Bakgrund: Demens innebär en rad olika sjukdomar som drabbar hjärnan och leder bland annat till en försämring av minnesfunktionen. Drygt 160 000 personer i Sverige är drabbade av en demenssjukdom och det räknas som en folksjukdom som inte bara drabbar den sjuke utan även den närstående. Närstående som vårdar en person med demens har en stor betydelse för sjuksköterskan och vid ett bra samarbete ges förutsättningar för att bedriva en god vård. Syftet: Att beskriva närståendes upplevelser av att leva med en person med demens samt att redovisa vilka undersökningsgrupper som ingår i de valda artiklarna i litteraturstudien. Metod: En deskriptiv litteraturstudie. Artikelsökningen skedde i PubMed och Cinahl som resultareade i 12 vetenskapliga artiklar med kvalitativ design som granskades. Huvudresultat: I fyra underrubriker presenterades huvudresultatet. Rubrikerna var upplevelse av rollförändring, upplevelse av tillgång till stöd och information, upplevelse av psykisk påfrestning och upplevelse utav inskränkningar i det dagliga livet. De flesta av deltagarna i de ingående artiklarna var make/maka, döttrar eller söner till en person med demens. Samtliga studier använde ett ändamålsenligt urval. Slutsatser: Närstående upplevde att deras roll förändrades och det var en psykisk påfrestning med många olika känslor så som oro, frustration, sorg, trötthet och även inskränkningar i det dagliga livet att leva med en person med demens. Tillgången på stöd och information i allmänhet av hälso- och sjukvården upplevdes bristfällig, det skulle behövas i ett tidigt skede av sjukdomen för att hantera olika svåra situationer, känslor och även minska utmaningarna. / Background: Dementia involves a range of diseases that affect the brain to an extent ending with the deterioration of memory functions. More than 160 000 people in Sweden are afflicted with dementia and the risk increases with age. Dementia is considered as a public health problem, affecting not only the patient but also the related parties. Related Parties who are caring for a person with dementia are of great importance for the nurse. A good cooperation between the related parties and caregivers are will provide the opportunity to give a proper care. Aim: To describe the related parties experiences of living with the person with dementia and to report the study groups included in the selected items in literature studies. Methods: A descriptive literature. The Article search was done in PubMed and CINAHL. As a result, 12 revised scientific articles with qualitative design. Results: The four sub-headings presented the main results which are all based on the related parties experience living with the person with dementia. The sub-headings were: the experience of the role change, access to support and information, experience of psychological distress and experiencing restrictions in daily life. Most of the participants in the included articles were husband/wife, daughters or sons of a person with dementia. All studies used adequate samples. Conclusions: Related parties felt that their roles were changed and it was a psychic burden to withstand stress with many different emotions such as anxiety, frustration, sadness, fatigue and even restrictions on the daily life of living with a person with dementia. Access to support and information in general health- care felt inadequate, which were needed in the early stages of the disease to deal with various difficult situations, emotions and even to reduce the challenges.

Serotonin and α1 adrenergic receptor antagonism may contribute to atypical antipsychotic drug effects. Clozapine (2.5 mg/kg) drug discrimination in C57BL/6 mice may selectively screen atypical antipsychotic drugs. Previous data show that the atypical antipsychotics olanzapine, risperidone, ziprasidone but not the typical antipsychotic haloperidol fully substitutes for clozapine. The present study demonstrated that the atypical antipsychotics quetiapine, sertindole, zotepine, iloperidone, melperone fully substituted for clozapine but aripiprazole did not. The typical antipsychotics fluphenazine and perphenazine failed to fully substitute for clozapine but chlorpromazine and thioridazine fully substituted for clozapine. This model does not differentiate between atypical and typical antipsychotic drugs but it may be useful in the detection of antipsychotics with potent serotonin and α1 adrenergic receptor antagonist actions.

The thesis explores the influence of cognitive training carried out in a second language on the elderly suffering from dementia. Having described the basic anatomy of the nervous system, neurolinguistic theories as well as ageing and having dealt with cognitive aspects in relation to language learning, the thesis aims at performing an experiment that should help dementia clients to broaden their vocabulary in a second language. This is to be achieved through individual therapy- like units using worksheets created specifically for these purposes. The results indicate that cognitive training in a second language is beneficial to dementia clients and could be used more extensively. Key words ageing, dementia, language, cognitive training, neurolinguistics

Background: Carriers of the APOE epsilon 4 allele are at increased risk of developing Alzheimer's disease (AD), and have been shown to have reduced cerebral metabolic rate of glucose (CMRgl) in the same brain areas frequently affected in AD. These individuals also exhibit reduced plasma levels of apolipoprotein E (apoE) attributed to a specific decrease in the apoE4 isoform as determined by quantification of individual apoE isoforms in APOE epsilon 4 heterozygotes. Whether low plasma apoE levels are associated with structural and functional brain measurements and cognitive performance remains to be investigated. Methods: Using quantitative mass spectrometry we quantified the plasma levels of total apoE and the individual apoE3 and apoE4 isoforms in 128 cognitively normal APOE epsilon 3/epsilon 4 individuals included in the Arizona APOE cohort. All included individuals had undergone extensive neuropsychological testing and 25 had in addition undergone FDG-PET and MRI to determine CMRgl and regional gray matter volume (GMV). Results: Our results demonstrated higher apoE4 levels in females versus males and an age-dependent increase in the apoE3 isoform levels in females only. Importantly, a higher relative ratio of apoE4 over apoE3 was associated with GMV loss in the right posterior cingulate and with reduced CMRgl bilaterally in the anterior cingulate and in the right hippocampal area. Additional exploratory analysis revealed several negative associations between total plasma apoE, individual apoE isoform levels, GMV and CMRgl predominantly in the frontal, occipital and temporal areas. Finally, our results indicated only weak associations between apoE plasma levels and cognitive performance which further appear to be affected by sex. Conclusions: Our study proposes a sex-dependent and age-dependent variation in plasma apoE isoform levels and concludes that peripheral apoE levels are associated with GMV, CMRgl and possibly cognitive performance in cognitively healthy individuals with a genetic predisposition to AD.

Drug delivery to the brain has challenged medical professionals for several decades, with 98% of small molecules and 100% of large molecules unable to cross the blood brain barrier (BBB). Biocompatible, biodegradable polymers have been extensively researched for the oral delivery of therapeutic agents, but to date has not been successfully manipulated for the formulation of an implantable device. We have therefore utilised such polymers for the formulation and design of an implantable nanoenabled multipolymeric drug delivery device (NMDDD) for the management of AIDS Dementia Complex (ADC). ADC is a central nervous system (CNS) complication of HIV, associated with a host of debilitating cognitive, motor and behavioural symptoms. ADC remains a serious manifestation of HIV/AIDS in both developing and developed countries, affecting both adults and children, with death expected within 6 months of initial diagnosis. Zidovudine (AZT), the current gold standard for the management of ADC, has demonstrated the best penetration into the CNS. It is capable of reducing viral replication in the CNS and managing neurological abnormalities associated with ADC, with clinical efficacy evidenced by the decline in morbidity and mortality of patients treated with this drug. Nanotechnology, an interdisciplinary field of research, involving the manipulation of matter on a submicron level, is receiving emerging interest for the formulation of novel drug delivery systems. As they can potentially be manipulated to react in a bioresponsive manner, nanopharmaceuticals have received much attention for site-specific drug delivery and were therefore employed in the formulation of an implantable NMDDD, with AZT employed as the model drug, for the management of ADC. Nanoparticles were prepared by means of an approach utilising controlled gelation of alginate, employing cationic crosslinking of the anionic alginate to precipitate nanoparticles. A 3-factor Box-Behnken statistical design was employed for the optimisation of nanoparticle and multipolymeric scaffold formulations. Nanoparticles measuring 68.04nm (SD<0.0002) in size with a zeta potential of -13.4mV (SD<0.0005) were formulated. Nanoparticles presented with a mean dissolution time (MDT) of 46.046 hours 30 days post exposure to phosphate buffered saline (PBS), pH 7.4. In an attempt to further retard drug release and to formulate a device for implantation in the frontal lobe of the brain, nanoparticles were dispersed within a robust multipolymeric matrix. Matrix erosion was calculated at 28%w/w (SD<0.001) for multipolymeric scaffold and a matrix resilience of 4.451%w/w (SD<0.007) was observed 30 days post exposure to PBS, indicating slow degradation of the NMDDD. MDT was reduced to 12.570 hours (SD<0.0005) with dispersion of the nanoparticles within a polymer matrix, supporting the application of the drug-loaded MDDD in the management of ADC patients. The optimised multipolymeric nanoparticulate scaffold was implanted into the frontal lobe of the rat brain, for investigation of drug release characteristics and tissue response to the device following in vivo administration.

Thesis advisor: Kenneth Williams / Approximately 15% of individuals infected with Human Immunodeficiency Virus (HIV) develop a neurological condition that consists of motor dysfunction and cognitive deterioration in late stage disease that is known as the AIDS dementia complex (ADC). This condition is mirrored in rhesus macaques infected with Simian Immunodeficiency Virus (SIV), which can be more easily studied. This project analyzed different macrophage populations in rhesus macaques infected and uninfected with SIV at early and terminal stage disease. Single and double immunohistochemistry stains were performed for the known macrophage and microglial markers CD163, CD16, CD68, Mac387, HAM56, and Iba-1, as well as for the SIV-p28 viral protein. Photographs and observations of the tissue stainings demonstrated that early after infection with SIV, there is an increase in perivascular macrophages and monocytes surrounding vessels and tissue edges, and the SIV-p28 protein is already present. There is also an observed change in the morphology of the microglia to an active, ramified state. After the development of AIDS and SIVE, the increase in all of the macrophage markers and the accumulation of activated microglia are clearly visible, especially surrounding and within lesions. Furthermore, these markers can be used to categorize the encephalitic lesions as “new” or “old” based on the presence or absence of Mac387 within the cells. All lesions contained CD68+ and HAM56+ macrophages, but “new” lesions presented with a relatively high count of Mac387+ macrophages that were newly imported from the periphery, whereas “old” lesions lacked Mac387+ cells. / Thesis (BS) — Boston College, 2009. / Submitted to: Boston College. College of Arts and Sciences. / Discipline: College Honors Program. / Discipline: Biology.

Thesis advisor: Paula Mathieu / The following work is a memoir that chronicles my grandmother’s battle with a rare form of frontotemporal dementia. This dementia robbed her of the ability to use and process language, though, unlike Alzheimer’s Disease, it did not affect her memory or capacity to recognize loved ones. My thesis follows my family’s journey as we learned to develop new methods of communication that did not rely on words, methods largely dependent on a vault of family memories passed down through several generations of strong women. Ultimately, my experience with my grandmother’s illness enabled me to come to new conclusions regarding the role of language in modern society, from the possibilities it creates to the boundaries it imposes. / Thesis (BA) — Boston College, 2010. / Submitted to: Boston College. College of Arts and Sciences. / Discipline: College Honors Program. / Discipline: English Honors Program. / Discipline: English.

Depression is associated with higher severity of memory disorders and has been shown to predict lower levels of cognitive functioning in those diagnosed with Mild Cognitive Impairment (MCI) or dementia. Yet, little is known about this association cross-culturally, particularly between Hispanics and European Americans. This study demonstrates that although levels of depression differed significantly across diagnostic group, Hispanics and European Americans were similar in levels of depression at each diagnosis. However, only for the European American group did depression levels predict lower scores in confrontational naming and semantic memory. Additionally, exploratory analyses of the entire sample demonstrated that lower depression predicted less likelihood of MCI or dementia diagnoses. This could indicate that there is a need for intervention and treatment of depression, in particular for later stages of MCI and dementia, that should be culturally catered to individual ethnicities. / Includes bibliography. / Thesis (M.A.)--Florida Atlantic University, 2018. / FAU Electronic Theses and Dissertations Collection

The aim of the study was to develop a participatory research model drawing from qualitative research about the lifeworld perspectives of people with early-stage dementia. Twelve participants with early-stage dementia were recruited from a compensatory adult school VUK (Voksenskolen for Undervisning og Kommunikation) in Denmark. They were trained in research skills to enable them to conduct a participatory research project in collaboration with the researcher. During the study, the participants informed the research project and the participatory research model. A combination of participant observations, interviews and focus groups were used with observations and interviews being conducted before the research skills' training to enable the researcher to plan the training and the participatory research project in accordance with the participants´ competencies and challenges. Data were analysed from a hermeneutic phenomenological perspective inspired from the work of Max Van Manen. The focus groups were used both during the training and the participatory research project and video data from these were analysed by a thematic analysis inspired by Braun and Clarke. The participatory research model illustrates the importance of recruiting and gaining consent from people with early-stage dementia in a way which takes into consideration the needs of the participants. It can be necessary to both adjust the recruitment strategy and the consent form. In order to allow them to be involved as active research participants, it is essential to plan and establish a research project which reflects the participants´ individual cognitive challenges. To simplify the project and establish small project groups can be supportive. Also role agreements are vital. It is essential to train and support them in different ways throughout the research process and, among other strategies; it is useful to have an errorless inspired learning environment with a structure that is repeated. Furthermore, it is important to evaluate continually to ensure the most constructive process throughout and focus groups can prompt more in-depth answers by the participants. The participants also need support and structure provided by the researcher in any dissemination phase. Furthermore, the researcher needs to invest in the interaction with the participants to establish trusting committed constructive research collaboration from the beginning. It is also important that the researcher balances the roles of being a researcher and a supporter together with being a teacher and a learner when collaborating with people with early-stage dementia. It is about balancing the power in the relationship. Furthermore, the researcher has to support the participants own peer-learning and -support together with creating a relaxed atmosphere. The participatory research model “Balanced Participation” takes these considerations into account, with the result that more people with early-stage dementia will be able to be involved in future qualitative participatory research.

Patients with Alzheimer’s Disease (AD) demonstrate a sensitive and specific short-term memory impairment for visual bindings (e.g. the combination of shapes and colours) that is absent in healthy ageing (Parra et al., 2009) and other dementias (Della Sala et al., 2012). This impairment is also seen in cases of asymptomatic, familial AD (Parra et al., 2010). The visual short term memory binding (VSTMB) impairment in AD has clear clinical and neuropsychological implications which are investigated in this thesis. Firstly, the utility of the VSTMB paradigm was contrasted with the Free and Cued Selective Reminding Task with Immediate Recall (FCSRT-IR) – which has recently been posited as a useful diagnostic marker of AD pathology (Dubois et al., 2014). The results indicated that the former is not affected by age, where the latter is, suggesting that the VSTMB paradigm provides a suitable baseline to measure cognitive decline associated with AD. The development of a parallel version of the FCSRT-IR is also reported. Secondly, a 24-week longitudinal study of patients receiving treatment for AD (donepezil hydrochloride) revealed that patients who respond to this treatment on cognitive scales also experience change in VSTMB performance. These responders, however, did not significantly improve on the FCSRT-IR during the study. This suggests that anticholinergic treatment may have an effect on VSTMB performance. Additionally, a meta-analysis that investigates the effect of a study’s funding on donepezil RCT outcome showed that industry-funded studies report larger changes in cognition than independent studies. Lastly, an auditory binding experimental paradigm was developed, with a view to reveal a non-visual binding impairment in AD, investigating whether the binding impairment reflects a general or modality-specific memory impairment. The overall conclusions of this thesis confirm that the VSTMB impairment has significant promise as an index of AD. The auditory binding paradigm, by contrast, shares conceptual similarity with the VSTMB paradigm, but may have restricted clinical use within the AD patient population.