O efeito da reabilitação neuropsicológica foi verificado em uma amostra de 16 pacientes com diagnóstico de doença de Alzheimer leve e moderado. Após ensaio clínico aberto com rivastigmina por 4 meses, os pacientes foram divididos em três grupos: sessões em grupo, individual e em casa com o cuidador. Os três grupos realizaram o mesmo protocolo de reabilitação, e antes e depois das 22 semanas de tratamento foram avaliados pelos mesmos instrumentos. Os resultados indicaram que as sessões em grupo são mais eficientes para sintomas psiquiátricos; individual para atividades da vida diária; e em casa, dependendo do perfil do paciente e do cuidador, pode ser uma alternativa de tratamento / The effect of a neuropsychological rehabilitation was tested in a sample of 16 patients with mild and moderate Alzheimer disease. After an open trial with rivastigmine for 4 months, they were divided in 3 groups: group sessions, individualized and at home with a caregiver. All 3 groups fulfilled the same rehabilitation protocol, and just before and after the 22 week period of treatment, all patients were evaluated using the same instruments. The results of the study indicated that group session are more effective for psychiatric symptoms, individualized sessions for activities of daily living training and at home training, depending on the patient's and caregiver's profiles, can be an option for treatment of these patients

Chan, Hung Yee. / Thesis submitted in: December 2007. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2008. / Includes bibliographical references (leaves 121-142). / Abstracts in English and Chinese. / LIST OF TABLES --- p.xi / Chapter CHAPTER 1 --- INTRODUCTION / The Hong Kong context --- p.1 / The research problem --- p.3 / Conclusion --- p.4 / Chapter CHAPTER 2 --- LITERATURE REVIEW / Introduction --- p.6 / Different interpretations of dementia --- p.7 / Experiences of caregivers of older people with dementia --- p.10 / Factors affecting caregiving experiences --- p.15 / Needs of family caregivers --- p.20 / Summary --- p.23 / Chapter CHAPTER 3 --- METHODOLOGY / Introduction --- p.25 / Aim and objectives --- p.25 / Research design --- p.25 / Sampling method --- p.26 / Data collection method --- p.28 / Pilot study --- p.32 / Data analysis --- p.34 / Validity and reliability --- p.37 / Ethical consideration --- p.40 / Summary --- p.41 / Chapter CHAPTER 4 --- RESULTS / Introduction --- p.42 / Demographic characteristics of informants and older people with dementia --- p.43 / Reasons of caregivers for providing home care --- p.45 / Meaning of care --- p.52 / Perceived difficulties in caregiving role --- p.56 / Sources of stress in the caregiving role --- p.59 / Sources of support in caregiving role --- p.62 / Needs of caregivers --- p.65 / Conclusion --- p.69 / Chapter CHAPTER 5 --- DISCUSSION / Introduction --- p.71 / Reason of providing home care --- p.72 / Chinese cultural influences on family caregiving experiences --- p.80 / Perceived difficulties in caregiving roles --- p.91 / Sources of stress --- p.96 / Sources of support in caregiving role --- p.101 / Needs of family caregivers --- p.104 / Conclusion --- p.108 / Chapter CHAPTER 6 --- CONCLUSION / Introduction --- p.110 / Implications to nursing knowledge --- p.110 / Implications to current practice --- p.112 / Limitation of the study --- p.114 / Recommendation to future research areas --- p.116 / Conclusion --- p.118 / REFERENCES --- p.121 / APPENDICES / Chapter Appendix 1 --- "Approval letter from Survey Ethics Committee, CUHK" --- p.143 / Chapter Appendix 2 --- Information letter to informant (English) --- p.144 / Chapter Appendix 3 --- Information letter to informant (Chinese) --- p.145 / Chapter Appendix 4 --- Interview guide --- p.146 / Chapter Appendix 5 --- An example of transcript of interview and preliminary analysis --- p.147 / Chapter Appendix 6 --- Letter of Access --- p.162

O efeito da reabilitação neuropsicológica foi verificado em uma amostra de 16 pacientes com diagnóstico de doença de Alzheimer leve e moderado. Após ensaio clínico aberto com rivastigmina por 4 meses, os pacientes foram divididos em três grupos: sessões em grupo, individual e em casa com o cuidador. Os três grupos realizaram o mesmo protocolo de reabilitação, e antes e depois das 22 semanas de tratamento foram avaliados pelos mesmos instrumentos. Os resultados indicaram que as sessões em grupo são mais eficientes para sintomas psiquiátricos; individual para atividades da vida diária; e em casa, dependendo do perfil do paciente e do cuidador, pode ser uma alternativa de tratamento / The effect of a neuropsychological rehabilitation was tested in a sample of 16 patients with mild and moderate Alzheimer disease. After an open trial with rivastigmine for 4 months, they were divided in 3 groups: group sessions, individualized and at home with a caregiver. All 3 groups fulfilled the same rehabilitation protocol, and just before and after the 22 week period of treatment, all patients were evaluated using the same instruments. The results of the study indicated that group session are more effective for psychiatric symptoms, individualized sessions for activities of daily living training and at home training, depending on the patient's and caregiver's profiles, can be an option for treatment of these patients

Text in English / The present paper analyses the neuroanatomical and neuropsychological backgrounds of art reception and art creation in modern visual art and creative processes. It critically presents two models of aesthetic experience to provide a comprehensive theoretical basis for the discussion. The research purpose is to show that with increasing experience and expertise the referential frame of the aesthetic judgment is changing and that neural processes involved in object recognition provide a starting point for visual aesthetics. Thus, the investigation focuses on constructing and testing neuropsychological theories that fall in the domain called 'neuroaesthetics'. These theories, in turn, serve as a starting point to formulate neural laws of art and aesthetics and aesthetic experience. Some artistic styles, such as expressionism, reflect specific neural processes. Various studies indicate correlations between hemispheric specialisation and art or creativity and show the right hemisphere plays a particular role in it. However, studies exploring the neural correlates of aesthetic preference have yielded mixed results. Furthermore, neuroimaging studies have proved that different categories of modern artworks are processed in different areas of the brain. These diverging results will be discussed in a critical assessment of the two models of aesthetic experience. Besides, the question of identifying exclusive neural correlates of aesthetic preference will be raised. Comparing amateurs and experts has revealed the more reduced the cortical activation, the more efficiently it works. Biological and neuropsychological factors of creativity point out the meaning of the activation level, cognitive inhibition and prefrontal cortex. Divergent thinking differs from convergent thinking in terms of the neural level. Neurodegenerative processes and brain injuries sometimes influence the artistic output surprisingly or even launch it. Lesion studies contributing to understanding art experience will be explained. / Psychology / M.A. (Psychology)

L’atrophie corticale postérieure (ACP) est un syndrome clinique assez rare d’apparition insidieuse et d’évolution progressive amenant des difficultés visuelles complexes, associées à une atrophie prédominant dans les régions corticales postérieures, en dépit d’une relative préservation des autres sphères de la cognition. Cependant, cette forme atypique de démence demeure encore mal caractérisée en début d’évolution. L’objectif principal de ce projet est de mieux caractériser sur le plan neuropsychologique l’ACP en début d’évolution. Une étude de cas neuropsychologique approfondie a été réalisée chez un patient de 63 ans atteint d’une ACP débutante (M.T.) présentant initialement des plaintes au niveau de la perception visuelle. Une batterie exhaustive de tests neuropsychologiques a été administrée afin d’évaluer l’ensemble des fonctions cognitives. Une évaluation fonctionnelle en ergothérapie a également été réalisée afin d’évaluer l’ampleur des difficultés dans les activités de la vie quotidienne, ainsi qu’une IRM anatomique haute résolution (3 Teslas). Les résultats de l’évaluation neuropsychologique ont mis en évidence des difficultés relativement sélectives à traiter de l’information visuelle spatiale tridimensionnelle, suggérant sur le plan clinique une atteinte de la voie dorsale. Les résultats de l’imagerie par résonance magnétique (IRM) ont mis en évidence une atrophie prédominant dans la région pariétale, surtout dans l’hémisphère droit, corroborant ainsi les atteintes sur le plan neuropsychologique. Cette étude dans son ensemble contribue à mieux documenter la nature des atteintes cognitives, fonctionnelles et cérébrales dans un syndrome progressif rare. / Posterior cortical atrophy (PCA) is an insidious, rare and progressive clinic syndrome which causes complex visual difficulties, associated with atrophy predominating in posterior cortical areas, despite a relative preservation in other cognitive domains. This unusual type of dementia has been poorly characterized in the very early stage of the disease from a neuropsychological standpoint. The main goal of this project is to better characterize PCA from a neuropsychological and functional perspective in the very early stage of the disease, through a very detailed single case study of a 63 years old patient who presented with slowly progressive difficulties in visual perception. A detailed neuropsychological assessment of patient M.T. was carried out in order to assess his abilities in different cognitive domains. A functional evaluation of his activities of daily living was also carried out. The results of the neuropsychological assessment revealed specific difficulties in processing three-dimensional, visuospatial information, suggesting lesions to the occipitoparietal pathway (dorsal stream). M.T. carried out a high-resolution 3T anatomical MRI, which revealed bi-parietal atrophy, predominating in the right hemisphere. This study helps better documenting the nature of neuropsychological, functional, and neuroanatomical deficits in the very early stage of PCA.

La Maladie d’Alzheimer est caractérisée par la formation de dégénérescences neurofibrillaires, constituées de protéine Tau anormalement hyperphosphorylée et agrégée. De nombreuses études traitent de possibles stratégies thérapeutiques basées sur l’inhibition de cette polymérisation, et présentent les effets bénéfiques de certaines molécules dont les polyphénols, mais les résultats obtenus jusque là, manquent de données au niveau moléculaire. Ainsi, après avoir synthétisé, une banque de polyphénols de structures différentes, et 3 peptides représentatifs de la région P de phosphorylation de Tau, c’est en suivant une stratégie combinant la RMN et la modélisation moléculaire, que nous avons évalué les paramètres dynamiques du complexe formé. Ce projet nous a apporté des informations en termes d’affinité, et de relations structure/activité et ainsi, de mieux appréhender les mécanismes d’interactions intervenant dans l’agrégation de Tau par les polyphénols. / Alzheimer's disease is characterized by the formation of neurofibrillary tangles constituted by abnormally hyperphosphorylated and aggregated Tau protein. Many studies deal with potential therapeutic strategies based on the inhibition of this polymerization, and show the beneficial effects of some molecules like polyphenols, but the obtained so far results show a lack of data at the molecular level. Thus, after the synthesis of, a library of polyphenols with different structures, and 3 representative peptides of the P2 phosphorylation Tau region, by following a strategy combining NMR and molecular modeling, we have evaluated dynamic parameters of the formed complex. This project has provided us informations in terms of affinity, and structure / activity relationships, and leading us to a better understanding of the mechanisms led to better understand the mechanisms involved in the aggregation Tau inhibition phenomena by polyphenols.

Le vieillissement des populations est corrélé à l’augmentation des pathologies neurodégénératives liées à l’âge, plus particulièrement la maladie d’Alzheimer. La recherche de marqueurs précoces de la maladie ainsi que l’élaboration de nouvelles stratégies thérapeutiques constituent un enjeu de taille. Parmi les mécanismes moléculaires de la formation des plaques amyloïdes actuellement explorés, les formes oligomériques tronquées de peptide amyloïde (Aß), notamment le peptide Aß3(?pE)??42? retrouvé à des stades précoces de la maladie, joueraient un rôle déterminant. Ces travaux de thèse ont permis de montrer, dans un premier temps, que l’injection intracérébrale de ce peptide chez la souris entraîne des altérations de la mémoire de travail et des capacités d’apprentissage, associées à une accumulation d’espèces réactives dérivées de l’oxygène dans des régions cérébrales spécifiques (hippocampe et bulbes olfactifs) de ces animaux. Des essais menés in vitro sur des cultures primaires de neurones de souris montrent leur implication dans les voies apoptotiques impliquant l’activation des caspases et la cascade métabolique de l’acide arachidonique. La seconde étape de ces travaux a constitué en l’étude des effets protecteurs d’un peptide antiapoptotique d’origine endogène, l’humanine (HN) et son variant S14G (HNG). In vitro, un effet protecteur de ces peptides a été mesuré après traitement de neurones en culture par le peptide A[bêta]3?(pE)42.??? Les résultats les plus marquants résident dans les observations faites in vivo : en effet, ces peptides inhibent l’effet délétère de l’injection intracérébroventriculaire du peptide Aß3?(pE??)42?? en restaurant les performances mnésiques des animaux dans les tests comportementaux. A la lumière de ces résultats, les peptides HN pourraient constituer de nouveaux outils thérapeutiques dans le traitement ou la prévention des dommages cellulaires précoces liés à la présence des oligomères solubles du peptide Aß / Aging of population is correlated to the increase of neurodegenerative disease, more particularly Alzheimer disease. Defining early diagnostic markers and new therapeutic strategies are highly relevant. Among the molecular pathways which are currently developed, N-terminal-truncated forms of amyloid-ß (Aß) peptide have been recently suggested to play a pivotal role in the disease. Among them, Aß3(?pE)42 ?peptide is the dominant Aß species in amyloid plaques. We first investigated the effects of soluble oligomeric Aß3(pE) 42 after intracerebroventricular injection on mice learning capacities and the molecular mechanisms of in vitro neurotoxicity. Mice injected with soluble Aß3(pE) 42 displayed impaired spatial working memory and delayed memory acquisition. These cognitive alterations were associated with free radical overproduction in hippocampus and olfactory bulbs. In vitro, Aß3(pE) 42 oligomers induced a redox-sensitive neuronal apoptosis involving caspase activation and an arachidonic acid-dependent pathway. The second goal of this work was to investigate the protective effects of the apoptosis rescue endogenous peptide humanin (HN) and its S14G mutant (HNG). In vitro, we measured their inhibitory effect on neuronal death and apoptotic events resulting from soluble Ab oligomer treatment. What’s of particular interest is the in vivo restoration of soluble Aß3(pE) 42 oligomer-induced mnesic impairment. Thus, HN peptides might serve as new drug candidates for treatment or prevention of early cellular damages linked to soluble A[bêta] oligomers

The present paper analyses the neuroanatomical and neuropsychological backgrounds of art reception and art creation in modern visual art and creative processes. It critically presents two models of aesthetic experience to provide a comprehensive theoretical basis for the discussion. The research purpose is to show that with increasing experience and expertise the referential frame of the aesthetic judgment is changing and that neural processes involved in object recognition provide a starting point for visual aesthetics. Thus, the investigation focuses on constructing and testing neuropsychological theories that fall in the domain called 'neuroaesthetics'. These theories, in turn, serve as a starting point to formulate neural laws of art and aesthetics and aesthetic experience. Some artistic styles, such as expressionism, reflect specific neural processes. Various studies indicate correlations between hemispheric specialisation and art or creativity and show the right hemisphere plays a particular role in it. However, studies exploring the neural correlates of aesthetic preference have yielded mixed results. Furthermore, neuroimaging studies have proved that different categories of modern artworks are processed in different areas of the brain. These diverging results will be discussed in a critical assessment of the two models of aesthetic experience. Besides, the question of identifying exclusive neural correlates of aesthetic preference will be raised. Comparing amateurs and experts has revealed the more reduced the cortical activation, the more efficiently it works. Biological and neuropsychological factors of creativity point out the meaning of the activation level, cognitive inhibition and prefrontal cortex. Divergent thinking differs from convergent thinking in terms of the neural level. Neurodegenerative processes and brain injuries sometimes influence the artistic output surprisingly or even launch it. Lesion studies contributing to understanding art experience will be explained. / Psychology / M.A. (Psychology)

Cette thèse de sociologie porte sur les pratiques de sommeil des couples vieillissants confrontés à une maladie neurodégénérative. Elle se fixe comme objectif de saisir les dynamiques temporelles et spatiales de ces pratiques de sommeil, centrales dans la vie du couple, au fil de l'évolution de la maladie en accordant une attention particulière aux relations de genre. Nous avons interviewé 30 couples à domicile, dont 12 concernés par la maladie à corps de Lewy et 18 par la maladie d'Alzheimer et nous avons intégré des dispositifs d'enquête tels que la rédaction de journaux de sommeil, de journaux audio et la constitution d'un ensemble de documentation photographique. L'analyse se déploie selon trois axes. Le premier axe consiste à analyser le rôle du veilleur de nuit assumé par le conjoint aidant. Nous avons constaté le passage du statut de conjoint dormant à celui de "conjoint veilleur". Le rôle de conjoint veilleur est caractérisé par la production d'un travail domestique de soin qui se déroule la nuit et que nous avons appelé "travail domestique nocturne de soin". Nos résultats montrent que ce travail domestique nocturne peut amener le conjoint veilleur à un état d'épuisement qui peut pousser au choix d'institutionnaliser son conjoint malade. Ce travail domestique s'articule avec un état d'inquiétude nocturne du conjoint veilleur qui engendre un sommeil spécifique que l'on peut qualifier de "sommeil en état d'alerte". Il est aussi doublement invisible : il est constitué par des activités se déroulant la nuit et il repose souvent sur les femmes. Le deuxième axe consiste à analyser l'impact de la maladie et des troubles cognitifs sur l'organisation des espaces liés au sommeil en mettant en lumière les négociations qui se font autour de la chambre conjugale. Nous avons dégagé les raisons pour lesquelles une partie des conjoints reste attachée au fait de dormir ensemble. Nous avons aussi analysé les dimensions corporelles liées au partage du lit, contexte où la relation entre les corps trouve son expression privilégiée. Nous avons exploré les expériences de distanciation des conjoints : les significations et les pratiques autour du choix de dormir en couple mais séparés, de faire chambre à part. Le dernier axe porte sur l'analyse des stratégies hétérogènes de la gestion du sommeil telles que l'utilisation des médicaments pour dormir, le recours à la garde nocturne en institution ou au domicile et, enfin, le sommeil diurne. Nous avons analysé les raisons de l'adhésion ou du refus de la part des conjoints aidants et nous avons constaté que la vulnérabilité qui caractérise la nuit et le sommeil peut rendre difficile le recours aux stratégies de gestion du sommeil. / This doctoral dissertation in sociology examines the sleep practices of ageing couples confronted with neuro-degenerative conditions. It aims to understand the time- and space-related aspects of these sleep practices, so central to couples’ lives, throughout the different stages of illness, and places particular emphasis on gender-based relations. Thirty couples were interviewed in their homes, 12 of whom were affected by Lewy Body Dementia and 18 by Alzheimer’s Disease. Empirical methods such as sleep journals, audio journals, and photographic documentation were incorporated into the study’s methodology. The study is divided into three branches. The first branch examines the role of “night-time guardian” assumed by the caregiving partner. The author was able to observe that a shift takes place from the status of sleeping partner to that of night-time caregiver. The role of the “night-time guardian” is characterized by domestic labor that takes the form of caregiving provided at night, a phenomenon the author calls “nocturnal domestic caregiving work”. The findings of the study show that this domestic night-time work can bring about a state of exhaustion in caregiving partners that can drive them to institutionalize the partner suffering from a medical condition. In addition to this domestic work, caregiving partners are prone to a state of night-time worry that results in a specific variety of sleep that can be described as “alert sleep”. This domestic work also goes largely unseen for two reasons: it is made up of activities that take place at night, and it often falls to women. The study's second branch offers an analysis of the impact of illness and cognitive disorders on the way areas of the home associated with sleep are organized, bringing to light the give-and-take that occurs where the marital bedroom is concerned. The author examined the reasons some sleep partners continue to insist on sleeping together. Also addressed are the bodily aspects of shared beds, a special context in which the bonds shared between bodies can be expressed in a unique way. The dissertation further explores the experience of placing distance between sleep partners: the meanings and practices surrounding the decision to sleep as a couple but in separate rooms. The final branch of the study examines a range of strategies used to manage sleep, such as taking sleeping medication, turning to in-home or institutional night-time caretaking, and day-time sleep. The author surveyed the reasons that caregiving partners accepted or refused to utilize these strategies, and the study’s findings show that the vulnerability represented by night and sleep can render it difficult to decide to use strategies to manage sleep.

A literatura científica vem debatendo sobre a existência de uma associação entre diabetes mellitus (DM) e demência, doença de Alzheimer (DA) e demência vascular (DV). O DM é um conhecido fator de risco para a doença cerebrovascular (DCV) e DV, porém não há consenso até o momento do real papel do DM no desenvolvimento das alterações neuropatológicas da DA. Objetivos: verificar a associação entre DM e demência, DM e alterações neuropatológicas da DA e DV. Métodos: os dados foram coletados do Banco de Encéfalos Humanos do Grupo de Estudos em Envelhecimento Cerebral da FMUSP estudados de 2004 a 2015. A amostra foi dividida em dois grupos: não diabéticos e diabéticos. Os diagnósticos de DM e de demência foram estabelecidos post-mortem mediante entrevista com informante. O diagnóstico de demência exigiu escore >= 1 na Escala de Avaliação Clínica da Demência (CDR) e Questionário sobre Declínio Cognitivo no Idoso (IQCODE) >= 3,42. O diagnóstico etiológico da demência foi determinado por exame neuropatológico por imuno-histoquímica. A proporção de casos de demência, de DA e de DV de não diabéticos e diabéticos foi determinada, assim como a relação entre DM e placas neuríticas (PN) e emaranhados neurofibrilares (ENF), e neuropatologia vascular. As análises estatísticas empregadas foram o teste de Mann-Whitney e regressão linear múltipla para variáveis quantitativas, teste de ?2, teste exato de Fisher e regressão logística múltipla para variáveis categóricas. Resultados: amostra total foi de 1.037 indivíduos, sendo 758 não diabéticos (73,1%) e 279 diabéticos (26,9%). Demência foi constatada em 28,7% em diabéticos. O DM não se associou à frequência mais elevada de demência (OR: 1,22; IC 95%: 0,81-1,82; p=0,34). O DM não está associado com ENF (p=0,81), PN (p=0,31), grupo infarto (p=0,94), angiopatia amiloide (p=0,42) e arteriolosclerose hialina (p=0,07). Após o ajuste para variáveis demográficas e para os fatores de risco vascular, o diagnóstico de DM não se associou ao diagnóstico neuropatológico de DA e vascular. Conclusão: o DM não está associado à demência e às alterações neuropatológicas da DA e de DV / The scientific literature has been debating the existence of an association between diabetes mellitus (DM) and dementia, Alzheimer\'s disease (AD) and vascular dementia (VaD). DM is a known risk factor for cerebrovascular disease (CVD) and VaD, but there is still no consensus on the real role of DM in the development of AD neuropathology. Objectives: to investigate the association among DM and dementia, neuropathology (NP) of AD and VaD. Methods: Data were collected from the cases included in the Brain Bank of the Brazilian Aging Brain Study Group between 2004 and 2015. Cases were divided into 2 groups: no diabetics and diabetics. Clinical diagnosis of dementia was determined by the scores >= 1.0 in the Clinical Dementia Rating (CDR) and >= 3.42 in the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Etiological diagnoses of dementia were determined by neuropathological examination, using immunohistochemistry. The proportion of dementia cases, AD and VaD of no diabetics and diabetics were investigated as well as the relationship among DM and neuritic plaques (NPq) and neurofibrillary tangles (NFT). Mann-Whitney test and multiple linear regression for quantitative variables, and chi-square test and multiple logistic regression for categorical variables were the statistical analyses applied. Results: Total sample included 1037 subjects, divided in 758 (73.1%) no diabetics and 279 diabetics (26.9%). Dementia was present in 27.8% of diabetics. DM did not increase the frequency for dementia (OR: 1.22; IC 95%: 0.81-1.82; p=0.34). DM was not associated with NFT (p=0.81), NPq (p=0.31), infarct group (0.94), cerebral amyloid angiopathy (0.42) and hyaline arteriolosclerosis (p=0.07). After adjustment for demographic variables and vascular risk factors, DM was not associated with DA and vascular NP. Conclusion: DM is not associated with dementia, AD and vascular neuropathology