Abstract The purpose of this study was to describe and explain the care of older people with dementia in surgical wards from the viewpoints of the patients and their close relatives, nursing staff and physicians. The study was conducted in two stages. The first stage of the study was conducted with a qualitative approach, collecting the data from older people with dementia (n=7), their close relatives (n=5), nursing staff (n=19) and physicians (n=9) using individual and group interviews. The data were analysed using inductive content analysis. The approach in the second stage was quantitative: data were collected with a questionnaire from the nursing staff (n=191). The data were analysed using descriptive statistics as well as explorative factor analysis. The nursing staff stated that responding to the physical, psychological and social needs of patients with dementia requires more effort and time than usual. The nursing staff pointed out that they did not have all the required know-how to provide good care for older people with dementia. The nursing staff with longer work experience indicated doing nothing more often than other nursing staff when encountering challenge behaviour of a patient with dementia. Concerns about well-being of a patient and feeling shame about patient’s behavioural symptoms were causing exhaustion among close relatives. Relatives expected some time for personal dialogue and support from the nursing staff. The patients experienced that they did not get enough information about their own care. The study provides new information that can be used to develop the care of older people with dementia in hospital environment. The results can be utilized in basic, further and updating education in the field of health care. / Tiivistelmä Tutkimuksen tarkoituksena oli kuvata ja selittää ikääntyvän muistisairaan potilaan hoitotyötä kirurgisella vuodeosastolla muistisairaiden potilaiden, omaisten, hoitohenkilökunnan ja lääkäreiden näkökulmasta. Tutkimus toteutettiin kahdessa vaiheessa. Ensimmäisen vaiheen lähestymistapa oli kvalitatiivinen eli laadullinen, ja aineisto kerättiin kirurgisilla vuodeosastoilla olevilta muistisairailta potilailta (n=7), omaisilta (n=5), hoitohenkilökunnalta (n=19) ja lääkäreiltä (n=9) yksilö-, pari- ja ryhmähaastatteluina. Aineisto analysoitiin induktiivisella sisällön analyysilla. Tutkimuksen toisen vaiheen lähestymistapa oli kvantitatiivinen eli määrällinen, ja aineisto kerättiin kyselylomakkeella kirurgisilla vuodeosastoilla työskentelevältä hoitohenkilökunnalta (n=191). Aineisto analysoitiin käyttäen kuvailevan tilastotieteen menetelmiä sekä eksploratiivista faktorianalyysia. Ikääntyvän muistisairaan potilaan hoitotyössä korostui fyysiseen, psyykkiseen ja sosiaaliseen avuntarpeeseen vastaaminen, joka vaati keskimääräistä enemmän aika- ja henkilöstöresursseja. Hoitohenkilökunta toi esille, ettei heillä ollut tarvittavaa tieto-taitoa muistisairaiden potilaiden hoitamiseen. Hoitajat, joilla oli pitkä työkokemus reagoivat muistisairaan potilaan käytösoireisiin muita hoitajia välinpitämättömämmin. Huoli potilaan voinnista ja häpeän tunne potilaan käytösoireista aiheuttivat puolestaan omaisen uupumista. Omaiset kaipasivatkin henkilökunnalta keskusteluapua ja tukea. Potilaat taas kokivat, etteivät he saaneet tarpeeksi tietoa hoitoaan koskevista asioita. Tutkimuksella tuotetaan uutta tietoa, jonka avulla voidaan kehittää ikääntyvän muistisairaan potilaan hoitotyötä sairaalaympäristössä. Tuloksia voidaan hyödyntää terveydenhuoltoalan perus-, jatko- ja täydennyskoulutuksessa.

Doctorat en Sciences Psychologiques et de l'éducation / info:eu-repo/semantics/nonPublished

Doctorat en sciences psychologiques / info:eu-repo/semantics/nonPublished

<p>Cilj rada: Posmatrano je da li postoji povezanost kliničkih parametara, bihejvioralnih simptoma i postignuća na testovima kognitivnih funkcija sa karakteristikama hoda kod obolelih od Parkinsonove bolesti. Analizirana je i povezanost nalaza hiperehogenosti strukture substantia nigra dobijenog transkranijalnim parenhimskim ultrazvukom sa karakteristikama hoda.Materijal I metode: Istraživanjem je obuhvaćeno 60 obolelih od Parkinsonove bolesti (22 žene i 38 mu&scaron;karaca, sa trajanjem bolesti 5,06&plusmn;4,54 godina, ukupnim UPDRS 39,76&plusmn;36,65, UPDRS III 24,28&plusmn;15,18) koji su prema stadijumu bolesti po Hen i Jarovoj skali (H&amp;Y) podeljeni u tri podgrupe sa po 20 ispitanika: H&amp;Y 1, 2 i 3. Kontrolnu grupu činilo je 35 zdravih ispitanika (19 žena i 16 mu&scaron;karaca) koji se od grupe obolelih nisu razlikovali u pogledu godina starosti (oboleli 64,21&plusmn;6,92 godina, zdravi 63,45&plusmn;7,75, p=0,832) i godina obrazovanja (oboleli 12,63&plusmn;3,16 godina, zdravi 12,57&plusmn;2,87, p=0,954). Iz analize su isključeni ispitanici čiji je skor MMSE bio manji od 24. Procena težine motornih znakova Parkinsonove bolesti vr&scaron;ena je Unifikovanom skalom za kvantifikovanje Parkinsonove bolesti, treći deo (UPDRS III). Za globalnu procenu kognicije je kori&scaron;ćena Revidirana Adenbrukova kogntivna skala (ACE- R), a za procenu egzekutivnih funkcija su kori&scaron;ćeni baterija za procenu frontalnih funkcija (FAB) i Egzekutivni intervju (EXIT-25). Za evaluaciju depresije kori&scaron;ćene su Hamiltonova skala za procenu depresije (HAM- D) i Bekova skala depresivnosti (BDI II), za procenu anksioznosti Hamiltonova skala za procenu anksioznosti (HAM- A), a za procenu apatije Skala apatije (AS).Određivanje vremenskih i prostornih parametara hoda vr&scaron;eno je pomoću GAITRite sistema, tokom &bdquo;on&rdquo; perioda. Analizirano je osam parametara hoda: vreme dvokoraka (CT), dužina dvokoraka (SL), vreme zamaha (ST) i vreme dvostrukog oslonca (DS), kao i njihovi koeficijenti varijacija (CV). Posmatran je i uticaj dvostrukog zadatka na parametre hoda. Kao dodatni zadatak tokom hoda primenjen je kognitivni zadatak (oduzima -7 tokom hoda), motorni zadatak (nosi ča&scaron;u punu vode) i kombinovani zadatak (oduzima i nosi ča&scaron;u istovremeno). Veličina hiperehogenosti substantia nigra merena je transkranijalnim parenhimskim ultrazvukom. Rezultati: U poređenju sa zdravim vr&scaron;njacima, oboleli od Parkinsonove bolesti imali su značajno izraženiji varijabilitet koraka pri hodu bez zadatka (skraćen SL, povećan CVSL i CVCT, varijabilitet koraka bio je jo&scaron; izraženiji, dok je pri motornom zadatku postojala i značajna razlika DS i CVDS (p&lt;0,05), tj. parametara kojima se izražava ravnoteža koraka. U uslovima kombinovanog zadatka ove razlike su se potencirale. Parametri hoda (SL, VCSL, CVCT I CVST) minimalno su se razlikovali kod obolelih u najranijim stadijumima bolesti (H&amp;Y 1) u odnosu na zdrave, dok su razlike postajale izraženije kako je bolest bila u odmaklijim stadijumima (H&amp;Y 2 I H&amp;Y 3). U grupi zdravih starost ispitanika korelirala je sa varijabilitetom koraka jedino u uslovima dvostrukog zadatka. Kod obolelih ova povezanost je uočena i pri hodu bez zadatka, a povezanost je bila jača u uslovima dvostrukog zadatka. Starost ispitanika i težina motornih znakova na UPDRS III korelirali su sa parametrima hoda kod obolelih od PB. Skorovi apatije i depresivnosti korelirali su sa promenama parametara hoda kod obolelih, s tim &scaron;to je apatija bila prisutna već u najranijim, a depresija tek u kasnijim stadijumima bolesti. Niža postignuća na testovima egzekutivnih funkcija povezana su sa pogor&scaron;anjem svih parametara hoda. Sa pogor&scaron;anjem parametara hoda tokom trajanja bolesti koreliraju i niža postignuća na testovima jezičkih i vidno- prostornih funkcija, kao i deficit pamćenja. Veličina hiperehogenosti korelira sa CV svih parametara hoda. Zaključak: Kod obolelih od Parkinsonove bolesti značajno se razlikuju vremenski i prostorni parametri hoda u poređenju sa zdravim, pre svega oni kojima se opisuje varijabilitet koraka. Ovi parametri su izraženiji kada se tokom hoda obavlja i dodatni kognitivni zadatak. Kada se tokom hoda obavlja motorni ili kombinovani motorni i kognitivni zadatak, pored varijabiliteta koraka javlja se i značajno produžen DS koji ukazuje na poremećaj ravnoteže. Na parametre hoda utiču starost ispitanika, težina i stadijum Parkinsonove bolesti. Apatija i depresija takođe značajno utiču na parametre hoda kod obolelih. Apatija se javlja u najranijim, a depresivnost tek u kasnijim stadijumima bolesti, &scaron;to govori u prilog stanovi&scaron;ta da je apatija zaseban simptom bolesti povezan sa dopaminergičkom disfunkcijom. Pogor&scaron;anja parametara hoda koreliraju sa o&scaron;tećenjem kognitivnih funkcija, pre svega egzekutivnih. U odmaklim stadijumima bolesti sa pogor&scaron;anjem hoda povezana su i lo&scaron;ija postignuća na testovima vidno-prostornih funkcija i pamćenja. Hiperehogenost substantia nigra na transkranijalnom parenhimskom ultrazvuku, koja se značajno če&scaron;će javlja i značajno je veće povr&scaron;ine kod obolelih u odnosu na zdrave, korelira sa varijabilitetom koraka.</p> / <p>Objectives: The aim of the study was to assess the contribution of clinical presentation, behavioral symptoms and cognitive functioning to gait characteristics in Parkinson&rsquo;s disease (PD). Hyperechogenicity of the substantia nigra on transcranial parenchimal ultrasound and its correlations with gait characteristics was also analyzed. Material and Methods: The experimental group consisted of 60 patients suffering from Parkinson&rsquo;s disease (22 women and 38 men, disease duration 5.06&plusmn;4.54, Unified Parkinson&#39;s Disease Rating Scale (UPDRS) total 39.76&plusmn;36.65, and UPDRS III 24.28&plusmn;15.18), who were classified into three subgroups according to the Hoehn and Yahr (H&amp;Y) stage of the disease: H&amp;Y 1, H&amp;Y 2 and H&amp;Y 3, with each subgroup containing 20 patients. The control group included 35 healthy subjects (19 women and 16 men) who were matched for years of age (64.21&plusmn;6.92 years PD vs 63.45&plusmn;7.75 healthy; p= .832) and formal education (12.63&plusmn;3.16 years PD vs 12.57&plusmn;2.87 healthy, p= .954). The subjects with MMSE&lt;24 were concerned demented and excluded from further analysis. The disease severity was assessed by the UPDRS, motor part (UPDRS III). Addenbrooke&rsquo;s Cognitive Examination-Revised (ACE-R) was used in assessment of global cognition, while executive functions were examined by Frontal Assessment Battery (FAB) and Executive Interview (EXIT-25) Hamilton&rsquo;s Depression Rating Scale (HAM-D) and Beck&rsquo;s Depression Inventory (BDI II) were used to screen for symptoms of depression, and the Apathy Scale (AS) and Hamilton&rsquo;s Anxiety Rating Scale (HAM- A) were used to assess apathy and anxiety. The measurements of spatial and temporal parameters of gait were performed using the GAITRite system, during the &ldquo;on&rdquo; state. The following eight parameters were analyzed: Cycle Time (CT), Stride Length (SL), Swing Time (ST) and Double Support Time (DS), as well as their coefficients of variation (CV). The impact of dual task on gait parameters was also observed. The subjects were asked to walk and simultaneously perform cognitive task (subtracting -7), then motor task (carrying a glass of water) and eventually combined task (subtracting and carrying a glass of water), while walking on the GAITRite electronic pathway. Transcranial parenchymal ultrasound was used to measure hyperechogenicity of substantia nigra. Results: Compared to healthy controls, PD patients had significantly higher gait variability during gait without additional tasks (decreased SL, increased CVSL and CVCT; p&lt; .05), whereas with a cognitive task the variability was even higher. During the motor task DS and CVDS were significantly increased as well, implying gait instability. A combined task had similar effects as the motor task, affecting all parameters. When the experimental group was divided into subgroups, variability of gait (SL, VCSL, CVCTandCVST) was minor in subgroup H&amp;Y 1, but more pronounced in later stages (H&amp;Y 2 and H&amp;Y 3). The age correlated with gait variability (CVCT and CVSL) only during the dual task in healthy subjects, whereas in PD patients the association was significant during normal gait and increased on the dual task. The age and severity of the disease on the UPDRS III also correlated with gait parameters. Apathy and depression were also associated with gait variability. Symptoms of apathy were significant in the earliest stages (H&amp;Y 1), whereas depression was notable in the later stages (H&amp;Y 3). Worse scores on tests of executive functions correlated with impairment of gait parameters. The impact of diminished language, visuo-spatial and memory functions on gait was also significant. Hyperechogenicity of the substantia nigra on transcranial parenchymal ultrasound occurred more frequently and was larger in PD patients and correlated well with gait variability. Conclusion: There is a significant impairment of temporal and spatial gait parameters in PD patients compared to healthy subjects, particularly the parameters of gait variability. These parameters become even more impaired during a simultaneous cognitive task. When a motor or combined task is performed, there is additional increase of DS, implying impairment of stability. Also, age and disease severity affect gait in PD patients. Apathy is significant in early stages (H&amp;Y 1) and depression in later stages (H&amp;Y 3), the finding which may be explained by the dopaminergic origin of apathy. Impairment of cognitive functions, most importantly executive dysfunction, are also associated with gait variability. Lower scores at visuo-spatial, language and memory tests are associated with worsened gait parameters of gait in later stages of PD. Finally, hyperechogenicity of the substantia nigra on transcranial parenchymal sonography, which occurs more frequently and is larger in PD patients, correlates with gait variability.</p>

Sutherland, Sparks and Lehmann (2010) proposed a new theory of memory consolidation, termed Distributed Reinstatement Theory (DRT), where the hippocampus (HPC) is needed for initial encoding but some types of memories are established in non-HPC systems through post-learning HPC activity. An evaluation of the current methodology of temporary inactivation was conducted experimentally. By permanently implanting two bilateral guide cannulae in the HPC and infusing ropivacaine cellular activity could be reduced by 97%. Rats were trained in a context-fear paradigm. Six learning episodes distributed across three days made the memory resistant to HPC inactivation while three episodes did not. Blocking post-learning HPC activity following three of six training sessions failed to reduce the rat’s memory of the fearful context. These results fail to support DRT and indicate that one or more memory systems outside the HPC can acquire context memory without HPC post-event activity. / x, 85 leaves : ill. ; 29 cm

Older Americans will comprise 22.9% of the population by the year 2050 (U.S. Bureau of the Census, 1989). The literature has focused attention on the informal networks and leisure activities of the older adult. Most older adults have an effective network of close relationships with family and friends.Schein (1985) suggests that impaired hearing reduces communication resulting in social withdrawal and diminished participation in leisure activities. Only recently has research addressed the impact of subjective memory impairment. The literature on self-reported memory complaints and objective measures of performance are mixed.The purpose of this study was to better understand the role self-reported hearing impairment and memory impairment have on the social contact and leisure activities of community adults. Results indicate that gender is a significant indicator of social contact. The hypothesis that individuals reporting memory difficulties would differ significantly in social contact and leisure activities from unimpaired individuals was supported. No significant multivariate effect appeared for hearing on social contact or leisure activities. / Department of Counseling Psychology and Guidance Services

Diss. (sammanfattning) Linköping : Linköpings universitet, 2009. / Härtill 5 uppsatser.

CNPQ / A exposição aguda, sub-crônica ou crônica ao etanol está envolvida com diversos problemas que afetam o cérebro e o sistema nervoso central, provocando déficits de aprendizagem e memória de curto ou longo prazo. Compostos bioativos como carotenoides, são novas opções terapêuticas capazes de reduzir os déficits de memória e atuar na redução do risco de doenças e manutenção da saúde. Neste sentido, a luteína, um carotenoide que contribui contra o estresse oxidativo, pode atuar como uma droga capaz de modificar ou atenuar os danos neuronais e os déficits de memória induzidos por etanol. Assim, no presente estudo foi avaliado o efeito da luteína sobre os déficits de memória induzidos por etanol em ratos na tarefa de reconhecimento de objetos. Os resultados encontrados demonstraram que a administração de luteína (100 mg/kg) melhorou a memória dos ratos na tarefa de reconhecimento de objetos [F(3,34) = 7,13; p < 0,05], enquanto as doses de 15 ou 50 mg/kg não apresentaram efeito; a administração sub-crônica de etanol (3 g/kg) causou déficit de memória em ratos na tarefa de reconhecimento de objetos [F(3,37) = 3.06; p < 0.05]; e a de luteína (50 mg/kg) preveniu o déficit de memória induzido pelo etanol [F(3,39) = 7.64; p < 0.05]. Além disso, a administração de luteína, etanol e a combinação luteína e etanol não alteraram os parâmetros de estresse oxidativo avaliados no córtex e hipocampo. Sugerindo que a prevenção do déficit de memória induzido por etanol não envolve estresse oxidativo no córtex e hipocampo. Assim, baseado nos resultados obtidos, a luteína pode ser considerada uma alternativa no tratamento dos déficits de memória induzidos por etanol, entretanto, mais estudos são necessários para avaliar o mecanismo envolvido neste efeito. / The acute exposure, sub-acute or chronic is involved with various problems affecting the brain and central nervous system, resulting in learning deficits and short or longterm memory. Bioactive compounds such as carotenoids, are new therapeutic options able to reduce memory deficits and act in reducing the risk of diseases and health maintenance. In this sense, lutein, a carotenoid that contributes against oxidative stress, can act as a drug able to modify or reduce neuronal damage and memory deficits induced by ethanol. Thus, this study evaluated the effect of lutein on memory deficits in rats induced by ethanol in the object recognition task. The results showed that lutein administration (100 mg/kg) improved the memory of rats in the recognition task objects [F(3,34) = 7.13; p < 0.05], while doses of 15 or 50 mg / kg showed no effect; the sub-chronic administration of ethanol (3 g/kg) caused memory deficit in rats recognition task objects [F(3,37) = 3.06; p < 0.05]; and lutein (50 mg/kg) prevents the memory deficit induced by ethanol [F(3,39) = 7.64; p < 0.05]. Furthermore, lutein administration, ethanol and combination lutein and ethanol did not change the parameters of oxidative stress evaluated in the cortex and hippocampus. This suggests that the prevention of memory deficits induced by ethanol does not involve oxidative stress in the cortex and hippocampus. Thus, based on the results obtained, lutein may be considered an alternative in the treatment of memory deficits induced by ethanol, however, more studies are needed to evaluate the mechanism involved in this effect.

OBJECTIVE: Metamemory is integral for strategizing about memory intentions. This study investigated the prospective memory (PM) deficit in Parkinson's disease (PD) from a metamemory viewpoint, with the aim of examining whether metamemory deficits might contribute to PM deficits in PD. METHOD: Sixteen patients with PD and 16 healthy older adult controls completed a time-based PM task (initiating a key press at two specified times during an ongoing task), and an event-based PM task (initiating a key press in response to animal words during an ongoing task). To measure metamemory participants were asked to predict and postdict their memory performance before and after completing the tasks, as well as complete a self-report questionnaire regarding their everyday memory function. RESULTS: The PD group had no impairment, relative to controls, on the event-based task, but had prospective (initiating the key press) and retrospective (recalling the instructions) impairments on the time-based task. The PD group also had metamemory impairments on the time-based task; they were inaccurate at predicting their performance before doing the task but, became accurate when making postdictions. This suggests impaired metamemory knowledge but preserved metamemory monitoring. There were no group differences regarding PD patients' self-reported PM performance on the questionnaire. CONCLUSIONS: These results reinforce previous findings that PM impairments in PD are dependent on task type. Several accounts of PM failures in time-based tasks are presented, in particular, ways in which mnemonic and metacognitive deficits may contribute to the difficulties observed on the time-based task.

Diss. (sammanfattning) Umeå : Umeå universitet, 2009. / Härtill 5 uppsatser. Även tryckt utgåva.