Made available in DSpace on 2014-07-29T15:29:10Z (GMT). No. of bitstreams: 1 Dissert_EbersonSRN.pdf: 1230800 bytes, checksum: 70200ae7fcfb893a1baed80412086408 (MD5) Previous issue date: 2011-04-29 / Dementia is a neurodegenerative syndrome by impressive and also by the high occurrence rates of morbidity in caregivers. Dementia with Lewy bodies is a complex neuropsychiatric frame member, considered the second cause of degenerative dementia in the elderly, and resulting impact on quality of life in caregivers. The objectives of this study were to identify in the literature, the impact of caregiving on the quality of life for caregivers of a patient with dementia to describe the strategies used by health professionals and researchers in Brazil or to mitigate the negative impacts of caring for the patient dementia and assessing quality of life for families living with and caring for patients with dementia with Lewy bodies. It was initially performed an integrative review the electronic databases of the National Library of Medicine (PubMed) and Latin American Health Sciences (LILACS), the interval from 1999 to 2010. Then a cross-sectional study evaluated 90 caregivers of patients with dementia with Lewy bodies, responding to a sociodemographic questionnaire and the instrument for assessing the quality of life, WHOQOL-BREF. The integrative review included 19 articles, showing that despite high rates of stress, anxiety and physical and mental burden of home caregivers of patients with dementia, there is little national scientific output in this regard. Strategies were listed health professionals in two papers, with proof of the applicability and effectiveness of these interventions help the needs of caregivers. The field study showed that caregivers were mostly men, with two primary school education, married, average age 47.4 years ± 13.8 years and average time as a caregiver of 13.9 ± 9.3 months. The highest average scores for quality of life was in the Physical Domain and the lowest in the psychological and Environment. Variables associated with quality of life were age and duration of caregiver. Caregivers aged 60-75 years had the lowest scores in the Physical Domain. Those who care for less time had the greatest impact in the psychological environment and quality of life. We conclude that it is necessary to support the emotional aspects of the professional caregiver, allowing for better management of the situation. Knowledge and understanding of the specific symptoms of the disease helps the adequacy of personal resources to deal with behavioral changes, identified as the factor most impacting on the caregiver's life. Special attention should be given to changes in the caregiver's health, so it does not become a "hidden patient" and unable to cope with the demands of patients with dementia with Lewy bodies. / A demência é uma síndrome neurodegenerativa impactante pela grande ocorrência e também pelos índices de morbidade nos cuidadores. A demência com corpos de Lewy é um quadro neuropsiquiátrico complexo associado, considerado como segunda causa de demência degenerativa em idosos, e que provoca impacto na qualidade de vida nos cuidadores. Os objetivos deste estudo foram identificar na literatura, o impacto do cuidado na qualidade de vida de quem cuida de um portador de demência; descrever as estratégias utilizadas por profissionais de saúde e ou pesquisadores brasileiros para amenizar os impactos negativos decorrentes do ato de cuidar do portador de demência e avaliar a qualidade de vida de familiares que convivem e cuidam de portadores de demência com corpos de Lewy. Inicialmente foi realizada uma revisão integrativa nas bases eletrônicas da National Library of Medicine (PubMed) e Literatura Latino Americana de Ciências da Saúde (LILACS), no intervalo de 1999 a 2010. Em seguida foi realizado estudo transversal que avaliou 90 cuidadores de pacientes com demência com corpos de Lewy, respondendo a um questionário sociodemográfico e ao instrumento de avaliação da qualidade de vida, WHOQOL-BREF. A revisão integrativa incluiu 19 artigos, evidenciando que, apesar de altos os índices de estresse, ansiedade e desgaste físico e mental dos cuidadores domiciliares de pacientes com demência, é escassa a produção cientifica nacional a esse respeito. Foram apontadas estratégias dos profissionais de saúde em dois artigos, com aplicabilidade e comprovação da eficácia dessas intervenções no auxilio às necessidades dos cuidadores. O perfilsociodemográfico do estudo de campo evidenciou que os cuidadores entrevistados eram na maioria homens, com 2º grau de escolaridade, casados, de idade média 47,4 ± 13,8 anos anos e média de tempo como cuidador de 13,9 ± 9,3 meses. A maior média dos domínios de qualidade de vida foi no Domínio Físico e a menor nos Domínios Psicológico e Meio Ambiente. As variáveis associadas à qualidade de vida foram a idade e o tempo de cuidador. Os cuidadores com idade entre 60 - 75 anos apresentaram piores escores no Domínio Físico. Aqueles que cuidam há menos tempo tiveram maior impacto nos Domínios Psicológico e Meio Ambiente da qualidade de vida. Conclui-se que é necessário suporte profissional aos aspectos emocionais do cuidador, permitindo melhor gerenciamento da situação. O conhecimento das especificidades e compreensão dos sintomas da patologia auxiliam na adequação dos recursos pessoais para enfrentar as alterações comportamentais, apontadas como o fator mais impactante na vida do cuidador. Atenção especial deve ser dada às alterações na saúde do cuidador, para que ele não se torne um paciente oculto e incapaz de lidar com as demandas do portador de demência com corpos de Lewy.

This master’s thesis deals with diagnostics of prodromal stage of Lewy body disease using microstate analysis. First part of the thesis includes theoretical background which is needed for understanding discussed topics and presented results. This part consists of description of the disease, diagnostic options, electroencephalography, pre-processing of the EEG record and the microstate analysis process. Theoretical background is followed by a practical part of the thesis. In the beginning, there is a chapter about a dataset, used EEG device, and own solution of the pre-processing. Microstate analysis is discussed next, its output parameters were compared between groups with statistical methods. Comparison of the subjects in prodromal stage of Lewy body disease and healthy controls brought significant differences in three parameters of microstates, in rate of unlabelled time frames and also for some counts of transitions between each map or unlabelled sections. Comparison of the subjects in prodromal stage of Lewy body disease and healthy controls brought significant differences in three parameters of microstates, in rate of unlabelled time frames and also for some counts of transitions between each map or unlabelled sections.

Les maladies neurodégénératives représentent un défi sociétal majeur. Trouver des outils pour mieux comprendre et diagnostiquer ces maladies est donc nécessaire. La spectroscopie infrarouge (IR) et Raman semblent être de bons candidats puisqu’elles peuvent caractériser l’état physiopathologique d’un échantillon. Le but de cette thèse a été d’appliquer ces méthodes à l’étude de peptides modèles, de tissus cérébraux et de liquides céphalorachidiens (LCR). Dans le cadre de l’étude des tissus cérébraux, la spectroscopie IR et Raman ont été couplées à la microscopie afin de combiner des informations spectrales et spatiales. Cela a permis de mieux comprendre la formation et le rôle des plaques amyloïdes dans la maladie d’Alzheimer (MA). Egalement, cela a permis de montrer l’intérêt d’utiliser ces méthodes dans des études futures pour suivre l’effet de différents traitements contre la sclérose en plaques. Concernant l’étude des LCR, la spectroscopie IR en mode ATR et la spectroscopie Raman exaltée de surface ont été utilisées afin de mettre en évidence des marqueurs spectroscopiques de la MA et de la maladie à corps de Lewy qui pourraient permettre un diagnostic plus précoce de ces maladies et un diagnostic différentiel entre ces deux. / Neurodegenerative diseases represent a major societal challenge. So, it is necessary to develop new tools for a better understanding and diagnosing of these diseases. Infrared (IR) and Raman spectroscopies seem to be good candidates since they can characterize the physiopathological conditions of a biological sample. The purpose of this thesis was to apply these methods to the study of model peptides, brain tissues and cerebrospinal fluids (CSF). As a part of brain tissue analysis, IR and Raman spectroscopy were coupled to microscopy in order to combine spectral and spatial information. This methodology improved our understanding of the formation and the role of amyloid plaques in Alzheimer’s disease (AD). Moreover, it allowed to demonstrate the potential of these approaches in future studies on the effect of various treatments against multiple sclerosis. Concerning the study of CSF, IR-ATR and surface enhanced Raman spectroscopy were applied to identify spectroscopic markers of AD and Lewy body disease that could enable early diagnosis of these diseases and discrimination between them.

Die Liquordiagnostik im Rahmen von Demenzerkrankungen ist trotz neuer diagnostischer Möglichkeiten im Bereich der PET(Positronen-Emissions-Tomographie)-Bildgebung weiterhin von hoher klinischer Relevanz. Insbesondere für die Alzheimer-Erkrankung existieren validierte Biomarker, die die Diagnose untermauern und bei der diagnostischen Abgrenzung anderer Demenzätiologien hilfreich sein können.Während unauffällige Liquorbefunde mit negativen Demenz- und Destruktionsmarkern die überwiegende Mehrzahl neurodegenerativer Demenzursachen mit hoher diagnostischer Sicherheit ausschließen, stellen in der klinischen Praxis vor allem überlappende Biomarkerprofile bei primär neurodegenerativen Demenzursachen ein substanzielles Problem bei der Befundinterpretation dar. Deshalb bedarf die Liquorbefundinterpretation stets einer kontextualisierten Betrachtung unter Würdigung der klinischen Symptomatik und Verlaufscharakteristika des entsprechenden demenziellen Syndroms. Außerdem stellen auchMischbefunde eine häufige diagnostische Herausforderung dar, ür deren Interpretation es profunder Kenntnisse im Bereich von Präanalytik, möglicher Liquorbefundkonstellationen und natürlich der verschiedenen in Betracht kommenden Demenzätiologien bedarf. Auch Liquorbiomarker für Synukleinopathien, Tauopathien sowie TDP43(Transactive response DNA binding protein 43 kDa)-Proteinopathien sind Gegenstand aktueller Untersuchungen, wenngleich diese noch nicht den Weg in die klinische Routinediagnostik gefunden haben.

Είναι γνωστό ότι η άνοια σχετίζεται με την απώλεια μνήμης, έκπτωση γλωσσικών ικανοτήτων, έλλειψη αυτονομίας και απώλεια της προσωπικής ταυτότητας του ασθενούς. Στόχος της παρούσας εργασίας είναι να αναδείξει τη σχέση αμφισημίας- άνοιας και να διερευνηθεί η σκοπιμότητα ύπαρξης ενός μεθοδολογικού εργαλείου για την εκτίμηση και τη διερεύνηση της γλωσσικής έκπτωσης στη άνοια μέσα από την γλωσσική επεξεργασία των λεξικών σχέσεων (μεταφορών –ομωνυμίας- μετωνυμιών) και να παρουσιάζει το προφίλ των ασθενών αυτών. Στην πρώτη ενότητα παρουσιάζω γενικά στοιχεία για την νόσο της άνοιας αλλά και στοιχεία για τους κυριότερους τύπους της νόσου όσον αφορά την γλωσσική συμπεριφορά των ασθενών. Στην ενότητα αυτή αναφέρω επίσης βασικά διαγνωστικά εργαλεία που χρησιμοποιούνται ευρέως για τον προσδιορισμό της νόσου, ενώ αναλυτικότερα στοιχεία για τα εργαλεία που χρησιμοποιούνται και τις δομές που εξετάζουν παρατίθενται στο παράρτημα. Κλείνοντας την ενότητα καταλήγω στα οφέλη και την αναγκαιότητα ύπαρξης πρώιμης διάγνωσης. Στην δεύτερη ενότητα αναφέρομαι κυρίως στο νοητικό λεξικό και στην δυσκολία πρόσβασης των ασθενών με πιθανή άνοια σε αυτό. Επιπλέον υπάρχουν στοιχεία για την λεξική κατάκτηση, επιλογή και ανάκτηση των πληροφοριών και φαίνεται η σχέση νοητικού λεξικού – αμφισημίας. Στην τρίτη ενότητα παρουσιάζω το φαινόμενο της αμφισημίας από την θεωρητική άποψη αρχικά της γλωσσολογίας, πως κατακτώνται οι αμφίσημες λέξεις και επεξεργάζονται σε σχέση με την ηλικία και καταλήγω στην νευρική συσχέτιση των λεξικών αμφισημιών με συγκεκριμένες εγκεφαλικές περιοχές. Στο τέλος της παρούσας ενότητας παρουσιάζω ευρήματα/ συμπεράσματα από πλήθος ερευνών που αφορούν την λεξική αμφισημία με διαφορετικές μεθόδους για κάθε τύπο άνοιας. Στην τελευταία ενότητα παρουσιάζω τις βασικές υποθέσεις μου πως η χρήση των λεξικών σχέσεων θα μπορεί να αποτελέσει διαγνωστικό εργαλείο στην άνοια. Επίσης παρουσιάζω την κατασκευή και τα αποτελέσματα της πειραματικής διαδικασίας ανάμεσα σε τέσσερα διαφορετικά υποκείμενα (πασχόντων –υγειών) διαφορετικής παθολογίας και σοβαρότητας. Ακολουθεί τέλος το παράρτημα με στοιχεία που αφορούν την διαφοροδιάγνωση της νόσου βάσει αλγορίθμων με τα γνωστικά ελλείμματα όπως παρουσιάζονται από τους φροντιστές των ασθενών αλλά και παθολογικών συμπτωμάτων που παρουσιάζουν, ενώ σε πίνακα υπάρχουν τα γλωσσικά στοιχεία που βοηθούν επίσης στην διαφοροδιάγνωση των κυριότερων τύπων άνοιας και τα αποτελέσματα της πειραματικής διαδικασίας. / It is well known that dementia is associated with memory loss, impaired language skills, lack of autonomy and loss of patients’ independence. The aim of this paper is to highlight the connection between ambiguity and dementia, and to investigate the feasibility of a methodological tool to assess and investigate the linguistic deduction in dementia through the linguistic processing of lexical relations (metaphor-homonymy-metonymy) and present the profile of such patients. In the first section I present general information as well as the linguistic features of the main types of dementia. In this section there is also a report on the diagnostic tools which are widely used to identify the disease. More detailed information about the use of these diagnostic tools is listed in the Annex. At the end of this section there is evidence about the benefits and the importance of early diagnosis. The second section is mainly referred to the mental lexicon and the difficulty patients with probable dementia face in accessing it. Furthermore there is evidence for lexical acquisition, selection and retrieval of information which shows the mental lexicon – ambiguity connection. In the third section I present the phenomenon of ambiguity, starting from the theoretical linguistic view; how the ambiguous words are conquered and processed in relation to age and lead to neural correlation of lexical ambiguity with specific brain regions. At the end of this section I present findings / conclusions of several researches, using different methods, on the lexical ambiguity on each type of dementia. The last section presents my basic assumptions concerning how the use of lexical relations can be a diagnostic tool in dementia. Furthermore, I present the construction and the results of the experimental process between four different subjects (patient-healthy) with different pathology and severity of the disease. Finally, at the annex, I present data on the differential diagnosis of the disease based on algorithms with cognitive deficits reported by caregivers of patients as well as pathology features. Also there is a board with differential linguistic elements which help distinguish the main types of dementia, along with the experimental material used and the results of the procedure.