En raison d’importantes transitions démographiques et épidémiologiques, le nombre de personnes atteintes de la maladie d’Alzheimer et d’autres troubles neurocognitifs majeurs augmentera rapidement dans les sociétés occidentales. Ces maladies posent des enjeux d’envergure pour les personnes atteintes, leurs proches, les communautés et l’organisation des services. Plus largement, ce sont les politiques publiques qui doivent être repensées. Sous ce principe, le gouvernement du Québec a mobilisé une équipe d’experts pour concevoir le Plan Alzheimer du Québec (PAQ) (2007). La principale stratégie de mise en œuvre qui découle de ce plan fût de soutenir le développement de 19 projets pilotes ayant principalement pour objectif de diagnostiquer plus rapidement les personnes atteintes de ces maladies et de rehausser la qualité de leur suivi, au sein des Groupes de médecines de famille (GMF). Le modèle d’appel à propositions développé par l’équipe ministérielle a convié les acteurs locaux du système sociosanitaire québécois le souhaitant à rédiger une proposition en fonction de leurs propres conditions locales de pratique, bien que la proposition devait globalement être en cohésion avec les priorités nationales. Dû au fait que ce type de stratégie de diffusion des politiques publiques vers les organisations délivrant des services pose des défis d’équilibre entre les priorités ministérielles et les réalités locales, nous nous sommes intéressés à la mise en œuvre du plan québécois. Plus précisément, notre principal but de recherche consistait à comprendre de quelle façon les orientations du PAQ se sont traduites dans les projets pilotes. Pour ce faire, nous avons mené une analyse secondaire de données qualitatives qui s’articule autour de trois stratégies de collecte de données : 1) les documents du ministère et ceux des 19 propositions développées par les acteurs locaux, 2) quatre entretiens semi-dirigés auprès d’acteurs-clefs ayant participé au niveau national à la mise en œuvre du PAQ et 3) 15 groupes de discussions focalisées ayant été réalisés auprès de gestionnaires et de professionnels impliqués au sein des innovations, dont des travailleuses sociales. La mise en œuvre du PAQ vers ses formes locales a donné lieu au développement d’une grande diversité de projets innovants, comprenant principalement des médecins, des infirmières et des travailleuses sociales. La mise en place d’un important dispositif d’accompagnement du changement, lors de l’implantation des innovations, a favorisé des ajustements entre les deux principes en apparences contradictoires que sont le respect des objectifs ministériels et l’encouragement des acteurs locaux à adapter le projet en fonction de leurs réalités. Cet accompagnement, globalement positif, a toutefois été mis en place tardivement, ce qui eut des effets durables sur l’implantation des innovations. Nous soutenons donc que la phase initiale de conception des innovations locales est un moment critique qui requiert d’accompagner les acteurs locaux, afin de clarifier le modèle proposé par la politique publique et favoriser la collaboration des principales personnes qui sont parties prenantes du changement.

Neurodegeneration is a chronic, progressive and debilitating condition that affects majority of the World's elderly population who are at greater risk. Numerous scientific studies suggest that there could be a common underlying molecular mechanism that promotes the degeneration and the subsequent neuronal loss, however so far the progress in this direction is rather limited. Abnormal protein misfoldings, as well as protein plaque formations in the brain, are some of the hallmark characteristic features of neurodegenerative disorders (NDDs). Genetic and environmental factors, oxidative stress, excessive reactive oxygen species formation, mitochondrial dysfunction, energy depletion and autophagy disruption etc. are some of the widely suspected mechanisms that manifest the cognitive, motor and emotional symptoms of these NDDs. Motivated by some molecular traits found in common in several NDDs, network-based systems biology tools and techniques were used in this study to identify critical molecular players and underlying biological processes that are common for Parkinson's, Alzheimer's and Huntington's disease. Utilizing multiple microarray gene expression datasets, several biomolecular networks such as direct interaction, shortest path, and microRNA regulatory networks were constructed and analyzed for each of the disease conditions. The network-based analysis revealed 26 genes of potential interest in Parkinson's, 16 in Alzheimer's and 30 in Huntington's disease. Many new microRNA-target regulatory interactions were identified. For each disorder, several routes for possible disease initiation and protection scenarios were uncovered. A unified neurodegeneration mechanism network was constructed by utilizing the significantly differentially expressed genes found in common in Parkinson's, Alzheimer's and Huntington's microarray datasets. In this integrated network many key molecular partakers and several biological processes that were significantly affected in all three NDDs were uncovered. The integrated network also revealed complex dual-level interactions that occur between disease contributing and protecting entities. Possibilities of microRNA-target interactions were explored and many such pairs of potential interest in NDDs were suggested. Investigating the integrated network mechanism, we have identified several routes for disease initiating, as well as alleviating ones that could be utilized in common for Parkinson's, Alzheimer's and Huntington's disease. Finding such crucial and universal molecular players in addition to maintaining a delicate balance between neurodegeneration promoters and protectors is vital for restoring the homeostasis in the three NDDs.

The vast majority of persons with Alzheimer’s disease and related dementias live at home and are cared for by families or close friends/neighbors. An essential element to daily care decisions is the caregiver’s appraisal of function in the family member with dementia. This dissertation comprises three separate papers exploring caregiver appraisal of functional capacity, using secondary data from a study conducted at Thomas Jefferson University of 88 patient-caregiver dyads, funded by the Alzheimer’s Association (L. Gitlin, PhD, principal investigator; Grant # IIRG-07-28686). The caregivers were primarily female (88.6%), white (77.3%), and spouses (55.7%), with a mean age of 65.8. All caregivers had a high school education or higher and had provided care from 6 months to 22 years. The majority of the participants with dementia were female (52.3%) and white (76.1) with a mean age of 81.7. Their scores on the MMSE ranged from 10 to 28 (M = 17.7, SD = 4.6, N = 87). The first paper examined construct and interrater reliability of the Functional Capacity Card Sort (FCCS), a tool designed to measure subjective caregiver appraisal. Using spearman’s rank correlations the FCCS was found to be statistically associated with the Caregiver Assessment of Function and Upset scale (r = .43, p < 0.0001, N = 86) and not statistically associated with the Neuropsychiatric Inventory scale (r = -.14, p = .16, N = 86), supporting convergent and discriminant validity respectfully. Kendall’s coefficient of concordance revealed a strong agreement among caregivers in the ranking of the six cards of the FCCS, Kendall W (5, 72) = 0.83, p = .0001, supporting interrater reliability of the FCCS. The second and third paper demonstrated the utility of the FCCS in distinguishing three groups of caregivers based on their estimation of functional capacity in the person with dementia compared to a gold standard occupational therapy assessment. Fifty-two (61%) of the caregivers overestimated function, 19 (22%) caregivers underestimated function, and 15 (17%) were concordant with the standardized assessment. Further analysis explored personal and home environment factors in relation to caregiver appraisal. The Kruskal-Wallis test showed cognitive status in the person with dementia (H (2, N = 85) = 3.67, p = .16) and caregiver depressive symptoms (H (2, N = 86) = 1.35, p = .51) were not associated with the caregiver’s appraisal of functional capacity in the person with dementia. Linear regression and proportional odds logistic regression, adjusted for cognitive status in the person with dementia, did not reveal a relationship between caregiver appraisal and the number of observed home hazards [F (1, N = 86) = .01, p = .94] or the unmet needs reported by the caregiver [Wald χ2 (1, N = 86) = .95, p = .33], respectively. Linear regression showed a trend towards the hypothesis that caregiver concordant/underestimation of functional capacity have greater home adaptations compared to caregiver overestimation [F (1, N = 86) = 3.06, p = .08]. The papers in totality demonstrate the utility of the FCCS to assess caregiver appraisal and interpret level of estimation, which can guide the therapeutic approach and treatment plan by an occupational therapist or other health professional. Further understanding of caregiver appraisal and associated factors is critical to providing best practice in dementia care. Limitations and future directions for research are discussed.

Alzheimer’s disease is a devastating neurodegenerative disorder and the leading cause of dementia. The disease manifests via several pathologies including neuroinflammation, oxidative stress, metal ion dyshomeostasis, and cell death. To address the multifaceted nature of this disorder, the design of several diverse compounds, targeting many pathological effects, was generated. First, a series of compounds based on curcumin and diosgenin were synthesized following the bivalent design strategy. Two compounds were discovered to have neuroprotective ability, anti-oxidative function, and anti-Aß oligomerization (AßO) properties. A second set of molecules was also designed, wherein a hybrid compound strategy was utilized. Three hybrids were to shown to protect MC65 cells from Aß-induced toxicity and to have significant anti-oxidative activity. Mechanistic studies propose that protection is through disruption of interactions between AßOs and partner proteins. Furthermore, one hybrid was also shown to be able to pass the BBB. Lastly, studies of glyburide, an anti-diabetic medication, have shown an off-target anti-inflammatory effect specific for the NLRP3 inflammasome, which has been implicated in AD development. Therefore, a series of glyburide analogs were synthesized and characterized. One analog was able to successfully inhibit the NLRP3 inflammasome and reduce IL-1ß expression without affecting blood glucose. In vivo studies demonstrated an ability to prevent or ameliorate adverse inflammation-related outcomes in murine inflammatory models. Altogether, these investigations have yielded three novel series of compounds, all capable of modifying Alzheimer’s disease pathology. These results warrant future investigations into the development, optimization, and characterization of these analogs as potential treatments for Alzheimer’s disease.

Mounting evidence indicates an involvement of inflammation in the pathogenesis of Alzheimer’s disease. While there are other mechanisms involved, it is this role of inflammatory processes that we wish to investigate. Triptolide is the major constituent in the Chinese herb, Tripterygium wilfordii Hook F, and has been used for centuries as part of Chinese herbal medicine. The four ringed structure has close homology to drugs of the steroid class and it has been shown to be beneficial as an anti-inflammatory for rheumatoid arthritis and for treatment of certain cancers. The aim of this study was to evaluate the potential therapeutic effect of Triptolide on the neuropathology and deficits of spatial 6 learning and memory in amyloid precursor protein (APP) and presenilin 1 (PS1) doubletransgenic mice, a well established Alzheimer’s disease (AD) mouse model. After treatment of APP/PS1 mice with Triptolide (40μg/kg, three times weekly,), initiated when the mice were 5 months old, for as little as 8 weeks, significant decrease in β-amyloid (Aβ) deposition and microglia activation was observed. Moreover, Triptolide treatment robustly rescued spatial memory deficits observed in APP/PS1 mice. However, APP processing, tau hyperphosphorylation, and the activities of the two major kinases involved in tau hyperphosphorylation, cyclin dependent kinase 5 (cdk5) and glycogen synthase kinase 3β (GSK3β) were not affected by the Triptolide treatment. Based on the recent finding for the inhibitory effect of Triptolide on Aβ-induced production of pro-inflammatory cytokines from microglia, we propose that Triptolide treatment may have beneficial properties in halting glial activation and help restore an immune system that fights plaque deposition. Although the exact mechanism of action has yet to be deduced, the increase in APP CTFs while having a significant decrease in amyloid plaque deposition suggests that alterations in gamma secretase activity may be a possible answer. Currently, these results support the use of Triptolide as an effective therapeutic to prevent the progression of Alzheimer’s disease.

Alzheimer's disease (AD) is a progressive neurodegenerative disorder and the leading cause of dementia, affecting ~5.2 million Americans. Current FDA approved medications provide mainly symptomatic relief and there are no agents available to delay or cure this disease. Multiple factors such as amyloid-β aggregates, dyshomeostasis of biometals, oxidative stress, and neuroinflammation have been implicated in the development of AD. Even though significant advances have been made in understanding the mechanisms leading to AD, the exact etiology still remains elusive. Given AD’s multifactorial nature, a multifunctional strategy of small molecule design would help to identify novel chemical templates. Recently our lab has developed hybrid molecules of curcumin and melatonin that exhibited potent neuroprotective ability in various AD models. Further modifications identified a lead compound with potent neuroprotective and antioxidative activity in MC65 cells, while also establishing the hybrid strategy as a viable approach in providing unique chemotypes with novel pharmacology. Further preliminary biological studies suggest that the lead is orally available and exhibits multifunctional properties both in vitro and in vivo on AD pathologies, thus strongly encouraging further structural examination. Herein, we report the structural exploration of this chemical template through structure-activity relationship studies at three domains: the phenyl domain, α,β-unsaturated β-ketone amide domain, and the indole domain. Collectively, the results show that the chemical space around the curcumin portion doesn’t favor electronic or steric/hydrophobic interactions, but might favor pi-pi (π-π) and hydrogen-bond interactions. Additionally, the α,β-unsaturated β-ketone amide domain is not as important as the linearity of the β-ketone acetamide. Moreover, the results indicate that a free rotatable β-OH might be the actual moiety that is important for the observed biological activity through favorable hydrogen bonds. Finally, steric interactions are not favored in the chemical space surrounding the indole nitrogen, suggesting that hydrogen bond interactions are required for the observed neuroprotective activity. Conversely, a hydrogen bond acceptor is necessary at the 5-position of the indole ring and bulky substitutions can be accommodated, with restrictions, suggesting steric tolerance and hydrophobic interactions at this position. These modifications have yielded a series of novel compounds that are capable of modifying AD pathology while shedding further light onto the chemical scaffold thus warranting future investigations into the development, optimization, and characterization of these curcumin/melatonin hybrids as potential treatments for AD.

Dementia causes an increasing social and economic burden worldwide, demanding action regarding its diagnosis, treatment and everyday management. Recent years have seen many advances in neurodegeneration research, but the search for new truly disease modifying therapies for Alzheimer's disease (AD) and frontotemporal dementia (FTD) has so far not been successful. This is mainly due to a lack of understanding of the precise intracellular events that lead up to neuronal dysfunction in early and in late stages of the disease. This thesis describes the approaches taken to extend the current knowledge about the intracellular effects of neuronal amyloid-beta and the signalling pathways causing neuronal death or disturbed synaptic function in dementia. Endophilin-1(Ep-1), amyloid-binding alcohol dehydrogenase (ABAD), peroxiredoxin-2 (Prx-2) and the EF-hand domain family, member D2 (EFHD2) have been found to be elevated in the human brain with dementia and in mouse models for frontotemporal lobar degeneration (FTLD) or AD. The expression of these proteins as well as the expression of c-Jun N-terminal kinase (JNK), c-Jun and APP were analysed by western blotting and real-time PCR in human brains affected by AD or FTLD as well as in mouse models for AD. This provided a new insight into the regulation of these proteins in relation to each other in the ageing brain and uncovered a new potential link between elevated levels of EFHD2, Prx-2 and APP in FTLD. By studying the effects of the overexpression of Ep-1 in neurons, this research has led to a better understanding of its role in JNK-activation. It furthermore verified a protective role for Prx-2 against neurotoxicity and pointed towards a new function for Prx-2 in the regulation of JNK-signalling. The analysis of the effect of increased levels of EFHD2 uncovered for the first time its involvement in the PI3K-signalling cascade in neuronal cells. The current work has therefore contributed to the knowledge about the cellular processes that are affected by Ep-1, Prx-2 and EFHD2 in different types of dementia and will greatly benefit future research into their actions in the neuronal network.

This thesis "Chronic Patients' Depression" looks into Alzheimer's disease patients' depression. Theoretical part focuses on topics of old age, dementia syndrome, Alzheimer's disease and depression. These topics are described also in their associations. Current researches in the field of study are mentioned too. Practical part deals with presence of depression in Alzheimer's persons. Hypothesis that depression is more frequent in early stage of dementia is tested. In the research there is used standardised method - Yesevage's Geriatric Depression Scale. Other methods which can bring new information is also used (Geriatric Depression Scale filled in by caring persons and structured observation). The outcome is 9,7% Alzheimer's patients suffer from depression. More persons with depression we can find in a group of Alzheimer's early stage however difference between group of early and advanced stage is not significant. This study occupies with assets of other methods for diagnostic of depression.

Nejedly, J.: Nutraceuticals 5. Compounds usable as an adjuvant in the treatment of Alzheimer's disease. Diploma thesis, Charles University in Prague, Faculty of Pharmacy in Hradec Kralove, Department of Pharmaceutical Botany and Ecology, Hradec Kralove 2014, 102 p. This literature review, dealing with the pathophysiology of Alzheimer's disease and possible use of nutraceutical products as an adjuvant in the therapy of the disease, has been done by analysis of foreign and domestic literature. In the chapter Alzheimer's disease, various pathological processes, leading to the development of the disease and also risk factors, clinical picture and a brief indications of currently used treatment, were introduced. The main part of thesis called Nutraceuticals has introduced a comprehensive overview and categorization of compounds (plant extracts) which can be used in influencing of Alzheimer's disease by the mechanism of action. In the chapter Nutraceuticals in Czech Republic, various product and suplements were listed, which are available on the market in Czech Republic and could be used as an adjuvant in the therapy of Alzheimer's disease. Finally, it was shown the evaluation (pros, cons, potential interaction) of substances and supplements, which have been state in the thesis, with a proposal for their...

Author: Kateřina Breiterová Title: Neurotropic and antioxidative activity of some selected species of monocotyledonous alkaloidal plants in vitro. VIII. Diploma thesis Charles Univerzity in Prague, Faculty of Pharmacy in Hradec Králové, Department of Pharmaceutical Botany and Ecology 2015, 101 p. More than 50 % cases of dementia are nowadays caused byAlzheimer's disease (AD). AD is a progressive neurodegenerative disease and it causes gradual memory loss, disorientation and behavioral disorders which affect patient's social and occupational life. AD is characteristic by loss of neurons in some regions of brain - for example hippocampus and cortex. Ethiopathogenesis of this disease is not completely known - that is why the treatment is still just symptomatic. Formation of β-amyloid deposits in brain tissue plays an important role - it is a protein which creates extracellular plagues around neurites and causes their degeneration and death. Intracellular tangles are made up of the changed τ-protein. These tangles also cause death of the neuronal cell. The degeneration of neurons is supported by reactive oxygen radicals too. The another problem is a glutamatergic system disorder. This set of excitatory amino acids is important for correct long-term memory formation. Patients with AD suffer from...