deglutição. Por causa destas alterações, os cuidadores tiveram dificuldade no gerenciamento da situação de alimentação. Nosso estudo desenvolveu questionários resumidos para avaliar a deglutição e a comunicação funcional / Introduction: Swallowing and its main characteristics are still unknown in frontotemporal dementia. Objectives: To characterize swallowing and feeding behavior of patients with frontotemporal dementia who have behavioral variant (bvFTD) and primary progressive aphasia (PPA). To characterize patients with FTD and their caregivers.To describe cognitive and behavioral aspects, functionalstatus, functional communication, and swallowing function in FTD.To describe swallowing problems and feeding behavior in bvFTD and PPA. To correlate cognitive and behavioral aspects, functional status, and communication with swallowing. To identify predictive factors associated with worsening of functionality of swallowing and feeding behavior in FTD. To evaluate the instruments used. To develop reduced versions of: \"Assessment of Feeding and Swallowing Difficulties in Dementia\" and \"Functional Outcome Questionnaire Aphasia\". Method: This study included 46 individuals with FTD in mild, moderate and severe phases, and their 46 caregivers. The Mini mental state examination (MMSE) and the Severe Mini mental state examination (SMMSE) were used to assess the cognitive aspects. The FTLD-modified Clinical Dementia Rating scale (FTLD-CDR) was used to confirm the stage of the disease. The Neuropsychiatric Inventory (NPI) was applied to investigate the behavioral problems. The Frontal Assessment Battery (FAB) investigated executive functions. The Index of Activities of Daily Living (Katz), Functional Outcome Questionnaire- Aphasia and Swallowing rating scale (SRE) evaluated the functional abilities. The Assessment of Feeding and Swallowing Difficulties in Dementia (QHADD) evaluated the difficulties in swallowing and feeding. Results: bvFTD and PPA groups showed no statistically significant difference in MMSE, CDR and FAB. Caregivers of patients with bvFTD had more hours of care per day compared to patients with PPA (p < 0.05). The groups differed in SRE (p < 0.05). The behavioral characteristics that were significant in the comparison between bvFTD and PPA groups were delirium, disinhibition, aberrant motor behavior and sleep disturbances (p < 0.05), and hallucinations (p = 0.01). Patients with bvFTD had more swallowing problems than patients with PPA, such as coughing and choking, difficulty with some food consistency and difficulty with specific food. Swallowing problems in bvFTD correlated with functionality, with the cognitive aspects (p < 0.05), with executive function and behavior (p < 0.01). In PPA, the semantic subtype showed more swallowing problems such as escape of saliva and food in mouth, multiple swallows, delay in initiation of swallowing and choking, these characteristics correlated with anxiety (p < 0.01), apathy and aberrant motor behavior (p = 0.01). The problems of feeding behavior were more frequent in logopenic subtype and correlated with communication difficulties. The major predictors of worsening of swallowing function were: functional decline, behavioral changes and impaired communication. Swallowing problems were observed at all stages of dementia. The BAF was the only instrument that had bad internal reliability. Conclusion: Swallowing problems were observed in the two variants from the early stages of dementia. Behavioral, cognitive and functional changes, and difficulties in communication compromised the anticipatory and oral preparatory phase of swallowing. Because of these changes, caregivers had difficulty in managing the feeding situation. Our study developed reduced versions of questionnaires to assess swallowing and functional communication

O desenvolvimento de Unidades de Terapia Intensiva Pediátrica (UTIP) aumentou a sobrevida de pacientes graves, que passaram a receber alta das UTIP e, conseqüentemente, aumentou o número de doenças crônicas sequelares. A proposta deste trabalho é identificar se houve diminuição da expectativa média de vida das crianças, após cinco anos de alta da UTIP, quais tipos de co-morbidades apresentam e identificar alterações no desempenho escolar, observando se necessitam de escola regular ou especial, os índices de reprovação e abandono escolar, correlacionando-os com situação sócio-econômica, doença da internação e tipo de atendimento prestado, público ou privado, no momento da internação. A pesquisa iniciou identificando as crianças internadas na UTIP da Santa Casa de Maringá, que possui atendimento misto (SUS E NÃO SUS), desde que, no momento da internação, apresentassem mais de vinte e oito dias de idade, ficassem internadas por mais de 24 horas e não evoluíssem para óbito durante a internação. Após seleção, aplicamos dois questionários, o primeiro relacionado à internação, com dados pessoais e clínicos, e o segundo aplicado às famílias das crianças encontradas após cinco anos da alta. Encontramos 84% da amostra, com taxa de sobrevida de 88% e 98% para NÃO SUS e SUS respectivamente. Observamos que 35% das crianças estão em escola especial e 18% com seqüelas motoras. No restante das crianças, o índice de reprovação chega a 45%, com 5% de abandono escolar / The development of Pediatric Intensive Care Units (PICU) increased the survival of critically ill patients, now discharged from PICU, and consequently, increased the number of chronic diseases and sequelae. The purpose of this study is to identify whether there was a decrease of average life expectancy of children after five years of discharge from PICU, what types of co morbidities present and identify changes in school performance, noting if they need regular or special school, the failure rates and dropout, correlating them with socioeconomic status, disease hospitalization and type of care provided, public or private, at the time of admission. The research began by identifying the children admitted to the PICU at Santa Casa de Maringá, which has mixed attendance (SUS AND NON SUS) since, at the time of admission, presented more than twenty-eight days old, stayed in hospital for more than 24 hours and not died during hospitalization. After selection, we applied two questionnaires, the first related to the hospital, with personal and clinical data, and the second applied to childrens families found five years after discharge. We found 84% of the sample, with survival rate of 88% and 98% for NO SUS and SUS, respectively. We observed that 35% of children are at special school and 18% of them with motor sequelae. In the remaining children, the failure rate is about 45%, with 5% of dropout

A perimenopausa é a fase da vida reprodutiva feminina caracterizada diversas alterações, inclusive cognitivas devido ao hipoestrogenismo. Através de estudo duplo-cego randomizado com 16 mulheres na perimenopausa deprimidas que receberam estradiol e 16 que receberam placebo analisou-se as alterações cognitivas da atenção, memória e linguagem; o efeito da reposição hormonal com estradiol e a correlação entre os sintomas depressivos e menopausais com as alterações destas funções. Os resultados mostraram: melhora do controle inibitório, memória imediata e tardia (verbal e visual) e da capacidade de nomeação nos dois grupos; melhora dos sintomas depressivos e menopausais para o grupo que recebeu reposição hormonal: e não correlação entre a melhora destes sintomas e a melhora das funções cognitivas / Perimenopause is the female reproductive life period characterized by several changes including cognitive impairments related to hypoestrogenism. In a randomized double-blind study 16 depressive perimenopaused women took estradiol, while another group of 16 depressive perimenopaused women took placebo. Cognitive alterations associated to attention, memory and language, and estradiol hormone replacement therapy effects were evaluated. In addition, correlations among symptoms of depression and menopause, and cognitive alterations were also analyzed. The results had shown, in both groups, an improvement in inhibitory mental control, in immediate and delayed (verbal and visual) memory, and in naming capacity. In the group that received hormone replacement therapy our findings revealed a weakening of depression and menopause symptoms, which had shown no correlation with cognitive functions

INTRODUÇÃO: O termo memória operacional (MO) refere-se a um constructo cognitivo capaz de armazenar e manter a informação acessível para uso determinado por um tempo limitado, possibilitando a manipulação de diversas informações simultâneas e sequenciais como operações matemáticas longas ou complexas, compreensão de palavras pouco frequentes, extensas ou frases complexas. A linguagem está entre as funções cognitivas que dependem do funcionamento da memória operacional e pode estar comprometida em várias condições patológicas, dentre elas o traumatismo cranioencefálico (TCE). Dados da literatura referentes a essa população ainda são restritos ou pouco consistentes. OBJETIVOS: investigar se o teste n-back é uma medida válida para identificar o déficit de memória em pacientes com TCE, estabelecer nota de corte e curva ROC do teste n-back, comparar o desempenho entre os indivíduos saudáveis e aqueles que sofreram TCE, comparar o teste n-back com os testes de linguagem e aspectos da lesão neurológica, tais como gravidade e tempo, tempo de coma e localização hemisférica da lesão nos resultados para verificar o desempenho e a relevância na separação dos casos em pacientes e controles.MÉTODOS: 53 indivíduos brasileiros (26 adultos com TCE e 30 adultos saudáveis) foram avaliados por bateria de estímulos verbais auditivos para verificar diferenças inter-grupos na capacidade de processamento da memória operacional, quanto ao numero de respostas corretas (acurácia), capacidade máxima de processamento na memória operacional (span) e também verificar a relação da memória operacional com habilidades linguísticas, através da comparação de testes. RESULTADOS: na comparação entre os pacientes e os indivíduos do grupo controle observou-se diferença estatisticamente significante entre os grupos tanto para os testes de base quanto para os resultados do n-back. Os grupos foram estatisticamente pareados em relação às variáveis sócio-demográficas (idade, escolaridade e gênero). O modelo estatístico com as variáveis do teste n-back demonstrou ótima separação dos casos em pacientes/ controle com a área sob a curva ROC de 89%. O modelo também mostrou convergência com os testes de linguagem para compreensão auditiva de sentenças, fluência verbal e aspectos discursivos-pragmáticos e com o nível cognitivo. O lado da lesão foi estatisticamente significante para o n-back, fluência verbal e discurso conversacional. CONCLUSÃO: Os resultados mostram que o n-back na maneira como foi desenhado é capaz de diferenciar os indivíduos alterados e os normais na habilidade de memória operacional. No estudo foi possível discriminar o comportamento de indivíduos com lesão encefálica adquirida e indivíduos saudáveis quanto à medida de acurácia e capacidade máxima de manipulação da informação na memória operacional. Esse comportamento reflete o funcionamento linguístico e cognitivo que se correlaciona com o mecanismo de memória operacional / INTRODUCTION: The term working memory (WM) refers to a construct cognitive capability of storing and keeping information on line to a determined use for a limited time, enabling the manipulation of diverse simultaneous and sequential information such as long or complex mathematical operations, comprehension of less frequent words, extensive or complex sentences. The language is among the cognitive functions which depends on the operational memory behavior and may be engaged in many pathological conditions, among them the TBI (traumatic brain injury). Literature dada relative to such population are still restrict or weak. AIM: investigate whether the n -back task is a valid measure for identifying memory deficits in patients with TBI; establish cutoff and ROC curve of n-back task; to compare performance between normals individuals and those who have suffered TBI; to compare n-back task with tests of language and aspects of neurological injury, such as severity, coma and hemispheric laterality of the lesion to verify the performance and relevance in the separation of cases. METHODOS: 53 individuals Brazilians (26 adults with TBI and 30 healthy adults) were assessed by a battery of auditory verbal stimuli for detecting differences between groups in the processing capacity of working memory, as the accuracy and span also check the relationship of working memory to language skills, through the comparison tests. RESULTS: in the comparison between patients and control subjects was observed statistically significant differences between groups thus to the tests as the basis tests as to results of the n -back. The groups were statistically matched in relation to socio-demographic variables (age, education and gender). The statistical model with variables of the n -back test showed good separation of cases where patients / control with the area under the ROC curve of 89 % . The model also showed convergence with language tests for auditory comprehension of sentences, verbal fluency and pragmatic - discursive aspects and the cognitive level. The side of the lesion was statistically significant for the n -back, verbal fluency and conversational discourse. CONCLUSION: the results demonstrated that the n-back on the way it was designed is able to distinguish the changed individuals and the normal on the working memory ability. On the study it was possible to discriminate the behaviors of individuals with acquired brain injury and healthy individuals regarding the accuracy and maximum capacity of manipulating information on the working memory. Such behavior reflects the linguistic and cognitive function which correlates with the working memory mechanism

Introdução: A deglutição e suas características principais ainda são desconhecidas na demência frontotemporal. Objetivos: Caracterizar a deglutição e o comportamento alimentar de pacientes com diagnóstico de demência frontotemporal que apresentam a variante comportamental (DFTvc) e a afasia progressiva primária (APP). Caracterizar os pacientes com DFT e seus cuidadores. Descrever aspectos cognitivos e comportamentais, funcionalidade global, comunicação funcional, e a funcionalidade da deglutição na DFT. Descrever os problemas de deglutição e do comportamento alimentar na DFTvc e APP. Correlacionar os aspectos cognitivos e comportamentais, funcionalidade global e a comunicação com as características da deglutição. Identificar fatores preditivos da piora da funcionalidade da deglutição e do comportamento alimentar na DFT. Avaliar o comportamento dos instrumentos empregados. Desenvolver a versão reduzida do Questionário de Habilidades de Alimentação e Deglutição nas Demências e do Questionário de Comunicação Funcional na Afasia. Método: Este estudo incluiu 46 indivíduos com DFT nas fases leve, moderada e grave, e seus 46 cuidadores. O Mini exame do estado mental (MEEM) e o Mini exame do estado mental grave (MEEM-g) foram usados para avaliar os aspectos cognitivos. A Escala de estadiamento da demência (CDR-DLFT) foi usada para confirmar a fase da doença. O Inventário Neuropsiquiátrico (INP) foi aplicado para investigar os problemas comportamentais. A Bateria de Avaliação Frontal (BAF) investigou as funções executivas. O Índice das Atividades de Vida Diária (Katz), Questionário para Avaliação da Comunicação Funcional na Afasia (QACFA) e a Escala de funcionalidade da deglutição (EFD) avaliaram as habilidades funcionais. O Questionário de Habilidades de Alimentação e Deglutição nas Demências (QHADD) avaliou as dificuldades na deglutição e alimentação. Resultados: Os grupos DFTvc e APP não mostraram diferença estatisticamente significante no MEEM, CDR e BAF. Os cuidadores dos pacientes com DFTvc apresentaram mais horas de cuidado por dia em comparação aos pacientes com APP (p<0,05). Os grupos diferiram na EFD (p < 0,05). As características comportamentais que foram significantes na comparação entre os grupos DFTvc e APP foram: delírio, desinibição, comportamento motor aberrante e distúrbios do sono(p < 0,05) e alucinação (p=0,01). Os pacientes com DFTvc tiveram mais problemas de deglutição do que os pacientes com APP, tais como: tosse e engasgos, dificuldade com alguma consistência alimentar e dificuldade com alimento específico. Os problemas de deglutição na DFTvc se correlacionaram com a funcionalidade, aspectos cognitivos (p < 0,05), com a função executiva e com o comportamento (p < 0,01). Na APP, o subtipo semântico apresentou mais problemas de deglutição, tais como: escape de saliva e comida da boca, múltiplas deglutições, atraso na iniciação da deglutição e engasgos, estas características se correlacionaram com a ansiedade (p < 0,01), apatia e comportamento motor aberrante (p=0,01). Os problemas do comportamento alimentar foram mais frequentes no subtipo logopênico e se correlacionaram com dificuldades de comunicação. Os principais fatores preditivos da piora da funcionalidade da deglutição foram: declínio funcional, alterações comportamentais e o comprometimento da comunicação. Os problemas de deglutição foram observados em todas as fases da demência. A BAF foi o único instrumento que não apresentou uma boa confiabilidade interna. Conclusão: Problemas na deglutição foram observados nas duas variantes desde os estágios iniciais da demência. As alterações comportamentais, cognitivas e funcionais, e dificuldades na comunicação comprometeram as fases antecipatória e preparatória oral da deglutição. Por causa destas alterações, os cuidadores tiveram dificuldade no gerenciamento da situação de alimentação. Nosso estudo desenvolveu questionários resumidos para avaliar a deglutição e a comunicação funcional / Introduction: Swallowing and its main characteristics are still unknown in frontotemporal dementia. Objectives: To characterize swallowing and feeding behavior of patients with frontotemporal dementia who have behavioral variant (bvFTD) and primary progressive aphasia (PPA). To characterize patients with FTD and their caregivers.To describe cognitive and behavioral aspects, functionalstatus, functional communication, and swallowing function in FTD.To describe swallowing problems and feeding behavior in bvFTD and PPA. To correlate cognitive and behavioral aspects, functional status, and communication with swallowing. To identify predictive factors associated with worsening of functionality of swallowing and feeding behavior in FTD. To evaluate the instruments used. To develop reduced versions of: \"Assessment of Feeding and Swallowing Difficulties in Dementia\" and \"Functional Outcome Questionnaire Aphasia\". Method: This study included 46 individuals with FTD in mild, moderate and severe phases, and their 46 caregivers. The Mini mental state examination (MMSE) and the Severe Mini mental state examination (SMMSE) were used to assess the cognitive aspects. The FTLD-modified Clinical Dementia Rating scale (FTLD-CDR) was used to confirm the stage of the disease. The Neuropsychiatric Inventory (NPI) was applied to investigate the behavioral problems. The Frontal Assessment Battery (FAB) investigated executive functions. The Index of Activities of Daily Living (Katz), Functional Outcome Questionnaire- Aphasia and Swallowing rating scale (SRE) evaluated the functional abilities. The Assessment of Feeding and Swallowing Difficulties in Dementia (QHADD) evaluated the difficulties in swallowing and feeding. Results: bvFTD and PPA groups showed no statistically significant difference in MMSE, CDR and FAB. Caregivers of patients with bvFTD had more hours of care per day compared to patients with PPA (p < 0.05). The groups differed in SRE (p < 0.05). The behavioral characteristics that were significant in the comparison between bvFTD and PPA groups were delirium, disinhibition, aberrant motor behavior and sleep disturbances (p < 0.05), and hallucinations (p = 0.01). Patients with bvFTD had more swallowing problems than patients with PPA, such as coughing and choking, difficulty with some food consistency and difficulty with specific food. Swallowing problems in bvFTD correlated with functionality, with the cognitive aspects (p < 0.05), with executive function and behavior (p < 0.01). In PPA, the semantic subtype showed more swallowing problems such as escape of saliva and food in mouth, multiple swallows, delay in initiation of swallowing and choking, these characteristics correlated with anxiety (p < 0.01), apathy and aberrant motor behavior (p = 0.01). The problems of feeding behavior were more frequent in logopenic subtype and correlated with communication difficulties. The major predictors of worsening of swallowing function were: functional decline, behavioral changes and impaired communication. Swallowing problems were observed at all stages of dementia. The BAF was the only instrument that had bad internal reliability. Conclusion: Swallowing problems were observed in the two variants from the early stages of dementia. Behavioral, cognitive and functional changes, and difficulties in communication compromised the anticipatory and oral preparatory phase of swallowing. Because of these changes, caregivers had difficulty in managing the feeding situation. Our study developed reduced versions of questionnaires to assess swallowing and functional communication

Text in Afrikaans / Depression as disorder is an ever-increasing phenomenon. Especially, during the adolescent years, depression seems to be on the increase. The developmental phase of adolescence, characterised by a fragile self-esteem, places high demands on the adolescent. The depressed adolescent frequently has a negative self-esteem manifesting from the adolescent's belief that the demands of this phase are inadequately met. It would appear as if the depressed individual constantly tends to see himself in a negative light. In this study the focus is on the negative thought processes (cognitive distortions) demonstrated by the depressed adolescent. The purpose of this study is to evaluate the effect of cognitive therapy on the self-esteem of the adolescent and interplay thereof with depression. Beck's psychotherapeutic model is evaluated in the light of a single case study / Educational Studies / M.Ed.