OCORRÊNCIA DE DEPRESSÃO E ANSIEDADE EM CUIDADORES PRIMÁRIOS DE INDIVÍDUOS COM DEMÊNCIA TIPO ALZHEIMER: ESTUDOS DE CASOS

RESUMO:A Demência Tipo Alzheimer tem evolução progressiva que compromete as atividades funcionais do portador, tornando-o dependente de um cuidador. O objetivo do presente estudo foi investigar a ocorrência de depressão e de ansiedade em cuidadores primários de adultos idosos portadores de Demência Tipo Alzheimer. Participaram da pesquisa duas esposas de cônjuges com esse quadro, cuidadoras primárias que exercem a função sem auxílio de cuidador secundário, com nível de escolaridade superior a quatro anos de estudo formal, sem auto-relato de intervenção psicológica atual ou prévia e sem história atual ou prévia de doenças neurológicas e/ou psiquiátricas. A ocorrência de sinais sugestivos de depressão e ansiedade foi avaliada através do Inventário Beck de Depressão e do Inventário Beck de Ansiedade. Para identificar o impacto do cuidado na saúde do cuidador foi utilizada uma entrevista semi-estruturada com questões que investigaram alguns aspectos emocionais, sociais e físicos. As participantes apresentaram sinais sugestivos de prejuízo da saúde psicológica: ambas demonstraram nível leve de depressão, apresentando o caso 1 escore inferior ao do caso 2, e ansiedade, mostrando o caso 1 nível mínimo e o caso 2, nível grave. Entre os fatores que podem ter contribuído para o maior comprometimento psicológico da cuidadora do caso 2, mencionam-se menor tempo pós-diagnóstico e de função de cuidador, rápida evolução da doença e estágio mais avançado da demência do cônjuge, assim como reduzido suporte familiar e social.PALAVRAS-CHAVE: Demência Tipo Alzheimer. Cuidador. Ansiedade. Depressão. ABSTRACT: Alzheimer Dementia presents a progressive evolution that impairs daily activities, what makes individuals with this kind of dementia caregiver dependents. This research aims to investigate the occurrence of depression and anxiety in primary caregivers of elderly adults with Alzheimer Dementia. Two cases of primary caregivers, not helped by secondary caregivers, married with elderly adults with Alzheimer dementia, participated of this study. They had studied for more than four years of formal education, without self-reported psychological intervention, and neurological or psychiatric diseases. Depression and anxiety symptoms were assessed through Beck Depression Inventory and Beck Anxiety Inventory. Towards the identification of influence of care activities on caregivers’ health an interview with questions about some emotional, social and physical aspects was administered. Both cases showed suggestive signs of impaired psychological health: the two wives presented low depression (case 1 presented a lower score when compared to case 2) and different levels of anxiety – case 1 showed a minimum level, while case 2 presented a severe level of anxiety. Among factors that can have contributed to the greater injury of case 2, there are smaller post-diagnosis interval, faster dementia evolution, more severe dementia phase and limited family and social support. KEYWORDS: Alzheimer Dementia. Caregiver. Anxiety. Depression

Impact of the Gut Microbiota on Atorvastatin Mediated Effects on Blood Lipids

Background and aims: The mechanisms of interindividual variation of lipid regulation by statins, such as the low-density lipoprotein cholesterol (LDL) lowering effects, are not fully understood yet. Here, we used a gut microbiota depleted mouse model to investigate the relation between the gut microbiota and the regulatory property of atorvastatin on blood lipids. Methods: Mice (C57BL/6) with intact gut microbiota or antibiotic induced abiotic mice (ABS) were put on standard chow diet (SCD) or high fat diet (HFD) for six weeks. Atorvastatin (10 mg/kg body weight/day) or a control vehicle were applied per gavage for the last four weeks of dietary treatment. Blood lipids including total cholesterol, very low-density lipoprotein, low-density lipoprotein, high-density lipoprotein and sphingolipids were measured to probe microbiota-dependent effects of atorvastatin. The expression of genes involved in hepatic and intestinal cholesterol metabolism was analyzed with qRT-PCR. The alteration of the microbiota profile was examined using 16S rRNA qPCR in mice with intact gut microbiota. Results: HFD feeding significantly increased total blood cholesterol and LDL levels, as compared to SCD in both mice with intact and depleted gut microbiota. The cholesterol lowering effect of atorvastatin was significantly attenuated in mice with depleted gut microbiota. Moreover, we observed a global shift in the abundance of several sphingolipids upon atorvastatin treatment which was absent in gut microbiota depleted mice. The regulatory effect of atorvastatin on the expression of distinct hepatic and intestinal cholesterol-regulating genes, including Ldlr, Srebp2 and Npc1l1 was altered upon depletion of gut microbiota. In response to HFD feeding, the relative abundance of the bacterial phyla Bacteroidetes decreased, while the abundance of Firmicutes increased. The altered ratio between Firmicutes to Bacteroidetes was partly reversed in HFD fed mice treated with atorvastatin. Conclusions: Our findings support a regulatory impact of atorvastatin on the gut microbial profile and, in turn, demonstrate a crucial role of the gut microbiome for atorvastatin-related effects on blood lipids. These results provide novel insights into potential microbiota-dependent mechanisms of lipid regulation by statins, which may account for variable response to statin treatment

Social instigation and aggressive behavior in mice: role of 5-HT 1A and 5-HT 1B receptors in the prefrontal cortex

Abstract Rationale Social instigation is used in rodents to induce high levels of aggression, a pattern of behavior with certain parallels to that of violent individuals. This procedure consists of a brief exposure to a provocative stimulus male, before direct confrontation with an intruder. Studies using 5-HT 1A and 5-HT 1B receptor agonists show an effective reduction in aggressive behavior. An important site of action for these drugs is the ventral orbitofrontal cortex (VO PFC), an area of the brain which is particularly relevant in the inhibitory control of aggressive and impulsive behavior. Objectives The objectives of the study are to assess the anti-aggressive effects of 5-HT 1A and 5-HT 1B agonist receptors [8-hydroxy-2-(di-n-propylamino) tetralin hydrobromide (8-OH-DPAT) and 129] in the VO PFC of socially provoked male mice. To confirm the specificity of the receptor, 5-HT 1A and 5-HT 1B antagonist receptors (WAY-100,635 and SB-224,289) were microinjected into the same area, in order to reverse the agonist effects. Results 8-OH-DPAT (0.56 and 1.0 μg) reduced the frequency of attack bites. The lowest dose of CP-93,129 (0.1 μg) also decreased the number of attack bites and lateral threats. 5-HT1A and 5-HT1B receptor agonists differed in their effects on non-aggressive activities, the former decreasing rearing and grooming, and the latter, increasing these acts. Specific participation of the 1A and 1B receptors was verified by reversal of anti-aggressive effects using selective antagonists WAY-100,635 (10.0 μg) and SB-224,289 (1.0 μg). Conclusions The decrease in aggressiveness observed with microinjections of 5-HT 1A and 5-HT 1B receptor agonists into the VO PFC of socially provoked mice, supports the hypothesis that activation of these receptors modulates high levels of aggression in a behaviorally specific manner

Déficits Primários e Secundários de Funções Executivas Pós-TCE: análise de dissociações

The present study evaluated the presence of associations and dissociations between impairments in episodic memory and executive functions in patients with traumatic brain injury (TBI), and verified whether these deficits were primary or secondary. Eighty-one patients with TBI were assessed using the Rey Auditory Verbal Learning Test and the Hayling Test. The results suggest that impairments in inhibition speed may contribute to deficits in episodic memory, and that initiation and inhibition abilities may be complementary and the first precedes the second. Our findings highlighted that primary executive impairment following TBI may lead to episodic memory deficits.Este estudo avaliou as associações e dissociações encontradas entre déficits de memória episódica em relação aos de funções executivas e verificou se estes déficits encontrados eram primários ou secundários. Os 81 pacientes pós-Traumatismo Cranioencefálico (TCE) foram avaliados por meio do Teste de Aprendizagem Auditivo-Verbal de Rey e do Teste Hayling. Os resultados sugerem que prejuízo na velocidade de controle inibitório pode contribuir para déficit na memória episódica e que as velocidades de iniciação e inibição parecem ser complementares, mas a primeira precede a segunda. Nossos achados ressaltam que os prejuízos executivos provavelmente sejam primários em nossa amostra de pacientes pós-TCE e que estes prejuízos podem causar déficits na memória episódica

Communicative, cognitive and behavioral impairments associated with right hemisphere stroke: national and international publications

 The present paper aims to outline an overview of national and international publications concerning research on the communicative, cognitive and behavioral impairments associated with a right hemisphere stroke. Research on LILACS and MEDLINE databases were done using keywords in Portuguese and in English: syndrome, hemisphere and right for the search on the right hemisphere impairments. Studies were selected taking into account inclusion criteria. Only few studies about these disorders were found, all of them international investigations. Cognitive disorders were the most frequently described. Sequelae including all cognitive functions, emotional and communicative processing are considered part of this set of right hemisphere impairments. More studies about the RHS are necessary to identify different clinical profiles and increase the efficiency of assessment and rehabilitation process.Keywords: neuropsychology; cognition; right hemisphere; CVA.  Este artigo visa traçar um panorama das publicações nacionais e internacionais quanto ao estudo das alterações comunicativo-cognitivo-comportamentais associadas as lesões vasculares de hemisfério direito. As bases LILACS e MEDLINE foram consultadas com as palavras-chave em português e em inglês: síndrome, hemisfério e direito. Os estudos foram selecionados a partir de critérios de inclusão. Encontraram-se poucos estudos que abordam essas alterações, todos internacionais, sendo as dificuldades cognitivas as mais descritas. Sequelas em todas as funções cognitivas e nos processamentos comunicativo e emocional são consideradas parte deste quadro. São indispensáveis estudos a respeito das alterações comunicativo-cognitivo-comportamentais pós-AVC de hemisfério direito para identificar diferentes perfis clínicos e contribuir para o aumento da eficácia dos procedimentos de avaliação e de reabilitação.Palavras-chave: neuropsicologia; cognição; hemisfério direito; AVC

Human-Centered Design Components in Spiral Model to Improve Mobility of Older Adults

As humans grow older, their cognitive needs change more frequently due to distal and proximal life events. Designers and developers need to come up with better designs that integrate older users’ needs in a short period of time with more interaction with the users. Therefore, the positioning of human end users in the center of the design itself is not the key to the success of design artifacts while designing applications for older adults to use a smartphone as a promising tool for journey planner while using public transportation. This study analyzed the use of human-centered design (HCD) components, the spiral model, and the design for failure (DfF) approach to improve the interactions between older users and designers/developers in gathering usability needs in the concept stage and during the development of the app with short iterative cycles. To illustrate the importance of the applied approach, a case study with particular focus on older adults is presented.The results presented in this study are based on “Assistant” project funded by AAL JP, co-funded by the European Union. The authors would like to thank Dr. Stefan Carmien, my colleague in Assistant, for mentoring and for reading and making comments in the earlier versions of this chapter; participating research institutes; funding agencies; and companies from Finland, Spain, Austria, France, and the United Kingdom for their active support throughout the project