Thesis (Ed. D.)--Illinois State University, 1998. / Title from title page screen, viewed July 3, 2006. Dissertation Committee: Toni McCarty (chair), Lanny Morreau, Patricia Klass, Jim Thompson. Includes bibliographical references (leaves 106-121) and abstract. Also available in print.

A interface entre a linguagem e demais funções cognitivas tem sido objeto de estudo e a ampla e extensa distribuição dos circuitos neuronais torna o tema bastante complexo. A dificuldade em avaliar o desempenho cognitivo de afásicos faz com que estes pacientes sejam excluídos em estudos que buscam descrever alterações cognitivas após AVE. A avaliação de linguagem, isoladamente, não permite predizer o desempenho em outras habilidades cognitivas. Além disso, o processamento da linguagem se apóia nas habilidades de atenção, memória e funções executivas. A literatura nacional é escassa neste tema. Este trabalho teve como objetivos: avaliar o desempenho dos indivíduos afásicos em tarefas cognitivas não linguísticas (atenção, memória verbal e não verbal, funções executivas e habilidades visuoespaciais), comparar o desempenho dos afásicos e não afásicos nestas tarefas e relacionar o desempenho dos afásicos nas tarefas cognitivas não linguísticas com a gravidade da afasia. Participaram da pesquisa 47 indivíduos, maiores de 18 anos, de ambos os gêneros, com escolaridade mínima de dois anos, e diagnóstico de primeiro episódio de AVE, confirmado por TC de crânio. Aplicada a seguinte bateria de testes: Protocolo de Praxias Gestuais (TBDA), Fluência verbal semântica (animais) e Fonológica (FAS), Teste de Trilhas A e B, Teste de Cancelamento, Aprendizado de Palavras (CERAD), Aprendizado de Figuras (BBRC-Edu), Praxias construtivas (CERAD), Extensão de Dígitos (ED) e Desenho do Relógio (TDR). A amostra foi dividida em três grupos: afásicos (AF, n=21), não afásicos com lesão em hemisfério esquerdo (NAF E, n = 17) e não afásicos com lesão em hemisfério direito (NAF D, n = 9). O grupo de afásicos foi também subdividido em grupos grave (AFg) e leve (AFl). Não houve diferença estatisticamente significante entre os grupos nas provas de Cancelamento, Teste de Trilhas, Praxias Construtivas. Os afásicos apresentaram pior desempenho, em comparação aos grupos NAF E e NAF D, nas provas de fluência semântica, praxias gestuais, ED (ordens direta e inversa), Aprendizado de Palavras, Evocação das Praxias Construtivas (pontuação total), Aprendizado de Figuras e TDR. Na prova de extensão de dígitos, ordem direta, constatou-se pior desempenho do grupo AFg, em comparação ao AFl. Foi encontrada correlação entre a gravidade da afasia e o desempenho no teste de extensão de dígitos em ordem direta (rho=0,860, p=0,0001) e ordem inversa (rho=0,543, p=0,0152), e nas provas de praxias gestuais, especialmente nas praxias bucofaciais e respiratórias (rho=0,708, p=0,016). Constatou-se pior desempenho dos grupos AF e NAF E, em comparação ao grupo NAF D, nas provas de reconhecimento de palavras, Aprendizado de Figuras e TDR. Fatores como prejuízo na expressão oral e hemiparesia interferiram no desempenho dos sujeitos afásicos. A literatura aponta e o estudo confirma que os afásicos demonstram grande variabilidade no desempenho. Mostram-se necessários instrumentos mais adequados para a avaliação das habilidades não linguísticas em afásicos, além de estudos que possam ser replicados em diferentes populações. A avaliação do afásico que não considere somente as habilidades linguísticas, mas também outras funções cognitivas, pode auxiliar na elaboração de planejamentos terapêuticos mais adequados e, aumentar a eficácia da terapia de linguagem / The interface between language and other cognitive functions has been studied and the broad and extensive distribution of neural circuits has made the theme become very complex. The difficulty in assessing cognitive performance in aphasic patients excludes these patients from studies describing post-stroke cognitive deficits. Language assessment itself does not allow predicting the performance in other cognitive skills. Furthermore, language processing is supported by other cognitve abilities such as attention, memory, and executive functions. The literature about this theme in Brazil is scarce. This study aimed to evaluate the performance of aphasic patients in non-linguistic cognitive tasks (attention, verbal memory, non-verbal memory, executive functions and visuospatial skills), to compare the performance of aphasic and non-aphasic patients in non-linguistic cognitive tasks, and to correlate the performance of aphasic patients in nonlinguistic cognitive tasks and the aphasia severity. Forty seven individuals over 18 years old were enrolled in this research, both male and female, with minimum schooling level of two years, and diagnosis of first episode of stroke confirmed by CT brain scan. The following battery of tests was applied: Gesture Praxis Protocol (BDAE), Semantic (animals) and Phonemic (FAS) verbal fluency, Trail Making Test A and B, Cancellation Test, Word List Memory (CERAD), Figure Learning (BCB-Edu), Constructional Praxis (CERAD), Digit Span (DS) and Clock Drawing Test (CDT). The sample was divided in three groups: aphasic (AP,n=21), non-aphasic with left hemisphere lesion (NAP E, n = 17), and non-aphasic with right hemisphere lesion (NAP D, n = 9). The group of aphasic patients was also subdivided in severe (APs) and mild (APm). There was no significant statistical difference between the groups in the Cancellation Test, in the Trail Making test, and in the Constructional Praxis. The aphasic presented worse performance in comparison to groups NAP E and NAP D in Semantic fluency task, gesture praxis, DS (forward and backward), Word List Memory, Constructional Praxis recall (total score), Figure Learning, and CDT. In the Digit Span test, forward order, it was observed worse performance of group APs, in comparison to APm. It was verified a correlation between the aphasia severity and the performance in the DS test, forward order (rho=0,860, p=0,0001) and backward order (rho=0,543, p=0,0152), and in the Gesture Praxis test mainly in bucco-facial and respiratory praxis (rho=0,708, p=0,016). It was observed worse performance of groups AP and NAP E, in comparison to group NAP D, in the Word Recognition task, Figure Learning and CDT. The impairment of oral expression and hemiparesis interfered in the performance of aphasic patients. Literature points, and the study confirms, that aphasic patients show great variability in the performance. More adequate instruments for the assessment of non-linguistic skills in aphasic patients are necessary, besides studies that may be replicated in different populations. The assessment oof aphasic patients considering not only linguistic skills, but also other cognitive functions may help in the elaboration of more appropriate therapeutic planning and increase the efficacy of language therapy

Le vieillissement de la population mondiale s’accompagne de l’augmentation de la prévalence d’un certain nombre de maladies chroniques incluant la démence. Si les études épidémiologiques sur les troubles cognitifs ont été et sont encore majoritairement menées dans les pays occidentaux, peu d’entre elles sont conduites dans les pays à faible et moyen revenus, comme les pays africains, qui ne sont pourtant pas épargnés par le phénomène. Le programme EPIDEMCA, Épidémiologie des Démences en Afrique Centrale, a pour objectif principal de contribuer à une meilleure connaissance de la démence et particulièrement de la maladie d’Alzheimer en zones rurale et urbaine de deux pays d’Afrique Centrale : la République Centrafricaine (RCA) et la République du Congo (Congo). Mon travail de thèse, s’inscrivant dans le cadre de ce programme, a pour objectif général de contribuer à une meilleure connaissance des troubles cognitifs (Mild Cognitive Impairment (MCI) et démence) par l’étude du lien entre les troubles cognitifs et les facteurs psychosociaux (événement de vie stressants et trouble de la personnalité dépendante) d’une part, et nutritionnels (dénutrition et consommation alimentaire) d’autre part. Le programme EPIDEMCA est une enquête épidémiologique transversale multicentrique en population générale âgée de 65 ans et plus menée en deux phases dans une zone rurale et une zone urbaine de RCA et du Congo entre 2011 et 2012. Les diagnostics de démence et de MCI étaient posés respectivement selon les critères du DSM-IV et de Petersen. Sur 2 002 sujets ayant accepté de participer à l’enquête, le statut cognitif et l’âge étaient disponibles pour 1 772 dont 1519 étaient indemnes de troubles cognitifs, 118 étaient atteints de MCI et 135 de démence. Concernant les facteurs psychosociaux, les résultats de notre première étude ont montré que le MCI était positivement associé au nombre total d’événements vécus sur la vie entière uniquement au Congo alors qu’il l’était au nombre total d’événements survenus à partir de l’âge de 65 ans et à une maladie physique grave chez un enfant après l’âge de 65 ans dans l’échantillon total. En revanche, la démence n’était associée ni à l’accumulation d’événements de vie, ni aux événements pris séparément. Les résultats de notre deuxième étude ont montré que le MCI était associé au trouble de la personnalité dépendante au Congo comme en RCA, alors que la démence ne l’était seulement au Congo.Du côté nutritionnel, notre troisième étude a montré une association significative entre la démence (mais pas le MCI) et les trois indicateurs de dénutrition utilisés (IMC inférieur à 18,5 kg/m2, périmètre brachial inférieur à 24 cm et circonférence musculaire brachiale (CMB) inférieure au 5ème percentile d’une population de référence) en RCA. Au Congo, le MCI était associé seulement à la CMB inférieure au 5ème percentile alors que la démence ne l’était à aucun indicateur. Notre quatrième étude a, quant à elle, trouvé qu’en RCA, les troubles cognitifs étaient associés à une consommation modérée d’alcool dans l’échantillon total ainsi qu’à une faible consommation d’oléagineux en zone rurale. Au Congo, en revanche, ils n’étaient associés à aucun groupe d’aliments ni même à la consommation d’alcool. Les travaux de cette thèse ont permis de contribuer à l’amélioration des connaissances sur l’épidémiologie des troubles cognitifs en Afrique centrale. Il n’en demeure pas moins que nos résultats ne sont qu’exploratoires et devront être confirmés par des études ultérieures, nécessaires préalables à la planification d’actions pertinentes et ciblées susceptibles de réduire le risque. / With the aging of the world population, prevalence of non-communicable diseases including dementia is increasing. While epidemiological studies on cognitive impairments have been mainly conducted in high-income countries, a few have been carried out in low-and middle-income countries, including African countries, not exempt from this phenomenon. The EPIDEMCA program, Epidemiology of Dementia in Central Africa, is aimed at contributing to a better understanding of dementia and Alzheimer's disease in rural and urban areas in two countries of Central Africa: the Central African Republic (CAR) and the Republic of Congo (ROC). This PhD thesis, which is part of this program, focuses on the relationship between cognitive disorders (Mild Cognitive Impairment (MCI) and dementia) and psychosocial factors (stressful life events and dependent personality disorder) on the one hand, and nutritional factors (undernutrition and dietary consumption) on the other.The EPIDEMCA program is a cross-sectional multicenter population-based epidemiological study carried out among people aged 65 years and over in rural and urban areas of CAR and ROC between 2011 and 2012 using a two-phase design. DSM-IV and Petersen criteria were required for a diagnosis of dementia and MCI, respectively. Among 2002 subjects who agreed to participate in the study, cognitive status and reliable age were available for 1772 people: 1519 were free of cognitive impairment, 118 suffered from had MCI and 135 from had dementia. As regards the psychosocial factors, our first study showed that MCI was positively associated with the total number of events experienced throughout a life span in Congo only, and, with the total number of events from the age of 65 onwards and with a child’s severe physical disease after the age of 65 in the total sample. On the contrary, dementia was associated with neither the accumulation of stressful life events nor individual events. Results of our second study showed that MCI was associated with the dependent personality disorder in Congo and CAR, while dementia was associated with this disorder in Congo only. Regarding nutritional factors, our third study showed a significant association between dementia (but not MCI) and the three markers of undernutrition used (BMI inferior to 18.5 kg/m2, mid-upper arm circumference inferior to 24 cm and arm muscle circumference (AMC) below the 5th percentile of a reference population) in CAR. In Congo, MCI was associated with only the AMC<5th percentile while dementia with none of markers. Our fourth study found that cognitive disorders were associated with light alcohol intake and a low consumption of oilseeds in rural areas only. In Congo, cognitive disorders were associated with neither food groups nor alcohol consumption. This PhD thesis has contributed to improve the knowledge available on the epidemiology of cognitive disorders in Central Africa. Nevertheless, our results are solely exploratory and require to be confirmed by further studies, prerequisites for relevant and targeted interventions with a view to reduce the risk.

M.Ed. / The aim of this research study was to conduct Narrative Therapy with an adolescent with cerebral palsy and a cognitive disability, to determine his experience of the disability. The study was motivated by the fact that no research has been conducted in South Africa on therapy with adolescents living with cerebral palsy and cognitive disability. The reason being that it was believed that a client needs to have the cognitive ability for therapeutic change to occur. Recent international research has proved that therapy can be successful with clients with cognitive disabilities, if the approach or techniques are on the client’s cognitive developmental level. The goal of the study was firstly to give a voice to a seventeen-year-old adolescent with cerebral palsy and a cognitive disability to tell his story. Secondly, to determine what internal resources he has to help him cope with the disability. Lastly, to make recommendations for other therapists who want to conduct therapy with adolescents living with disabilities. A qualitative research approach with a single case study as research design from a selected sample was used. A qualitative approach is useful in studies where the meaning individuals give to there experience are investigated. The focus is on a seventeen-year-old adolescent with cerebral palsy and a cognitive disability and his experience of the disability. The researcher as therapist uses Narrative Therapy to describe and document the adolescent’s experience. Data was gathered through a variety of techniques (interviews, Narrative therapy sessions, observations and therapeutic letters), which enhanced the reliability of the study. The researcher was also the therapist who conducted Narrative Therapy and she had the opportunity to explore and describe the adolescent’s experience. From the data, certain themes and sub-themes were identified that highlighted aspects of living with a disability. / Me. H. Krige

Bakgrund Kognitiv sjukdom är förvärvade och bestående skador i hjärnan som påverkar personens förmåga att självständigt klara av sitt alldagliga liv i olika utsträckning. De fyra vanligaste diagnoserna är Alzheimers sjukdom, vaskulär demens, frontotemporallobsdemens och Lewy body demens. Ibland drabbas personer med kognitiv sjukdom av sjukdomstillstånd som kräver vård inom slutenvården. Slutenvården med sin sterila miljö är inte anpassad för personer med kognitiv sjukdom. Miljön i slutenvården är okänd och kan därför skapa oro hos den här patientgruppen. Syfte Syftet var att belysa sjuksköterskors erfarenheter av att vårda personer med kognitiv sjukdom inom slutenvården. Metod Metoden som använts är litteraturöversikt med induktiv ansats och resultatet består av femton artiklar som valts ut från artikelsökningar i två olika databaser, relevanta för forskning inom omvårdnad och hälsovetenskap. Artiklarna kvalitetsgranskades, analyserades enligt ett flödesschema och presenteras i tre kategorier med tio underkategorier. Resultat Litteraturöversiktens resultat visade att organisatoriska faktorer som tidsbrist, slutenvårdensmiljö och olika arbetssätt är något som påverkar sjuksköterskors erfarenheter av att vårdapersoner med kognitiv sjukdom. Det visade att sjuksköterskor har ett behov av kunskap och utbildning i kognitiva sjukdomar då upplevelsen är att kunskapen från grundutbildningen inte är tillräcklig. Det finns ett behov hos sjuksköterskor att kunna ge personer med kognitiv sjukdom en personcentrerad vård för att kunna säkerställa att personens behov blir tillgodosedda och då kan närstående vara till stor hjälp. Resultatet visade att sjuksköterskor har en viktig roll i att säkerställa att personer med kognitiv sjukdom får en god vård men det visade också att arbetsbelastningen på sjuksköterskor är hög. Slutsats Slutsatsen blir att slutenvårdens utformning och miljö borde anpassas efter personer med kognitiv sjukdom, att sjuksköterskor har ett behov av utbildning och kompetensutveckling samt att detta skulle gynna alla parter i slutändan. / Background  Cognitive disorders are acquired and permanent damages to the brain which affects the person's ability to manage their everyday life to varying extent. Four of the most common diagnoses are Alzheimer's disease, vascular dementia, frontotemporal dementia and Lewy body dementia. People with cognitive disorders may become so ill that they need treatment in hospital. The sterile environment in hospitals is not adjusted for this patient group. It’s an unknown environment that may cause anxiety for them. Aim  The aim of this literature review was to illuminate nurses' experience of caring for people with cognitive disorders in hospital wards. Method  The method used was a literature review with an inductive approach and the result consists of fifteen articles from searches in two different databases which are relevant to research within nursing- and health science. The articles have been quality audited, analyzed and are presented in three main categories with ten subcategories. Results  The results showed that organizational factors such as lack of time, hospital environment and different ways of working are affecting nurses' experiences of caring for people with cognitive disorders. It displays that nurses need more knowledge and education about cognitive disorders as they experience that the education they got in nursing school is not enough. There’s a need among nurses to give people with cognitive disorders a person centered care in order to fulfill the person's needs and in this part of caring the person’s next of kin can play an important role. The result displays that nurses play a big part in making sure that persons with cognitive disorders are properly cared for but also that the workload for nurses is high. Conclusion  The conclusion is that hospital environment and design should be adjusted for people with cognitive disorders, that nurses need education and competence development and that everybody would profit from this in the end.

Avaliou-se, três vezes, ao longo de um mês, a função cognitiva de doentes em tratamento da dor oncológica e comparou-se o desempenho dos que recebiam opióides (Grupo Recebendo Opóides – GRO, n=14) ao dos que não os recebiam (Grupo Sem Opióides – GSO, n=12); analisaram-se também as relações entre função cognitiva, intensidade da dor e dose do opióide. A função cognitiva foi avaliada por meio do Teste de Trilhas, Mini-exame do Estado Mental, Teste de Extensão de Dígitos, Bateria Breve de Rastreio Cognitivo e Inventário de Depressão de Beck. Para a identificação de diferenças, o nível de significância foi estabelecido em 5%. A análise longitudinal para o GSO mostrou melhora da memória incidental (P=0,005) e do aprendizado (P=0,016); entretanto, piora das habilidades construtivas e vísuo-perceptivas (P=0,039). Para o GRO observou-se melhora da memória incidental (P=0,038). Em ambos os grupos não houve modificação no Teste de Trilhas, Mini-exame do Estado Mental, Teste de Extensão de Dígitos e demais testes da Bateria Breve de Rastreio Cognitivo. A comparação entre os grupos mostrou que o GSO teve melhor desempenho na atenção/concentração e memória operacional (2ª avaliação, P=0,029) e funções executivas (1ª avaliação, P=0,023). A análise de correlações no GRO demonstrou que à dor menos intensa corresponderam escores maiores no Mini-exame do Estado Mental (P =0,001), na memória incidental (P =0,030 e 0,014), na memória imediata (P=0,042) e na memória tardia (P =0,037), avaliados pela Bateria Breve de Rastreio Cognitivo. Não se observaram correlações no GSO. Não houve correlação entre a dose do opióide e o desempenho nos testes. O GSO teve melhor desempenho que o GRO em alguns testes, na análise comparativa entre grupos e na análise longitudinal. No entanto, essa superioridade não se expressou nas três avaliações e nem na maioria dos testes. A correlação negativa entre intensidade da dor e função cognitiva no Grupo Recebendo Opióides indicou que a intensidade da dor influenciou o desempenho cognitivo. Há necessidade de outros estudos que ampliem o conhecimento sobre o tema. / The cognitive functions of patients in oncologic pain treatment were assessed three times, over the period of a month. The performance of patients in treatment with opioids (Group Receiving Opioids – GRO, n=14) was compared with that of a group of patients receiving treatment without the administration of opioids (Group Without Opioids – GWO, n=12). Relations between cognitive function, pain intensity and opioid dose were also analysed. The cognitive function was assessed by the Trail Making Test, Mini-mental State Examination, Digit Span Test, Brief Cognitive Screening Battery and Beck Depression Inventory. In order to identify statistical differences, the significance level was established in 5%. The longitudinal analysis to the GWO showed improvement in incidental recall (P=0,005) and learning (P=0,016); however, deterioration in the constructional and visuoperceptual abilities was noticed (P=0,039). Improvement was observed in the incidental recall (P=0,038) of the GRO. In both groups there were no changes in the Trail Making Test, Mini-mental State Examination, Digit Span Test, Beck Depression Inventory and other tests from Brief Cognitive Screening Battery. The comparison between groups showed that GWO had better performance in attention/concentration, working memory (P=0,029) and also in executive functions (P=0,023). The analyses of the correlations in GRO demonstrated that less intense pain corresponds to higher scores in Mini-mental State Examination (P =0,001), in incidental recall (P=0,030 e P =0,014), in immediate recall (P=0,042) and in delayed recall (P=0,037) assessed by the Brief Cognitive Screening Battery. No correlations were observed in GWO. There was no correlation between opioid dose and performance in the results. In the longitudinal tests and comparative analyses between the groups, GWO had better performance than GRO. However, this superiority was not verified in the three assessments, as well as in the case of the majority of the tests results. The negative correlation between pain intensity and cognitive function on the group receiving opioids indicated that pain intensity had an influence on cognitive performance. Further research is necessary to broaden the knowledge about this issue.

Avaliou-se, três vezes, ao longo de um mês, a função cognitiva de doentes em tratamento da dor oncológica e comparou-se o desempenho dos que recebiam opióides (Grupo Recebendo Opóides – GRO, n=14) ao dos que não os recebiam (Grupo Sem Opióides – GSO, n=12); analisaram-se também as relações entre função cognitiva, intensidade da dor e dose do opióide. A função cognitiva foi avaliada por meio do Teste de Trilhas, Mini-exame do Estado Mental, Teste de Extensão de Dígitos, Bateria Breve de Rastreio Cognitivo e Inventário de Depressão de Beck. Para a identificação de diferenças, o nível de significância foi estabelecido em 5%. A análise longitudinal para o GSO mostrou melhora da memória incidental (P=0,005) e do aprendizado (P=0,016); entretanto, piora das habilidades construtivas e vísuo-perceptivas (P=0,039). Para o GRO observou-se melhora da memória incidental (P=0,038). Em ambos os grupos não houve modificação no Teste de Trilhas, Mini-exame do Estado Mental, Teste de Extensão de Dígitos e demais testes da Bateria Breve de Rastreio Cognitivo. A comparação entre os grupos mostrou que o GSO teve melhor desempenho na atenção/concentração e memória operacional (2ª avaliação, P=0,029) e funções executivas (1ª avaliação, P=0,023). A análise de correlações no GRO demonstrou que à dor menos intensa corresponderam escores maiores no Mini-exame do Estado Mental (P =0,001), na memória incidental (P =0,030 e 0,014), na memória imediata (P=0,042) e na memória tardia (P =0,037), avaliados pela Bateria Breve de Rastreio Cognitivo. Não se observaram correlações no GSO. Não houve correlação entre a dose do opióide e o desempenho nos testes. O GSO teve melhor desempenho que o GRO em alguns testes, na análise comparativa entre grupos e na análise longitudinal. No entanto, essa superioridade não se expressou nas três avaliações e nem na maioria dos testes. A correlação negativa entre intensidade da dor e função cognitiva no Grupo Recebendo Opióides indicou que a intensidade da dor influenciou o desempenho cognitivo. Há necessidade de outros estudos que ampliem o conhecimento sobre o tema. / The cognitive functions of patients in oncologic pain treatment were assessed three times, over the period of a month. The performance of patients in treatment with opioids (Group Receiving Opioids – GRO, n=14) was compared with that of a group of patients receiving treatment without the administration of opioids (Group Without Opioids – GWO, n=12). Relations between cognitive function, pain intensity and opioid dose were also analysed. The cognitive function was assessed by the Trail Making Test, Mini-mental State Examination, Digit Span Test, Brief Cognitive Screening Battery and Beck Depression Inventory. In order to identify statistical differences, the significance level was established in 5%. The longitudinal analysis to the GWO showed improvement in incidental recall (P=0,005) and learning (P=0,016); however, deterioration in the constructional and visuoperceptual abilities was noticed (P=0,039). Improvement was observed in the incidental recall (P=0,038) of the GRO. In both groups there were no changes in the Trail Making Test, Mini-mental State Examination, Digit Span Test, Beck Depression Inventory and other tests from Brief Cognitive Screening Battery. The comparison between groups showed that GWO had better performance in attention/concentration, working memory (P=0,029) and also in executive functions (P=0,023). The analyses of the correlations in GRO demonstrated that less intense pain corresponds to higher scores in Mini-mental State Examination (P =0,001), in incidental recall (P=0,030 e P =0,014), in immediate recall (P=0,042) and in delayed recall (P=0,037) assessed by the Brief Cognitive Screening Battery. No correlations were observed in GWO. There was no correlation between opioid dose and performance in the results. In the longitudinal tests and comparative analyses between the groups, GWO had better performance than GRO. However, this superiority was not verified in the three assessments, as well as in the case of the majority of the tests results. The negative correlation between pain intensity and cognitive function on the group receiving opioids indicated that pain intensity had an influence on cognitive performance. Further research is necessary to broaden the knowledge about this issue.

Introduktion: Demenssjukdomar beskrivs som en folksjukdom där en person så ofta som var tredje sekund insjuknar i världen, och i Sverige beräknas samhällskostnaden till närmare 62,9 miljarder kronor årligen. I enlighet med patientlagen skall all vård bedrivas i samråd med patienten, vilket kan försvåras när personen har en kognitiv funktionsnedsättning. Syfte: Syftet var att beskriva delaktighet för personer med kognitiv funktionsnedsättning och deras anhöriga vid beslut om livsuppehållande åtgärder.  Metod: Litteraturöversikt med beskrivande design baserad på tio kvalitativa originalartiklar från PubMed och CINAHL som kvalitetgranskats. Resultatanalysen av artiklarna utgick från Fribergs modell för innehållsanalys. Resultat: Det framkom att personer med kognitiv funktionsnedsättning har olika uppfattningar om hur aktivt delaktiga de vill vara i beslut om livsuppehållande åtgärder. Det fanns de som ansåg att besluten skulle avgöras av vårdgivare och inte av dem själva, men det fanns även de som ville vara mera aktiva i beslut om livsuppehållande åtgärder. De som ville vara mera aktiva i besluten hade gemensamt att de ville underlätta för familj och anhöriga då de var medvetna om att sjukdomen en dag skulle göra dem oförmögna att förmedla sina önskningar.  Slutsats: Personer med kognitiv funktionsnedsättning har olika uppfattningar hur delaktiga de vill vara rörande beslut om livsuppehållande åtgärder. Resultatet pekar på att ett personcentrerat förhållningssätt hos vårdpersonal underlättar för personer med kognitiv funktionsnedsättning att förmedla sin önskan om delaktighet vid beslut om livsuppehållande åtgärder. Anhöriga till personer med kognitiv funktionsnedsättning upplevde ett behov av utbildning för vårdpersonal i samtalsteknik riktade till patientgruppen samt i sjukdomar som ger kognitiv funktionsnedsättning. / Introduction: Dementia diseases are described as a public disease where a person falls ill as often as every three seconds in the world, and in Sweden the estimated social cost is almost 62.9 billion SEK yearly. In accordance with the Patient Act, all care must be provided in consultation with the patient, which can be difficult when the person has a cognitive impairment. Aim: The aim was to describe the participation of people with cognitive disabilities and their relatives when deciding on life support measures.  Method: Literature review with a descriptive design based on ten qualitative original articles collected from PubMed and CINAHL that were quality reviewed. The analysis of the articles was based on Friberg's model for content analysis. Results: It emerged that people with cognitive disabilities have different views on how actively they want to be involved in decisions about life-sustaining measures. There were those who believed that decisions should be made by caregivers and not by themselves, but there were also those who wanted to be more active in decisions about life-sustaining measures. Those who wanted to be more active in the decisions had in common that they wanted to make it easier for family and relatives as they were aware that the disease would one day make them unable to convey their wishes. Conclusion: Persons with cognitive disabilities have different views on how involved they want to be in decisions about life-sustaining measures. The result indicates that a person-centered approach among healthcare professionals makes it easier for persons with cognitive disabilities to convey their desire for participation in decisions about life-sustaining measures. Relatives of persons with cognitive impairment experienced a need for training for care staff in conversational techniques aimed at the patient group as well as various diseases that cause cognitive impairment.

Bakgrund   Antalet personer med kognitiva sjukdomar ökar dramatiskt. Största andelen av människor som drabbas av kognitiva sjukdomar är äldre vuxna, 65 år eller äldre. Personer med kognitiva sjukdomar upplever att de har sämre livskvalitet och mindre mobilitet. Därför är fysisk aktivitet för denna patientgrupp en viktig fråga för att förbättra deras livskvalitet via implementering av personcentrerad omvårdnad. Därför finns det behov av att genomföra en icke-systematisk litteraturöversikt för att belysa den evidens och forskning som finns inom området. Syfte  Syftet var att beskriva upplevelser av fysisk aktivitet hos personer med kognitiva sjukdomar som är 65 år eller äldre.  Metod Denna studie är en icke-systematisk litteraturöversikt som inkluderar 16 vetenskapliga originalartiklar med kvalitativ metodansats. Databaserna PubMed och CINAHL användes för inhämtning av artiklarna med hjälp av olika sökordskombinationer. Alla de inkluderade artiklarna kvalitet granskades med hjälp av Sophiahemmet Högskolas bedömningsunderlag och resultatet analyserades med hjälp av en integrerad dataanalys. Resultat I resultatet sammanställdes fyra huvudkategorier: Positiva upplevelser av fysisk aktivitet, Upplevelser av hinder vid fysisk aktivitet, Upplevelser av social interaktion och Omgivningens betydelse vid fysisk aktivitet. Resultatet visade en nyanserad bild av olika subjektiva upplevelser där positiva emotionella upplevelser och upplevelser av social interaktion var centrala. Känsla av sammanhang, interprofessionella samspel samt betydelse av miljö var viktiga faktorer som bidragit till både positiva och negativa upplevelser hos personer med kognitiva sjukdomar. Slutsats Denna icke-systematisk litteraturöversikt visade behov av personcentrerat omvårdnad samt interprofessionell, tvärvetenskaplig rehabilitering i form av fysisk aktivitet hos personer med kognitiva sjukdomar. Evidensbaserad implementering kan med fördel användas i syfte att skapa individuellt anpassade tränings- och aktivitetsprogram samt förbättra sjuksköterskans kunskap, kompetens och genomförande av omvårdnadsarbete inom denna patientgrupp. En effektiv planering, resursfördelning och genomförande av interventioner som inkluderar social interaktion mellan vårdtagare, deras anhöriga och vårdpersonal bidrar till positiva upplevelser av fysiska aktiviteter hos personer med kognitiva sjukdomar. / Background The number of people with cognitive disorders is increasing. The largest proportion of people affected by cognitive disorders are people 65 years of age or older. People with cognitive disorders experience a lower quality of life and less mobility. Physical activity for this patient group is an important issue to improve their quality of life via the implementation of person-centered care. Aim The aim was to describe experiences of physical activity in people with cognitive disorders aged 65 or older. Method This study is a non-systematic literature review that includes 16 original scientific articles with a qualitative methodological approach. The databases PubMed and CINAHL were used to retrieve the articles using different search word combinations. All the included articles were analyzed by Sophiahemmet Högskolas assessment basis document. An integrated data analysis method was used. Results In the result four main categories were compiled: Positive experiences of physical activity, Experiences of obstacles during physical activity, Experiences of social interaction and The importance of the environment during physical activity. The result showed a nuanced picture of different subjective experiences where positive emotional experiences and experiences of social interaction were central. A sense of coherence, interprofessional interaction and the importance of the environment were factors that contributed to both positive and negative experiences. Conclusions This non-systematic literature review showed a need of person-centred nursing as well as interprofessional, interdisciplinary physical activity rehabilitation for people with cognitive disorders. Evidence-based implementation can be used in order to create individually adapted training and activity programs and to improve the nurse's knowledge, competence and implementation of nursing work within this patient group. An effective planning, resource allocation and implementation of interventions that include social interaction between care recipients, their relatives and care staff contributes to positive experiences of physical activities in people with cognitive disorders.

I hela världen lever omkring 55 miljoner personer med en kognitiv sjukdom. I Sverige beräknas omkring 150 000 personer ha en kognitiv sjukdom. Kognitiva sjukdomar påverkar det dagliga livet för både personer som lever med sjukdomen, men omgivningen kan även påverkas. Det är vanligt att utveckla beteendemässiga och psykiska symtom vid kognitiv sjukdom och en av de vanligaste bakomliggande orsakerna till uppkomsten av dessa symtom är smärta.  Syftet med litteraturstudien var att beskriva sjuksköterskors erfarenheter av smärtlindrande strategier i vården av personer med kognitiv sjukdom.  Vald metod för att besvara syftet är litteraturöversikt. Resultatet har sammanställts genom kvalitativ innehållsanalys av 17 stycken vetenskapliga artiklar med kvalitativ design, publicerade mellan åren 2013-2023.  Resultatet presenteras i tre huvudkategorier: Hinder och möjligheter, Samverkan samt Organisation. Nedsatt verbal kommunikation kan vara ett hinder för att upptäcka, bedöma, lindra och utvärdera smärta. När den verbala förmågan är nedsatt kan beteendeförändringar och kroppsspråk läsas av för att upptäcka smärta. Samverkan mellan sjuksköterska och anhöriga, samt samverkan med andra yrkeskategorier i teamet, kan underlätta arbetet med smärtlindring.  Slutsatsen är att sjuksköterskors erfarenheter av smärtlindrande strategier hos personer med kognitiv sjukdom är en utmaning. Sjuksköterskors erfarenheter inom omvårdnad kopplat till smärtlindrande strategier för personer med kognitiv sjukdom är värdefulla att ta vara på för att kunna utveckla mer anpassade verktyg och rutiner för denna målgrupp. För att kunna möta personens unika behov framkommer det att ett personcentrerat förhållningssätt i omvårdnaden är meningsfullt. Sjuksköterskor uppger ett behov av mer kunskap om kognitiva sjukdomar för att kunna upptäcka och bedöma smärta, samt kunna sätta in lämpliga åtgärder för att lindra smärta. Teamsamverkan behöver lyftas fram och stärkas i det dagliga arbetet med personer med kognitiv sjukdom. / Worldwide, around 55 million people live with a cognitive disorder. In Sweden, it is estimated that around 150,000 people have a cognitive disorder. Cognitive disorders affect the daily life of both people living with the disorder, but also the surroundings can be affected. It is common to develop behavioral and psychological symptoms in cognitive disorder and one of the most common underlying causes for the onset of these symptoms is pain. The purpose of the literature study was to describe nurses' experiences of pain-relieving strategies in the care of people with cognitive disorders. The chosen method to answer the purpose is a literature review. The result has been compiled through thematic content analysis of 17 scientific articles with a qualitative design, published between the years 2013-2023. The results are presented in three main categories: Obstacles and opportunities, Collaboration and Organization. Impaired verbal communication can be a barrier to detecting, assessing, alleviating and evaluating pain. When verbal ability is impaired, behavioral changes and body language can be read to detect pain. Cooperation between nurses and relatives, as well as cooperation with other occupational categories in the team, can facilitate the work with pain relief. The conclusion is that nurses' experiences of pain-relieving strategies in people with cognitive disorders are a challenge. Nurses' experiences in nursing linked to pain-relieving strategies for people with cognitive disorders are valuable to take advantage of in order to develop more adapted guidelines and routines for this target group. In order to be able to meet the person's unique needs, it appears that a person-centered approach in nursing makes sense. Nurses state a need for more knowledge about cognitive disorders in order to be able to detect and assess pain, as well as to be able to implement appropriate measures to relieve pain. Team collaboration needs to be highlighted and strengthened in the daily work with people with cognitive disorders.