Les modifications de la morphologie du cortex cérébral induites par la maladie d'Alzheimer à ses stades précoces contribuent à l'intérêt croissant à l'égard des biomarqueurs de la morphologie corticale. Ceux-ci permettraient notamment une meilleure compréhension de l'impact de cette pathologie sur l'anatomie cérébrale et une détection plus précoce de la maladie. L'originalité de notre travail par rapport au reste de la littérature est de s'intéresser à la morphologie des surfaces interne (interface substance blanche / substance grise) et externe (interface substance grise / liquide cérébro-spinal) du cortex cérébral. Dans cette perspective, nous avons développé des méthodes d'estimation de la courbure et de la dimension fractale des surfaces corticales. A partir de ces biomarqueurs morphologiques et de l'épaisseur corticale dont la méthode d'estimation a été précédemment développée dans le laboratoire, nous avons exploré l'impact de la maladie d'Alzheimer sur la morphologie du manteau cortical et nous avons évalué leur apport individuel et celui de leur association au diagnostic précoce de la maladie. Nos résultats montrent une influence significative de la pathologie sur la morphologie des sillons et sur celle des circonvolutions des surfaces corticales interne et externe. En termes d'application diagnostique, nous montrons que prises isolément, l'épaisseur corticale présente une meilleure capacité prédictive que la courbure corticale, nous ne constatons en revanche aucune capacité prédictive de la dimension fractale. Par contre, nous montrons que l'utilisation conjointe de l'épaisseur corticale et de la courbure permet une amélioration significative du diagnostic précoce. / Morphological alterations of the cortical mantle in early stage of Alzheimer's disease have led to an increasing interest towards morphological biomarkers of the cerebral cortex. By providing a quantitative measure of the cortical shape, morphological biomarkers could provide better understanding of the impact of the disease on the cortical anatomy and play a role in early diagnosis. Therefore, as a primary goal in this study, we developed cortical surface curvature and fractal dimension estimation methods. We then applied those methods, together with the estimation of cortical thickness, to investigate the impact of Alzheimer's disease on the cortical shape as well as the contribution of cortical thickness and cortical curvature to the early diagnosis of Alzheimer's disease. The originality of this work lies in the estimation of sulcal and gyral curvature of the internal (gray matter/white matter boundary) and external (gray matter/cerebrospinal fluid boundary) cortical surfaces in addition to the fractal dimensions of these boundaries. Our results showed significant impact of Alzheimer's disease on sulcal and gyral shapes of the internal and external cortical surfaces. In addition, cortical thickness was found to have better ability than cortical curvature for the early diagnosis of Alzheimer's disease; no significant ability for the early diagnosis was found using fractal dimension. However, we found significant improvement in early diagnosis by combining cortical thickness and cortical curvature.

Submitted by Alison Vanceto (alison-vanceto@hotmail.com) on 2017-06-08T11:55:52Z No. of bitstreams: 1 DissFAAM.pdf: 2168613 bytes, checksum: c80ea0c2ce14ed6b12536e4420bd312e (MD5) / Approved for entry into archive by Ronildo Prado (ronisp@ufscar.br) on 2017-06-13T18:03:42Z (GMT) No. of bitstreams: 1 DissFAAM.pdf: 2168613 bytes, checksum: c80ea0c2ce14ed6b12536e4420bd312e (MD5) / Approved for entry into archive by Ronildo Prado (ronisp@ufscar.br) on 2017-06-13T18:03:48Z (GMT) No. of bitstreams: 1 DissFAAM.pdf: 2168613 bytes, checksum: c80ea0c2ce14ed6b12536e4420bd312e (MD5) / Made available in DSpace on 2017-06-13T18:12:18Z (GMT). No. of bitstreams: 1 DissFAAM.pdf: 2168613 bytes, checksum: c80ea0c2ce14ed6b12536e4420bd312e (MD5) Previous issue date: 2017-02-23 / Outra / Background: Little is known about how the change in walking speed in longitudinal studies can predict the occurrence of falls in older adults with mild cognitive impairment. Objetives: To identify if there are differences in the gait speed of Cognitively Preserved (CPr) elderly persons, elderly persons with Mild Cognitive Impairment (MCI) and with Alzheimer`s Disease (AD) in mild stage, in a 6-month period. To verify if the change in the gait speed (ΔGS= Final Gait speed – Initial Gait speed) predicts the occurrence of falls in elderly with MCI and AD in mild stage. Methods: 110 elderly people participated in the study. Out of these: 40 with CPr, 36 with MCI and 34 with AD in the mild stage. Initially the 10-meter walk test was applied and a fall schedule was given. A 6-month follow-up was carried out, by means of monthly telephone calls to the volunteers and the filling of a fall schedule. After six months, the 10-meter walk test was applied and the fall schedule was retrieved. Results: The MCI and AD groups of elderly in mild stage presented lower gait speed compared to the elderly in the CPr group at the two assessment moments. There was no significant difference in delta gait speed amongst the groups. In the age-adjusted univariate logistic regression analysis, the delta failed to predict falls in the elderly with MCI or in elderly with AD. Conclusion: Older adults with MCI and AD in the mild stage were identified as having lower gait speed compared to CPr sujeitos. Changing in the gait speed over a six-month period does not predict the occurrence of falls in elderly with MCI or AD in mild stage. / Contextualização: Pouco se tem conhecimento sobre como a mudança da velocidade da marcha em estudos longitudinais, pode predizer a ocorrência de quedas em idosos com comprometimento cognitivo em estágios iniciais. Objetivos: a) identificar se há diferenças na velocidade da marcha entre idosos preservados cognitivamente (PrC) com transtorno neurocognitivo leve (TNL) e com doença de Alzheimer (DA) na fase leve ao longo de seis meses; b) Verificar se a mudança da velocidade da marcha (ΔVM= velocidade final - velocidade inicial) prediz a ocorrências de quedas em idosos com TNL e DA nesse período. Método: Participaram do estudo 110 idosos. Destes 40 PrC, 36 com TNL e 34 com DA. Inicialmente foi aplicado o teste de caminhada de 10 metros e entregue um calendário de quedas. Realizou-se um seguimento de seis meses por meio de ligações mensais para os voluntários e preenchimento do calendário de quedas. Após seis meses, aplicou-se novamente o teste de caminhada e o calendário de quedas foi resgatado. Resultados: Os idosos dos grupos com TNL e com DA apresentaram velocidades de marcha menor quando comparados com os idosos do grupo PrC, nos dois momentos de avaliação (p<0,001). Não houve diferença significativa no delta da velocidade da marcha entre os grupos (p=0,063). Na análise de regressão logística univariada, ajustado para idade, o ΔVM não conseguiu predizer quedas em idosos com TNL (p=0,185) nem em idosos com DA (p=0,232). Conclusão: Identificou-se que os idosos com TNL e DA na fase leve tem velocidades da marcha menores quando comparados com idosos PrC. A mudança da velocidade da marcha em um período de seis meses não prediz a ocorrência de quedas em idosos com TNL, nem idosos com DA na fase leve.

Submitted by Aelson Maciera (aelsoncm@terra.com.br) on 2017-06-26T17:52:34Z No. of bitstreams: 1 TeseJHA.pdf: 1814260 bytes, checksum: 140f576789c3cbb7e3aa416fc5dc4416 (MD5) / Approved for entry into archive by Ronildo Prado (ronisp@ufscar.br) on 2017-06-27T19:44:07Z (GMT) No. of bitstreams: 1 TeseJHA.pdf: 1814260 bytes, checksum: 140f576789c3cbb7e3aa416fc5dc4416 (MD5) / Approved for entry into archive by Ronildo Prado (ronisp@ufscar.br) on 2017-06-27T19:45:05Z (GMT) No. of bitstreams: 1 TeseJHA.pdf: 1814260 bytes, checksum: 140f576789c3cbb7e3aa416fc5dc4416 (MD5) / Made available in DSpace on 2017-06-27T19:52:05Z (GMT). No. of bitstreams: 1 TeseJHA.pdf: 1814260 bytes, checksum: 140f576789c3cbb7e3aa416fc5dc4416 (MD5) Previous issue date: 2017-03-28 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Introduction: Recent studies reported mobility deficits and higher prevalence of falls in older people with cognitive impairment, even in mild stages of impairment. However, differences in mobility during simple and dual task situations between older people with preserved cognition (PC), mild cognitive impairment (MCI) and Alzheimer’s disease (AD) (mild stage) are still not clear. Sophisticated mobility tools and dual task activities with new, functional and challenging secondary tasks could be effective in identifying subtle motor changes. Moreover, a better understanding about the relationship between cognitive and motor changes and the fall risk factors in older people with MCI and AD could provide new knowledge about the physiopathology of MCI and AD and could help in better planning of screening, prevention and interventions of falls, MCI and AD. Objective: to analyze mobility, functional dual task and falls in older people with PC, MCI and mild AD. Method: The sample was composed by 40 community-dwelling older people with PC, 40 MCI and 38 mild AD. All volunteers performed an assessment, including anamneses, history of falls in the past year, cognition (Addenbrooke’s cognitive Examination-revised version and Frontal Assessment Battery), dual task (Timed up and go test-TUG associated with the motor-cognitive task of calling a phone number) and functional mobility (10-meter walk test and TUG). The TUG phases (sit-to-stand, walking forward, turn, walking back and turn-to-sit) were assessed using a system of movement analysis (Qualisys motion system). Still, the occurrence of falls was collected prospectively in a 6-month follow up using falls calendar and monthly calls in older people with MCI and AD. Sociodemographic and clinical, level of physical activity, functional status, functional mobility, cognitive and depressive variables were analyzed as potential fall risk factors. For statistical analysis, a significance level of α=0.05 was adopted and the SPSS software was used (20.0). Results: Older people with cognitive impairment (MCI and mild AD) presented more falls (retrospective data) compared to people with PC, and specific characteristics (place, consequences) about history of falls between groups were identified. Regarding dual task and 10-meter walk tests, only measures of dual task test distinguished older people with mild AD from PC and MCI and no measure could differ MCI and PC groups. In relation to functional mobility (kinematic data), all TUG phases could differentiate older people with AD from PC, except the sit-to-stand phase. The walking forward phase differed older people with PC from MCI, specifically on range of motion variables during stance phase. The walking back, turn and turn-to-sit phases distinguished older subjects with AD from MCI. Regarding the association between cognitive domains and mobility, different cognitive domains predicted the 10-meter walk test and the isolated cognitive-motor task measures among groups. The visuospatial domain was independently associated with TUG (total time) in MCI and AD groups and with the dual task test in all three groups. No significant associations were found between the walking TUG phases and cognitive domains in any group. However, executive function deficits was associated with impairments of transition TUG phases in the three groups. The visuospatial domain was identified as an independent predictor of turn-to-walk and turn-to-sit measures in the AD Group. During the 6-month follow-up, 52,6% of MCI people and 51,4% of AD people fell at least once. After multivariate analysis, the dual task test and the turn-to-sit phase were able to independently predict falls in older people with MCI and AD, respectively. Conclusion: The dual task test used was able to distinguish older people with AD from PC and MCI. The analysis of transition and also the walking TUGT phases separately is essential in the identification of mobility patterns among cognitive profiles of older people. Still, the findings demonstrate the importance of considering the influence of specific cognitive domains in daily mobility tasks in order to improve rehabilitation and prevention of cognitive and mobility disturbances. The prediction of visuospatial domain on postural transition tasks may provide insight into why people with AD have an elevated fall risk. The modifiable fall risk factors found can be used to detect risk of falls, as well as improving interventions for preventing falls in older adults with MCI and AD, with focus on exercises involving dual task and transition postural activities. / Introdução: Estudos recentes identificaram prejuízos em tarefas de mobilidade e maior prevalência de quedas em idosos com comprometimento cognitivo, mesmo em estágios leves. Porém, as diferenças na mobilidade em situações simples e de dupla tarefa entre idosos preservados cognitivamente (PC), com comprometimento cognitivo leve (CCL) e doença de Alzheimer (DA) na fase leve ainda não são claras. Nesse sentido, instrumentos sofisticados que avaliem a mobilidade e atividades de dupla tarefa com tarefas secundárias funcionais e desafiadoras podem ser sensíveis para identificar pequenas mudanças motoras. Ainda, um melhor entendimento da relação existente entre as alterações cognitivas e motoras e os fatores de risco a quedas em idosos com CCL e DA forneceriam novos conhecimentos dos distúrbios e poderiam auxiliar em melhoras no planejamento do rastreio e tratamento de CCL, DA e quedas em idosos. Objetivo: Analisar a mobilidade, dupla tarefa funcional e quedas em idosos preservados cognitivamente, com CCL e DA na fase leve. Método: A amostra foi composta por 40 idosos da comunidade PC, 40 CCL e 38 DA na fase leve. Todos os sujeitos participaram de uma avaliação, com os seguintes itens: anamnese, histórico de quedas no último ano, cognição (Bateria de Avaliação Frontal e Exame Cognitivo de Addenbrooke-versão revisada), dupla tarefa (teste Timed up and go-TUG associado à tarefa cognitivo-motora de discar um número de telefone) e mobilidade funcional (teste de velocidade de marcha de 10 metros e teste TUG). As fases do teste TUG levantar-se, marcha ida, retornar, marcha volta e virar-se para sentar foram avaliadas a partir do sistema de análise de movimento Qualisys motion system. Ainda, a ocorrência de quedas foi coletada ao longo de seis meses por meio de calendário e telefonemas mensais nos Grupos CCL e DA. Variáveis sociodemográficas e clínicas, gasto calórico semanal, status funcional, mobilidade funcional, cognição e depressão foram analisadas como potenciais fatores de risco para quedas. Para análise estatística, adotouse um nível de significância de α = 0,05 e utilizou-se o software SPSS (20.0). Resultados: Os idosos com distúrbio cognitivo (CCL e DA leve) apresentaram mais quedas (dados retrospectivos) quando comparados a idosos PC, e características específicas das quedas (local, consequências) entre os grupos foram identificadas. Quanto aos testes de dupla tarefa e velocidade de marcha, somente medidas do teste de dupla tarefa distinguiram idosos com DA leve de PC e CCL e nenhuma medida conseguiu diferir os grupos CCL e PC. Em relação à mobilidade funcional (dados cinemáticos), todas as fases do TUG conseguiram diferenciar idosos com DA de PC, exceto a fase levantar-se. A fase marcha ida diferiu idosos PC de CCL, especificamente em variáveis de amplitude de movimento durante a fase de apoio da marcha. As fases marcha volta, retornar e virar-se para sentar diferiram idosos com DA de CCL. A respeito da associação entre domínios cognitivos e mobilidade, diferentes domínios cognitivos previram as medidas dos testes velocidade de marcha de 10 metros e tarefa cognitivo-motora isolada entre os grupos estudados. O domínio visuo-espacial foi independentemente associado com o TUG (tempo total) nos grupos CCL e DA e com o teste de dupla tarefa nos três grupos. Não houve associação significativa entre as fases de marcha do TUG e os domínios cognitivos em nenhum grupo. No entanto, déficit nas funções executivas foi associado com prejuízo nas fases de transição do TUG nos três grupos. O domínio visuo-espacial foi identificado como um preditor independente das medidas das fases retornar e virar-se para sentar no Grupo DA. Durante o seguimento de seis meses, 52,6% das pessoas com CCL e 51,4% de DA caíram. Após análise multivariada, o teste de dupla tarefa e a fase virar-se para sentar do TUG foram capazes de predizer quedas de forma independente em idosos com CCL e DA leve, respectivamente. Conclusão: O teste de dupla tarefa utilizado foi capaz de distinguir idosos com DA de PC e CCL. Não somente as fases de transição do TUG, como também as análises das fases de marcha separadamente, são essenciais na diferenciação dos padrões de mobilidade entre perfis cognitivos de idosos. Ainda, os achados demonstram a importância de considerar a influência de domínios cognitivos específicos em tarefas de mobilidade do dia a dia a fim de melhorar o rastreio e a reabilitação de distúrbios cognitivos e de mobilidade. A predição do domínio visuoespacial em tarefas de transição postural pode fornecer novas informações sobre os motivos do maior risco de quedas em DA. Os fatores de risco modificáveis encontrados no trabalho podem ser usados para detectar o risco de quedas, assim como melhorar intervenções para prevenir quedas em idosos com CCL e DA, com o enfoque em exercícios envolvendo atividades de dupla tarefa e de transição postural.

Cognitive impairment is considered as essential feature of non-motor symptoms in Parkinson's disease (PD). It is a result of underlying pathological processes in the brain of PD patients and it leads to decreased quality of life. In this thesis an analysis of the structure and profile of cognitive impairment is presented with special emphasis on executive functions and memory. We take diagnostic entities developed for the description of PD cognitive spectrum such as mild cognitive impairment (PD-MCI) and dementia (PD-D) as examples of heterogeneity and different severity of cognitive impairment in PD. However, neuropsychological methods in Czech version that would measure these diagnotic units were not adequatly validated. In the experimental part we test a hypothesis, if gait disorder with falls in PD is interconnected with cognitive impairment, and if PD-fallers have more severe cognitive deficit than PD-non-fallers. On the basis of nine validity or normative data studies we show psychometric properties and clinical utility of several basic neuropsychological methods in the Czech population for memory (Rey Auditory Verbal Learning Test, California Verbal Learning Test, Second Edition, Memory For Intentions Screening Test and Enhanced Cued Recall Test), sustained attention and executive functions...

Neuropsychological aspects of preclinical stages of neurodegenerative diseases are an extensively studied topic in neuropsychological research. Neuropsychological assessment can be helpful for the estimation of conversion risk in individual cases. The focus of neuropsychological research shifted from the evaluation of dementia to mild cognitive impairment (MCI) or even to the detection of cognitive change before significant cognitive decline. In the theoretical part is presented a contemporary outline of preclinical stages of neurodegenerative diseases. The construct of MCI is the most studied topic in the prodromal stage of neurodegeneration and this part is dedicated to comprehensive analysis of MCI. The empirical research includes five studies on screening methods of cognitive abilities, memory and verbal fluency tests. We present normative and validity data in older adults and show their detection potential in MCI or preclinical stages of neurodegenerative diseases. Furthermore, we tried to show the detection potential of different memory measures in patients with MCI and estimate the relations between hippocampal atrophy and memory performance. Key words mild cognitive impairment, dementia syndrome, Alzheimer's Disease, neuropsychological assessment, diagnostic procedures

Gait and balance disorders and the resulting falls are a substantial part of Parkinson's disease (PD) and other movement disorders. Especially in the late stage of PD more than 80 % of the patients fall. History of falls remains the best predictor of falls nonetheless, but it can not be used in falls prevention. Dopaminergic pharmacotherapy improves postural stability and gait in PD only in the early stage and the dopaminergic responsiveness of these symptoms decreases significantly during the disease progression. The impact of this medication on future falls risk remains still unclear. The connection between balance and gait disorders and cognitive impairment in PD is also not fully understood. The current state of knowledge about gait and balance disorders and cognitive impairment in PD is not satisfactory. Therefore the aims of the experimental part of this thesis were prospective monitoring of risk factors and predictors of falls, observation of the impact of dopaminergic medication on future falls risk and verifying the relationship between gait and balance disorders and cognitive impairment in PD. The fourth aim of the thesis was to specify the type and severity of gait and balance disorders in patients with essential tremor (ET). Although ET is one of the most common neurological disorders,...

This diploma thesis explores problematic areas of patients with Huntington's disease in their performance during activities of daily living (ADLs) from the perspective of patients and their caregivers. The aim of the research was also to assess a possible correlation between cognitive impairment and the patient's performance in ADL. Twenty-five patients with their caregivers met the selection criteria for the research. There were used standardized assessment methods available in Czech: the Montreal Cognitive Assessment (MoCA), the Canadian Occupational Performance Measure (COPM) and the questionnaire for caregivers called Bristol Activities of Daily Living Scale (BADLS-CZ). The statistical analyses consisted of methods of the nonparametric statistics, qualitative analysis was processed by data categorizing. Caregivers reported more problematic areas in ADLs which was significantly confirmed in the statistical hypothesis testing (p <0,05). A significant correlation was seen between the results of the questionnaire and the results of the MoCA assessment (rSp = -0,620; p <0,05). For various reasons, patients with Huntington's disease did not mention as many problematic areas in performing ADL as their caregivers. Therefore, it is appropriate in clinical practice to supplement the assessment of the patient's...

Aumento das concentrações de cortisol em idosos com Doença de Alzheimer (DA) tem sido relatado como resultado da ausência de inibição do eixo hipotálamo-pituitária-adrenal (HPA) em decorrência da disfunção hipocampal observada nestes indivíduos. Além disso, associação entre concentrações elevadas de cortisol e comprometimento da memória tem sido evidenciada em idosos saudáveis. Entretanto, pouco se sabe a respeito do envolvimento do estresse nas concentrações de cortisol, no desempenho cognitivo e nas estratégias de coping tanto em idosos saudáveis como naqueles com comprometimento cognitivo leve (CCL) e DA. Assim, este estudo teve o objetivo de investigar a associação entre intensidade de estresse, concentrações de cortisol, estratégias de coping e desempenho cognitivo em idosos saudáveis, com CCL e DA. Para isto, concentrações basais de cortisol salivar foram analisadas em uma amostra composta por 40 idosos saudáveis, 31 idosos com CCL amnéstico e 40 indivíduos com DA leve. O desempenho cognitivo global foi avaliado a partir do mini-exame do estado mental (MEEM), o desempenho da memória através da Bateria Breve de Avaliação Cognitiva (BBAC) e pelo teste de extensão de dígitos na ordem inversa. A intensidade do estresse foi avaliada a partir da Lista de Sintomas de Stress (LSS) e as estratégias de coping através da Escala de Coping de Jalowiec (ECJ). Desta forma, foram observadas concentrações de cortisol marginalmente mais elevadas nos idosos com DA do que nos idosos saudáveis (p = 0.062). Além disso, verificou-se associação positiva entre cortisol e desempenho da memória nos idosos saudáveis (p = 0.008), enquanto correlação negativa entre estas variáveis foi observada no grupo CCL (p = 0.011). Não foi verificada associação significativa nos idosos com DA (p > 0.05). Ademais, observou-se correlação positiva entre as concentrações de cortisol e a intensidade de estresse somente nos idosos com CCL (p = 0.056). Com relação às estratégias de enfrentamento, observou-se que os idosos com CCL que elegem o coping focado no problema apresentam intensidade de estresse menor que os idosos que utilizam o coping focado na emoção (p = 0.048). Estes resultados sugerem que a associação entre concentrações de cortisol, desempenho da memória, intensidade de estresse e coping varia em função da presença ou ausência de comprometimento cognitivo e da percepção das limitações cognitivas / Increased cortisol levels have been reported in elderly with Alzheimers disease (AD) as a result of the lack in the hypothalamic-pituitary-adrenal (HPA) axis inhibition as a function of hipocampal atrophy observed in those subjects. Moreover, association between high cortisol levels and memory impairment has been demonstrated in healthy elderly subjects. However, little is known about the stress involvement in the cortisol levels, in the cognitive performance and in the coping strategies in both elderly with mild cognitive impairment (MCI) and with AD. Thus, this study aimed to investigate the association between stress intensity, cortisol levels, coping strategies and cognitive performance in healthy elderly, subjects with CCL and with DA. Basal salivary cortisol was measured in a sample composed of 40 healthy elderly subjects, 31 individuals with amnestic MCI and 40 subjects with mild AD. Global cognitive performance was evaluated with the Mini Mental State Exam (MMSE) and memory performance was assessed with the Brief Cognitive Screening Battery (BCSB) and the backward digit span test. Stress intensity was evaluated with the Stress Symptoms List (SSL) and coping strategies with the Jalowiec Coping Scale (JCS). Marginally higher cortisol levels were observed in the subjects with AD group in comparison with healthy elderly (p = 0.062). Furthermore, positive association between cortisol levels and memory performance was observed in the healthy elderly (p = 0.008) while negative correlation was observed between these variables in the MCI group (p = 0.011). No significant association was exhibited in the AD group (p > 0.05). Moreover, positive correlation between cortisol levels and stress intensity was observed only in the MCI group (p = 0.056). Regarding the coping strategies, it was observed that those MCI subjects who elect problem focused coping exhibit higher stress intensity than those MCI who use emotion focused coping (p = 0.048). These results suggest the association between cortisol levels, memory performance, stress intensity and coping strategies may vary as a function of the presence or absence of cognitive impairment and as a function of the cognitive deficits awareness

Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-10-18T10:59:05Z No. of bitstreams: 1 simoneaparecidadelima.pdf: 11944336 bytes, checksum: 0e1ac41a19e092727ed00321ff4ebca2 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-10-25T12:06:26Z (GMT) No. of bitstreams: 1 simoneaparecidadelima.pdf: 11944336 bytes, checksum: 0e1ac41a19e092727ed00321ff4ebca2 (MD5) / Made available in DSpace on 2016-10-25T12:06:26Z (GMT). No. of bitstreams: 1 simoneaparecidadelima.pdf: 11944336 bytes, checksum: 0e1ac41a19e092727ed00321ff4ebca2 (MD5) Previous issue date: 2008-08-29 / O envelhecimento populacional é hoje um fenômeno universal. O aumento da população idosa se associa com maior prevalência dos quadros de demência. O Brasil possui um percentual de 9,6% de idosos e a demência se coloca como uma das maiores causas de morbidade nesta faixa etária, com prevalência estimada entre 2% e 25% dos pacientes com 65 anos ou mais. Paralelamente ao declínio cognitivo que acontece com o envelhecimento, constata-se uma maior incidência de doenças crônicas não transmissíveis nos idosos. As maiores incidências destas doenças são: a doença renal crônica, o diabetes e a hipertensão A doença renal crônica (DRC) tem apresentado uma crescente prevalência, tornando-se um problema de relevância mundial e verifica-se um aumento progressivo da média de idade da população de pacientes em terapia renal substitutiva. A depressão e o declínio cognitivo constituem duas das enfermidades mais prevalentes em geriatria. Com freqüência se associam ou até mesmo, uma pode simular a outra, o que ocasiona grandes dificuldades diagnósticas A depressão é extremamente comum em pacientes portadores de doença renal crônica, mas suas causas são desconhecidas. O presente trabalho tem como objetivo avaliar a função cognitiva, depressão e qualidade de vida em pacientes de diferentes da doença renal crônica. / Population aging is today an universal phenomenon. The increase of the elderly population is associated with larger prevalence of dementia. Elderly people constitute 9,6% of all Brazilians and dementia is one of the most prevalent morbidity, with estimated prevalence of 2% to 25% ou ranging from 2% to 25% in those aged 65 years or more. Parallel to the cognitive impairment that happens with the aging, we verify a higher incidence of non transmissible chronic diseases, such as chronic kidney disease (CKD), hypertension, and diabetes mellitus. Of particular interest is CKD, since its prevalence is increasing worldwide, it is considered a world health problem, its diagnosis among the elderly population is very high, what explains the high mean age of patients in renal replacement therapy. The depression and the cognitive impairment constitute two of the most prevalent diseases in geriatrics. It is not uncommon that they come together, and sometimes, one simulates the other, what makes the diagnosis very difficult. Depression is quite common among patients with CKD, but its causes are still not known. In this study, we aim to assess the cognitive function ,depression and life quality in patients of different from the chronic renal disease.

INTRODUÇÃO: O comprometimento cognitivo leve tem sido estudado em tarefas de linguagem com alta demanda cognitiva. Análises com base em compreensão de textos que exigem realização de inferências são recentes. Este estudo teve como objetivo verificar o desempenho de sujeitos com comprometimento cognitivo leve em tarefas de compreensão textual que necessitem da realização de inferências e compara-lo ao desempenho de sujeitos normais. MÉTODOS: Foram avaliados 60 sujeitos com idade entre 60 e 89 anos, de ambos os sexos. Os sujeitos foram divididos em dois grupos, sendo 30 sujeitos normais e 30 sujeitos com comprometimento cognitivo leve e pareados por faixa de escolaridade (até 4 anos, de 4 a 8 anos e acima de 9 anos). O instrumento utilizado foi a versão em português do teste do \"Gerenciamento do Implícito\" que utiliza cinco tipos distintos de inferências (explícitas, lógicas, pragmáticas, distratoras e outras). Foi avaliado o raciocínio inferencial ao fornecer a resposta de 60 questões referentes à leitura de 20 textos pequenos e comparado o desempenho entre os grupos. RESULTADOS: O grupo de sujeitos com comprometimento cognitivo leve mostrou desempenho significativamente menor na realização de inferências do tipo pragmáticas do que o grupo de sujeitos normais. Para os demais tipos de inferências não houve diferença estatística. CONCLUSÃO: Sujeitos com comprometimento cognitivo leve apresentam pior desempenho na realização de inferências do tipo pragmáticas. A semelhança no desempenho entre os grupos para realizar as demais inferências reforça a preservação de aspectos linguístico-cognitivos no comprometimento cognitivo leve. Os resultados confirmam a possibilidade de diferenciar sujeitos com comprometimento cognitivo leve e normais por meio de testes de linguagem / INTRODUCTION: The mild cognitive impairment has been studied in language tasks with high cognitive demand. Analyses based on comprehension of texts that require carrying out inferences are recent. This study aimed to verify the performance of subjects with mild cognitive impairment in textual comprehension tasks that require carrying out inferences and compares it to the performance of normal subjects. METHODS: We evaluated 60 subjects aged between 60 and 89 years, of both sexes. The subjects were divided into two groups, 30 normal subjects and 30 subjects with mild cognitive impairment, matched for education (up to 4 years, 4-8 years and over 9 years). The instrument used was the Portuguese version of the test of \"Managing the implied\" that uses five distinct types of inferences (explicit, logical, pragmatic, distracting and other). We evaluated the inferential reasoning to provide the answer 60 questions about reading 20 small texts and compared the performance between groups. RESULTS: The mild cognitive impairment group showed significantly lower performance in the type inferences pragmatic than the group of normal subjects. For other types of inferences there was statistical difference. CONCLUSION: The group with mild cognitive impairment showed worse performance in carrying out pragmatic type inferences. The similarity in performance between the groups to perform the other inferences demonstrates the preservation of linguistic-cognitive aspects in mild cognitive impairment. The results confirm the possibility of differentiating subjects with mild cognitive impairment and normal through language tests