SUMMARY Relevance and novelty of the topic. Cargivers of persons with clinical dementia experience a lot of social, psychological and physical health problems and feel burdened. Until recently there has been very little analysis of stress factors influencing the caregivers stress. Aim of the study. To measure and examine psychosocial stress of family members and relatives who are caregivers of persons with dementia at home. Methods. Caregivers of persons with dementia filled out an anonymous qeustionaire. The interviews were conducted from December, 2004 to February, 2005. Respondents, who participated in research, were members of Kaunas and Vilnius Alzheimer’s clubs, and the data was collected during the meetings of these two clubs in Kaunas Dainava Center for Psychological Health and Vilnius Antakalnis health centre respectively. 22 respondents were from Kaunas and 28 from Vilnius. From the 50 respondents, who participated in research, 35 (70%) were women, and 15 (30%) were men. The average age was 62 years (the range of age was 40-94 years). The questionnaire that was used to gather data consisted of five parts: general questions about the caregiver and the person with clinical dementia; Greene’s Relatives Stress Scale, Clinical Dementia Rating Scale and Rapid Disability Rating Scale. Results. 7 (14%) respondents experienced a low level of psychosocial stress, 30 (60%) – average, and 13 (26%) – high level of stress. Most often the caregiver for person with clinical... [to full text]

Demencija sergančių ligonių priežiūra yra labai sudėtinga. Dienos centrai gerina ligonių, jų šeimos narių gyvenimo kokybę, padeda ligoniams ilgiau išlikti bendruomenėje. Kaune tokio centro nėra, tad buvo įvertintas dienos centro kūrimo poreikis ir paruoštas galimas dienos centro veiklos modelis/ organizacinė struktūra. Darbo tikslas. Įvertinti dienos centro, demencija sergantiems ligoniams, kūrimo poreikį Kauno mieste. Uždaviniai. 1. Įvertinti dienos centro kūrimo poreikį apklausiant demencija sergančių ligonių globėjus bei sveikatos priežiūros specialistus. 2. Įvertinti dienos centro, demencija sergantiems ligoniams, kūrimo galimybes peržvelgiant teisinę bazę. 3. Paruošti galimą dienos centro veiklos modelį/ organizacinę struktūrą, ligoniams sergantiems demencija, remiantis literatūra ir apklausos rezultatais. Tyrimo metodika. Tyrimas buvo atliekamas anoniminės anketinės apklausos būdu penkiose Kauno Psichikos sveikatos centruose ir Alzheimerio klube 2006 m. rugsėjo – 2007 m. sausio mėnesiais. Anketas užpildė 25 ligonių globėjai (G) ir 41 sveikatos priežiūros specialistas (SPS). Tiriamąją grupę sudarė 66 asmenys, iš jų – 60 moterų ir 6 vyrai. Globėjų grupėje amžiaus vidurkis buvo 58 metai (amžiaus ribos 29 – 78 metai), o SPS grupėje - 42 metai (amžiaus ribos 25 – 74 metai). Dienos centro kūrimo poreikio įvertinimui naudotos dvi apklausos anketos: anketa skirta ligonių globėjams ir anketa – sveikatos priežiūros specialistams. Duomenys analizuoti SPSS – 10.0 kompiuterine... [toliau žr. visą tekstą] / The care of patients with dementia is very difficult. Day centres improve the quality of life of these patients and their family members, help to stay longer in the community life. There is no such day centre in Kaunas, so it was evaluated the requirement of creation such centre and prepared the possible model/ structure. Aim of the study To evaluate the requirement of creation the day centre for the patients with dementia in Kaunas city. Objectives 1. Evaluate the requirement of the creation of day centre by questioning the health care specialists and carers of patients with dementia. 2. Evaluate the possibility of creation such centre for the patients with dementia reviewing the law basis. 3. Prepare the possible model/ structure of the day centre for the patients with dementia, according to the data in literature and results of the questioning. Methods. The research was performed by anonymous questioning in 5 Kaunas Mental health care centres and in Alzheimer‘s club during the period of 2006 september - 2007 january. 25 carers (C) and 41 health care specialists (HCS) completed the questionnaire. The research group was formed of 66 people – 60 women and 6 men. The average age in the carers group was 58 years ( age range 29 - 78 years), and in HCS group - 42 years (age range 25 - 74 years). There were used two questionnaires for evaluation the requirement of creation the day centre: first questionnaire was for the carers of the patients and other one – for the health care... [to full text]

SUMMARY The aim of this study was to investigate the requirements for patients with dementia and optimization of activities for nursing. Methods of study – primary data were obtained from the databases of the K.Grinius nursing and supportive treatment hospital activities in 2002-2004, and using of nurses and patients relative’s interview data collected by the specific questionnaire. During 2002-2004 years all data was enrolled to the information database. Statistical analysis was performed using MS EXCEL 2000 standard statistical programming packets. Results. During 2002-2004, the part of patients with dementia among all patients statistically significantly increased, so significantly increased the part of bed-days. The duration of nursing and supportive treatment was without significant changes, but hospital lethality have tendency to increase in average by 2.3 % /yrs, while the number of patients have tendency to decrease during this years. During the investigated period, the expenses for one bed-day were without significant changes and in averaged per year accounted 50.61 Lt. The expenses of state for one bed-day during 2002-2004 accounted 41.54 Lt. The expenses of Lithuanian state for nutrition and drugs was without significant changes and respectively accounted 8.69 and 11.90 Lt. Detecting nursing personnel, working with dementive patients, occupational peculiarities evaluated, that majority of nursing respondents were in middle-age, majority of them working in night... [to full text]

Demencija yra vienas iš dažniausiai sutinkamų psichikos sutrikimų vyresniame amžiuje. Pastebėta, kad dalis vyresnio amžiaus pacientų, kuriems vėliau išsivysto demencija, dažniau nei bendraamžiai skundžiasi pažinimo sutrikimais, tačiau kasdieninė veikla yra nesutrikusi. Ši būklė buvo pavadinta lengvu kognityviniu sutrikimu (LKS). Neurosonografiniai tyrimai pateikia daug naudingos informacijos apie funkcinius galvos ir kaklo kraujagyslių parametrus. Tyrimo tikslas buvo nustatyti neurosonografinių galvos ir kaklo arterijų parametrų vertę prognozuojant demenciją lengvu kognityviniu sutrikimu sergantiems pacientams. Tyrimo uždaviniai: 1) ištirti LKS turinčių pacientų demografines ir klinikines charakteristikas ir įvertinti jų ir progresavimo į demenciją ryšį; 2) ištirti LKS turinčių pacientų ekstrakranijinės kraujotakos parametrus ir įvertinti jų ir progresavimo į demenciją ryšį; 3) ištirti LKS turinčių pacientų intrakranijinės kraujotakos parametrus ir įvertinti jų ir pogresavimo į demenciją ryšį; 4) ištirti LKS turinčių pacientų miego arterijų sienelių parametrus ir įvertinti jų ir pogresavimo į demenciją ryšį; 5) ištirti LKS turinčių pacientų miego arterijų aterosklerozinius požymius ir įvertinti jų ir pogresavimo į demenciją ryšį; 6) įvertinti bendrą tiriamųjų demografinių ir klinikinių charakteristikų bei neurosonografinių parametrų diagnostinę reikšmę prognozuojant progresavimą iš lengvo kognityvinio sutrikimo į demenciją. / Dementia is one of the most commonly occurring mental disorders in older age. It was noticed that some of the elderly patients who later develop dementia, more often than contemporaries complained of cognitive impairment, but daily activities were not affected. This condition was called mild cognitive impairment (MCI). Neurosonographic studies provide a lot of useful information about the functional head and neck vascular parameters. The aim of our study was to provide more information about the significance of the extra- and intracranial arterial blood flow and carotid arterial wall parameters for prediction of dementia for patients with MCI. Objectives of the study is 1) to investigate the demographic and clinical characteristics of MCI patients and to assess their relation with progression to dementia; 2) to investigate blood flow parameters of the extracranial arteries and to assess their relation with progression to dementia; 3) to investigate blood flow parameters of the intracranial arteries and to assess their relation with progression to dementia; 4) to investigate the intima-media thickness and stiffness of carotid arteries walls and to assess their relation with progression to dementia, 5) to investigate the atherosclerotic changes and to assess their relation with progression to dementia; 6) to assess the value of demographic and clinical characteristics and neurosonographic parameters for prediction of dementia.

<p>Alchajmerova bolest je najče&scaron;ća demencija od svih demencija i karakteri&scaron;e je depozicija senilinih plakova i neurofibrilarnih klubadi u kortikalnim moždanim regionima, koje daljim razvojem bolesti postaju atrofične. Klinički se karakteri&scaron;e smetnjma na planu pamćenja, egzekutivnih funkcija, pažnje i ostalih kognitivnih funkcija uz odustsvo sposobnosti samostalnog funkcionisanja u svakodnevnom životu. Blagi kognitivni poremeća (BKP) je klinički entitet koji se smatra početnim stadijumom demencije u kom se registruju smetnje na planu pamćenja, ali i drugih kognitvnih funkcija, uz očuvanu funkcionalnost u svakodnevnom životu. Kod obe bolesti je utvrđeno da pored kortikalnog zahvatanja, patolo&scaron;kim procesom je zahvaćena i bela masa mozga. U dana&scaron;nje vreme se mirkostrukturno o&scaron;tećenje bele mase mozga može ispitati difuzionim tenzorskim imidžinogom (DTI) na magnentoj rezonanci mozga (MR). Cilj: Utvrditi razlike neuropsiholo&scaron;kih skorova i razlike DTI parametara između obolelih od AB, BKP i kontrolne grupe zdravih ispitanika, kao i utvrditi da li postoji korelacija između neuropsiholo&scaron;kih skorova i DTI parametara kod BKP i AB.&nbsp; Metode: U istraživanje je uključeno tri ispitivane grupe od po 30 ispitanika: oboleli od AB u blagom stadijumu bolesti, oboleli od amnestičkog multi-domen BKP i kontrolna grupa zdravih ispitanika. Dijagnoza kod obolelih u obe grupe je postavljena na osnovu kliničkih kriterijuma aktuelnih dijagnostičkih kriterijuma iz 2011. godine. Kod svih ispitanika je sprovedeno detaljno neuropsiholo&scaron;ko testiranje u cilju procene kognitivnih funkcija (smetnji na planu pamćenja, egzekutivnih funkcija, pažnje, govora, vizuospacijalnih i vizuokonstrukcionih sposobnosti), depresivnosti i drugih neuropsihijatrijskih simptoma i kvaliteta života. Samo je kod obolelih od AB dopunski vr&scaron;ena procena sposobnosti svakodnevnog funkcionisanja. Kognitivne funkcije su ispitane formiranjem kognitivnih domena, na osnovu pretpostavke o zajedničkom predmetu merenja kori&scaron;ćenih testova. Potom je načinjen MR mozga, u okviru koje je analiziran i DTI. Dalja obrada DTI je sprovedena primenom TBSS metode, čime su dobijene vrednosti DTI parametara: frakcione anizotropije (FA), srednje difuzivnosti (SD), radijalne difuzivnosti (RD) i aksijalne difuzivnosti (DA). Nakon toga je načinjena korelacija neuropsiholo&scaron;kog postignuća i DTI parametara kori&scaron;ćenjem Pirsonovog, odnosno Spirmanovog koeficijenta korelacije. Rezultati: Oboleli od AB su imali lo&scaron;ije postignuće na planu vizuelnog pamćenja, verbalnog pamćenja, neposrednog upamćivanja, odloženog prisećanja, pažnje, govora, egzekutivnih funkcija, mi&scaron;ljenja, radne memorije i vizuospacijalnih i vizuokonstrukcionih sposobnosti u odnosu na kontrolnu grupu zdravih. Oboleli od BKP su imali lo&scaron;ije postignuće u odnosu na kontrolnu grupu zdravih u domenima vizuelno pamćenje, neposredno upamćivanje, odloženo prisećanje, govor, mi&scaron;ljenje i vizuospacijalne i vizuokonstrukcione sposobnosti. Obe grupe obolelih su ispoljile vi&scaron;e depresivnih simptoma u odnosu na kontrolnu grupu zdravih ispitanika. Takođe, obe grupe obolelih ispoljavaju statistički značajno vi&scaron;e neuropsihijatrijskih simptoma u odnosu na zdrave ispitanike, gde se kod obolelih od AB registruju sumanute ideje, halucinacije, agitacija, euforija, dezinhibicija, ritabilnost i apatija, dok se kod obolelih od BKP registruju anksioznost i iritabilnost. Oboleli od AB imaju lo&scaron;iji kvalitet života u odnosu na zdrave ispitanike, dok između oboleli od BKP i zdravih ispitanika nema razlike u proceni kvaliteta života. &Scaron;to se tiče DTI parametara, oboleli od AB imaju niži FA i vi&scaron;u SD, RD i DA u odnosu na zdrave ispitanike na vi&scaron;e puteva bele mase: prednji krak kapsule interne, prednja korona radijata, telo korpusa kalozuma, cingulum, kapsula eksterna, fornix-strija terminalis, koleno korpusa kalozuma, donji fronto-okcipitalni fascikulus, zadnja korona radijata, gornji fronto-okcipitalni fascikulus, gornji longitudinalni fascikulus i fascikulus uncinatus. Oboleli od BKP imaju sniženu FA i povi&scaron;enu SD, RD i DA u regiji forniksa u odnosu na zdrave ispitanike. Kod obolelih od AB registrovane su značajne povezanosti mikrostrukturnog o&scaron;tećenja bele mase i o&scaron;tećenja svih kognitivnih domena, izuzev domena mi&scaron;ljenje, dok su kod obolelih od BKP registrovane značajne povezanosti mikrostrukturnog o&scaron;tećenja bele mase i o&scaron;tećenja svih kognitivnih domena, izuzev domena egzekutivne funkcije. U grupi obolelih od BKP je bilo vi&scaron;e registrovanih korelacija o&scaron;tećenja domena verbalno pamćenje, odloženo prisećanje i govor sa o&scaron;tećenjem bele mase mozga, dok je kod AB bilo vi&scaron;e registrovanih korelacija o&scaron;tećenja domena vizuelno pamćenje, neposredno upamćivanje, pažnja, radna memorija i vizuospacijalne i vizuokontrukcione sposobnosti sa o&scaron;tećenjem bele mase mozga. Depresivnost je jedino u grupi BKP značajno korelirala sa o&scaron;tećenjem određenih puteva bele mase mozga. Zaključak: U blagom stadijumu obolelih od AB se registruje kognitivno o&scaron;tećenje svih ispitivanih domena, vi&scaron;e su ispoljeni depresivni simptomi, utvrđen je veliki broj neuropsihijatrijskih simptoma i naru&scaron;en je kvalitet života u odnosu na zdrave ispitanike. Kod obolelih od BKP je registrovano kognitivno o&scaron;tećenje vi&scaron;e od pola procenjivanih kognitivnih funkcija, vi&scaron;e su ispoljeni depresivni simptomi i utvrđeno prisustvo anksioznosti i iritabilnosti, dok kvalitet života nije naru&scaron;en u ovoj fazi bolesti u odnosu na zdrave ispitanike. Rezultati vezani za mikrostrukturno o&scaron;tećenja mozga u najranijim fazama AB ukazuju da je neuronska mreža značajno o&scaron;tećena u najranijim kliničkim fazama bolesti, dok je u stadijumu BKP izolovana na o&scaron;tećenje u regiji forniksa. U grupi obolelih od BKP je bilo vi&scaron;e registrovanih korelacija o&scaron;tećenja domena verbalno pamćenje, odloženo prisećanje i govor sa o&scaron;tećenjem bele mase mozga, dok je kod AB bilo vi&scaron;e registrovanih korelacija o&scaron;tećenja domena vizuelno pamćenje, neposredno upamćivanje, pažnja, radna memorija i vizuospacijalne i vizuokontrukcione sposobnosti sa o&scaron;tećenjem bele mase mozga. Stepen depresivnosti i o&scaron;tećenje bele mase mozga je povezano isključivo na nivou BKP.</p> / <p>Alzheimer&#39;s disease (AD) is the most common dementia of all dementia with deposition of senile plaques and neurofibrillary tangles in cortical brain regions, which become atrophic in the further disease development. It`s main clinical characteristics are impairment of memory, executive function, attention and other cognitive functions with impairment in daily living activities. Mild cognitive impairment (MCI) is a clinical entity considered as an initial stage of dementia with present memory impairment, as well as other cognitive functions, while maintaining the functionality of the everyday life. In both diseases, pathological processes affect also the white matter of the brain. Nowadays, microstructural damage of the brain white matter is diagnosed by using diffusion tensor imaging (DTI) in the brain magnetic resonance imaging (MR). Objective: The aim of this study was to determine differences in neuropsychological scores and differences in DTI parameters between patients with AD, MCI and control groups of healthy subjects, as well as to determine whether there is a correlation between scores and DTI parameters in MCI and AD.&nbsp; Methods: The study included three groups of 30 patients each: of AD patients in the mild stage of the disease, patients with multi-domain amnestic MCI, and healthy controls. The patient&rsquo;s diagnosis are based upon clinical criteria of current diagnostic criteria proposed in 2011. All patients had assessment of cognitive functions (impairment of memory, executive function, attention, language, visuospatial and construction abilities), depressive symptoms and other behavioral disorders and quality of life. Only in patients with AD, we also assessed ability of daily living activities. Cognitive functions were tested by forming cognitive domains, based on the assumption of a common object of measurement of analyzed tests. Further, participants had MRI scan, in which DTI was analyzed. DTI post-processing was carried out by using TBSS method, whereby the values of DTI parameters were: fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD) and axial diffusivity (DA). We conducted correlation analysis of the neuropsychological achievements and DTI parameters using Pearson or Spearman&rsquo;s correlation coefficient, dependent on variable distribution. Results: The patients with AD had lower scores in the field of visual memory, verbal memory, immediate and delayed recall, attention, language, executive functions, reasoning, working memory and visuospatial and construction abilities compared to the control group. Patients with MCI had lower scores compared to the control group in the domains of visual memory, immediate and delayed recall, language, reasoning, and visuospatial and construction abilities. Both groups of patients have more depressive symptoms in relation to the control group of healthy subjects. In addition, both groups of patients exhibited a significantly higher degree of behavioral disorders as compared to healthy subjects, where AD patients experienced delusions, hallucinations, agitation, euphoria, disinhibition, irritability and apathy, while MCI patients experienced anxiety and irritability. Patients with AD had a poor quality of life compared to healthy subjects, whereas people with MCI did not. As for the parameters of DTI, AD patients had decrease of FA and increase of MD, RD, and DA compared to the healthy subjects in the multiple white matter tracts: anterior limb of internal capsule, anterior part of corona radiata, the body of the corpus callosum, cingulum, external capsule, fornix- striae terminalis, genu of the corpus callosum, inferior frontal-occipital fasciculus, posterior corona radiata, superior frontal-occipital fasciculus, superior longitudinal fasciculus and fasciculus uncinatus. Patients with MCI had decreased FA and increased MD, RD and DA in the fornix compared to healthy subjects. In AD patients, there was significant association between microstructural white matter brain damage and all cognitive domains, except domain reasoning, while in patients with MCI significant association was evident between microstructural white matter damage and all cognitive domains, except the domain of executive function. Results related to the microstructural white matter brain damage in mild AD indicates that wide neural network is significantly damaged at the earliest clinical stages of the disease, while in MCI stage only fornix shows microstructural white matter brain damage. Level of impairment of verbal memory, delayed recall and language correlates more frequently in MCI group compared to mild AD group, where impairment in the field of visual memory, immediate recall, attention, working memory and visuospatial and construction abilities correlates more frequently with white matter brain damage. Association of depressive symptoms and white matter brain damage was significant in MCI patients. Conclusion: In mild AD, cognitive impairment is present in all cognitive domains; patients experience more depressive symptoms and wider spectrum of behavioral disorders with compromised quality of life compared to healthy subjects. In MCI patients, cognitive impairment is present in more than half of the assessed cognitive functions; patients also experience more depressive symptoms, as well as anxiety and irritability without quality of life deterioration compared to healthy subjects. Results related to the microstructural white matter brain damage in mild AD indicates that wide neural network is significantly damaged at the earliest clinical stages of the disease, while in MCI stage only fornix shows microstructural white matter brain damage. Level of impairment of verbal memory, delayed recall and language correlates more frequently in MCI group compared to mild AD group, where impairment in the field of visual memory, immediate recall, attention, working memory and visuospatial and construction abilities correlates more frequently with white matter brain damage. The degree of depression correlated significantly with white matter brain damage solely at the level of MCI.</p>