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.

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.

This abstract will provide a brief overview of the following literature review. Alzheimer’s disease (AD) is the most common cause of dementia, and is a rapidly growing public health concern, as an increasing number of the world’s population is living well beyond 65 years of age. Alzheimer’s Disease is a progressive neurodegenerative condition, first presenting with mild memory impairment, and advancing over the course of years to profound memory loss, complete immobility, lack of speech and facial recognition. Currently, only palliative treatments are available to delay the progression of the disease, and lessen the severity of the cognitive impairment. However, until a cure is available, researchers and physicians have turned their attention to alternate therapies, one of the most important being exercise. Research efforts have now turned to examining the relationship between the positive physiological responses to exercise, and attenuation of the classic neurodegenerative patterns in patients with AD. The current study examined the effects of aerobic exercise, strength training and resistance-based exercise, and multimodal exercise (containing both of the aforementioned exercise modalities) on the physical and mental/cognitive health of patients with mild cognitive impairment (MCI) and AD. Thus far, exercise therapy has proven to be of great potential value as a supplement to pharmacological treatment, as well as a stand-alone prescription for patients with a milder form of cognitive impairment due to the onset of a neurodegenerative condition. The benefits can be grouped into two categories, cognitive and physiological. The effects on cognitive function range from improved memory to increased independence in activities of daily living, and the physiological effects range from improved clearance of amyloid beta plaques in the brain, to reduction of neuroinflammatory processes. The available research on this subject is extensive, covering a variety of exercise modalities at different intensities, and taking into consideration effects on individuals with MCI, early AD, and advanced AD. The general consensus is that continued, long-term adherence to an appropriate exercise routine can delay cognitive decline, and help patients with neurodegenerative diseases to live independently for a longer period of time. The improvements in cognition, memory, immediate recognition, and other related cognitive functions are mostly attributed to the heightened health of the brain tissue and neural circuitry due to exercise. Exercise (mainly aerobic) enhances cerebral blood flow, improves cardiovascular health, reduces the risk for type 2 diabetes mellitus, and has several other important effects that prevent the formation of pathological biomarkers of AD and promote neurogenesis. Atrophy of regions such as the hippocampus, amygdala, and cerebral cortex can be prevented, and reversed to a certain extent, as a result of long-term exercise therapy. The results of current research could assist physicians and caregivers to provide the appropriate type and intensity of exercise to patients with early, intermediate, and advanced stages of Alzheimer’s disease. Proactive exercise therapy for individuals with a known family history of neurodegenerative disease may help to maintain brain volume, specifically in the hippocampus, and reduce the risk of severe cognitive impairment. Future directions for research include examining the combined effects of pharmacological treatment and exercise therapy, and determining the average amount of time by which exercise delays the progression of early stage cognitive impairment to advanced impairment. Key Terms: aerobic exercise, Alzheimer’s disease, amyloid plaque, hippocampus, mild cognitive impairment, neurodegeneration, neurofibrillary tangle

O acidente vascular encefálico (AVE) é uma doença comum e de grande impacto para a saúde da população, uma vez que é considerado a principal causa de incapacidades neurológicas, principalmente motora e cognitiva. Considerando que os exossomos e o seu conteúdo podem ser marcadores prognóstico de demência em pacientes com Doença de Alzheimer, avaliamos o perfil exossomal circulante em pacientes pós AVE isquêmico com e sem comprometimento cognitivo. Ainda, é de conhecimento que os pacientes tratados com trombolíticos apresentam redução na dependência funcional a longo prazo, assim é de interesse avaliar os exossomos periféricos destes pacientes. Este trabalho visou investigar o perfil de exossomos circulantes em pacientes após diagnóstico de AVE isquêmico (AVEI) nas fases aguda e crônica. Foram determinados o conteúdo de proteína total e a atividade da acetilcolinesterase (AChE), marcadores de exossomos, além de correlacionar escores de comprometimento neurológico com os parâmetros bioquímicos. Ainda, considerando que o estresse oxidativo tem um papel central na fisiopatologia da isquemia cerebral, determinamos o conteúdo de espécies reativas e a atividade da enzima superóxido dismutase (SOD) em exossomos circulantes. Os fatores comprometimento cognitivo e o uso do trombolítico na fase aguda da doença não mostraram ter influência sobre os parâmetros estudados. Os resultados sugerem que uma diminuição de exossomos circulantes, já que houve uma redução na quantificação de proteínas totais na fase crônica, pode sugerir um prejuízo no sistema de remoção de materiais tóxicos levando ao acúmulo de materiais indesejados disso, o estado oxidativo exossomal, representado pelos níveis de espécies reativas e a atividade da SOD, foi alterado na fase crônica quando comparado com a fase aguda. Estes resultados sugerem que há uma alteração do perfil dos exossomos ao longo do tempo nos pacientes com AVE isquêmico. Nossos dados indicam que os níveis de espécies reativas na fase aguda podem predizer alterações no perfil dos exossomos na fase crônica de pacientes com comprometimento cognitivo, especificamente nas atividades das enzimas SOD e AChE e na concentração de proteínas totais. Estas associações não foram observadas em pacientes sem comprometimento cognitivo. Correlacionamos os parâmetros bioquímicos com as escalas de déficit neurológico, os escores do Mini-Exame do Estado Mental (MEEM) foram inversamente proporcionais aos níveis de AChE naqueles pacientes que não receberam o tratamento trombolítico na fase aguda. Assim, nossos dados demonstram que o prejuízo cognitivo (menores escores de MEEM) está associado a maiores níveis de atividade da AChE em exossomos circulantes. O papel dosexossomos na fisiopatologia da isquemia cerebral, assim como na predição de diagnóstico de comprometimento cognitivo precisa ser melhor investigado. / Stroke is a common disease and has a major impact on the public health, since it is considered the main cause of neurological disabilities, mainly motor and cognitive impairment. Considering that exosomes’ content may be prognostic markers of dementia in patients with Alzheimer's disease we evaluated the circulating exosomal profile in patients with ischemic stroke with and without cognitive impairment. Furthermore, it is known that thrombolytic therapy reduces long-term disability, so it is interesting to evaluate the peripheral exosomes of these patients. This work aimed to investigate the profile of circulating exosomes in patients after diagnosis of ischemic stroke in the acute and chronic phases. Total protein content and acetylcholinesterase activity (AChE), markers of exosomes were determined, also it was correlated the scores of cognitive function tests with biochemical parameters. Considering that oxidative stress plays a central role in the pathophysiology of cerebral ischemia, we determined the content of reactive species and the activity of the superoxide dismutase enzyme (SOD) in circulating exosomes. The factors cognitive impairment and the use of thrombolytic in the acute phase of the disease did not show influence on the studied parameters. The results suggest that a decrease in circulating exosomes, since there was a reduction in the quantification of total proteins in the chronic phase, may suggest a damage in the system of removal of toxic materials leading to the accumulation of unwanted materials. The exosomal oxidative state, represented by the reactive species levels and the SOD activity, was altered in the chronic phase when compared to the acute phase These results suggest that the profile of the exosomes is altered over time in patients with ischemic stroke. Our data indicate that reactive species levels in the acute phase may predict changes in the exosome profile in the chronic phase of patients with cognitive impairment, specifically in the activities of SOD and AChE enzymes and in the concentration of total proteins. These associations were not observed in patients without cognitive impairment. We correlated the biochemical parameters with the the scores of the assessment of cognitive function tests, the Mini-Mental State Examination (MMSE) scores were inversely proportional to the AChE levels in those patients who did not receive the thrombolytic treatment in the acute phase. Thus, our data demonstrate that cognitive impairment (lower MMSE scores) is associated with higher levels of AChE activity in circulating exosomes. The role of exosomes in the pathophysiology of cerebral ischemia, as well as in the prediction of diagnosis of cognitive impairment, needs to be better investigated.

abstract: ABSTRACT Millions of US aging individuals are at risk for mild cognitive impairment (MCI), the early stage of Alzheimer's disease (Ad). Ad is progressive; there is no clinical cure to date. Certain drugs treat symptoms yet fog memory. Memory activity is critical to strengthen cognition. The Phoenix Art Museum (PAM) and Banner Alzheimer's Institute (BAI) founded the Arts Engagement Program (AEP), a non-clinical, specialized arts program for adults with (MCI) and their caregiver. The museum environment is thought to enhance communication and raise self-esteem in certain MCI individuals. The interior surroundings may spurn memory enhancement. Scholarship to substantiate this theory is minimal; therefore, further studies are required. Empirical literature regarding design elements researched specific types of memory impairment was employed. The hypotheses that design elements of the museum's infrastructure and design elements from art themes enhance memory, and the results of these findings when applied to other environments enhance memory emerged. An experience-based study was performed. Semi-structured interviews noting design elements of both infrastructure and art were conducted after each of nine AEP sessions with volunteers from 8 dyads, a term used by the PAM as one caregiver and one MCI individual. The presiding docent was later interviewed. Volunteer interviews with dyads and docents was coded and ranked. Overlapping themes that tallied five or higher were considered significant due the low sample size. Results showed that neither group considered infrastructure design elements or art theme design elements a contributor to memory enhancement. The hypotheses proved null. Both groups expressed pleasure in experiencing the PAM’s environment. Keywords: MCI, infrastructure, art themes. / Dissertation/Thesis / Masters Thesis Design 2015

Submitted by ANANDA GHELFI RAZA LEITE null (ananda_rzleite@outlook.com) on 2017-07-10T14:53:36Z No. of bitstreams: 1 Dissertacao de Ananda Ghelfi Raza Leite 19maio 2017 - PJFVB (1).pdf: 4614865 bytes, checksum: e2c5970793560c04e57c5c3f23235a62 (MD5) / Approved for entry into archive by Monique Sasaki (sayumi_sasaki@hotmail.com) on 2017-07-13T20:14:53Z (GMT) No. of bitstreams: 1 leite_agr_me_bot.pdf: 4614865 bytes, checksum: e2c5970793560c04e57c5c3f23235a62 (MD5) / Made available in DSpace on 2017-07-13T20:14:53Z (GMT). No. of bitstreams: 1 leite_agr_me_bot.pdf: 4614865 bytes, checksum: e2c5970793560c04e57c5c3f23235a62 (MD5) Previous issue date: 2017-06-23 / Pró-Reitoria de Pós-Graduação (PROPG UNESP) / Introdução: As demências são comuns nos idosos e sua prevalência aumentou nas últimas décadas. Em 2025, o Brasil estará na sexta posição mundial em número absoluto de idosos. No país, a grade curricular do curso de graduação em Medicina, de acordo com as Diretrizes Curriculares para este curso, contempla o ensino de demência e seu manejo, havendo poucos relatos na literatura cientifica sobre a qualidade do ensino oferecido ou sobre o conhecimento e a capacidade de identificação da demência. Diante disso, propõe-se estudo sobre os conhecimentos e atitudes a respeito de questões relacionadas ao declínio cognitivo em idosos por parte de estudantes e residentes de Medicina. Objetivo: Avaliar os conhecimentos e atitudes em demências por parte de estudantes de medicina e dos médicos residentes das áreas que mais atuam com demência em idosos. Métodos: Estudo transversal no qual foi realizada a aplicação aos estudantes e residentes de um questionário contendo itens sobre o aprendizado em demências durante a graduação médica e um instrumento britânico, adaptado transculturalmente ao Brasil, sobre conhecimentos e atitudes em demências em idosos. Os resultados de conhecimento e atitudes sobre demência foram comparados entre especialistas e generalistas e entre os momentos de suas carreiras. Resultados: Dos participantes deste estudo, 57% eram do sexo feminino, 60,3% relataram ter tido base em alterações cognitivas durante a graduação, e destes, 57% relataram ter tido base teórica e prática; 89,8% dos participantes afirmaram ter realizado curso extracurricular durante a graduação no qual foi abordado o tema. Com relação ao questionário de conhecimentos, os graduandos acertaram menos questões do escore “epidemiologia” do que os residentes iniciantes e menos do que os residentes finalistas. No escore “diagnóstico”, os alunos do sexto ano acertaram menos do que os residentes iniciantes e finalistas, assim como os residentes iniciantes acertaram menos do que os residentes finalistas. Observou-se que as os alunos do sexto ano concordaram mais com as afirmações referentes às atitudes “2” (“As famílias preferem ser informadas a respeito da demência de seu parente o mais rápido possível”) e “4” (“Fornecer diagnóstico geralmente é mais útil do que prejudicial”) do que os residentes iniciantes. Já na atitude “6” (“Os pacientes com demência podem esgotar recursos com resultado pouco positivo”), os graduandos concordaram menos com a afirmação do que os residentes iniciantes. Conclusão: Os resultados permitiram uma leitura mais detalhada dos tópicos envolvidos na capacitação médica para a detecção de alterações cognitivas em idosos, assim como a avaliação do perfil do especialista e do generalista quanto à avaliação dos quadros demenciais e das atitudes frente ao paciente, sendo que os graduandos, apesar de acertarem menor quantidade de questões no questionário de conhecimentos, apresentaram atitudes mais positivas frente ao paciente com demência. / Introduction: Dementias are common in the elderly and its prevalence has increased in the recent decades. By 2025, Brazil will rank sixth among countries with the highest numbers of elderly persons. In Brazil, the curriculum of the undergraduate course in Medicine, according to the Curricular Guidelines for this course, include dementia education and its management, but there are few reports in the scientific literature about the quality of education offered. Therefore, we propose a study on the knowledge and attitudes about issues related to cognitive decline in the elderly by students and medical residents. Objective: To assess the knowledge and attitudes about dementia by medical students and medical residents of the areas that the most act with dementia in the elderly. Methods: Crosssectional study; questionnaires containing topics about dementia education during medical graduation and knowledge and attitudes about dementia were used. The results of the knowledge and attitudes about dementia were compared between: students and residents, residents of the different programs and residents in different moments of their residency. Results: Of the participants of this study, 57% were female, 60.3% reported having basis on dementia during graduation, and of these, 57% reported having both theoretical and practical basis; 89.8% of the subjects attended extracurricular courses on dementia during graduation in which the topic was addressed Regarding the knowledge questionnaire, medical students’scores on “epidemiology” were lower than the scores of the residents in the beginning and in the end of the residency. Considering the scores on "diagnosis", the medical students’ scores were lower than the scores of the residents in the beginning of the residency and the latters’ scores were lower than the scores of the residents in the end of the residency. It was observed that the medical students agreed more with the statement of the attitude 2 (The families prefer to be informed about the dementia of their relative as rapidly as possible) and 4 (Providing the diagnosis is generally more useful than harmful.) than junior residents. Considering attitude 6(The patients with dementia can drain resources with little positive result), the medical students agreed less than the residents of the beginning of the programs. Conclusion: The results allowed a more detailed reading of the topics involved in medical training for the detection of cognitive alterations in the elderly, as well as the evaluation of the expert and generalist profile regarding the evaluation of dementia and attitudes towards the patient, although they answered less questions in the knowledge questionnaire, presented more positive attitudes towards the patient with dementia.

O acidente vascular encefálico (AVE) é uma doença comum e de grande impacto para a saúde da população, uma vez que é considerado a principal causa de incapacidades neurológicas, principalmente motora e cognitiva. Considerando que os exossomos e o seu conteúdo podem ser marcadores prognóstico de demência em pacientes com Doença de Alzheimer, avaliamos o perfil exossomal circulante em pacientes pós AVE isquêmico com e sem comprometimento cognitivo. Ainda, é de conhecimento que os pacientes tratados com trombolíticos apresentam redução na dependência funcional a longo prazo, assim é de interesse avaliar os exossomos periféricos destes pacientes. Este trabalho visou investigar o perfil de exossomos circulantes em pacientes após diagnóstico de AVE isquêmico (AVEI) nas fases aguda e crônica. Foram determinados o conteúdo de proteína total e a atividade da acetilcolinesterase (AChE), marcadores de exossomos, além de correlacionar escores de comprometimento neurológico com os parâmetros bioquímicos. Ainda, considerando que o estresse oxidativo tem um papel central na fisiopatologia da isquemia cerebral, determinamos o conteúdo de espécies reativas e a atividade da enzima superóxido dismutase (SOD) em exossomos circulantes. Os fatores comprometimento cognitivo e o uso do trombolítico na fase aguda da doença não mostraram ter influência sobre os parâmetros estudados. Os resultados sugerem que uma diminuição de exossomos circulantes, já que houve uma redução na quantificação de proteínas totais na fase crônica, pode sugerir um prejuízo no sistema de remoção de materiais tóxicos levando ao acúmulo de materiais indesejados disso, o estado oxidativo exossomal, representado pelos níveis de espécies reativas e a atividade da SOD, foi alterado na fase crônica quando comparado com a fase aguda. Estes resultados sugerem que há uma alteração do perfil dos exossomos ao longo do tempo nos pacientes com AVE isquêmico. Nossos dados indicam que os níveis de espécies reativas na fase aguda podem predizer alterações no perfil dos exossomos na fase crônica de pacientes com comprometimento cognitivo, especificamente nas atividades das enzimas SOD e AChE e na concentração de proteínas totais. Estas associações não foram observadas em pacientes sem comprometimento cognitivo. Correlacionamos os parâmetros bioquímicos com as escalas de déficit neurológico, os escores do Mini-Exame do Estado Mental (MEEM) foram inversamente proporcionais aos níveis de AChE naqueles pacientes que não receberam o tratamento trombolítico na fase aguda. Assim, nossos dados demonstram que o prejuízo cognitivo (menores escores de MEEM) está associado a maiores níveis de atividade da AChE em exossomos circulantes. O papel dosexossomos na fisiopatologia da isquemia cerebral, assim como na predição de diagnóstico de comprometimento cognitivo precisa ser melhor investigado. / Stroke is a common disease and has a major impact on the public health, since it is considered the main cause of neurological disabilities, mainly motor and cognitive impairment. Considering that exosomes’ content may be prognostic markers of dementia in patients with Alzheimer's disease we evaluated the circulating exosomal profile in patients with ischemic stroke with and without cognitive impairment. Furthermore, it is known that thrombolytic therapy reduces long-term disability, so it is interesting to evaluate the peripheral exosomes of these patients. This work aimed to investigate the profile of circulating exosomes in patients after diagnosis of ischemic stroke in the acute and chronic phases. Total protein content and acetylcholinesterase activity (AChE), markers of exosomes were determined, also it was correlated the scores of cognitive function tests with biochemical parameters. Considering that oxidative stress plays a central role in the pathophysiology of cerebral ischemia, we determined the content of reactive species and the activity of the superoxide dismutase enzyme (SOD) in circulating exosomes. The factors cognitive impairment and the use of thrombolytic in the acute phase of the disease did not show influence on the studied parameters. The results suggest that a decrease in circulating exosomes, since there was a reduction in the quantification of total proteins in the chronic phase, may suggest a damage in the system of removal of toxic materials leading to the accumulation of unwanted materials. The exosomal oxidative state, represented by the reactive species levels and the SOD activity, was altered in the chronic phase when compared to the acute phase These results suggest that the profile of the exosomes is altered over time in patients with ischemic stroke. Our data indicate that reactive species levels in the acute phase may predict changes in the exosome profile in the chronic phase of patients with cognitive impairment, specifically in the activities of SOD and AChE enzymes and in the concentration of total proteins. These associations were not observed in patients without cognitive impairment. We correlated the biochemical parameters with the the scores of the assessment of cognitive function tests, the Mini-Mental State Examination (MMSE) scores were inversely proportional to the AChE levels in those patients who did not receive the thrombolytic treatment in the acute phase. Thus, our data demonstrate that cognitive impairment (lower MMSE scores) is associated with higher levels of AChE activity in circulating exosomes. The role of exosomes in the pathophysiology of cerebral ischemia, as well as in the prediction of diagnosis of cognitive impairment, needs to be better investigated.

Introdução: O envelhecimento populacional vem sendo acompanhado por um aumento mundial na prevalência de demência. Entretanto, uma revisão sistemática da literatura evidenciou que pouco se sabe sobre a prevalência de demência e comprometimento cognitivo em populações etnicamente diferentes, como a indígena. Isto é, particularmente, relevante dado o aumento da expectativa de vida dessa população e, consequentemente, do número de idosos e das modificações em seu perfil de morbidade e mortalidade. Objetivo: Identificar a prevalência de comprometimento cognitivo na população indígena brasileira, caracterizando o perfil de desempenho cognitivo, de declínio cognitivo subjetivo e de humor e associando com fatores sociodemográficos, hábitos, antecedentes de saúde e humor. Método: Foram incluídos 217 indivíduos com idade igual a ou maior que 50 anos, de ambos os sexos, da etnia Mura, moradores da aldeia de Pantaleão, no município de Autazes, em Manaus - Amazonas. Os participantes foram submetidos a testes de avaliação de atenção, memória operacional, memória declarativa de curto e longo prazos, fluência verbal, habilidade visuoconstrutiva, bem como avaliação de humor, sintomas depressivos, declínio cognitivo subjetivo e desempenho funcional. Resultados: A prevalência de comprometimento cognitivo variou em função da faixa etária. A amostra total incluiu indivíduos com 50 anos de idade ou mais, a prevalência de comprometimento cognitivo foi 43,3%, nos participantes com 60 anos ou mais, a prevalência aumentou para 43,7% e para 51,1% naqueles com 65 anos ou mais. Em relação aos fatores associados, a idade e a escolaridade influenciaram as chances de comprometimento cognitivo em todas as faixas etárias. Nos participantes com 50 anos ou mais, a cada um ano de idade, aumenta em 3% a chance de comprometimento cognitivo (OR = 1,03), e a cada um ano de escolaridade esta chance diminui em 26% (OR = 0,74). Já nos participantes com 60 anos ou mais e nos com 65 anos ou mais, a cada um ano de idade, aumenta em 9% a chance de comprometimento cognitivo (OR = 1,09) e a cada um ano de escolaridade esta chance diminui em 29% (OR = 0,71). Além da idade e escolaridade, o IMC e a renda influenciaram a chance de comprometimento cognitivo nos participantes com idade 50 anos e 60 anos. A cada ponto no IMC, diminui em, aproximadamente, 10% a chance de comprometimento cognitivo (OR = 0,90). Em relação à renda, a cada unidade da renda familiar diminui em 48% a chance de comprometimento cognitivo nos idosos com idade 60 anos. Comparando com os indígenas sem comprometimento cognitivo, aqueles com comprometimento cognitivo tiveram pior desempenho em todos os testes cognitivos, exceto nos de fluência verbal e habilidade visuoconstrutiva, além de maior intensidade no declínio cognitivo subjetivo e nos sintomas depressivos (p 0,05). Conclusão: A prevalência de comprometimento cognitivo em adultos e indígenas aumenta nas faixas etárias maiores, e a chance de desenvolver algum comprometimento aumenta nos participantes mais velhos, com menor escolaridade e renda familiar. Estes achados podem contribuir para implementação de políticas públicas relacionadas ao cuidado da saúde do índio e à capacitação dos profissionais da saúde, incluindo a equipe de enfermagem, para identificação precoce de indivíduos vulneráveis ao desenvolvimento de comprometimento cognitivo. / Introduction: Population ageing has been accompanied by a worldwide increase in the pervasiveness of dementia. However, a systematic review of the literature shows that little is known about the prevalence of dementia and cognitive impairment among ethnically different, such as indigenous, populations. This is particularly relevant given the increase in life expectancy of this population and, consequently the number of elderly individuals, as well as the modification in their morbimortality profile. Objective: To identify the prevalence of cognitive impairment in the indigenous Brazilian population through an assessment of its cognitive performance profile, subjective cognitive decline and mood and associating it with sociodemographic factors, habits, health history and mood. Method: 217 individuals were included of equal to or greater than 50 years of age, of both sexes, of the Mura ethnic group, and residents of the Pantaleão village, in the municipality of Autazes, Amazonas. The participants were submitted to evaluation testing of attentiveness, operating memory, short-term and long-term declarative memory, verbal fluency, visual-constructional ability, as well as evaluation of mood, symptoms of depression, subjective cognitive decline and functional performance. Results: The prevalence of cognitive impairment varied according to age group. While in the total population sample, which included individuals 50 years of age and older, the prevalence of cognitive impairment was 43.3%, among participants 60 years or older, this prevalence increased to 43.7% and to 51.1% for those 65 years or older. In relationship to associated factors, age and schooling influenced the chances of cognitive impairment among all of the age groups. In participants of 50 years or older, for each year of age, there is a 3% increase in the chance of cognitive impairment (OR = 1,03) and for each year of schooling this chance diminishes by 26% (OR = 0,74). On the other hand, in participants of 60 years of age or more, for each year of age, there is a 9% increase in the chance of cognitive impairment (OR = 1,09) and for each year of schooling, this chance diminishes by 29% (OR = 0,71). Beyond age and schooling, the body mass index negatively influenced the chance of cognitive impairment in participants aged 50 years and 60 years. Beyond this, for each household income unit, there is a 48% decrease in the chance of cognitive impairment in the elderly participants aged 60 years. Compared with indigenous individuals without cognitive impairment, those with cognitive impairment performed worse on all cognitive tests, except those of verbal fluency and visual-constructional ability, besides a greater intensity of subjective cognitive decline and symptoms of depression (p 0.05). Conclusion: The prevalence of cognitive impairment in adults and indigenous individuals increases among older age groups and the chance of acquiring some kind of impairment increases among older participants with less schooling and lower household incomes. These findings can contribute to the implementation of public policies related to indigenous health care and the training of health professionals, including nursing teams, for the early identification of individuals vulnerable to the development of cognitive impairment.

Objetivo: Avaliar a atrofia do corpo caloso (CC) em pacientes com doença de Alzheimer (DA) e comprometimento cognitivo leve (CCL) e quantificar quais regiões dessa estrutura são mais acometidas nessa doença como uso de técnicas quantitativas de ressonância magnética. Metodologia: O estudo contou com a participação de 75 indivíduos sendo 22 controles normais (CN), 30 com CCL e 23 com DA. O volume total do corpo caloso e suas 3 diferentes sub regiões foram delimitadas em cortes sagitais de imagem de ressonância magnética. Os volumes obtidos foram corrigidos para a variação de volume intracraniano. As mascaras foram co-registradas a mapas de relaxometria e transferência de magnetização para analise quantitativa. Resultados: Encontramos atrofia e redução dos valores de relaxometria e transferência de magnetização nos pacientes do grupo DA. As tres sub regiões do corpo caloso apresentaram redução de volume na doença sendo que a atrofia foi maior nas regiões anteriores. Não encontramos diferença significativa nos parâmetros estudados entre CCL e CN. Conclusões: Embora o corpo caloso esteja envolvido no processo de desconexão cortical presente na doença de Alzheimer seu envolvimento não é precoce. / Objective: To evaluate the atrophy of the corpus callosum (CC) in patients with Alzheimer disease (AD) and mild cognitive impairment (CCL) and quantify which regions of this structure are most affected in this disease as using quantitative MRI techniques. Methodology: The study counted on the participation of 75 individuals being 22 normal controls (CN), 30 with CCL and 23 with AI). The total volume of the corpus callosum and its v 3 different sub regions were delimited in sagittal sections of magnetic resonance imaging. The volumes obtained were corrected for intracranial volume variation. The masks were recorded with maps of relaxometry and transfer of magnetization for quantitative analysis. Results: We found atrophy and reduced values of relaxometry and magnetization transfer in patients in the AD group. The three sub regions of the corpus callosum showed volume reduction in the disease, with atrophy being greater in the anterior region. We found no significant difference in the parameters studied between CCL and CN fit .Conclusions: Although the corpus callosum is involved in the process of cortical detachment present in Alzheimer\'s disease, its involvement is late.

Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2017-11-17T10:19:33Z No. of bitstreams: 2 Tese - Danielly Bandeira Lopes - 2015.pdf: 2774897 bytes, checksum: c12573466129a0392a45ef3426425b0e (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2017-11-17T10:20:06Z (GMT) No. of bitstreams: 2 Tese - Danielly Bandeira Lopes - 2015.pdf: 2774897 bytes, checksum: c12573466129a0392a45ef3426425b0e (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2017-11-17T10:20:06Z (GMT). No. of bitstreams: 2 Tese - Danielly Bandeira Lopes - 2015.pdf: 2774897 bytes, checksum: c12573466129a0392a45ef3426425b0e (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2015-12-16 / Population aging is a global phenomenon that will continue to reach all regions of the world. The main changes that can be followed by the aging are with respect to cognitive and functional aspects. This study aimed to estimate the incidence of cognitive and functional changes in the elderly living in isolated community, reminiscent of quilombo, located in the northeastern of Goias state, called Kalunga. We conducted a longitudinal study with noninvasive methods, based on primary data of cognitive and functional changes of the elderly who participated in prevalence study in 2011. Were collected and analyzed identification data (age, gender), socio-demographic factors (education, place), cultural and prior morbidities (hypertension, diabetes) participants through semi-structured questionnaire. The cognitive and functional data were obtained by applying the Mini Mental State Examination (MMSE) and the Pfeffer Functional Activities Questionnaire (PFAQ), respectively. In total were reassessed 43 elderly. Most were male (51.2%), married (69.8%), illiterate (90.7%) with a mean age of 74.2 years, hypertension (53.5%) and smoker (48.8%). The incidence of individuals with cognitive and functional change was 4% year, similar in comparison to other studies on cognitive disorders and dementia. Only low levels of schooling and the presence of diabetes mellitus presented a significant association with the individuals' cognitive and functional profile. However, there was a significant decline in cognition and functionality of these assessed in 2011 and reassessed in 2014. / O envelhecimento populacional é um fenômeno global que continuará a atingir todas as regiões do mundo. As principais alterações que podem vir acompanhadas do envelhecimento são com relação aos aspectos cognitivos e funcionais. Este trabalho propôs estimar a incidência de alterações cognitivas e funcionais em idosos residentes em comunidade isolada, remanescente de quilombo, localizada no nordeste do estado de Goiás, denominada Kalunga. Foi realizado um estudo longitudinal, com métodos não invasivos, baseado em dados primários, das alterações cognitivas e funcionais de idosos que participaram de estudo de prevalência em 2011. Foram coletados e analisados dados de identificação (idade, gênero), sociodemográficos (escolaridade, procedência), culturais e de morbidades prévias (hipertensão arterial, diabetes) dos participantes por meio de questionário semiestruturado. Os dados de avaliação cognitiva e funcional foram obtidos por meio da aplicação do Mini Exame do Estado Mental (MEEM) e do Questionário de Atividades de Vida Diária (QAVD) de PFEFFER, respectivamente. No total foram reavaliados 43 idosos. A maioria era do gênero masculino (51,2%), casada (69,8%), analfabeta (90,7%), com idade média de 74,2 anos, hipertensa (53,5%) e tabagista (48,8%). A incidência de indivíduos com alteração cognitiva e funcional foi de 4% ao ano, semelhante em comparação a outros estudos sobre distúrbios cognitivos e demência. Apenas baixa escolaridade e presença de diabetes mellitus apresentaram associação significativa com o perfil cognitivo e funcional dos indivíduos. Entretanto, houve um declínio geral e significativo na cognição e funcionalidade dos mesmos avaliados no primeiro (2011) e segundo momentos (2014).