As intervenções cognitivas voltadas a idosos saudáveis ainda encontram-se pouco estudadas na literatura nacional, apesar de terem sido investigadas em outros países. O treino de memória oferecido a idosos com Comprometimento Cognitivo Leve (CCL) tem recebido cada vez mais atenção de pesquisadores e parece também beneficiar esta população. Não se sabe se o treino tem efeito a longo prazo e nem se os benefícios são os mesmos para idosos saudáveis e com CCL. Esta pesquisa teve como intuito avaliar o impacto do treino de memória de oito sessões oferecido a idosos controles normais (CN) e com CCL com alta escolaridade em parâmetros cognitivos. Para isso, contamos com a participação de 61 idosos acompanhados pela equipe multidisciplinar do Laboratório de Neurociências LIM 27 do Instituto de Psiquiatria da FMUSP aleatoriamente divididos em grupo experimental - GE (sendo 17 CN e 18 com CCL) e grupo controle - GC (sendo 12 CN e 14 com CCL). Estes grupos foram avaliados em quatro momentos diferentes, a saber, antes da intervenção (T0), uma semana após o término da intervenção (T1), um mês após a última avaliação (T2) e seis meses após T1 (T3). O GE recebeu treino de memória com ênfase na categorização e grifos entre T0 e T1. O GC realizou todas as avaliações no mesmo tempo de GE, mas o treino foi lhes oferecido depois de T3. Observou-se melhora em ambos os grupos GE de T0 para T1 quando comparados ao grupo GC em testes de atenção, velocidade de processamento, estratégias mnemônicas, e em testes de memória. Estes efeitos parecem se manter a curto e a longo prazo, mostrando, de maneiras diferentes, os benefícios do treino e a existência de plasticidade cognitiva em ambas as populações estudadas / The cognitive interventions aimed at elderly healthy are little studied in the national literature, despite having been investigated in other countries. The memory training offered to seniors with mild cognitive impairment (MCI) has received increasing attention from researchers and also seems to benefit this population. It is not known whether the training has long-term effect, nor whether the benefits are the same for healthy elderly and MCI. This study was aimed to evaluate the impact of eight memory training sessions offered to elderly normal controls (NC) and seniors with MCI in cognitive parameters. For this, we had the participation of 61 older people accompanied by a multidisciplinary team of the Laboratory of Neurosciences LIM 27, Institute of Psychiatry, FMUSP randomly divided into experimental group - EG (including 17 NC and 18 with MCI) and control group - CG (being 12 NC and 14 with MCI). These groups were evaluated at four different times, namely before the intervention (T0), one week after the intervention (T1), one month after the last assessment (T2) and six months after T1 (T3). EG received memory training with emphasis on categorization and underline words between T0 and T1. The CG performed all the assessments at the same time EG, but the training was offered to them after T3. Improvement was observed in both groups EG from T0 to T1 when compared to the CG on tests of attention, processing speed, mnemonic strategies, and memory tests. These effects seem to keep the short and long term, showing, in different ways, the benefits of training and the existence of cognitive plasticity in both populations studied

abstract: Alzheimer’s disease (AD) is characterized by the degeneration of cholinergic basal forebrain (CBF) neurons in the nucleus basalis of Meynert (nbM), which provides the majority of cholinergic input to the cortical mantle and together form the basocortical cholinergic system. Histone deacetylase (HDAC) dysregulation in the temporal lobe has been associated with neuronal degeneration during AD progression. However, whether HDAC alterations play a role in cortical and cortically-projecting cholinergic nbM neuronal degeneration during AD onset is unknown. In an effort to characterize alterations in the basocortical epigenome semi-quantitative western blotting and immunohistochemistry were utilized to evaluate HDAC and sirtuin (SIRT) levels in individuals that died with a premortem clinical diagnosis of no cognitive impairment (NCI), mild cognitive impairment (MCI), mild/moderate AD (mAD), or severe AD (sAD). In the frontal cortex, immunoblots revealed significant increases in HDAC1 and HDAC3 in MCI and mAD, followed by a decrease in sAD. Cortical HDAC2 levels remained stable across clinical groups. HDAC4 was significantly increased in prodromal and mild AD compared to aged cognitively normal controls. HDAC6 significantly increased during disease progression, while SIRT1 decreased in MCI, mAD, and sAD compared to controls. Basal forebrain levels of HDAC1, 3, 4, 6 and SIRT1 were stable across disease progression, while HDAC2 levels were significantly decreased in sAD. Quantitative immunohistochemistry was used to identify HDAC2 protein levels in individual cholinergic nbM nuclei immunoreactive for the early phosphorylated tau marker AT8, the late-stage apoptotic tau marker TauC3, and Thioflavin-S, a marker of mature neurofibrillary tangles (NFTs). HDAC2 nuclear immunoreactivity was reduced in individual cholinergic nbM neurons across disease stages, and was exacerbated in tangle-bearing cholinergic nbM neurons. HDAC2 nuclear reactivity correlated with multiple cognitive domains and with NFT formation. These findings identify global HDAC and SIRT alterations in the cortex while HDAC2 dysregulation contributes to cholinergic nbM neuronal dysfunction and NFT pathology during the progression of AD. / Dissertation/Thesis / Doctoral Dissertation Neuroscience 2018

Executive function describes high-level cognitive-abilities including planning, decision-making, set switching and response inhibition. Impairments of the executive functions in disease states may be subtle but can greatly reduce the quality of life and independence. The overarching theme of this project was to investigate the network of brain regions that are needed to support executive function. This was undertaken using a two-fold approach: one, to apply network analysis to resting state functional Magnetic Resonance Imaging (rs-fMRI) and Diffusion Tensor Imaging (DTI) data in order to describe how differences in morphometry and connectivity correlate to executive function differences of individuals with Mild Cognitive Impairment (MCI), and two, to describe the brain networks involved in one form of executive function, decision-making under uncertain conditions, in young, healthy individuals. Impaired decision-making can dramatically impact day-to-day functioning and understanding the underlying network of regions that support this task can provide a target for future intervention studies. Data from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) were used in the studies of MCI. Individuals were grouped by their executive abilities. A regions-of-interest approach was used to parcel and label various brain regions and a network of connections was constructed out of these regions. Differences between the networks were then compared between the MCI subjects with good and poor executive functions. Those with high executive abilities showed decreased functional network connectivity and increased structural network connectivity. The second arm of these studies was based an original decision-making paradigm that was used to compare of networks involved in decision-making at times of uncertainty in healthy young individuals using both electroencephalography (EEG) and task-based functional magnetic resonance imaging (fMRI). Overall we found greater network connectivity in the uncertain condition of the task than in the certain condition. This suggests that with increased uncertainty comes increased organized connectivity. Taken together, the results of this study re-iterate the notion that cognition depends upon the efficient communication between a network of brain regions rather than on isolated regions. They also highlight the importance of having a well-defined network of nodes and connections for optimal executive functioning.

Obstructive Sleep Apnoea (OSA) is a disease characterised by repetitive upper airway obstructions which are manifest by desaturation and arousal from sleep. It has been known for many years that this interruption to the normal architecture of sleep may present to the clinician as excessive daytime somnolence often with a complaint of difficulties with concentration and short term memory. Previous work had demonstrated a relationship between variables of cognitive dysfunction in patients with obstructive sleep apnoea, however, little was known about which components of the syndrome contributed to this outcome and whether specific clinical thresholds of sleep disordered breathing could be defined for the development of cognitive dysfunction. In the context of this body of work cognitive dysfunction is defined as: a level of cognitive performance below normal derived values for a given cognitive test, when the subjects performance is controlled for age, sex and level of education.

Increasing numbers of older patients with cognitive impairment and disturbed behaviour are likely to present to acute care hospitals in the future. Nurses are not well disposed towards care due to safety and morale issues caused by knowledge deficits, job stress, oppressed group behaviours and ageist attitudes. Patient outcomes are often poor with multiple adverse events, long lengths of stay and levels of mortality. Disturbed behaviour may be caused by delirium, depression or other mental disorders and dementia or all. The research question addressed was “Can the instigation of a person-centred approach to care of patients with cognitive impairment and disturbed behaviour result in decreased nursing stress, improved patient care practices, outcomes and relatives’ satisfaction?” A conceptual framework incorporating the constructs of Person-Centred Care, the Integrated Structural Model of Human Behaviour and Practice Development informed the action research methods utilised. The processes of facilitation were used to undertake four action research cycles incorporating plans, actions, observations and reflections in one 25-bed acute aged care ward in a large tertiary referral hospital The first cycle involved setting up the study, recruitment of nurses and patients, gathering of baseline data and application of nonparticipant observational studies of the quality of nurse-patient interactions which served to inform the plan for interventions. The following three cycles demonstrated efforts to undertake those interventions through strategies to increase nursing empowerment and knowledge in the context of constant staff turnover and diversions that compromised support and participation. During the study there were few apparent adverse patient outcomes with significant improvements in patient analgesic administration, relatives’ satisfaction with care, nursing care practices involving the completion of a Communication and Care Cues form and nurses’ interactions with the patients. New care planning tools were developed that will enable ongoing activities for practice improvement. Conversely, there was a significant increase in the nurses’ stress levels when caring for hypoactive delirious patients, a trend towards more emotional exhaustion, high nursing turnover and increased sick leave rates. Nursing care practices were unchanged and the new care planning tools were not well utilised. Reflection on the implications and limitations of action research methods supported by practice development strategies in the dynamic, often chaotic environment experienced during the study, suggested that if there is an absence of hierarchical managerial sponsorship for such activities, then sustainable change is difficult. Therefore, it was shown that a person-centred approach to care of patients with cognitive impairment and disturbed behaviour using action research methods in this environment, can result in some enhanced nurse-patient interactions, patient care practices, outcomes and relatives’ satisfaction. However, progress is likely to be slow and time consuming. Further improvements require attention to the well-being status of the nurses through actions that generate feelings of empowerment through individual recognition, knowledge enhancement, adequate access to patient information and sufficient time to undertake their duties as equal members of the multidisciplinary team.

<p>Syftet med denna litteraturstudie var att beskriva hur smärta, hos äldre personer som har diagnosen demens, kan identifieras och vilka hjälpmedel som finns att tillgå för att skatta/bedöma smärta hos dem som har diagnosen demens. Dessutom var syftet att beskriva vilka kriterier/särdrag man använder sig av vid smärtbedömningen hos de med sjukdomen demens. Artiklar söktes i följande databaser: Academic Search Elite, Cinahl, High Wire Press, Pub Med och i Science Direct. Dessa databaser valdes relaterat till att de är erkända och hade ett relativt stort utbud på relevanta artiklar inom ämnet.Designen i denna studie var beskrivande litteraturstudie där resultatet baseras på vetenskapliga artiklar. Totalt 31 artiklar var relevanta för studien och togs med i resultatet, av dessa var 24 kvalitativa, 4 kvantitativa och 3 artiklar var både kvalitativa och kvantitativa. Granskningen av kvaliteten av artiklarna som ingår i studien visade att den metodologiska kvaliteten var relativt hög.Resultatet visade att det fanns en del olika indikatorer som bedöms vid smärtskattning.Till de vanligaste indikatorerna hör ansiktsuttryck, smärtord och smärtljud men personer med demens och smärta kan även reagera med att dra sig undan, bli tysta eller ibland bli aggressiva och agiterade.Det fanns ett flertal smärtskattningsinstrument och observationsskalor med olika upplägg och kombinationer av bedömningskriterier. Smärtbedömning hos äldre med demens försvåras av att deras kognitiva förmåga liksom den verbala förmågan tenderar att försämras med deras sjukdom. Studien visade också att smärtskattning hos personer med kognitiv svikt är ett komplicerat och viktigt arbete för personal inom sjukvården.</p> / <p>The purpose of this literature review was to describe the pain, in older people who have been diagnosed with dementia, experience can be identified and the available aids, the pain of those who have been diagnosed with dementia. Furthermore, the purpose was to describe the criteria/characteristics used to make pain assessments on persons with dementia.Articles were found in the following databases: Academic Search Elite, Cinahl, High Wire Press, Pub Med and Science Direct. These databases were choosen because they are recognized and had a relatively wide range of relevant articles on the subject. The design of this study was descriptive literature review, where the outcome is based on scientific articles. In total, 31 articles were relevant to the study and were included in the result, of these articles, 24 were qualitative, 4 quantitative and 3 articles were both qualitative and quantitative. The review of articles included in the study, showed that the methodological quality was relatively high.The results indicated that there were different indicators considered while doing the pain assessment. The most common indicators include facial expression, pain words and sounds of pain, but persons with dementia and pain can also react with withdrawal, become quite or even become aggressive and agitated.There were several of pain-assessment instruments and observation scales with different set-ups and combinations of criteria. Pain assessment on elderly people with dementia is complicated, thus, their cognitive ability tends to deteriorate with their illness.The study also showed that pain assessment on persons with cognitive impairment is a complex and important work for health care staff.</p>

<p><strong>Bakgrund:</strong> Studier visar att smärta är vanligt förekommande (80-88 %) hos äldre personer. Demenssjukdom är en neurologisk skada i hjärnan där den verbala och kroppsliga kommunikationen försämras. Detta bidrar till problem att känna igen smärta hos personer med demenssjukdom. <strong>Syftet: </strong>Syftet<strong> </strong>var att belysa hur vårdpersonal kan känna igen smärta hos personer med demenssjukdom. <strong>Metod: </strong>En systematisk litteraturstudie där datainsamlingen genomfördes i databaserna Cinahl, PsycINFO och PubMed. Texterna analyserades induktivt för att finna koder och deduktivt för att sammanställa resultatet. <strong>Resultat: </strong>Genom ömsesidigt förtroende byggdes en relation upp mellan vårdpersonal och person med demenssjukdom. Vårdpersonalen lärde känna personen med demenssjukdoms vanor och mönster vilket ledde till att det blev lättare att upptäcka avvikande beteende. Beteendeförändringar i form av social tillbakadragenhet, aggressivitet och förändringar i sov- och matvanor kunde indikera smärta. Smärta kunde även visa sig genom ansiktsuttryck, verbalt- och kroppsligtspråk samt genom fysiologiska tecken. Smärtuttrycken yttrade sig olika genom demenssjukdomens olika faser. <strong>Slutsats: </strong>Det går att känna igen smärta hos personer med demenssjukdom och även hos personer med svår demenssjukdom. En förutsättning är dock att personalen känner personen.</p> / <p><strong>Background:</strong> Research shows that pain is common (80-88%) among older adults. Dementia is a neurological disease which impairs the verbal communication and the body language. This contributes to the problem of recognizing pain in cognitively impaired elders. The <strong>Aim</strong> was to illustrate how nursing staff to cognitively impaired elders could recognize pain. <strong>Method:</strong> A review of literature has been conducted and the data was collected in Cinahl, PsycINFO and PubMed. Inductive and a deductive analysis were used. <strong>Findings:</strong> Relationship between nursing staff and the cognitively impaired elders is built through mutual trust. By knowing the habits of the cognitively impaired elder the nursing staff is able to detect changes in their behaviour. Behavioural changes like social withdrawal, aggression and changes in sleeping and eating habits could indicate pain. Pain could also be recognized by facial expression, verbal communication, body language and physiological symptoms. However people with different levels of cognitive impairment express pain in different ways. <strong>Conclusion:</strong> It is possible to recognize pain in cognitively impaired even when the person is suffering from a severe dementia disease. To do this, knowing the person seems necessary.</p>

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 topic of this thesis is the new requirements that will be put upon the facilities management when the elderly are living longer in their own homes, in spite of illness, impairment and old age. For many reasons, especially demographic ones, this issue has come to the fore and since it has substantial political impact and considerably affects our living conditions, it will most certainly appear on the agenda of most Swedish housing companies in the near future. The growing number of inhabitants in need of care and rehabilitation is a current subject in many countries of the industrial world. More medical conditions can be treated, but often at an ever increasing cost. Care and housing are often interlinked and more interest is being paid to the possibility of offering care to elderly in their own homes. This development must lead to a discussion of the home as a hospital ward from time to time, and the demands it places on facilities management and security. So far the prospects of telecare services and "Smart homes" has been very little discussed in parallel, although in many aspects they share the same technological base. The principal interest of the housing companies is to find a role in accordance with their mainstream business, and at the same time co-operate with other municipal actors directly in charge of offering assistance and service. There has been only limited study and research into the complex interaction between technology, home-based social service and the housing company. The purpose here is to develop an understanding of the requirements placed on both the housing company and the CP when a tenant is to be subjected to minor and more extensive care at home, or suffers from an illness or an impairment which requires special equipment or technical adjustment in the home. A model to interpret this situation has been developed in this thesis. / QC 20100806

Syftet med denna litteraturstudie var att beskriva hur smärta, hos äldre personer som har diagnosen demens, kan identifieras och vilka hjälpmedel som finns att tillgå för att skatta/bedöma smärta hos dem som har diagnosen demens. Dessutom var syftet att beskriva vilka kriterier/särdrag man använder sig av vid smärtbedömningen hos de med sjukdomen demens. Artiklar söktes i följande databaser: Academic Search Elite, Cinahl, High Wire Press, Pub Med och i Science Direct. Dessa databaser valdes relaterat till att de är erkända och hade ett relativt stort utbud på relevanta artiklar inom ämnet.Designen i denna studie var beskrivande litteraturstudie där resultatet baseras på vetenskapliga artiklar. Totalt 31 artiklar var relevanta för studien och togs med i resultatet, av dessa var 24 kvalitativa, 4 kvantitativa och 3 artiklar var både kvalitativa och kvantitativa. Granskningen av kvaliteten av artiklarna som ingår i studien visade att den metodologiska kvaliteten var relativt hög.Resultatet visade att det fanns en del olika indikatorer som bedöms vid smärtskattning.Till de vanligaste indikatorerna hör ansiktsuttryck, smärtord och smärtljud men personer med demens och smärta kan även reagera med att dra sig undan, bli tysta eller ibland bli aggressiva och agiterade.Det fanns ett flertal smärtskattningsinstrument och observationsskalor med olika upplägg och kombinationer av bedömningskriterier. Smärtbedömning hos äldre med demens försvåras av att deras kognitiva förmåga liksom den verbala förmågan tenderar att försämras med deras sjukdom. Studien visade också att smärtskattning hos personer med kognitiv svikt är ett komplicerat och viktigt arbete för personal inom sjukvården. / The purpose of this literature review was to describe the pain, in older people who have been diagnosed with dementia, experience can be identified and the available aids, the pain of those who have been diagnosed with dementia. Furthermore, the purpose was to describe the criteria/characteristics used to make pain assessments on persons with dementia.Articles were found in the following databases: Academic Search Elite, Cinahl, High Wire Press, Pub Med and Science Direct. These databases were choosen because they are recognized and had a relatively wide range of relevant articles on the subject. The design of this study was descriptive literature review, where the outcome is based on scientific articles. In total, 31 articles were relevant to the study and were included in the result, of these articles, 24 were qualitative, 4 quantitative and 3 articles were both qualitative and quantitative. The review of articles included in the study, showed that the methodological quality was relatively high.The results indicated that there were different indicators considered while doing the pain assessment. The most common indicators include facial expression, pain words and sounds of pain, but persons with dementia and pain can also react with withdrawal, become quite or even become aggressive and agitated.There were several of pain-assessment instruments and observation scales with different set-ups and combinations of criteria. Pain assessment on elderly people with dementia is complicated, thus, their cognitive ability tends to deteriorate with their illness.The study also showed that pain assessment on persons with cognitive impairment is a complex and important work for health care staff.