Hip fracture is a global and a growing public health problem. More women than men sustain hip fractures, the incidence increases exponentially with age and mean age is above 80. About one third of hip-fracture patients suffer from dementia and are prone to develop acute confusional state (delirium). Delirium is one of the most common complications after hip-fracture surgery, and seriously impacts on morbidity and mortality. Malnutrition is also common in hip-fracture patients and is associated with postoperative complications, such as delayed healing of the wound, infections and decubitus ulcers. Arthroplasty is usually preferred procedure in displaced femoral neck fractures but is, however, controversial in patients with dementia due to the fear of dislocation of the prosthesis. The aims of this thesis are to identify risk factors for delirium and the impact of delirium on rehabilitation outcome, to evaluate whether a postoperative multi-factorial intervention program could reduce delirium, to investigate the effect of a nutritional intervention and to evaluate complications, functional outcome and mortality regarding two surgical methods, hemiarthroplasty (HAP) and internal fixation (IF), in old patients with femoral neck fracture. Thirty-eight out of 61 consecutive patients (62%) were delirious on admission to hospital or developed postoperative delirium. An increased risk of postoperative delirium was found among hip-fracture patients with dementia and/or depression. Delirious patients were hospitalized longer, were more dependent in their activities of daily living, had poorer psychological well-being and suffered more complications than non-delirious patients. A postoperative multi-factorial and multidisciplinary intervention program reduced the incidence, at 55% vs 75% (p=0.003), and number of days with delirium, 5 vs 10 days (p=0.009). Postoperative complications were also reduced; decubitus ulcers 9% vs 22% (p= 0.010), urinary tract infections 31% vs 51% (p=0.005), falls 12% vs 27% (p=0.007), and the mean hospitalization period was 10 days shorter in the intervention group (p=0.030). Malnutrition was common among all these patients (53 %) and associated with postoperative complications such as decubitus ulcers and delirium. However, the nutritional intervention had no effect on nutritional parameters at four months, nevertheless men had better nutritional outcomes than women. A higher proportion of patients with dementia operated on using HAP had regained their pre-fracture ability to walk independently at the one-year follow up compared with those operated on using IF. Six of 83 patients dislocated their HAP during hospitalization and during an episode of delirium, none had dementia. No difference in mortality between the surgical methods was seen. Dementia per se should not be a reason to disqualify patients from being treated with the most appropriate surgical method. It is clinically important to discriminate between dementia and delirium, since delirium can be prevented and treated even in patients with dementia. Old patients undergoing surgery have special needs that are not always catered for in ordinary orthopaedic or surgical wards. The special care for these patients should include: a combined nursing and medical care based on comprehensive geriatric assessments, systematic prevention, detection and treatment of postoperative complications such as delirium, hypoxemia, urinary tract infections, pain, malnutrition and an active rehabilitation. It is obvious that improved quality of care reduces patient suffering and seemingly the costs for society.

Im Beitrag werden Anwendungen aus dem Web2.0-Bereich, die besonders geeignet sind, bestimmte Behinderungsgruppen in ihrem Kommunikationsverhalten zu unterstützen, identifiziert und klassifiziert. In Verbindung mit der Betrachtung von möglichen Barrieren in diesen Web2.0-Anwendungen kann daraus abgeleitet werden, welche Anwendungen besonders kommunikationsunterstützend für bestimmte Behinderungsgruppen wirken und welche Maßnahmen zur Steigerung der Nutzungsraten getroffen werden sollten.

中文摘要 厚朴，採用厚朴植物之樹皮，是ㄧ種已知可應用於治療精神疾病的傳統天然藥物，例如：憂鬱症等。厚朴主要的有效多酚環成分已被證實具有抗氧化、抗發炎及抗興奮性毒殺等神經保護作用，因此，推測厚朴可作為一種潛在治療像是帕金森氏症這累神經退化性疾病之藥物。本研究之目的為探討厚朴是否可以預防與治療因百草枯及MPTP所誘導的毒害及學習、記憶和運動功能缺失等行為異常現象。本研究監測Oregon-R品系之果蠅(年齡：1-2, 20天或30天)之壽命在長期暴露於百草枯(5-20 mM)並先給予厚朴(100, 300或600 mg/L)治療之變化。其結果顯示，厚朴無法延長暴露在百草枯環境下之果蠅壽命。另外，我們給予雄性ICR小鼠(30-35 g)，連續五天，每日一劑MPTP(25 mg/kg, i.p.)，誘導神經毒性及行為異常現象。在共同投藥組別，在給予MPTP注射前一小時，先以灌餵方式給予小鼠厚朴(100或300 mg/kg)預防，連續五天後，只單獨給予厚朴治療連續十四天。後投藥組別，在給予最後一劑MPTP後，連續十四天給予厚朴(100或300 mg/kg).治療。在控制組別中，給予生理食鹽水(0.9%, i.p.)及灌餵玉米油。結果顯示，MPTP與厚朴並不影響小鼠之運動協調功能，然而，可利用新位置辨識能力測試及新物體辨識認知行為測試，檢測因MPTP所引起之認知功能障礙現象，由我們結果中顯示，不論是與MPTP共同給予厚朴治療抑或是後處理厚朴皆可恢復因MPTP所造成的認知功能障礙現象，此外，厚朴也可恢復因MPTP所造成多巴胺神經元及多巴胺轉運子受損之情形，另外，我們也初步發現，厚朴可在海馬迴中使Nrf2表現量提升。因此，初步結果表明，厚朴將可成為未來治療帕金森氏症之天然藥物。 / Cortex Magnoliae, the bark of Magnolia officinalis, has been prescribed in the traditional herbal medicine to treat a variety of mental disorders including depression. The main constituents of cortex Magnoliae contain the biphenyl compounds such as honokiol and magnolol. Both biphenyl compounds were shown to have the neuronal protective effect which is related to the anti-oxidation, anti-inflammation, and anti-excitatory toxicity. Thus, it was proposed that cortex Magnoliae may act as the potential therapeutic agent for the treatment of neurodegenerative disorders such as Parkinson’s disease (PD). The aim of the present study was to examine whether cortex Magnoliae exhibits the neuroprotective and therapeutic action against the neuronal toxicity and behavioral deficits in learning, memory, and motor function induced by neurotoxin paraquat and 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) in PD-like models. The lifespan of flies from Oregon-R strain of Drosophila melanogaster (age: 1-2, 20 or 30 days) chronically exposed to paraquat (5-20 mM) with pre-treatment of Cortex Magnoliae (100, 300 or 600 mg/L) were measured. Results showed that pre-treatment of Cortex Magnoliae could not extend the lifespan of the flies reduced by paraquat. On the other hand, male ICR mice (30-35g) were administered with MPTP (25 mg/kg, i.p.) once daily for 5 consecutive days to induce neurotoxicity and behavioral impairment. In co-treatment group, male mice were orally administrated with cortex Magnoliae (100 or 300 mg/kg) 1 hour before MPTP injection for 5 days and then followed by oral administration of cortex Magnoliae alone for consecutive 14 days. Mice in post-treatment group were orally administered with cortex Magnoliae (100 or 300 mg/kg) for consecutive 14 days after the final injection of MPTP. Mice in control group were injected with saline (0.9%, i.p.) and orally administrated with vehicle (corn oil). Our results showed that MPTP and cortex Magnoliae did not affect mouse coordination and balance in beam walking test. However, cortex Magnoliae improved the cognitive impairments determined by novel-location recognition task (NLRT) and novel-object recognition task (NORT) in MPTP-induced PD mouse. Additionally, cortex Magnoliae restored MPTP-induced loss of dopaminergic neurons and recovered MPTP-induced loss of dopamine transporters in striatum. Cortex Magnoliae also activated Nrf2 in hippocampus. Therefore, the preliminary results suggest that cortex Magnoliae may be a novel candidate for the treatment of Parkinson's disease in the future. The pharmacological mechanism of cortex Magnoliae in PD treatment needs further study.

Objective: To study awareness of cognitive dysfunction in patients with very mild Alzheimer’s disease (AD) and subjects with mild cognitive impairment (MCI). Methods: A complaint interview covering 13 cognitive domains was administered to 82 AD and 79 MCI patients and their caregivers. The patient groups were comparable according to age and education, and Mini Mental State Examination (MMSE) scores were ≥24 in all cases. The discrepancy between the patients’ and caregivers’ estimations of impairments was taken as a measure of anosognosia. Results: Self-reports of cognitive difficulties were comparable for AD and MCI patients. However, while in comparison to caregivers MCI patients reported significantly more cognitive impairment (p < 0.05), AD patients complained significantly less cognitive dysfunctions (p < 0.001). Conclusions: While most MCI patients tend to overestimate cognitive deficits when compared to their caregiver’s assessment, AD patients in early stages of disease underestimate cognitive dysfunctions. Anosognosia can thus be regarded as a characteristic symptom at a stage of very mild AD (MMSE ≥24) but not MCI. Accordingly, medical history even in mildly affected patients should always include information from both patient and caregiver. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Hensikt: Hensikten med studien var todelt. Den ene delen tok sikte på å belyse hvordan manved screeningkunne finne ut om personer med kognitiv svikt oppfyller helsekravene for fortsatt å kunne kjøre bil. Den andre delen så på ergoterapeutens rolle og kunnskapsgrunnlag i slike førerkortvurderinger. Metode:Tverrsnittsstudie hvor den ene delen varbygd på data fra 99 pasientjournaler med fokus på to nevropsykologiske tester(NorSDSA og UFOV)og en praktisk kjøretest(P-Drive). Den andre delen varbygd på data fra en webbasert spørreundersøkelse sendt ut til 1857 norske ergoterapeuter. Resultat:UFOV hadde signifikant korrelasjon med utfall i praktisk kjøretest, høy sensitivitet og høy PPV, slik at ved en ikke-godkjent UFOV er det grunn til å fortsette med praktisk kjøretest. NorSDSA hadde lav sensitivitet, men høy spesifisitet som indikerer atde som får godkjent på NorSDSA bør fortsette med en praktisk kjøretest.I praktisk kjøretest var det skår på kjørehandlingene «Løser problem, «Reaksjon» og «Oppmerksomhet mot venstre» som hadde størst sammenheng med resultatet av førerkortvurderingen. Det varfå ergoterapeuter i Norge som haddeførerkortvurderinger som sittarbeidsområde. Informantene i undersøkelsen opplevde at de kunne haen sentral rolle i å vurdere helsekravene for førerkort, men at de mangletbåde kunnskap, gyldige og pålitelige metoder og nasjonale retningslinjer for slike vurderinger. Konklusjon:Fra et folkehelseperspektiv, er utfordringentidlig å identifisere sjåfører med økt risiko, uten unødig begrense andre. Studien viser at det er behov for både å gjennomføre nevropsykologiske tester samt praktisk kjøretesti vurdering av helsekrav for personer med kognitiv svikt.Det er behov for mer forskning på området, og dessutenbehov for å utarbeide nasjonale retningslinjer.Ergoterapeutene oppfattet sinrolle i førerkortvurderinger som sentral med spesielt praktisk kjøretestsom et viktig bidrag. / Aim: The aim of thestudy was dual. First, itsought to determine whether individuals with cognitive impairments meet health requirements fordrivingsafety. Second, itexaminedthe role of occupational therapists and their knowledge of driver assessments. Method:For part 1, across-sectional study was applied, based partly on data from 99 patient records,focusing on two neuropsychological tests (NorSDSA and UFOV) and on-roaddriver performancetest(P-Drive). The second part wasbased on data from an online survey sent to 1.857 Norwegian occupational therapists. Result:UFOV had significant correlation with outcome in P-Drive, high sensitivity, and high PPV. A failed UFOV indicates a reason to continue with an on-roadtest. NorSDSA had low sensitivity but high specificity and high PPV. Passing NorSDSA indicates a reason to continue with an on-road test. The items in P-Drive that had the highest correlation with the result of the driving assessment were problem solving,reaction, and attention to the left.Few occupational therapists in Norway were involved in driving assessment. Survey participants felt that they might play a central role in assessing the health requirements for driving but lacked the knowledge, valid and reliable methods, and national guidelines for driving assessments. Conclusion: From a public health perspective, the challenge is to identify at-risk drivers as early as possible, without unnecessarily restricting other drivers. This study shows a need for conducting neuropsychological tests and for a practical driving test to assess people with cognitive impairment. This area requires further study, just as there is a need for national guidelines.Occupational therapists perceived a central role for them in driving assessment. They believed they could contribute most effectively through a driving test. / <p>ISBN 978-91-86739-50-8</p>

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The physiological state of menopause is characterized by an irreversible loss of ovarian function, with a resulting decrease in estrogen production, leading to the appearance of metabolic, cognitive, and behavioral alterations. For this reason, understanding how the decrease in the estrogen production contributes to the progress of menopausal symptoms can be very useful for the development of alternative therapies than hormone replacement therapy. In this context, the data show that ovariectomized Wistar rats treated with (PhSe)2 at a dose of 5 mg/kg once a day for 30 days presented lower plasma triglyceride levels and increased HDL levels when compared to control ones. Moreover, (PhSe)2 administration reduced the weight gain and fat abdominal accumulation induced by ovariectomy. It was also observed that (PhSe)2 treatment improved hepatic oxidative stress parameters in ovariectomized rats (ascorbic acid and reduced glutathione levels, and glutathione S-transferase and catalase activities). Additionally, (PhSe)2 treatment at a dose of 5 mg/kg once a day for 30 days improved the performance of ovariectomized Wistar rats in the Morris Water Maze test, possibly by inhibiting the increase in brain acetylcholinesterase activity induced by ovariectomy. The present results suggest a promising role of (PhSe)2 against the cognitive decline related to menopause. The transition to menopause is associated with an increased risk of depressed mood. On this bases, the obtained results demonstrate that the prolongation of immobility time in the tail suspension test and forced swimming test in ovariectomized mice submitted to subchronic stress protocol was prevented by (PhSe)2 treatment at a dose of 10 mg/kg. It was also found a possible involvement of the serotonin system in this effect, demonstrated by the modulation of 5-HT2A/2C and 5-HT3 receptor subtypes. Although (PhSe)2 had inhibited in vitro monoamine oxidase A and B activities, treatment of ovariectomized mice with (PhSe)2 did not alter neither MAO-A nor MAO-B ex vivo activity. These findings suggest that (PhSe)2 treatment could influence mood and behavior in postmenopausal women. In order to investigate a possible mechanism of action for the hypocholesterolemic effect of (PhSe)2 it was observed that (PhSe)2 treatment increases the LDL receptor levels and augment the adenosine monophosphate (AMP)-activated kinase (AMPK) activation state without inhibiting directly 3-hydroxy-3-methylglutaryl coenzyme A reductase (HMGR) enzyme activity in HepG2 cell cultures. These findings are in accordance with those from in vivo studies previously published. In addition, L6 skeletal muscle cells treated with (PhSe)2 presented an augment in glucose transporter 4 (GLUT4) translocation from the cytosol to the cell membrane via an increase in AMPK phosphorylation state, which could be linked to the hypoglycemic properties presented by (PhSe)2 in other studies. In conclusion, the body of evidence presented in this thesis points to the use of (PhSe)2 as a promising alternative therapy for the management of postmenopausal symptoms. However, it is important to mention that the global net effects of (PhSe)2 still need to be better described in order to identify possible negative side effects. / A menopausa caracteriza-se pela suspensão irreversível da função ovariana, com declínio da produção de hormônios estrogênicos. A falta desses hormônios culmina no aparecimento de alterações metabólicas, cognitivas e comportamentais. Por essa razão, entender de que maneira a depleção de hormônios ovarianos contribui para o surgimento dos sintomas característicos da menopausa pode ser extremamente útil para o desenvolvimento de tratamentos alternativos à terapia de reposição hormonal. Nesse contexto, os dados aqui apresentados demonstram que ratas Wistar ovariectomizadas que foram tratadas com disseleneto de difenila [(PhSe)2] na dose de 5 mg/kg uma vez ao dia durante um período de 30 dias possuíam reduzidos níveis plasmáticos de triglicerídeos e aumentados níveis de HDL quando comparadas as ratas controle não ovariectomizadas. Além disso, a administração de (PhSe)2 foi capaz de reduzir o ganho de peso e o acúmulo de gordura abdominal nas ratas ovariectomizadas. Também foi observado que o tratamento com (PhSe)2 melhorou parâmetros hepáticos relacionados a estresse oxidativo nas ratas ovariectomizadas (níveis de ácido ascórbico e glutationa reduzida (GSH) e atividade das enzimas glutationa S-transferase e catalase). O tratamento com (PhSe)2 na dose de 5 mg/kg uma vez ao dia durante um período de 30 dias também melhorou o desempenho das ratas Wistar ovariectomizadas no teste do Labirinto Aquático de Morris, possivelmente por impedir o aumento da atividade da enzima acetilcolinesterase cerebral observado nas ratas ovariectomizadas. Dessa forma, os resultados sugerem um possível efeito benéfico do (PhSe)2 para o tratamento do declínio cognitivo associado a menopausa. Ainda com relação aos sintomas apresentados pelas mulheres durante a menopausa, dados da literatura mostram que a transição para a menopausa associa-se a um risco aumentado para o aparecimento de sintomas do tipo depressivos. Com base nisso, foi evidenciado que fêmeas ovariectomizadas de camundongos Swiss submetidas a um protocolo de estresse sub-crônico apresentavam aumento no tempo de imobilidade nos testes de Suspensão da Cauda e do Nado Forçado, ambos preditivos de comportamento do tipo depressivo.Também foi observado que esse prolongamento no tempo de imobilidade apresentado pelas fêmeas ovariectomizadas foi prevenido pelo tratamento com (PhSe)2 na dose de 10 mg/kg administrado 30 minutos antes de cada exposição ao protocolo de estresse. Além disso, evidenciou-se o envolvimento dos receptores de serotonina do tipo 5-HT2A/2C e 5-HT3 no efeito do tipo antidepressivo apresentado pelo (PhSe)2. Embora o (PhSe)2 tenha inibido a atividade de ambas isoformas da enzima monoamino oxidase (MAO-A e MAO-B) in vitro, não foi observada inibição da atividade de tais enzimas quando sua atividade foi determinada ex vivo. Com base nesses resultados sugere-se que o tratamento com (PhSe)2 pode influenciar aspectos relacionados ao humor e ao comportamento em mulheres no período pós-menopausa. No intuito de elucidar os mecanismos envolvidos no efeito hipocolesterolêmico do (PhSe)2 em culturas de células HepG2 observou-se que este composto orgânico de selênio leva a um aumento nos níveis de receptores de LDL e a um aumento no estado de ativação da enzima adenosina monofosfato (AMP) quinase (AMPK), sem inibir diretamente a atividade da HMG-CoA redutase. Esses resultados corroboram com os achados de outros trabalhos, os quais demonstram um efeito hipocolesterolêmico do (PhSe)2 in vivo. Além disso, também foi buscado um possível mecanismo para o efeito hipoglicemiante apresentado pelo (PhSe)2 em trabalhos anteriores: resultados obtidos a partir de culturas de células L6 (células de músculo esquelético de ratos), sugerem que o (PhSe)2 aumenta a translocação do transportador de glicose 4 (GLUT4) do citosol para a membrana celular devido a um aumento no estado de ativação da enzima AMPK. Em conclusão, o conjunto de resultados apresentado nesta tese aponta o uso do (PhSe)2 como uma terapia alternativa bastante promissora para o tratamento de algumas das principais conseqüências da menopausa, a saber aumento no ganho de peso, dislipidemia, prejuízos cognitivos e ocorrência de episódios depressivos. Entretanto, faz-se importante mencionar que os efeitos globais do (PhSe)2 ainda precisam ser melhor caracterizados no intuito de verificar a existência de possíveis efeitos adversos.

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Retinal nerve fiber layer measurement in patients with Alzheimer's disease The current ophthalmologist's possibilities in diagnostics of Alzheimer's disease Alzheimer disease (AD) is the most common cause of dementia syndrome and mild cognitive impairment. To enroll the disease most securely there are used so called biomarkers using evidence of changed brain metabolism by pozitron emission tomography (PET) and in cerebrospinal fluid or the brain's structure magnetic resonance imaging (MRI). These methods are expensive, organisationally and temporally challenging and burdening for the patients. According to that reasons we are still seeking for alternative attitudes suitable for early diagnosis. The evaluation of thickness of retinal nerve fiber layer (RNFL) which is well accessible to examination through optical aparatus of the eye could be one of the options. The aim of our work was to present current knowledges about Alzheimer's disease targeting relations of Alzheimer's disease and an ophthalmological finding. In the next part of this paper we introduce the retinal nerve fiber layer measurement by optical coherence tomography (OCT) as a potential diagnostics method by screening of patients with Alzheimer's disease and to present our results measured in our cohort of patients. The studied cohort...

Depressive disorder is the most widespread psychological illness and is responsible for the disability of many. However, this disease is not only a pathological change of mood, current research shows that depression can also be connected with a cognitive impairment, a pathological changes in optimal functioning. This impairment can not only deepen the illness but as well worsen work and personal life of a patient. This paper aims on presenting the basics of the disease, its causes, and the ways in which depression and cognitive deficits are currently treated. Since the research is carried out in an intercultural context, the studied cultures of the Czech Republic and Mexico are presented in the context of current theories. The intecultural research examines the cognitive deficit of depressed patients. The results of depth of depression, neuropsychological tests, and tests evaluating rumination are compared interculturally. There were no important statistically significant differences found between the two cultures. On the other hand, the results show some impairment in cognitive functioning in depressive patients. Keywords: depression cognitive functions cognitive impairment ruminations intercultural comparison study Mexico Czech republic