Doctoral thesis deals with dementia, which social, health and economic impacts are alarming worldwide. Expected dramatic increase in the number of people with cognitive impairment will put high demands on health and social care. Population aging and the increase of elderly persons aged 65+ evoked a need to address this issue, since age is the major risk factor for dementia. Conflicting conclusions of the European and international studies confirm the difficulty of quantifying the disease. Different definitions and measurement methods lead to different results. In the Czech Republic, in comparison with other developed European countries, there is no relevant research on the expected increase in the number of people with dementia or trends and determinants of severe cognitive impairment. Available estimates of the prevalence of dementia in the Czech Republic are based exclusively on the international prevalence studies EURODEM and Eurocode. Dissertation provides an estimate of the number of people with dementia in the Czech Republic to 2050 based on the construction of life tables for demented people. The thesis also includes analysis of risk factors of severe cognitive impairment based on socio-demographic and health variables. This knowledge is very important for the development and maintenance of effective policies and programs responsive to the needs of individuals living with cognitive impairment in the Czech Republic.

Traumatic brain injury (TBI) is a multi-faceted disease that affects individuals on physical, cognitive and emotional levels. The specific aims of this research are to explore the prevalence of depression and the relationship between depression, neuropsychological performance and clinical variables in a cohort with TBI. This is accomplished through the retrospective review of 75 neuropsychological reports containing information on clinical variables, performance on neuropsychological measures and Beck Depression Inventory- Second Edition (BDI-II) scores of individuals who had sustained a TBI. The neuropsychological domains assessed via the standardized neuropsychological measures were the domains of attention, concentration, memory, learning, non-verbal and abstract reasoning, manual dexterity, verbal recall, working memory, perception, psychomotor performance, incidental learning, concept formation and verbal fluency. These results were statistically analysed to determine relationships with depression and clinical variables. The investigations undertaken in this study signified particularly pertinent relationships in the interactions among the variables of interest. Higher education level was found to be extremely critical in assisting retention of cognitive abilities following a TBI. Primary language was also a significant differentiator of performance among tests. Age had contrasting effects, with increasing age being favourable on the Similarities Test and related to poorer performance on the Letter Cancellation Test. Increasing GCS scores were related to slower performance on the Letter Cancellation Test and decreased performance on the RAVLT Free Recall Test. Longer PTA duration was related to worse performance on the Matrix Reasoning Test. These results indicate that these indicators of injury severity did not correlate with cognitive performance in this sample after TBI. The high incidence of depression in this study confirms that major depression is a very common occurrence after TBI. This has widespread implications for patient and family counselling, and psychotropic interventions in treatment planning after TBI. Further research on the emotional and cognitive aspects of TBIs within the South African population is needed to supplement the lack of information currently available. It is recommended that further studies build on the current study by exploring larger samples, and using more stratification specificity in terms of the type of injury sustained as well as functional outcomes. Copyright / Dissertation (MA)--University of Pretoria, 2010. / Psychology / unrestricted

Aim: The overall aim of the thesis was to explore and describe registered nurses’ (RNs) and certified nursing assistants’ (CNAs) experiences of detection and assessment of pain in older people with cognitive impairment and dementia. A further aim was to evaluate the Abbey Pain Scale-SWE (APS-SWE) in dementia care practice. Methods: An exploratory and descriptive design was used in Study I. An exploratory and interpreting design was used in Study II and Study III. A prospective, descriptive, observational and instrumental design was used in Study IV. Focus group interviews (I) and individual interviews (II, III) were applied to explore and describe RNs’ and CNAs’ experiences of pain assessment in people living with dementia. Qualitative content analysis (I) and philosophical hermeneutics (II) were used to analyse qualitative data. Observation, instrument, and questionnaire were applied to evaluate reliability and face validity of the APS-SWE for pain assessment. Descriptive statistics and reliability analyses were used to analyse quantitative data (IV). Results: RNs in special housing accommodation settings experiences that pain assessment in people with dementia is challenging primarily due to their changed RN consultant role, which to a great extent is directed into administrative and consultative tasks rather than bedside care. This has led to decreased time in daily nursing care, preventing recognising symptoms of pain. This have also led to that RNs are dependent on information from CNAs who are the front-line staff providing daily care (I). CNAs’ perception of signs of pain in people with dementia emerges from being present in the care situation and alertness on physical and behavioural changes that could be due to pain, and from providing the care in a preventive, protective and supportive way to prevent painful situations occurring (II). RNs and CNAs working in home healthcare team use a variety of strategies to detect and assess pain. A trustful work relationship based on staff continuity and a good relation to the person in need of care facilitates pain assessment situations (III). Systematic observation of older people living in special housing accommodation during rest and mobility using the APS-SWE demonstrates that the scale has adequate internal consistency, reliability, and face validity for pain assessment (IV). Conclusions: This thesis found that the RNs’ and CNAs’ detections and assessments of pain rely on solid cooperation, staff continuity, and good knowledge of the person cared for. It was also revealed that there is a lack of using appropriate and assisting pain tools. The APS-SWE show adequate reliability and face validity and can serve as a useful pain tool to assist in detection and assessment of pain in older people who are limited in verbalising pain recognisable. Further evaluation of how the person-centred perspective is applied in pain assessment situations is needed in order to evaluate positive outcomes in people with dementia. Further psychometric evaluation of the APS-SWE in clinical dementia care practice is needed to strengthen validity and reliability. / <p>Study IV</p><p>Karlsson C, Ernsth Bravell M, Ek K, Johansson L &amp; Bergh I (2014): Reliability and face validity of the Abbey Pain Scale-SWE in Swedish dementia care practice. Submitted June, 2015.</p>

INTRODUÇÃO: O envelhecimento da população é uma tendência social conhecida em países desenvolvidos e cada vez mais pronunciada em países em desenvolvimento. A demência é considerada um dos principais problemas de saúde devido ao rápido crescimento populacional de idosos, sendo os distúrbios de linguagem considerados importantes nesses quadros. O discurso tem ganhado destaque para a identificação dos distúrbios linguísticos nas demências assim como no seguimento desses pacientes. A caracterização das diferenças pode auxiliar no diagnóstico diferencial e contribuir para a criação de ferramentas futuras que auxiliem na intervenção clínica e ajudem a evitar a evolução e/ou progressão dos quadros demenciais. O processo de transcrição e análise do discurso é bastante laborioso, desta forma o uso de métodos computacionais tem auxiliado na identificação e extração de características linguísticas. OBJETIVO: identificar alterações em aspectos micro e macrolinguísticos que diferenciem indivíduos com doença de Alzheimer, comprometimento cognitivo leve e idosos sem comprometimento cognitivo na tarefa de narrativa de figuras em sequência e explorar a ferramenta computacional (Coh-Metrix-Dementia) para análise do discurso desses sujeitos. MÉTODO: Foram avaliados 60 indivíduos, sendo 20 em cada grupo de pesquisa (doença de Alzheimer leve - GDA, comprometimento cognitivo leve amnéstico - GCCLa e controle - GC). Os indivíduos foram solicitados a enunciar uma narrativa baseada em 22 cenas em sequência, que retratam a história da \"Cinderela\". Foram aplicados também os seguintes testes linguístico-cognitivos: Fluência Verbal, Teste de Nomeação do Boston e Camel and Cactus test. Utilizou-se o Coh-Metrix- Dementia para extração automática das métricas. RESULTADOS: Os valores extraídos pelo Coh-Metrix-Dementia foram tratados estatisticamente sendo possível levantar métricas capazes de distinguir os grupos estudados. Em relação aos aspectos microlinguísticos destacaram-se a redução nas habilidades sintáticas, maior dificuldade no resgate verbal, discursos com menor coesão e coerência local no GDA. No nível macrolinguístico o GDA apresentou os discursos menos informativos, com maior prejuízo em relação a coerência global e maior número de modalizações. O GDA também apresentou maior comprometimento da estrutura narrativa. Não foi possível discriminar o GCCLa e GC em nenhuma métrica do discurso deste estudo. Foram feitas adaptações em relação a segmentação das sentenças para um melhor funcionamento da ferramenta computacional. CONCLUSÃO: Os indivíduos do GDA apresentaram discursos com maior comprometimento macro e microestrutural. O uso da ferramenta computacional se mostrou um importante aliado para análises discursivas / INTRODUCTION: Population aging is a social trend known in developed countries and increasingly pronounced in developing countries. Dementia is considered one of the main health problems due to the rapid population growth of the elderly, and language disorders are considered important in these settings. The discourse is important for the identification of linguistic disorders in dementias as well as in the follow-up of these patients. The discourse differences characterization can help on the differential diagnosis and contribute to the creation of future tools for clinical intervention and help prevent the evolution and/or progression of dementia. The transcription and discourse analysis are laborius, thus the use of computational methods helped in the identification and extraction of linguistic characteristics. OBJECTIVE: The objective of this study was to identify changes in micro and macrolinguistic aspects that differentiate individuals with Alzheimer\'s disease, mild cognitive impairment and healthy elderly individuals during narrative of figures in sequence and to explore the computational tool (Coh-Metrix-Dementia) to analyze the subjects\' discourse. METHODS: 60 subjects were evaluated, 20 of them in each research group (mild Alzheimer\'s disease - GDA, amnestic cognitive impairment - GCCLa and control - CG). The subjects were asked to construct a narrative based on sequence of pictures, about the \"Cinderella´s Story\". The following linguistic-cognitive tests were also applied: Verbal Fluency, Boston Naming Test, and Camel and Cactus test. Coh-Metrix-Dementia was used for automatic metrics extraction. RESULTS: The values extracted by Coh-Metrix-Dementia were statistically treated and it was possible to obtain metrics capable of distinguishing the studied groups. In relation to the microlinguistic aspects, it was found the reduction in syntactic abilities, greater difficulty in verbal rescue, discourses with less cohesion and local coherence in the GDA. In the macrolinguistic level the GDA presented the less informative discourses, with greater loss in global coherence and the greater number of modalizations. The GDA also presented greater impairment on narrative structure. It was not possible to discriminate GCCLa and GC in any discourse´s metric in this study tool functioning. CONCLUSION: The GDA subjects presented discourses with greater macro and microstructural impairment. The computational tool usage proved to be an important ally for discursive analysis

Introdução: A hipertensão arterial é uma doença crônica com alta prevalência na população e, se não tratada, está relacionada a complicações cardiovasculares graves incluindo insuficiência renal, doença arterial coronária e acidente vascular cerebral. A associação entre os valores de pressão arterial (PA) e o desempenho cognitivo, tanto em pessoas adultas hipertensas quanto normotensas também tem sido demonstrada, e a hipertensão arterial é um importante fator de risco para a ocorrência de demência vascular. No entanto, a relação entre a gravidade da hipertensão, suas alterações vasculares e o déficit cognitivo é pouco conhecida. Objetivo: avaliar as alterações de função cognitiva em pacientes com hipertensão arterial de diferentes estágios e suas correlações com as propriedades arteriais funcionais e estruturais avaliadas por métodos não invasivos e com a circulação cerebral avaliada pelo Doppler transcraniano. Métodos: Trata-se de um estudo transversal em pacientes com hipertensão arterial seguidos na unidade de hipertensão arterial do Incor e um grupo de controles normotensos. Os pacientes foram divididos em três grupos: normotensão, hipertensão estágio-1 e hipertensão estágio-2. Os pacientes foram submetidos aos seguintes procedimentos: avaliação da rigidez arterial pela medida da velocidade de onda de pulso, medida da espessura da íntima média das artérias carótidas e da pressão central não invasiva, avaliação do fluxo cerebral pelo Doppler transcraniano e testes para a avaliação da função cognitiva. Resultados: Foram incluídos 221 indivíduos (150 hipertensos e 71 normotensos) por um período de 24 meses. Comparado com os indivíduos normotensos, a disfunção cognitiva é mais frequente nos pacientes com hipertensão arterial e está diretamente relacionada com a gravidade da doença. Os pacientes com hipertensão tiveram maior rigidez arterial, menor resposta de vasorreatividade cerebral e pior desempenho cognitivo. Conclusão: As alterações da função cognitiva são mais frequentes nos pacientes com hipertensão arterial e se relacionaram com a gravidade da doença. Os pacientes hipertensos têm maiores alterações vasculares que se associaram com pior desempenho cognitivo / Introduction: Hypertension is a high prevalent chronic disease in the population and, if not treated, is related to severe cardiovascular complications including stroke, renal failure and coronary artery disease. The association between blood pressure (BP) values and cognitive performance both in hypertensive and normotensive adults have been shown and hypertension is an important risk factor for occurrence of vascular dementia. However, the relationship between the hypertension severity, their vascular changes and cognitive impairment is less studied. Objective: to evaluate the cognitive function changes in patients with hypertension at different stages and their correlations with functional and structural arterial proprieties changes evaluated by non-invasive methods and with cerebral blood flow evaluated by transcranial Doppler. Methods: It is cross-sectional study in patients with hypertension followed at the hypertension unit of the Heart Institute (Incor) and a control normotensive group. Patients were divided into three groups: normotension, hypertension stage-1 and hypertension stage-2. All patients were undergone to the following procedures: arterial stiffness evaluation by pulse wave velocity, intima media thickness measurement of the carotids arteries and the noninvasive central blood pressure, cerebral blood flow evaluated by Transcranial Doppler and tests for cognitive function evaluation. Results: There were included 221 individuals (150 hypertensives and 71 normotensives) during a period of 24 months. Compared to normotensive individuals, cognitive impairment is more frequent in patients with hypertension and it is proportionally greater with the hypertension severity. Patients with hypertension have greater vascular changes, lower cerebral vasoreactivity response and worse cognitive performance. Conclusion: Cognitive function changes are frequent in hypertensive patients and are related to the severity of the disease. Hypertensive patients have greater vascular changes that were associated to worse cognitive performance

The process of controlling executive and motor behaviours is central to one’s ability to self-regulate and accomplish day-to-day goals across the lifespan. Executive and motor control share a set of underlying neural substrates that support a common set of processes, including planning, sequencing and monitoring of behaviour. They share a bidirectional relationship, such that gains or deficits in one area can have profound effects on the other. This doctoral dissertation examines the interplay between executive and motor control at three distinct stages of life and in the context of neurological conditions whose clinical manifestations shed additional light on the nature of the constructs. Central to each investigation is the methodological theme of intraindividual variability, as a means of leveraging valuable data within-persons. Chapter 2 examines executive and motor control in typically developing children and children with attention-deficit/hyperactivity disorder (ADHD). Findings suggest that dysregulation of motor processes accounts for hyperactive symptoms in ADHD and detracts from higher-order executive control. Chapter 3 examines the impact of mild traumatic brain injury (mTBI) in young adult varsity athletes, who routinely practice executive motor control by virtue of their level of play. Findings suggest that the impacts of mTBI are discernible through a dampened electrophysiological response during computerized tests of higher order executive functioning, and may not outweigh the otherwise myriad health benefits of athletic engagement. Chapter 4 examines the impact of dementia on executive motor control during gait dual-tasking in older adults. Findings suggest that the consistency of performance across multiple indicators of gait is sensitive to dementia, and that engagement in cognitive and social lifestyle behaviours is protective against likelihood of both dementia and mild cognitive impairment (MCI) classification. On mass, these findings highlight the importance of assessing executive motor control to understand the pathophysiology of neurological conditions. The potential benefits that may generalize from one area to the other offer unique opportunities for preventative and rehabilitative efforts. / Graduate

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第18872号 / 医博第3983号 / 新制||医||1008(附属図書館) / 31823 / 京都大学大学院医学研究科医学専攻 / (主査)教授 河野 憲二, 教授 古川 壽亮, 教授 髙橋 良輔 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DGAM

Cette thèse vise à tester l’hypothèse selon laquelle la maladie d’Alzheimer (MA), à ses différents stades, est responsable d’un dysfonctionnement synaptique. Ce dernier, conjointement avec d’autres processus pathologiques, pourrait mener à des modifications de l’excitabilité neuronale au sein de régions cérébrales spécifiques et, en conséquence, à des altérations de la connectivité fonctionnelle au sein des réseaux neuronaux auxquels contribuent ces régions cérébrales.Deux objectifs principaux ont été visés tout au long de ce projet. Le premier ambitionnait l’identification de nouveaux marqueurs électrophysiologiques du continuum de la MA. Le second aspirait à une meilleure compréhension de la relation entre les changements électrophysiologiques, les anomalies structurelles et métaboliques ainsi que les déficits cognitifs des patients souffrant d’une MA ou étant à risque de la développer. Afin de répondre à ces buts de recherche, une approche multimodale combinant l’exploration électrophysiologique via la magnétoencéphalographie (MEG), métabolique et structurelle via un appareil hybride associant la tomographie par émission de positons avec comme traceur le fluorodésoxyglucose (FDG) et l’imagerie par résonance magnétique structurelle (TEP-IRM), et enfin cognitive via un examen neuropsychologique a été mise en place pour tous les participants qu’ils soient dans le cadre d’un vieillissement normal ou pathologique.La première étude a investigué la manière dont le continuum de la MA altère la dynamique de l’activité cérébrale spontanée et comment cette dernière est reliée aux anomalies structurelles, métaboliques et cognitives associées à la MA. Les résultats ont principalement montré des altérations dans l’activation du réseau du mode par défaut chez les patients avec une MA constituant un corrélat électrophysiologique supplémentaire du dysfonctionnement synaptique de la MA.La deuxième étude a étudié la relation entre l'activité rythmique cérébrale en bande de fréquence alpha et les altérations en mémoire épisodique verbale en utilisant la tâche de rappel libre/rappel indicé-16 items. Nos résultats ont principalement mis en évidence un nouveau corrélat électrophysiologique du dysfonctionnement à court terme en mémoire épisodique qui peut accompagner le vieillissement pathologique.Enfin, notre dernière étude a visé à fournir une vue d'ensemble des changements électrophysiologiques associés au continuum de la MA. Nos résultats ont principalement montré une diminution globale de la connectivité fonctionnelle en bande de fréquence alpha chez les patients avec une MA soutenant la théorie selon laquelle l'hypoconnectivité apparait à un stade tardif de la démence. Ceci suggère la présence d'un syndrome de déconnexion sévère dans la MA.De manière générale, ce projet de recherche a permis l’identification de marqueurs électrophysiologiques supplémentaires de la MA ainsi qu’une meilleure compréhension du lien entre les modifications électrophysiologiques et le déficit cognitif, les anomalies structurelles ainsi qu’avec les changements métaboliques observés dans la MA. / Doctorat en Sciences psychologiques et de l'éducation / info:eu-repo/semantics/nonPublished

Screening of global cognitive performance is of great importance in the detection of early cognitive impairment in neurodegenerative diseases. In contrast to complex neuropsychological assessment, cognitive screening tests offer some advantages as saving time or finance and administration of screening tests makes lower demands on clinicians. Validation of cognitive screening tests for specific diagnostic groups of patients is necessary as well as Czech normative studies that enable an objective evaluation of the cognitive performance of Czech patients. In the theoretical part, we presented the syndrome of mild cognitive impairment as a pre-dementia state in neurodegenerative diseases. We focused on the assessment of mild cognitive impairment and using five different cognitive screening tests (Mini-Mental State Examination, Montreal Cognitive Assessment, Dementia Rating Scale 2. edition, Frontal Assessment Battery, Clock Drawing Test) in the detection of cognitive impairment. Then we focused on Parkinson's disease (PD), especially on the evolution of different stages of cognitive deficit in PD and their detection by cognitive assessments. The empirical research included studies analyzing the potential of the five cognitive screening tests to detect mild cognitive impairment. We provided results...

The diagnosis of neurodegenerative diseases leading to dementia is increasingly moving to the earlier stages in an effort to find the disease-modifying treatment for these diseases. Prodromal and preclinical stages of the diseases have become the primary research interests. Neuropsychology is specifically focused on early cognitive markers and development of methods that would be able to reliably assess these markers and to evaluate the risk of progression of cognitive decline in individual cases. The theoretical part of the thesis presents the current knowledge in the field of neurodegenerative diseases, it is specifically focused on Alzheimer's disease (AD) as the most common cause of dementia. We also present the current trends in neuropsychological diagnostics of early AD and the approach to subjective and objective evaluation of cognitive functioning. Building on that, we present the rationale for the empirical part of the thesis. The empirical part of the thesis extends the existing knowledge in the field of AD. We present and discuss seven original publications that follow three basic objectives: first, to characterize subjective cognitive complaints of individuals at risk of AD, second, to evaluate the potential of selected standard and experimental neuropsychological methods to detect...