<p>Sammanfattning Syftet med studien var att beskriva anhörigas upplevelser av att leva tillsammans med eller i närheten av en person som har drabbats av Alzheimers sjukdom. Studien utgick från ett socialt, fysiskt och psykiskt perspektiv. Studien byggde på 18 vetenskapliga artiklar som kvalitet granskades med hjälp av en granskningsmall. Artiklar söktes genom databaserna Academic Search Elite, Cinahl och Vård I Norden Online. Urvalskriterierna var att artiklarna svarade på studiens syfte, var skrivna på svenska eller engelska och publicerade mellan åren 2000 till 2008. Resultatet visade att anhöriga ställs inför en dramatisk förändring som är krävande, utmanande och de anhöriga upplevde oro, sorg, stress och skuld. Det sociala nätverket minskade och det leder oftast till ensamhet och isolering. Resultatet visade också att anhöriga är i behov av stöd från släkt och vänner samt från hälso- och sjukvården. Sammanfattningsvis upplevde majoriteten av anhöriga en ökad belastning av att vara anhörig till en person med Alzheimers sjukdom.</p><p>Nyckelord: Alzheimers sjukdom, familj, anhöriga, upplevelser.</p> / <p>Abstract The aim of the study was to describe relative’s experiences of living with or near a person that has Alzheimer’s disease. The study builds on social, physical and psychic perspectives. The studies were based on 18 scientific articles that were quality checked with the aid of a review model. Articles were applied for through the databases Academic Search Elite, Cinahl and Vård I Norden Online. The selection criteria’s were that the articles replied on the study's aim, were written on Swedish or English and published between the years 2000 to 2008. The result showed that relatives were set to a dramatic change that were requiring, challenging and the relatives experienced dread, sorrow, stress and debt. The social network decreased and the result was often decreased loneliness and isolation. The result also showed that the relatives were in need of aid from family and friends, and from the healthcare. To summary the majority experienced that the burden increased of being relatives to a person with Alzheimer’s disease.</p><p>Keywords: Alzheimer’s disease, family, relatives, experience.</p>

<p>Elderly committing suicide can be in a “preclinical phase” of dementia. Depressive symptoms may indicate a risk to develop a disease of dementia, for example Alzheimer’s Disease. Today almost 10% of the Swedish population older than 65 years suffer from a cognitive impairment diagnosed as dementia. Symptoms of dementia are associated with degenerative changes in the brain caused by a deposition of amyloid, leading among others things to a nerve cell death. A clinical diagnosis can be hard to set, and a definitive diagnose can only be set after a pathological examination, which only is possible after death. For this study we used Congo red staining of brains sections to find amyloid in autopsies from elderly people committing suicide. 35 cases (>60 year) were studied. Of the 35 cases 1/3 showed to be positive for amyloid deposition. This result in addition to other studies suggest that depressive symptoms is a “preclinical phase” of dementia, and therefore the suicide risk for this group must be consider to be elevated. However, more reliable prospective studies most be done to confirm this retrospective study.</p>

Identification of modifiable risk factors for Alzheimer’s disease (AD) is crucial in order to diminish suffering from this devastating disease. The aim of this thesis was to investigate if different aspects of glucose metabolism, insulin, fatty-acid composition or other vascular risk factors predict the future development of AD and dementia. This thesis is based on the Uppsala Longitudinal Study of Adult Men (ULSAM) cohort, which started in 1970. A total of 2322 men at age 50 were examined with focus on vascular risk factors. The cohort was re-examined at ages 60, 71, 77, 82 and 88. Incident diagnoses of AD, vascular dementia, other dementias and cognitive impairment were assessed in 2005–2010. The risk of AD was increased in subjects with lower early insulin response measured with both an intravenous glucose tolerance test at 50 years and an oral glucose tolerance test at 71 years of age. The presence of vascular risk factors such as hypertension, obesity, hypercholesterolemia and smoking increased the risk of future vascular dementia but not of AD. Furthermore, saturated fatty acids at midlife were inversely associated with risk of AD. No evidence of a protective effect of omega-3 fatty acids against dementia was found. The susceptibility allele, APOE ε4, was the strongest individual risk factor. APOE ε4 carriers with vascular risk factors had the greatest risk of developing dementia. Low insulin response was a risk factor for AD mainly in APOE ε4 non-carriers. Disturbances in insulin and glucose metabolism, vascular risk factors and fatty acids are linked differentially to the pathogenesis of AD and vascular dementia. These observations should be considered when future clinical approaches are planned to prevent and postpone the onset of dementia. / ULSAM

The present study evaluated olfactory and cognitive abilities of the Tg6799 (also called 5xFAD) strain of Alzheimer’s disease (AD) model mice of two different age groups (2-3 and 8-10 months of age), and one group of healthy control mice (9-10 months). Employment of an operant conditioning paradigm using an automated olfactometer, an olfactory habituation/dishabituation test and a spatial learning test with non olfactory cues resulted in data showing that the 5xFAD mice develop olfactory impairments already at 2-3 months of age. The impairments consisted in a robust impairment in olfactory sensitivity, decreased responsiveness to novel odors and an inability to discriminate between enantiomeric odor molecules in the 5xFAD mice compared to control mice. Spatial learning deficits were also detected at this age, suggesting that cognitive functions were also affected. No differences in magnitude of the olfactory or spatial learning impairments could be detected between the age groups of model mice tested. Histological examination of development and presence of amyloid β (Aβ) plaques in the brains showed that plaques develop mainly between the ages of 3 and 8 months. This indicates that soluble Aβ rather than the formation of plaques might be responsible for the olfactory impairment and spatial learning impairments found. By 10 months of age plaque load of the 5xFAD mice was massive. The results of the present study clearly show that the 5xFAD strain might be suitable for research on human AD with regard to the early onset of olfactory impairments.

The pathogenesis of Alzheimer’s disease (AD), the most common senile dementia, is a complex process. A crucial event in AD is the aggregation of amyloid-β protein (Aβ), a cleavage product from the Amyloid Precursor Protein (APP). Aβ40, a common component in amyloid plaques found in patients, aggregates in vitro at concentrations, much higher than the one found in vivo. But in the presence of charged lipid membranes, aggregations occurs at much lower concentration in vitro compared to the membrane-free case. This can be understood due to the ability of Aβ to get electrostatically attracted to target membranes with a pronounced surface potential. This electrostatically driven process accumulates peptide at the membrane surface at concentrations high enough for aggregation while the bulk concentration still remains below threshold. Here, we elucidated the molecular nature of this Aβ-membrane process and its consequences for Aβ misfolding by Circular Dichroism Spectroscopy, Differential Scanning Calorimetry and Nuclear Magnetic Resonance Spectroscopy. First, we revealed by NMR that Aβ40 peptide does indeed interact electrostatically with membranes of negative and positive surface potential. Surprisingly, it even binds to nominal neutral membranes if these contain lipids of opposite charge. Combined NMR and CD studies also revealed that the peptide might be shielded from aggregation when incorporated into the membrane. Moreover, CD studies of Aβ40 added to charged membranes showed that both positively and negatively membranes induce aggregation albeit at different kinetics and finally that macromolecular crowding can both speed up and slow down aggregation of Aβ.

Alzheimers sjukdom påverkar både patienten och den som vårdar honom eller henne. En anhörig vårdar ofta patienten och det har visat sig att de är utsatta för olika svårigheter.  Syftet med denna studie var att beskriva anhörigas upplevelser av att vårda en familjemed­lem med Alzheimers sjukdom. Metoden som användes för att besvara syftet var att göra en litteraturstudie enligt Polit och Becks (2004) beskrivning av genomförandet av en litteratur­studie. Dataanalysen skedde med kvalitativ ansats genom att artiklarna lästes igenom nog­grant och gemensamheter och mönster bland anhörigvårdares upplevelser söktes. Studiens resultat baserades på åtta veten­skapliga artiklar från vilka fem teman framkom. Resultatet visade att många anhörigvår­dare upplevde en förlust av relationer. De saknade relationen både med patienten och med vänner. De tyckte även att det var viktigt att ha fritid och tid för sig själva, vilket ofta var svårt att åstadkomma. Viljan till att söka ny kunskap blev stor när de tog på sig rollen som anhörigvårdare, och många upplevde olika lidanden och besvär såsom skuld och de­pression. Upplevelserna i resultatet åskådliggjorde att en stor del av de anhöriga inte kände välbefinnande. Detta resultat pekar på vikten av att sjuksköterskor är medvetna om de upplevelser och känslor anhörigvårdare har. / Alzheimer’s disease afflicts both the patient and the person caring for him or her. A relative often provides care for the patient and it appears as though they are exposed to different adversities. The aim of this study was to describe the experiences of relatives which care for a family member suffering from Alzheimer’s disease. The method used to answer the aim was to do a literature review by using Polit and Becks (2004) description of how to make a literature review. The data analysis was made with a qualitative approach by reading the articles accurately and patterns among the experiences family caregivers have been sought. The results of the study are based on eight scientific articles. Five themes emerged from these articles. The results show that many family caregivers experienced a loss of relationships. They missed the relationship with the patient as well as the relationship with friends. They also thought that it was important to have leisure, which often is hard to accomplish. The desire to seek for new knowledge became large when they became family caregivers, and many of them experienced different sufferings and troubles such as guilt and depression. The results show that many of the relatives did not experience well-being. On account of this it is important that nurses know about the experiences and feelings family caregivers have.

Elderly committing suicide can be in a “preclinical phase” of dementia. Depressive symptoms may indicate a risk to develop a disease of dementia, for example Alzheimer’s Disease. Today almost 10% of the Swedish population older than 65 years suffer from a cognitive impairment diagnosed as dementia. Symptoms of dementia are associated with degenerative changes in the brain caused by a deposition of amyloid, leading among others things to a nerve cell death. A clinical diagnosis can be hard to set, and a definitive diagnose can only be set after a pathological examination, which only is possible after death. For this study we used Congo red staining of brains sections to find amyloid in autopsies from elderly people committing suicide. 35 cases (&gt;60 year) were studied. Of the 35 cases 1/3 showed to be positive for amyloid deposition. This result in addition to other studies suggest that depressive symptoms is a “preclinical phase” of dementia, and therefore the suicide risk for this group must be consider to be elevated. However, more reliable prospective studies most be done to confirm this retrospective study.

Sammanfattning Syftet med studien var att beskriva anhörigas upplevelser av att leva tillsammans med eller i närheten av en person som har drabbats av Alzheimers sjukdom. Studien utgick från ett socialt, fysiskt och psykiskt perspektiv. Studien byggde på 18 vetenskapliga artiklar som kvalitet granskades med hjälp av en granskningsmall. Artiklar söktes genom databaserna Academic Search Elite, Cinahl och Vård I Norden Online. Urvalskriterierna var att artiklarna svarade på studiens syfte, var skrivna på svenska eller engelska och publicerade mellan åren 2000 till 2008. Resultatet visade att anhöriga ställs inför en dramatisk förändring som är krävande, utmanande och de anhöriga upplevde oro, sorg, stress och skuld. Det sociala nätverket minskade och det leder oftast till ensamhet och isolering. Resultatet visade också att anhöriga är i behov av stöd från släkt och vänner samt från hälso- och sjukvården. Sammanfattningsvis upplevde majoriteten av anhöriga en ökad belastning av att vara anhörig till en person med Alzheimers sjukdom. Nyckelord: Alzheimers sjukdom, familj, anhöriga, upplevelser. / Abstract The aim of the study was to describe relative’s experiences of living with or near a person that has Alzheimer’s disease. The study builds on social, physical and psychic perspectives. The studies were based on 18 scientific articles that were quality checked with the aid of a review model. Articles were applied for through the databases Academic Search Elite, Cinahl and Vård I Norden Online. The selection criteria’s were that the articles replied on the study's aim, were written on Swedish or English and published between the years 2000 to 2008. The result showed that relatives were set to a dramatic change that were requiring, challenging and the relatives experienced dread, sorrow, stress and debt. The social network decreased and the result was often decreased loneliness and isolation. The result also showed that the relatives were in need of aid from family and friends, and from the healthcare. To summary the majority experienced that the burden increased of being relatives to a person with Alzheimer’s disease. Keywords: Alzheimer’s disease, family, relatives, experience.

An estimated 5.4 million individuals in the United States have Alzheimer’s disease, and the number is expected to rise exponentially over the next 50 years. Content analysis was used to examine the availability and content of online resources accessible through the Alzheimer’s Association and the National Institute on Aging (NIA) that addressed emotional and physical intimacy for a marital unit. The analysis resulted in ten documents from the Alzheimer’s Association’s website, seven from the NIA’s website, and four additional documents produced from external links that met these criteria. Five major themes emerged from these documents regarding the subject of emotional and physical intimacy. These categories included: (a) defining sexuality and intimacy, (b) changes that occur in the relationship due to a dementia diagnosis, (c) reasons for the change in the relationship, (d) responses to a dementia diagnosis, and (e) strategies for managing the changes due to a dementia diagnosis.

Att vara anhörigvårdare till en person med Alzheimers sjukdom innebär förändringar inom familjen som kan vara svåra att hantera. Sjuksköterskan kan hjälpa anhörigvårdaren att lättare hantera rollen som vårdare genom att ge adekvat information och stöd. Syftet var att undersöka behovet av stöd och information hos anhörigvårdare till personer med Alzheimers sjukdom. Metoden var en litteraturstudie där fyra kvalitativa samt tio kvantitativa artiklar sammanställdes till ett resultat. Resultatet visade på ett stort behov av information och stöd under hela sjukdomsprocessen. Det sociala nätverket och vårdpersonal utgjorde ett stort stöd för anhörigvårdarna. Stödgrupper och stödprogram visade sig vara uppskattade av anhörigvårdare då de tillgodosåg behovet av både stöd och information. Anhörigvårdare ville ha adekvat information i ett tidigt skede av sjukdomen och det fanns ett uttalat behov av individanpassad information. Sjuksköterskans uppgift är att uppmärksamma dessa behov och tillgodose dem, genom att hjälpa anhörigvårdare att etablera kontakt med andra i samma situation. Det bör ingå i utbildningen att uppmärksamma anhörigvårdare och deras behov för att få en ökad förståelse för deras situation. Fortsatt forskning är önskvärt för att lyfta fram anhörigvårdarnas behov. / To become a caregiver to a person with Alzheimer´s disease means a lot of changes in the family that can be hard to cope with. The nurse can give adequate information and support to help the caregiver handle the role as a career. The purpose of the study was to examine the needs of information and support to caregivers of persons with Alzheimer’s disease. The literature study was based on four qualitative and ten quantitative articles. These articles were processed and compiled to a result. The result showed a great need of information and support through the whole process of the disease. The social network and health professionals were a great support to the caregivers. Support groups and support interventions were valuable to the caregivers because their needs of support and information were satisfied. The caregivers wanted information about Alzheimer's disease in its early stages and that information should be tailored individually. A task that should be provided by the nurse is to identify the needs of the caregivers and help them establish a contact with other peers in satisfying these needs. The nurse education should include the caregivers’ needs and therefore allowing the nurse a better understanding of each caregiver given situation. Therefore, there is a need for further research in highlighting the needs of caregivers.