Bakgrund: Vid Alzheimers sjukdom försämras de kognitiva funktionerna vilket innebär svåra psykiska och sociala funktionsnedsättningar. Det finns inget botemedel för Alzheimers sjukdom och dess sjukdomsförlopp är långdraget med upp till 10–15 år och leder sedermera att personen avlider. I tidiga skeden av Alzheimers sjukdom riskerar anhöriga förbinda sig med orimliga åtaganden utan tanke på sjukdomens progression och det ökande vårdbehovet. Syfte: Syftet med denna studie var att beskriva upplevelsen av att vara anhörigvårdare till personer med Alzheimers sjukdom samt granska datainsamlingsmetoden i de valda artiklarna. Metod: Föreliggande studie var en beskrivande litteraturstudie med deskriptiv design som baserades på 12 artiklar med både kvalitativ och kvantitativ ansats. Materialet inhämtades genom sökningar i databasen PubMed. Huvudresultat: Resultatet visar att anhörigvårdare till personer med Alzheimers sjukdom upplever känslor av oro, stress, ångest, skam och skuldkänslor vid vårdandet av sin anhörige. Dessa känslor upplevs som värre i relation med att sjukdomen progredierar och det ökade omvårdnadsbehovet leder till att anhörigvårdare känner rädsla över att bli utbrända och ett förlorat hopp om framtiden. Motsatsen till detta är anhörigvårdare med ett förhållningssätt att varje dag var unik och därför accepterande sin nya roll i livet. Detta gav anhörigvårdare högre livskvalitet och upplevde därmed mindre nivåer av ångest i vardagen som resulterade i hopp om framtiden. Slutsats: Hur anhörigvårdaren upplever situationer som negativ eller positiv präglas av hur de hanterar och förhåller sig till situationer. Strategierna som används ger antingen ökad eller minskad stress och korrelerar med risken för att bli utbränd. / Background: Alzheimer's disease is impaired cognitive functions, which means severe mental and social disabilities. There is no cure for Alzheimer's disease and its course is up to 10-15 years and subsequently leads to the person dies. In the early stages of Alzheimer's disease relatives commit themselves with excessive commitments with no thoughts given to the disease's progression and the increasing need for care. Within the health care the health professionals sees the problems associated with being a family caregiver and the risk of them becoming burned out. Aim: The aim of this study was to describe the experience of being a family caregiver to people with Alzheimer’s disease and examine the data collection method in the selected articles. Method: The present study was a literature study with a descriptive design based on 12 scientific articles with both qualitative and quantitative approach. The material was gathered through searches in the database PubMed. Main results: The result shows that the family caregivers of people with Alzheimer's disease experience feelings of anxiety, stress, shame and guilt when caring for their loved one. These feelings are experienced as worse in relation with the disease progresses and the increased need for nursing leads to that the family caregivers feel fear of becoming burned out and feel lost hope for the future. The opposite of this is family caregivers with an attitude that every day was unique and therefore accepting their new role in life. This gave the family caregivers a higher quality of life and thus less experienced levels of anxiety in everyday life that resulted in feeling hope for the future. Conclusion: The experience of the family caregivers could either be positive or negative in managing of a person with Alzheiemer’s disease. The way of managing characterized how the family caregiver relates to situations. The managing of the strategys either reduce or induce levels of stress and correlates with the risk of being bournt-out.

Introduktion: Idag finns det ungefär 160 000 personer i Sverige som har någon form av demens, och risken att drabbas utav demens ökar med stigande ålder. Alzheimers är den vanligaste formen av demenssjukdom. Personer som befinner sig tidigt i sin Alzheimers utveckling klarar sig relativt bra med ett begränsat stöd från sin omgivning. Att vårda sin närstående med Alzheimers är krävande, och det ställs stora krav på den som är omvårdnadsansvarig. Syfte: Syftet med denna litteraturstudie är att beskriva anhörigvårdares upplevelse av att vårda sin närstående som lever med diagnotiserad Alzheimers sjukdom. Syftet är också att beskriva de valda artiklarnas undersökningsgrupper. Metod: En beskrivande litteraturstudie. Data har samlats in via PubMed och 10 artiklar valdes ut till denna litteraturstudie. Artiklarna var av antigen kvalitativ eller kvantitativ ansats. Resultat: Resultatet baseras på fem underrubriker utifrån anhörigvårdarnas upplevelser: "Upplevselsen av den psykiska påfrestningen", "brist på stöd och information", "upplevelsen av att vårda sin närstående utifrån ett genusperspektiv", "livsstilsförändringar" och "förväntningar och farhågor". Slutsats: Anhörigvårdarna är i stort behov av stöd och rådgivning både från sin sociala omgivning, men framförallt ifrån sjukvårdens olika institutioner. Sjuksköterskan har en viktig roll att fylla. Sjuksköterskan ska tillgodose både den som är drabbad utav Alzheimers, men även dennes anhöriga med individanpassad information och stöttning. / Introduction: Today, there are about 160 000 people in Sweden who have some form of dementia, and the risk out of dementia increases with age. Alzheimer's is the most common form of dementia. Persons who are early in their development of Alzheimer cope relatively well with limited support from their surroundings. Caring for relatives with Alzheimer's are demanding, and it places great demands on the care that is responsible. Purpose: The purpose of this study is to describe the experience of family caregivers for their relatives who live with diagnosed Alzheimer's disease. The aim is also to describe the selected articles study groups. Method: A descriptive literature. Data was collected via PubMed and 10 articles were selected for this study. The articles were of either qualitative or quantitative approach. Results: The results are based on five sub-headings based on family caregivers: "Feels notification of mental stress", "lack of support and information", "the experience of caring for their loved one from a gender perspective", "lifestyle changes" and "expectations and concerns". Conclusion: family caregivers are in great need of support and advice both from their social environment, but above all from different healthcare institutions. The nurse has an important role to play. The nurse will satisfy both the afflicted out of Alzheimer's, but also his family with personalized information and jacking.

Background: Dementia is a degenerative neurological disorder that afflicts a growing proportion of the global population. Complementary alternative medicine (CAM) modalities are under investigation for their therapeutic value in the management of dementia. Purpose: Nursing care of dementia sufferers can include managing agitation and negative behaviors; this study investigates staff appraisal of the Multi-Sensory Stimulation Environment (MSSE) as an intervention for these nursing challenges. Methods: A purposive sample of nursing staff employed in residential care for dementia patients were recruited 10 weeks after the initiation of an open-access MSSE at the facility to complete a confidential self-administered questionnaire. Results: 79% of potential participants returned completed surveys for a total sample of n = 23. 70% of survey respondents felt that residents were utilizing the MSSE "Somewhat Frequently" or "Very Frequently." 77% of the staff felt the MSSE should continue in use at the facility or continue with some alterations. The sample suggested that the MSSE is helpful for mood, specifically anger, sadness, anxiety, and restlessness, but not for boredom. Higher-scoring items in favor of the MSSE intervention included confusion, perseverating, wandering, and interpersonal conflict. Conclusion: Several components of agitation and negative behavior in the dementia population appear to be improved with the use of an MSSE according to this sample. Further research is needed to support the results of this sample and to explore more detailed recommendations regarding the use of MSSE in dementia care.

A demência é uma síndrome que afeta a memória, comportamento e as atividades de vida diária, e é uma das maiores causas de dependência entre pessoas idosas. Muitas vezes, o principal cuidador do idoso com demência é o cônjuge, e este pode carregar um fardo significativo comprometendo também a qualidade da relação. Este estudo teve como objetivo avaliar os efeitos do trabalho com canções em musicoterapia na relação conjugal de quatro casais, nos quais um dos cônjuges é diagnosticado com doença de Alzheimer em fase inicial ou moderada. O trabalho foi realizado no modelo de estudo de casos múltiplos, por se tratar de um tema pouco explorado, possibilitando um levantamento mais detalhado do processo. Foram aplicadas a Anamnese e a Ficha Musicoterapêutica para coletar informações iniciais, seguidas de 12 sessões de musicoterapia, uma vez por semana. Antes e ao fim das sessões foram aplicadas entrevistas com roteiro semiestruturado, e o conteúdo das entrevistas foi interpretado por meio da análise de conteúdo de Bardin. Também se avaliou, dentro da perspectiva do cuidador, a satisfação com as relações familiares e de amizade e a qualidade do relacionamento conjugal antes e depois da doença. Os resultados sugerem que as intervenções possibilitaram momentos prazerosos, com benefícios principalmente para o cuidador. Depoimentos indicaram que as intervenções ofereceram ferramentas para que o cuidador pudesse lidar melhor com os sintomas comportamentais do cônjuge com demência, beneficiando a qualidade da relação conjugal. Apesar do número limitado de participantes, espera-se contribuir com a reflexão acerca das possibilidades de cuidado e com diretrizes para a aplicação mais assertiva de estratégias dentro do contexto estudado / Dementia is a syndrome that affects memory, behavior and activities of daily living, and is one of the major causes of dependence among the elderly. Often the primary caregiver of the elderly with dementia is the spouse, which can carry a significant burden, also compromising the quality of their relationship. This study aimed to evaluate the effects of singing in music therapy on the marital relationship of four couples, in which one of the spouses is diagnosed with early or moderate Alzheimer\'s disease. The work was carried out as a multiple case study, being an unexplored topic, allowing for a more detailed survey of the process. Anamnesis and the Music Therapy data were applied to collect initial information, followed by 12 sessions of music therapy. Before and after the process, interviews with a semistructured script were applied and its content was interpreted through Bardin\'s content analysis. From the perspective of the caregiver, the satisfaction with family and friendship relationships and the quality of the conjugal relationship before and after the illness were also evaluated. The results suggest that the interventions allowed pleasant moments, with benefits mainly for the caregiver. Some testimonials indicated that the interventions offered tools so that the caregiver could better deal with the behavioral symptoms of the spouse with dementia, benefiting the quality of the conjugal relationship. Despite the limited number of participants, it is expected to contribute to the reflection about the possibilities of care, with guidelines for the more assertive application of strategies within the context studied

Alzheimers sjukdom, AD, är en progressiv neurodegenerativ sjukdom som orsakas av amyloida-beta plack (Ab) och nervtrådsnystan bestående av proteinet tau. Karakteristiskt för AD är förlusten av kolinerga nervceller i hippocampus och frontala cortex, som orsakar en försämring av korttidsminne och nedsatt kognitiv förmåga. Konventionella behandlingar med acetylkolinesterashämmare och NMDA-receptorantagonister har inte visat tillräcklig kognitiv effekt och behovet av behandling är stort. Syftet med denna litteraturstudie var att undersöka kognitiv effekt och säkerhet av behandling med monoklonala antikroppar vid Alzheimers sjukdom. Antikropparna som studerades var bapineuzumab, solanezumab, gantenerumab, crenezumab och ponezumab, riktade mot epitoper på Ab, och BAN2401, riktad mot protofibriller. Samtliga antikroppar var av typen humaniserad eller human tillhörande G-klassen och undersöktes i fas II-III, randomiserade, dubbelblinda och placebokontrollerade studier på patienter med mild till måttlig AD. Undantaget är gantenerumab som studerades på patienter med prodromal AD. Studier av antikropparna i transgena möss har visat förändring av Ab och en viss effekt på minne, därav togs studierna vidare. Primära utfallsvariabler var Alzheimer’s Disease Assessment Scale- Cognitive Subscale (ADAS-Cog), Disability Assessment For Dementia (DAD), The Clinical Dementia Rating – Sum of Boxes (CDR-SB) och Mini Mental State Examination (MMSE). Resultat för bapineuzumab, gantenerumab, crenezumab och ponezumab visade ingen signifikant kognitiv effekt mellan studiestart och studieslut jämfört med placebo. För solanezumab observerades en statistiskt signifikant skillnad i ADAS-Cog (p = 0,04) och MMSE (p = 0,01) jämfört med placebo, dock var skillnaderna små. ADAS-Cog, -1,6 poäng med 95% konfidensintervall -3,1 till 0,1. MMSE, 0,8 poäng med 95 % konfidensintervall 0,2 till 1,4. För BAN2401 påvisades signifikant kognitiv effekt och den har tagits vidare för en fas III-studie. Samtliga antikroppar ansågs vara säkra för patienterna med avsikt på biverkningar, dock var risken för amyloid-related imaging abnormalities (ARIA) hög vid behandling med bapineuzumab och gantenerumab. Ett läkemedel mot denna förödande folkhälsosjukdom skulle innebära ett revolutionerande framsteg för människan, sjukvården och samhället. / Alzheimer’s disease, AD, is a progressive neurodegenerative disease caused by amyloid-beta plaques (Ab) and neurofibrillary tangles composed of tau. Characteristic of AD is a loss of cholinergic neurons located in hippocampus and frontal cortex, which results in impaired short-term-memory and cognitive function. The conventional therapies, acetyl-choline-esterase-inhibitors and NMDA-receptor-antagonists, have insufficient effects and the need for a new therapy is huge. The aim of this literature study was to examinee cognitive effect and safety of therapy with monoclonal antibodies against AD. The analysed antibodies were bapineuzumab, solanezumab, gantenerumab, crenezumab and ponezumab, which are directed against epitopes of Ab, and BAN2401, which is directed against protofibrils. All antibodies were humanized or human of G-class and were examined in phase II – III, randomized, double-blind and placebo-controlled studies in patients with mild to moderate AD. The exception is gantenerumab which was studied in patients with prodromal AD. Previous studies of the antibodies in transgenic mice have shown a change in Ab and some effect on memory, hence the studies were taken to humans.  Primary endpoints were Alzheimer’s Disease Assessment Scale- Cognitive Subscale (ADAS-Cog), Disability Assessment For Dementia (DAD), The Clinical Dementia Rating – Sum of Boxes (CDR-SB) and Mini Mental State Examination (MMSE). Results for bapineuzumab, gantenerumab, crenezumab and ponezumab showed no significant cognitive effect between the start and the end of the studies, compared to placebo. There was a statistically significant difference in ADAS-Cog (p = 0,04) and MMSE (p = 0,01) between solanezumab and placebo, though the differences were small. ADAS-Cog, -1,6 points, with 95% confidence interval of -3,1 to 0,1. MMSE, 0,8 points, with 95% confidence interval of 0,2 to 1,4. BAN2401, with protofibrils as drug target, was the only antibody in which a significant cognitive effect was demonstrated. The study has been taken further to phase III. All antibodies were considered safe for patients with the intentions of adverse effects. However, the risk for amyloid-related imaging abnormalities (ARIA) was high in treatment with bapineuzumab and gantenerumab. A drug against this devastating public health disease would mean a revolutionary advance for humans, health care and the society.

Com o crescente envelhecimento populacional, as síndromes demenciais têm tido alta prevalência na população idosa acima dos 60 anos. Em todo o mundo, a ausência de uma rede de suporte formal adequada traz a responsabilidade ao cuidador familiar que passa a exercer essa função que pode durar longos períodos. A presente pesquisa tem como objetivo compreender a experiência da cuidadora familiar de idoso com a doença de Alzheimer ao longo do processo de cuidar, conhecer sobre os aspectos positivos e/ou negativos desse cuidar e identificar necessidades próprias e/ou particulares das cuidadoras de idosos com esse tipo de demência. Trata-se de uma pesquisa de natureza qualitativa. Foram entrevistadas 9 cuidadoras familiares (04 esposas e 05 filhas). Os princípios éticos de sigilo, privacidade, confidencialidade, não identificação dos dados das colaboradoras e liberdade de participação foram respeitados. Os depoimentos foram gravados a partir da entrevista aberta com a seguinte questão norteadora: Como é para você a experiência de acompanhar e cuidar de seu marido (pai ou mãe, irmã (o)) com demência de Alzheimer? As unidades de significado emergiram tendo como fundamento o método fenomenológico proposto por Giorgi e Sousa (2010). A reflexão a respeito das 19 unidades de temáticas desveladas como os principais temas de análises dos nove depoimentos de cuidadoras familiares foram relacionadas às três fases no longo processo do adoecimento: 1. Início que é marcado pela percepção de alguns sintomas, a demora no diagnóstico, a peregrinação por médicos, a oscilação de sentimentos, da negação à impotência, as mudanças na rotina, o medo do desconhecido e do futuro, tentativa de minimizar ou normalizar o problema e o impacto inicial do diagnóstico na vida do doente e da cuidadora principal; 2. O processo da jornada em que se observa a sobrecarga do cuidado, a diminuição da participação social, o sentimento de impotência, a proximidade com o Ser Superior, a percepção de morte em vida, a busca por suporte e apoio, a tentativa de estagnar a evolução da doença, a necessidade de reorganizar a rotina e de ressignificar a experiência vivida, a percepção sobre aspectos positivos do cuidar como forma de fortalecer a sensação de bem-estar e modificar a maneira de olhar o processo de adoecimento de seu ente querido; 3. O processo final da jornada que é percebido como solitário, doloroso e sofrido, com muitas dúvidas, medos e estigmas, a falta de acolhimento e o silencio de profissionais. A partir da análise dos principais temas observados buscou-se ampliar a compreensão de que a jornada do cuidar não é finalizada com a morte do ente querido devido à necessidade da elaboração, ressignificação e retomada da vida após a perda, abrindo espaço para discussão, reflexão e mudanças para todos aqueles envolvidos nesse processo. São apresentadas também recomendações para cuidadores familiares e profissionais de saúde nos cuidados às pessoas com Doença de Alzheimer / With the growing aging population, dementia syndromes have had high prevalence in the elderly over 60 years. Worldwide, the absence of adequate formal support network brings responsibility to family caregiver who comes to perform this function that can last long periods. This research aims to understand the experience of elderly family caregivers with Alzheimer\'s disease throughout the care process, know about the positive and negative factors of that care and identify particular needs of caregivers of elderly with dementia. This is a qualitative research. Nine family caregivers were interviewed (04 wives and 05 daughters). The ethical principles of confidentiality, privacy, confidentiality, no identifying data and freedom of participation were respected. The statements were recorded from an open interview with the following question: \"How is it for you the experience of caring of your husband (father or mother, sister) with Alzheimer\'s dementia\"? The units of meaning emerged taking as a basis the phenomenological method proposed by Giorgi and Sousa (2010). The reflection on the 19 thematic units unveiled as the main themes of analysis of the nine testimonies of family caregivers were related to three stages in the long process of becoming ill: 1. The beginning which is marked by the perception of some symptoms, delay in diagnosis, the pilgrimage by doctors, the oscillation of feelings, from denial to helplessness, changes in routine, fear of the unknown and the future, try to minimize or normalize the problem and the initial impact of the diagnosis in the life of the patient and the primary caregiver;2. The journey of process where there is the burden of care, decreased social participation, the feeling of helplessness, the proximity with a superior being, the perception of death in life, the search for support, the attempt to stalling the progress of the disease, the need to reorganize the routine and give new meaning to lived experience, the perception of positive aspects of caring as a way to strengthen the sense of well-being and change the way of looking at the disease process of their loved one ; 3. The final process of the journey that is perceived as lonely, painful and suffered, with many doubts, fears and stigmas, lack of support and the silence of professionals. From the analysis of the main issues observed sought to broaden the understanding that the journey of care is not finished with the death of loved one due to the need of reframing and resumption of life after loss, making room for discussion, reflection and changes for all those involved in this process. Recommendations of caring people with Alzheimer\'s disease for family caregivers and health professionals are also shown in this study

O Mal de Alzheimer é a causa mais importante de demência em idosos. A progressão dos sintomas da doença está associada com modificações estruturais nas sinapses colinérgicas em determinadas regiões cerebrais e, consequentemente, à diminuição do potencial de neurotransmissão colinérgica. Desta forma, o aumento da capacidade de neurotransmissão colinérgica constitui o mecanismo fundamental dos fármacos utilizados para o tratamento do Mal de Alzheimer. Atualmente, o único tratamento clínico eficaz para o Mal de Alzheimer (MA) é a utilização de inibidores da acetilcolinesterase (AChE). Os anticolinesterásicos são os fármacos mais promissores desenvolvidos até hoje, pois é a única classe terapêutica que mostrou melhora nos sintomas cognitivos do MA. Para esse projeto, foram utilizadas diferentes técnicas de modelagem molecular como estratégia de planejamento racional de fármacos, tendo como base os inibidores de Acetilcolinesterase (AChE) descritos na literatura além dos que possuem estruturas depositadas no PDB, incluindo alguns que já vêm sendo utilizados no tratamento do Mal de Alzheimer. O objetivo foi planejar e testar novos potenciais inibidores desse alvo terapêutico, na tentativa de obter e futuramente otimizar novos protótipos como futuros candidatos a fármacos em Mal de Alzheimer. Os objetivos estendem-se a propostas de novos potenciais protótipos, selecionados de bases de dados de compostos comerciais contendo propriedades de fármacos. Os screenings virtuais foram tendenciados às estruturas dos inibidores já reportados da literatura bem como ao padrão farmacofórico comum a eles, a ser modelado. / Alzheimer\'s disease is the leading cause of dementia in the elderly. The progression of symptoms is associated with structural changes in cholinergic synapses in specific brain regions and consequentely to decrease the potential of cholinergic neurotransmission. Thus, the increased capacity of cholinergic neurotransmission is the fundamental mechanism of the drugs used to treat Alzheimer\'s disease. Currently, the only effective clinical treatment for Alzheimer\'s (MA) is the use of inhibitors of acetylcholinesterase (AChE). Cholinesterase inhibitors are the most promising drugs developed so far, it is the only therapeutic class that showed improvement in cognitive symptoms of MA. For this project, we used different techniques of molecular modeling as a strategy for rational design of drugs based on inhibitors of acetylcholinesterase (AChE) in the literature than those which have structures deposited in the PDB, including some that have already been used in the treatment Alzheimer\'s disease.The objective was to design and test new potential inhibitors of therapeutic target in attempts to obtain and optimize future new prototypes as future drug candidates in Alzheimer\'s disease. The goals extend to proposals from potential new prototypes, selected from databases of commercial compounds containing properties of drugs. The virtual screenings were trends to structures of the inhibitors already reported in the literature as well as the pharmacophoric pattern common to them, to be modeled.

Bakgrund Personer med demenssjukdom har stor risk att utveckla beteendemässiga och psykiska symtom efter kirurgi vilket ställer höga krav på omvårdnadsarbetet i det postoperativa förloppet. Aktuell forskning som undersöker sjuksköterskor som har hand om denna patientgrupp i det postoperativa förloppet är begränsad och med anledning med detta ansågs det värdefullt att genomföra en studie som undersöker detta fenomen närmare. Syfte Studien syftade till att undersöka sjuksköterskors kunskaper om demenssjukdom samt beskriva sjuksköterskors arbetssätt i att lindra beteendemässiga och psykiska symtom hos personer med demenssjukdom som genomgått kirurgi. Metod Detta var en deskriptiv tvärsnittsstudie vilken använde sig av en onlinebaserad enkätundersökning som datainsamlingsmetod. Instrumentet Basic Knowledge of Alzheimer’s Disease (BKAD) användes för att testa kunskaper om den vanligaste typen av demenssjukdom. Kunskapen om beteendemässiga och psykiska symtom vid demens och metoder som sjuksköterskor använder sig av för att lindra dessa undersöktes genom utformade frågeställningar. Data inhämtades från januari till april månad år 2019 och totalt deltog 50 sjuksköterskor. Resultat Kunskapen om Alzheimers sjukdom var bristande och likaså även kunskapen om hur man behandlar beteendemässiga och psykiska symtom vid demens. Sjuksköterskors möten med denna patientgrupp rankades överlag som svåra och det visade sig att sjuksköterskor hade haft flertalet sådana möten i den postoperativa vårdverksamheten. Vidare rapporterades det att sjuksköterskors utbildning i demensvård från den grundläggande sjuksköterskeutbildningen var minimal och att utbildning i demensvård borde höjas i den grundläggande sjuksköterskeutbildningen. Slutsats och kliniska implikationer Demensvård som läroämne bör få större omfattning i den grundläggande sjuksköterskeutbildningen. Utbildningsinsatser bör prioriteras för att höja sjuksköterskors kunskaper om vård för personer med demenssjukdom genom organisatoriskt och pedagogiskt stöd. Om kunskapen i demensvård höjs torde även omvårdnaden för personer med demenssjukdom bli bättre. / Background People with dementia have a great risk of developing behavioral and psychological symptoms after surgery. This puts challenges on the nurses’ care for these patients. Current research that investigate nurses’ who care for these individuals in the postoperative phase is limited. Therefore, it was considered being important to investigate this phenomenon further.    Aim The study sought to investigate nurses’ knowledge of dementia, and their work methods in alleviating behavioral and psychological symptoms in dementia for people who had undergone surgery. Method The study was carried out as a descriptive, cross-sectional study using online surveys. The Basic Knowledge of Alzheimer’s Disease (BKAD) was used to test participants’ knowledge of Alzheimer’s disease. The knowledge of behavioral and psychological symptoms in dementia, and nurses’ working methods to alleviate these behaviors and symptoms was investigated by using developed questions. The study collected data from January to April, 2019 and a total of 50 nurses’ participated.  Result There was a deficit in the knowledge of Alzheimer’s disease, and also in the knowledge of how to treat behavioral and psychological symptoms in dementia. Nurses’ reported an overall difficulty in treating a person suffering from behavioral and psychological symptoms, and nurses’ also reported having several encounters with a person with dementia in the surgical ward. Nurses’ stated that training in dementia care in the baccalaureate program was low, and for this reason nurses’ stated that they wished that dementia care would get more attention. Conclusion and clinical implication Dementia care in the baccalaureate program would benefit from getting more attention. Different interventions in education of dementia care by using organizational support ought to be implemented in this process. If the knowledge of dementia care is increased there is a chance that the care for these individuals would become better.

A doença de Alzheimer (DA) é a principal causa de demência na população idosa mundial. O tratamento de primeira escolha em pacientes com DA de grau leve a moderado é com anticolinesterásicos, que promovem modesta melhora cognitiva. Trabalhos mostram que o lítio também possui efeito benéfico para o tratamento da DA e que é ainda mais eficaz se utilizado como prevenção dos sintomas de demência, mesmo em doses mais baixas que as terapêuticas. O objetivo desse trabalho foi avaliar o efeito de uma microdose de lítio em associação com um anticolinesterásico, para a memória e neuroproteção em modelos in vitro e in vivo de neurodegeneração induzida com o peptídeo <font face = \"symbol\">bA1-40. Em culturas organotípicas de hipocampo de camundongos c57Bl/6 de 12 meses de idade, foi observado aumento significativo da morte neuronal após incubação de <font face = \"symbol\">bA (10 <font face = \"symbol\">mg/mL). O tratamento com 10 <font face = \"symbol\">mM de lítio protegeu as fatias de hipocampo da morte celular, independente do tratamento com rivastigmina. O tratamento das fatias com lítio não alterou a atividade da acetilcolinesterase, diferente do observado com rivastigmina, porém, houve aumento não significativo da densidade de BDNF, em relação às fatias não tratadas. Para os estudos in vivo, camundongos C57Bl/6 machos de 10 meses de idade foram submetidos a três sessões de aquisição de memória em esquiva ativa (EA) e, em seguida, à cirurgia estereotáxica para implante de minibomba osmótica contendo veículo ou <font face = \"symbol\">bA (0,46 nmol). No dia seguinte, iniciou-se o tratamento com rivastigmina (Riv; 0,3 mg/kg/dia). Formaram-se 5 grupos: veículo, <font face = \"symbol\">bA, Li, Riv e Li+Riv. Os grupos tratados com lítio receberam o fármaco (0,3 mg/kg/dia) desde os 2 meses de idade e o tratamento foi mantido até o final dos experimentos. Todos os grupos tratados com Li e/ou Riv foram infundidos com <font face = \"symbol\">bA. O grupo veículo foi tratado com água. Os animais passaram por dois testes em EA, aos 7 e 35 dias após a cirurgia; a partir do 28º dia, foram realizadas avaliações de atividade motora e de memória de curta duração, utilizando-se caixa de atividade motora e teste de reconhecimento de objeto novo, respectivamente. Observou-se que o grupo <font face = \"symbol\">bA apresentou perda de memória em EA e no teste de reconhecimento de objeto novo, quando comparado ao grupo veículo. Nenhum dos tratamentos, no entanto, foi eficaz em prevenir esse prejuízo ou promover melhora no desempenho dos animais nos testes de memória. Não houve formação de placas amiloides em nenhum dos grupos, avaliada por meio da coloração com tioflavina S, sugerindo que o prejuízo cognitivo observado foi devido à forma solúvel do peptídeo. O peptídeo <font face = \"symbol\">bA induziu o processo autofágico no grupo <font face = \"symbol\">bA, verificado pelo aumento da formação de autofagossomos (avaliados por LC3-II) e níveis inalterados de p62 em relação ao veículo. Os tratamentos promoveram uma diminuição não significativa de autofagia, em relação ao grupo <font face = \"symbol\">bA. Dados os resultados in vivo e in vitro, concluiu-se que ambos os fármacos, em monoterapia, promovem efeitos benéficos, porém, quando associados, os efeitos são perdidos. / Alzheimer\'s disease (AD) is the leading cause of dementia in the elderly. The first- choice treatment for patients with mild to moderate AD is a cholinesterase inhibitor, which leads to a modest cognitive improvement. Previous studies have shown that lithium also has a beneficial effect for the treatment of AD, but more effective if used to prevent the symptoms of dementia, even at lower doses than the therapeutic ones. The objective of this work was to evaluate the effect of a lithium microdose in association with a cholinesterase inhibitor on memory and neuroprotection in both in vivo and in vitro models of neurodegeneration induced by <font face = \"symbol\">bA1-40 peptide. By using organotypic culture of hippocampus of 12-month-old c57Bl/6 mice, it was verified a significant increase in neuronal death after incubation with <font face = \"symbol\">bA (10 <font face = \"symbol\">mg/ml). Treatment with 10 <font face = \"symbol\">bM lithium protected the hippocampal slices from cell death, independently of rivastigmine. Treatment with lithium in slices did not alter acetylcholinesterase activity, different from that observed with rivastigmine, however, there was a non-significant increase in BDNF density, in relation to untreated slices. For the in vivo evaluation, 10- month-old male C57Bl/6 mice underwent three sessions of active avoidance memory acquisition (AA) and then, stereotactic surgery for the implant of an osmotic minipump containing vehicle or <font face = \"symbol\">bA (0.46 nmol). At the next day, the treatment with rivastigmine (Riv, 0.3 mg/kg/day) was started. Five groups were formed: vehicle, <font face = \"symbol\">bA, Li, Riv and Li+iv. The lithium-treated groups received the drug (0.3 mg/kg/day) from 2 months of age and the treatment was kept until the end of the experiments. All drug-treated groups were infused with <font face = \"symbol\">bA. Vehicle group was treated with water. The animals underwent two tests in AA: at 7 and 35 days after surgery; from the 28th day, motor activity and short-term memory evaluations were performed, using a motor activity cage and the novel object recognition test, respectively. <font face = \"symbol\">bA group presented memory loss in AA and in the novel object recognition test when compared to vehicle group. None of the treatments, however, was effective in preventing this injury or promoting improvement in the performance of the animals in memory tests. There was no amyloid plaque formation in any of the groups, which was evaluated by thioflavin S staining, suggesting that the observed cognitive impairment was due to the soluble forms of the peptide. <font face = \"symbol\">bA peptide induced autophagic process in <font face = \"symbol\">bA group, as evidenced by an increase in formation of autophagosomes (assessed by LC3-II) and unaltered levels of p62 when compared to vehicle group. The treatment with Li and Riv promoted a non-significant decrease of autophagy, in relation to <font face = \"symbol\">bA group. Together, the results suggest that the drugs promote beneficial effects when used in monotherapy, however, when associated, the effects are no longer observed.

Sammanfattning Bakgrund: Alzheimers sjukdom är en sjukdom med långsamt förlopp. Den drabbades minne försämras gradvis och symtom så som aggressioner, tolkningssvårigheter, lokalsinne osv. försämras. Alzheimers sjukdom brukar i vardagligt tal kallas för ”de anhörigas sjukdom”. Anhöriga som tidigare haft en kärleksrelation med sin make/maka får nu anta rollen som vårdare och därmed ansvara för sin make/makas liv men också det praktiska runt omkring. Vården bär således även ansvaret att genomföra tre genomföra tre samtal med familjen, dels familjesamtal, samt att vården skall skicka ut ett avslutande brev, och det skall ske en uppföljning med familjen.  Syfte: Anhörigas beskrivningar av sin livssituation när en familjemedlem drabbas av Alzheimers sjukdom – ur ett make/maka perspektiv  Metod: En kvalitativ litteraturstudie som baserades på fyra patografier som framtagits via en sökning på Libris. Data har analyserats genom en kvalitativ innehållsanalys utifrån Graneheim, Lindgren och Lundman (2017) och deras exempel på en analys.   Resultat: I studien framkom fyra kategorier. Kategorin upplevda känslor orsakade av en förändrad relationhandlar om hur den friska partnern upplever hur relationen till make/maka förändras i form av att ha blivit en vårdare. I kategorin känslan av ökat ansvar hos den anhörigebeskrivs upplevelser av att ha fått olika typer av ansvar i deras nya livssituation. I kategorin sorgekänslor i vardagen hos den anhörigeframkommer det en enorm sorg som författarna bär på samt att de får en försämrad livskvalité. Den slutgiltiga kategorin heter skuldkänslor i beslutsfattande situationer i vardagen och handlar om skuld och dåligt samvete i olika situationer som uppstår under sjukdomsförloppet.  Slutsats:Studien visade att makar till en familjemedlem med Alzheimers sjukdom påverkas oerhört mycket psykiskt. Efter att ha blivit vårdare och vårdat sin sjuka partner under flera år framkom det att även den friska får en försämrad livskvalité med oro, sorg och skuldkänslor. Anhöriga får även ett ökat ansvar då de ofta saknar hjälp och stöd. Familjefokuserad omvårdnad handlar om att även anhöriga ska sättas i fokus och få det stöd och hjälp de behöver. Denna studien visar dock på att anhöriga inte får tillräckligt med hjälpinsatser för att klara vårda sin sjuka familjemedlem utan att själv påverkas negativt.