CLASSIFICATION OF BIPOLAR DISORDER, MAJOR DEPRESSIVE DISORDER, AND HEALTHY STATE USING VOICE

Objective: In this study, we propose a voice index to identify healthy individuals, patients with bipolar disorder, and patients with major depressive disorder using polytomous logistic regression analysis.Methods: Voice features were extracted from voices of healthy individuals and patients with mental disease. Polytomous logistic regression analysis was performed for some voice features.Results: With the prediction model obtained using the analysis, we identified subject groups and were able to classify subjects into three groups with 90.79% accuracy.Conclusion: These results show that the proposed index may be used as a new evaluation index to identify depression

Effects of dance therapy on balance, gait and neuro-psychological performances in patients with Parkinson's disease and postural instability

Postural Instability (PI) is a core feature of Parkinson’s Disease (PD) and a major cause of falls and disabilities. Impairment of executive functions has been called as an aggravating factor on motor performances. Dance therapy has been shown effective for improving gait and has been suggested as an alternative rehabilitative method. To evaluate gait performance, spatial-temporal (S-T) gait parameters and cognitive performances in a cohort of patients with PD and PI modifications in balance after a cycle of dance therapy

Caracterização de um Coorte nos cuidados primários na região de Aveiro – Portugal

European Health reports from the World Health Organization reveal that life expectancy is steadily increasing. Dementia and depression are among the pathologies that most affect the elderly; a frail population, with limited resources and funds. Often the first point of contact for these patients is the family doctor in primary health care settings. With this in mind the overall goal of this thesis was to implement, in a primary health care setting, previously validated cognitive and depression tests, so as to identify putative at risk patients namely for dementia and depression. The study also addressed polypharmacy usage as well as inappropriate polypharmacy medication (PIM) in the elderly. To carry out the proposed research a primary care based cohort (pcb-Cohort) was set up; comprising 568 individuals once the exclusion criteria are considered. Upon applying the Clinical Dementia Rate (CDR), 68 individuals (12%) have a score of CDR≥1, of these 7 are less than 65 years old. The pcb-Cohort was also scored for comorbidities and significant correlations with: neurological conditions, gastrointestinal disorders (GID), respiratory and osteoarticular (OA) diseases are evident. Genotyping for APOE was also carried out, and a correlation with the risk allele for dementia, ε4, and poor CDR scores (CDR≥1) is evident. The DSM-5 criteria for neurocognitive disorders (NCD) were subsequently applied. The study group falls to 286 individuals of who 61 exhibit NCD-mild (22%) and 36 NCD-major (13%); 10 are less than 65 years old. Correlations with neurological conditions and respiratory diseases are sustained but those with GID and APOE genotype are not. Depression also afflicts the aged and in the pcb-Cohort, 174 of the 568 scored positive in the GDS (Geriatric Depression Scale) and 282 have possible depression, of which 74 are confirmed with a depression diagnosis. For both possible and confirmed depression (174 and 74) correlations were evident with OA, GID and a history of depression, and sustained even when shorter versions of the GDS were analyzed. The elderly are a risk group for potentially polypharmacy and PIM usage. The Beers criteria were applied to the pcb-Cohort for individuals over 65 years old and 361 individuals have relevant medication usage information. From this study group 94.5% exhibit polypharmacy and 47.4% use at least 1 PIM and the major group is Benzodiazepines. Clearly this is a concern as risk for the patients is increased. It is possible from the work carried out to propose several recommendations. Namely monitoring individuals at the primary point of care to identify potential cases of dementia and depression that can then be recommended for specialist consultations. This could perhaps be carried out by organizing campaigns at primary health care centres. Future work will focus on these aspects with the intent of contributing to the quality of life in the elderly.Relatórios da Organização Mundial da Saúde indicam que a expectativa de vida está a aumentar. Demência e depressão estão entre as patologias que mais afetam os idosos; uma população frágil, com recursos e fundos limitados. Muitas vezes, o primeiro ponto de contato para estes pacientes é o médico de família nos cuidados de saúde primários. Com isso em mente, o objetivo geral desta tese foi implementar, nos cuidados de saúde primários, testes cognitivos e de depressão previamente validados, de modo a identificar possíveis pacientes em risco de demência e depressão. O estudo também abordou o uso de polifarmácia, bem como o uso de medicação potencialmente inapropriada (PIM) em idosos. Para realizar a investigação proposta, foi criada uma coorte baseada nos cuidados de saúde primários (pcb-Coorte); compreendendo 568 indivíduos, uma vez considerados os critérios de exclusão. Ao aplicar o ‘Clinical Dementia Rating’ (CDR), 68 indivíduos (12%) têm uma pontuação de CDR≥1, dos quais 7 com menos de 65 anos de idade. O pcb-Coorte também foi caracterizado para as comorbidades, e correlações significativas com: condições neurológicas, doenças gastrointestinais (GID), respiratórias e osteoarticulares (OA) são evidentes. A genotipagem para a APOE foi realizada, e uma correlação com o alelo de risco para demência, ε4, e baixo desempenho cognitivo (CDR≥1) é clara. Subsequentemente os critérios do DSM-5 para transtornos neurocognitivos (NCD) foram aplicados. O grupo de estudo diminui para 286 indivíduos, dos quais 61 exibem NCD-ligeiro (22%) e 36 NCD-major (13%); 10 têm menos de 65 anos de idade. Correlações com condições neurológicas e doenças respiratórias são sustentadas, mas aquelas com o genótipo de risco APOE e GID não são. A depressão também afeta os idosos e no pcb-Coorte, 174 dos 568 tiveram pontuação positiva na GDS (Escala Geriátrica de Depressão) e 282 têm possível depressão, dos quais 74 estão confirmados com um diagnóstico de depressão. Para ambos os grupos de depressão possível e confirmada (174 e 74) as correlações com OA, GID e uma história de depressão, são evidentes, e mantêm-se mesmo quando versões mais curtas da GDS são analisadas. Os idosos também representam um grupo de risco para uso potencialmente de polifarmácia e PIM. Os critérios de Beers foram aplicados ao pcb-Coorte para indivíduos com mais de 65 anos e 361 indivíduos tinham informações relevantes sobre o uso de medicamentos. Deste grupo de estudo 94.5% apresentam polifarmácia e 47.4% utilizam pelo menos 1 PIM, sendo o grupo principal os Benzodiazepínicos. Claramente isto é uma preocupação, pois o risco para os pacientes é aumentado. É possível a partir do trabalho realizado propor várias recomendações. Ou seja, monitorizar os indivíduos no ponto primário de atendimento para identificar possíveis casos de demência e depressão que podem ser recomendados para consultas especializadas. Isto talvez pudesse ser feito através da organização de campanhas nos cuidados de saúde primários. O trabalho futuro focar-se-á nestes aspectos com a intenção de contribuir para a qualidade de vida dos idosos.Programa Doutoral em Biomedicin

Changes in cortisol but not in brain-derived neurotrophic factor modulate the association between sleep disturbances and major depression

Sleep disturbance is a symptom consistently found in major depression and is associated with a longer course of illness, reduced response to treatment, increased risk of relapse and recurrence. Chronic insomnia has been associated with changes in cortisol and serum brain-derived neurotrophic factor (BDNF) levels, which in turn are also changed in major depression. Here, we evaluated the relationship between sleep quality, salivary cortisol awakening response (CAR), and serum BDNF levels in patients with sleep disturbance and treatment-resistant major depression (n = 18), and in a control group of healthy subjects with good (n = 21) and poor (n = 18) sleep quality. We observed that the patients had the lowest CAR and sleep duration of all three groups and a higher latency to sleep than the healthy volunteers with a good sleep profile. Besides, low CAR was correlated with more severe depressive symptoms and worse sleep quality. There was no difference in serum BDNF levels between groups with distinct sleep quality. Taken together, our results showed a relationship between changes in CAR and in sleep quality in patients with treatment-resistant depression, which were correlated with the severity of disease, suggesting that cortisol could be a physiological link between sleep disturbance and major depression

\u27I am not disabled. It\u27s my environment that makes me disabled\u27: A critical ethnography of age-related vision loss (ARVL) in older adulthood

This thesis aims to deepen understandings of how various aspects of the environment shape how older adults with age-related vision loss (ARVL) negotiate and engage in occupation. The thesis further raises critical awareness of the ways in which environmental features, embedded in ageist and ableist assumptions, shape and perpetuate experiences of disability for older adults with ARVL. A critical ethnography was undertaken, informed by theoretical concepts drawn from critical gerontology, environmental gerontology, a critical occupational perspective, and critical disability theory. A total of ten older adults with ARVL participated in three data generation sessions consisting of a narrative interview, semi-structured in-depth interview, and participant observation session. Seven community organization representatives participated in a semi-structured in-depth interview and sixteen relevant documents were critically reviewed. This work is comprised of five integrated manuscripts, in addition to the introduction, methodology, and discussion chapters. Chapter two presents a scoping review that explores pre-existing research addressing factors, including demographic, emotional, behavioral, diagnostic, and environmental, which influence the occupational engagement of older adults with ARVL. Chapter four provides a rationale for expanding the application of a critical sensibility to existing conceptualizations of the environment in an effort to expand the field of environmental gerontology beyond a micro-and meso-level approach towards a holistic view of the environment. Chapter five explores how a critical disability theory approach could lead to new research foci in the study of ARVL. Key findings of the critical ethnography are presented in chapters six and seven. Chapter six focuses on exploring those attributes that older adults with ARVL perceive as being the markers of a \u27good old age\u27 and how their negotiations of everyday occupation occur in relation to these markers. Chapter seven aims to highlight how experiences of disability for the informants are shaped through interactions with environmental features, thereby highlighting the socio-political production of disability. This work points to novel empirical, methodological, and theoretical insights relevant to the ARVL field. This work also has implications for persons with vision loss, vision rehabilitation professionals, and researchers as well as for the development of vision-friendly environments and inclusive social policy

Working within the preference of people with dementia

Section A: Preferred music interventions’ effect on psychological and behavioural outcomes for people with dementia: a systematic review. A previous review concluded that preferred music is an effective intervention for managing agitation in people with dementia; however, the majority of the research articles included were pilot studies. A systematic review is carried out in this work to investigate the effect of preferred music on people with dementia. Six search engines yielded 240 papers, of which 12 were eligible. The report reviewed studies that investigated outcomes including agitation, anxiety, depression and overall emotional state. Inconsistent results are found across studies of most outcomes. Methodological issues mean that some studies are prone to bias. Consequently, it is difficult to draw conclusions from the review. The results suggest the need for further investigation into this area of research. Section B: Development of the video analysis scale of engagement (vase) tool for people with advanced dementia. The current study sought to develop a valid, reliable and unobtrusive tablet computer-based observational tool to appraise a continuous scale of engagement with people with advanced dementia. VASE was designed to enable the rating of moment-by-moment changes in engagement during an intervention, which would be useful for process evaluation in research. An initial version of the Video Analysis Scale of Engagement (VASE) was tested. Face validity and content validity were conducted to validate an operational definition of engagement and develop an acceptable protocol for the tool. Thirty-seven non-professional and professional volunteers were recruited to view and rate people with dementia’s level of engagement in the music activities using the VASE. An inter-class coefficient (ICC) test gave a high level of rating agreement across professionals and non-professionals. However, the ICC results of within-professionals were mixed. Mixed-linear modelling suggested there that the types of interventions (active or passive music listening), the particular intervention session being rated, five second “stages” of each video and the age of those doing the rating could affect the ratings. Results suggested that raters used the VASE in a dynamic fashion, and that the tool was able to distinguish between interventions. Further investigation and adjustments are warranted for this to be considered a valid and reliable tool in the measurement of engagement of people with advanced dementia in a group activity setting