Há evidências convincentes de que o início da doença de Alzheimer é precedido por uma redução de estímulos sensoriais, como ocorre durante a aposentadoria, catarata, surdez e degeneração macular, em um cérebro idoso que apresenta deficiência de receptores tipo GABAA. Neste trabalho foi utilizado um modelo computacional fenomenológico do koniocortex, que é a primeira camada cortical que recebe estímulos sensoriais, adaptado para simular as fases iniciais da doença de Alzheimer. A arquitetura e as propriedades dos neurônios do modelo computacional do koniocortex se assemelham as do cérebro, sendo também capaz de aprender, permitindo com isso que a memória de curto prazo seja testada em qualquer momento. Usando o modelo computacional é possível também analisar as fases iniciais da doença de Alzheimer simulando o \"envelhecimento\" do koniocortex artificial através de um conjunto de parâmetros referentes à plasticidade intrínseca, à acetilcolina, aos estímulos sensoriais, ao pruning sináptico, entre outros. O modelo computacional revela que, quando o envelhecimento afeta os neurônios que expressam receptores GABA-A ocorrendo na sequência uma redução dos estímulos sensoriais, o resultado dessa cascata de eventos leva ao hipermetabolismo e ao início da fase de deposição excessiva das placas -amiloide / There is compelling evidence that Alzheimers disease onset is preceded by a reduction of sensory stimuli like during job retirement, cataract, deafness or even macular degeneration, over an aged brain with impaired GABA-A receptor inhibitions. In this paper, was adapted a phenomenological computational model of the koniocortex which is the first cortical layer that receives sensory stimuli to simulate the initial phases of Alzheimers disease. The architecture and neurons properties of the modeled koniocortex resemble those of the brain, so that the model is also able to learn, thereby allowing the assessment of short-term memory at any moment. By using the computational model, it is possible to analyze the initial phases of Alzheimers disease by aging the artificial koniocortex through a set of parameters related to intrinsic plasticity, acetylcholine, sensory stimuli, synaptic pruning, among others. The computational model shows that when aging occurs in such way that GABA-A receptor expressing neurons are affected, and, in the sequence, a reduction of sensory stimuli takes place, the result of this cascade of events leads to hypermetabolism and to the initial phase excessive deposition of beta-amyloid plaques

O processo de envelhecimento pode gerar perdas cognitivas que, se agravadas, podem acarretar o diagnóstico de demência, sendo a Demência de Alzheimer (DA) a mais comum. A DA é uma doença neurodegenerativas que afeta principalmente a memória e a linguagem. Procedimentos de ensino baseados no paradigma de equivalência de estímulos e no ensino por exclusão, apesar de testados com sucesso em diferentes populações com problemas de desenvolvimento, têm gerado poucas pesquisas com idosos com perdas cognitivas. Esta pesquisa apresenta três estudos, com objetivos distintos, mas complementares. O Estudo 1 teve como objetivo avaliar se idosos institucionalizados sem DA formariam classes de estímulos equivalente a partir de um procedimento de ensino de relações condicionais entre palavras ditadas, fotos, nomes impressos de profissões e de graus de parentesco; adicionalmente, pretendia-se verificar que essas relações se mantinham ao longo de um mês, em três testes de manutenção. Cinco idosos institucionalizados passaram pelo ensino de relações arbitrárias, em uma estrutura de treino linear com ensino de novas relações por exclusão. Testes de equivalência foram conduzidos em seguida à Fase de Ensino, e após cinco, 15 e 30 dias. Todos os idosos demonstraram desempenho por exclusão na Fase de Ensino e aprenderam todas as relações com o número mínimo de blocos de ensino programados (exceto uma participante). Todos os idosos apresentaram formação de classes de equivalência. Quatro dos idosos apresentaram manutenção dessas classes em todos os testes de manutenção. O procedimento, portanto, mostrou-se efetivo para esses idosos e gerou formação de equivalência, apesar da sua condição de institucionalização. O Estudo 2 teve como objetivo avaliar se idosos com DA, também institucionalizados, demonstrariam desempenho por exclusão e aprenderiam relações condicionais entre quatro nomes ditados e quatro fotos, em um procedimento de ensino por exclusão. Seis idosas com diagnóstico de DA passaram por tarefas de emparelhamento ao modelo, em que as relações entre modelos ditados e fotos foram ensinadas por exclusão. Apesar de todas as idosas terem respondido por exclusão na primeira apresentação de um estímulo modelo novo e seu comparação correspondente em pelo menos duas das três tentativas em que tal desempenho era possível, apenas duas mantiveram essa relação ao longo das demais tentativas e aprenderam as relações ensinadas. Possíveis motivos para esse desempenho são discutidos. O Estudo 3 avaliou se idosos institucionalizados, com DA e comprometimento cognitivo, formariam classes de equivalência a partir de um ensino de relações arbitrárias com estrutura de treino um-para-muitos, procedimento de dica atrasada e ensino por exclusão. Quatro idosas passaram pelo ensino de relações condicionais entre estímulos visuais (nomes escritos, fotos e nomes de profissões). Todas aprenderam as relações ensinadas com o número mínimo de blocos programados, porém apresentaram dificuldade em formar classes de equivalência e manter tais relações nos testes de manutenção após cinco e oito dias. Os procedimentos de ensino empregados foram eficientes em gerar a aprendizagem das relações, mas tal aprendizagem, nessas idosas, não sustentou a formação e manutenção de classes de equivalência. / The aging process can cause cognitive impairments that, if aggravated, may lead to the diagnosis of dementia, with Alzheimers Dementia (AD) being the most common. Alzheimers Dementia is a neurodegenerative disease that primarily affects memory and language. Teaching procedures based on the paradigm of stimulus equivalence and on teaching by exclusion, although successfully tested in different populations with developmental problems, have generated little research with elderly people with cognitive impairments. This paper presents three studies, with different but complementary aims. Study 1 aimed to assess whether institutionalized elderly people without AD would form classes of equivalent stimuli from a procedure of teaching conditional relationships among dictated words, photos, printed names of professions and degrees of relatedness; additionally, it aimed to verify whether these relationships would be maintained over a month, using three maintenance tests. Five hospitalized elderly subjects underwent teaching of arbitrary relationships in a linear training structure with the teaching of new relationships by exclusion. Equivalence tests were conducted following the teaching phase, and after five, 15 and 30 days. All the elderly subjects demonstrated performance by exclusion in the teaching phase and learned all the relationships within the minimum number of programmed teaching blocks (except for one participant). All the subjects presented the formation of equivalence classes. Four of the elderly subjects presented maintenance of these classes in all the maintenance tests. The procedure, therefore, was effective for these elderly subjects and generated equivalence formation, despite their hospitalization condition. Study 2 aimed to assess whether institutionalized AD patients would demonstrate performance by exclusion and learn the conditional relationships between four dictated names and four photos, in a teaching by exclusion procedure. Six elderly women diagnosed with AD underwent pairing to the sample tasks, in which the relationships between dictated sample and photos were taught by exclusion. Despite all the elderly women responding by exclusion in the first presentation of a new sample stimulus and its corresponding comparison in at least two of the three trials in which this performance was possible, only two maintained this relationship throughout the other trials and learned the relationships taught. Possible reasons for this behavior are discussed. Study 3 evaluated whether hospitalized elderly subjects, with AD and cognitive impairments, would form equivalence classes from the teaching of arbitrary relationships using a one-to-many training structure, a procedure of delayed hints and teaching by exclusion. Four elderly subjects underwent the teaching of conditional relationships among visual stimuli (written names, photos and names of professions). All learned the relationships taught within the minimum number of programmed blocks, however, they presented difficulty forming equivalence classes and maintaining such relationships in the maintenance tests at five and eight days. The teaching procedures employed were efficient in generating the learning of relationships, however, such learning, in these elderly subjects, did not support the formation and maintenance of equivalence classes.

Bakgrund: Demenssjukdomar är en av världens största folksjukdomar. Sjukdomen karakteriseras av nedsatt kognition, perceptionssvårigheter och personlighetsförändringar. Samtidigt kan demenssjukdomen medföra sekundära symtom såsom depression och aggression. Dessa symtom kan uppkomma till följd av att individen upplever hot för sin identitet som därmed påverkar individens hälsa negativt. Sedan många hundra år tillbaka i tiden har hundar ansetts ha en positiv effekt på människors hälsa. I samband med att den medicinska vetenskapen fokuserade mer på läkemedlens botande möjlighet hamnade djurens effekt i skuggan. Idag kan hundar användas som behandlingstillägg inom många olika områden och som olika behandlingsformer.  Syfte: Syftet med studien är att belysa hundens betydelse som resurs för att främja god hälsa hos personer med demenssjukdom. Metod: En litteraturöversikt har genomförts i detta examensarbete, där det analyserades 10 vårdvetenskapliga artiklar av kvantitativ forskningsdesign.  Resultat: Resultatet består av fyra kategorier: hundens påverkan på psykisk hälsa, hundens påverkan på beteende, hundens påverkan på kognition och hundens påverkan på fysisk funktion. Minskad depression, aggression, förbättrad social kompetens och kognition kunde påvisas av interventioner med hund. Det har dock inte framkommit att antidepressiva läkemedel reducerades i samband med interventionen. En studie har kunnat påvisa effekten av hundar på fysisk funktion hos personer med demenssjukdom.  Diskussion:Hundar har genom sin närvaro en positiv inverkan på hälsan hos personer med demenssjukdom genom att dämpa symtom som sjukdomen medför. Lite underlag kunde även hittas för att hundar kan positivt påverka den fysiska funktionen genom att uppmuntra personen med demenssjukdom till ökad aktivitet. Dessa djur kan vara den enkla och eleganta resursen som Barker förespråkar för att främja hälsa hos personer med demenssjukdom.

Alzheimer's Disease (AD) prevalence is 47 million in the world, 160,000 in Sweden. AD will increase by 70% in 50 years. AD cost is $7.9 trillion dollars in medicine and healthcare costs annually. Modifiable risk factors need to be mapped. Objective: Explore the relationship between sleep disorders and AD. Method: Searching PubMed and ScienceDirect for a literature review with 20 articles that were quality-reviewed. Result: Sleep-related factors that increase the risk of AD 1) Sleep disorders, sleep disturbed breathing, sleep apnea and insomnia. 2) The influence on cognitive ability, learning and memory showed correlation with sleep parameters. Sleep longer than 9 hours or less than 7 hours, daily naps longer than one hour were associated with increased AD risk 3) Other diseases and interfering factors, depression, cognitive impairment. Carriers of the APOE4-e4 gene with depression or cognitive impairment. IL-1b, a marker for inflammation, increases the risk of sleep disorders. People with clinician-verified depression and APOE-e4 were associated with a very high risk of AD, people with APOE-e4 and sleep disorders were associated with a high risk of AD. Symptoms of poor sleep that may be a sign of mechanisms are inflammation and tau / Ab accumulation as a sign of neurodegeneration. Conclusion: Sleep disorders, sleep parameters, disturbed REM sleep and genes are important for AD incidence. Programs to improve health literacy, control and treatment of sleep disorders and depression, limitation of risk factors, training in risk factors and sleep interventions. Interdisciplinary AD research needs to address the problem through transdisciplinary collaboration. / Prevalensen för Alzheimers sjukdom (AD) är 47 miljoner i världen varav 160 000 i Sverige. Antalet personer med AD kommer att öka med 70 % om 50 år. Kostnaderna för AD är 7900 miljarder dollar i medicin och vårdkostnader årligen. Påverkbara riskfaktorer kan därför behöva kartläggas. Syfte: Att kartlägga kunskapsläget kring och samband mellan sömnstörningar och AD. Metod: Sökning i PubMed och ScienceDirekt för en litteraturöversikt med 20 artiklar som kvalitetsgranskades och analyserades. Resultat: Sömnrelaterade faktorer som ökar risken för AD 1) Sömnsjukdomar, sömnrelaterad andningsstörning, sömnapné och insomni 2) Sömnpåverkan, fragmenterad sömn, otillräcklig sömnkvalitet, otillräcklig REM sömnslängd och ”REM latency”. Påverkan på kognitiv förmåga, inlärning och minne visade samband med sömnparametrar. Sömn längre än 9 timmar eller kortare än 7 timmar, dagliga tupplurar längre än en timme var associerat med ökad AD risk 3) Andra sjukdomar och samverkande faktorer, depression, kognitiv påverkan. Bärare av APOE4-e4 genen som hade depression eller kognitiv nedsättning. IL-1b, en markör för inflammation ger större risk för sömnstörningar. Personer med kliniskt etablerad depression och APOE-e4 associerades med mycket hög risk för AD, personer med APOE-e4 och sömnstörningar associerades hög risk för AD. Symptom vid sämre sömn som kan vara tecken på mekanismer är inflammation samt tau/Ab ansamling som tecken på neurodegeneration. Slutsats: Sömnstörningar, störd REM sömn och gener har betydelse för AD incidens. Program med hälsoinformation för att öka hälsolitteracitet behövs samt kontroll och behandling av sömnstörningar, depression och begränsning av riskfaktorer, utbildning i riskfaktorer och sömninterventioner. Tvärvetenskaplig AD forskning behöver hantera problemet genom ämnesövergripande samverkan.

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Taking medication at the prescribed times is very important for people with mental issues like schizophrenia, dementia Alzheimer’s and depression. But their condition itself keeps them from doing so. They are either forgetful or choose not to take the pills intentionally. This could lead to missing dosage or overdosing both of which are dangerous to the person’s health. Hence a pill box that monitors the dosage and keeps them from being able to access the pills at undesired times is needed. The aim of the thesis is to design such a pill box for the company Victrix AB in Stockholm, Sweden, by expanding on their current pill box, Dosis. In the project, the locking mechanism to keep the lids closed was rigorously designed in phases after understanding the user conditions. The end result is a locked daily pill box that is ergonomic to use for people of all ages, mental and physical conditions. The product sets itself apart from its competitors by being compact, less medical looking and very easy to use. / Att ta mediciner vid föreskrivna tidpunkter är mycket viktigt för personer med psykiska problem som schizofreni, alzheimers, demens och depressioner. Dock kan deras tillstånd hindra dem från att göra det. De är antingen glömska eller så väljer de att inte ta medicinen avsiktligt. Sådant beteende kan leda till saknad dosering eller överdosering, vilka båda är farliga för personens hälsa. Därmed behövs en pillerask som övervakar doseringen och hindrar dem från att komma åt pillerna vid oönskade tidpunkter. Syftet med examensarbetet har varit att designa en sådan pillerask för företaget Victrix AB i Stockholm, Sverige, genom att utöka sin nuvarande ask, Dosis. I projektet designades låsmekanismen noggrant i faser, genom en ökad förståelse av användarförhållandena, för att hålla locken stängda,. Slutresultatet blev en låst daglig pillerask som är ergonomisk för personer i olika åldrar med mentala och fykiska problem. Produkten skiljer sig från dess konkurrenter genom att vara kompact, inte ha ett typiskt medicinskt utseende samt mycket enkel att använda.

Alzheimer’s disease is a neurodegenerative disease that affects approximately 6% of the global population aged over 65 and is forecasted to become even more prevalent in the future. Accurately diagnosing the disease in an early stage can play a large role in improving the quality of life for the patient. One key development for performing this diagnosis is applying machine learning to perform computer-aided diagnosis. Current research in the field has been focused on removing assumptions about the used data sets, but in doing so they have often discarded objective metadata such as the patient’s age, sex or priormedical history. This study aimed to investigate the effect of including such metadata as additional input features to neural networks used for diagnosing Alzheimer’s disease through binary classification of magnetic resonance imaging scans. Two similar neural networks were developed and compared, one with these additional features and the other without them. Including the metadata led to significant improvements in the network’s classification accuracy, and should therefore be considered in future computer-aided diagnostic systems for Alzheimer’s disease. / Alzheimers sjukdom är en form av demens som påverkar ungefär 6% av den globala befolkningen som är äldre än 65 och förutspås bli ännu vanligare i framtiden. Tidig diagnos av sjukdomen är viktigt för att säkerställa högre livskvalitet för patienten. En viktig utveckling inom fältet är datorstödd diagnos av sjukdomen med hjälp av maskininlärning. Dagens forskning fokuserar på att ta bort subjektiva antaganden om datamängden som används, men har ofta även förkastat objektiv metadata såsom patientens ålder, kön eller tidigare medicinska historia. Denna studier ämnade därför undersöka om inkluderandet av denna metadata ledde till bättre prestanda hos neuronnät som används för datorstödd diagnos av Alzheimers genom binär klassificering av bilder tagna med magnetisk resonanstomografi. Två snarlika neuronnät utvecklades och jämfördes, med skillnaden att den ena även tog metadata om patienten som indata. Inkluderandet av metadatan ledde till en markant ökning i neuronnätets prestanda, och bör därför övervägas i framtida system för datorstödd diagnos av Alzheimers sjukdom.

Bakgrund: Demens förekommer i många former och yttras på olika sätt i ett degenerativt förlopp. Globalt lider 55 miljoner människor av denna sjukdom. En majoritet av befolkningen blir alltmer äldre och behovet av omsorg ökar med avsaknad av tillräckligt med platser på särskilda boenden. Omsorgen sköts mer i det ordinära boendet med involvering av anhöriga vars tillvaro belastas och välbefinnande successivt försämras. Syfte: Belysa anhörigas upplevelser tiden efter att deras demenssjuke familjemedlem flyttat till särskilt boende. Metod: En litteraturöversikt av enbart kvalitativ forskning. Sökning av artiklar genomfördes i databaserna Cinahl och MedLine. En manifest kvalitativ innehållsanalys valdes av de 13 artiklar som ingick. Det analyserade materialet baserades på intervjuer. Resultat: Analysen av de anhörigas upplevelser resulterade i 3 teman. ”Emotionell belastning”, ”En ökad finansiell utmaning” och ”En harmonisk tillvaro”. I dessa teman framkommer ökad ensamhet, sorg, skuldkänslor, oroat samvete samt ekonomiska svårigheter. Slutsats: Tiden efter den närstående residerat i ny boendeform befinner sig anhöriga i en omvälvande fas i livet med stor omställning. En ofta redan tumult och svårt belastad tillvaro, övergår i ett skede med nya emotionellasvårigheter. / Background: Dementia manifests itself in different ways in the degenerative process. Globally, 55 million people suffer from this disease. A majority of the population is getting older and the need for care increases with the lack of nursing home facilities. Homebased care of dementia is more prevalent. Informal caregivers are commonly involved in care which gradually decreases their well-being. Aim: Elucidate informal caregivers’ experiences after nursing home admission of their relative with dementia. Method: A literature review of qualitative research. Articles were searched in the databases Cinahl and MedLine. A manifest qualitative content analysis was selected of the 13 articles that were included. The analyzed data was based on interviews. Results: The analysis of the relatives' experiences resulted in 3 themes. "Emotional burden", "An increased financial challenge" and "A harmonious existence". These themes identified increased loneliness, grief, guilt, troubled conscience and financial difficulties. Conclusion: Relatives are in an upheaval phase in life with major adjustment after their family member with dementia resides in the nursing home. An often already tumultuous and heavily burdened existence transitions into a stage with new emotional difficulties.

Introduction: Alzheimer's disease is a neurodegenerative disease that initially manifests itself primarily as impaired short-term memory and impaired language ability. The course of the disease is mainly due to an atrophy in the brain that can be attributed to the protein amyloid B and tau. Monoclonal antibodies that target Alzheimer's disease often have a high rate of cerebral edema, where proteinaceous fluid leaks into the extracellular space of the brain and creates edema. Some of the most common symptoms for amyloid-related imaging abnormalities (ARIA-E) are headache, dizziness, and blurred vision. In a few cases, patients with ARIA-E need to be hospitalized for observation, but most show a decline in ARIA-E within one to two months. Objective: To investigate the frequency of ARIA-E in clinical studies of monoclonal antibodies to patients with Alzhiemer's disease and to investigate the role of the ApoE4 allele in the development of ARIA-E. Method: Literature review of five RCT studies based on four different monoclonal antibodies. PubMed was used to search for the RCT-studies. Results: ARIA-E varies between different types of antibodies. ARIA-E usually occurs early in treatment when the degree of amyloid b is highest in the brain. Most cases are asymptomatic and treatment resumes within 1-2 months. Conclusion: Aria-E frequency correlates strongly with dose strength as well as APOE4 -status and most of the incidences are asymptomatic. With the right titration and individually selected drugs as well as individual dosages a safe care can be established for patients with Alzheimer's disease. If treatment is initiated at an early stage, the risk of side effects is reduced and more neurons can be saved from atrophy. The combination of several different types of medicine will further reduce the risk of ARIA-E.