Distúrbios de atenção em pacientes com crises parciais complexas

A study of concentrated attention patterns in epileptic patients was conducted with the objectives: characterization of the patients' epileptic condition; assessment of the concentrated attention levels in epileptic and nonepileptic individuals; comparison of the attention levels of the two groups. An evaluation was performed of 50 adult outpatients with complex partial seizures and 20 non-epileptic individuals (comparative group) at the Neuroepilepsy Ambulatory Unit, State University of Campinas SP, Brazil. METHOD: characterization of seizure types, frequency and duration; concentrated attention assessment (Concentrated Attention Test - Toulouse-Piéron); comparison of the epileptic with non-epileptic individuals. RESULTS: A statistically significant difference was observed between the groups with regard to Correct Response, Wrong Response and No Response. A difference was observed in relation to Time, but it was statistically insignificant. The epileptic patients presented inferior cognitive performance in relation to concentrated attention when compared with the non-epileptic individuals, findings compatible with the clinical complaints.Estudou-se o padrão da atenção concentrada em pacientes epilépticos, com o objetivo de se caracterizar a condição epiléptica, avaliar os níveis de atenção concentrada em epilépticos e em sujeitos não-epilépticos e comparar esses níveis entre os grupos. Foram avaliados 50 pacientes adultos com crises parciais complexas em atendimento no Ambulatório de Neuroepilepsia da Universidade Estadual de Campinas SP, Brasil. Também foram estudados 20 sujeitos sem epilepsia, para efeito comparativo. MÉTODO: caracterização tipológica, freqüência e duração das crises; avaliação da atenção concentrada (Teste de Atenção Concentrada - Toulouse-Piéron); e comparação dos resultados dos pacientes dos pacientes com os sujeitos não-epilépticos. RESULTADOS: Houve diferença estatisticamente significativa entre ambos os grupos nos itens Acertos e Erros + Ausências. No item Tempo houve diferença, mas sem significância estatística. Os pacientes apresentaram desempenhos cognitivos inferiores nos padrões de atenção concentrada em comparação com os não-epilépticos, resultados esses compatíveis com as queixas clínicas.33533

Mild cognitive impairment

The term mild cognitive impairment (MCI) describes a clinical entity in which there is a decline in one or more cognitive functions, leading to a relative loss of ability to perform complex activities (e.g. professional activities); individual with MCI do not meet diagnostic criteria for dementia. MCI may be secondary to diverse etiologies, including poorly controlled systemic diseases, polypharmacy, depression, etc; however, in many cases, it corresponds to an incipient stage of dementia, such as Alzheimer’s disease or vascular dementia. Individuals with MCI may improve, stabilize, or progress to a fully developed dementia, according to the underlying cause. The diagnosis of MCI is based on clinical criteria and complimentary tests aim to disclose treatable diseases and to identify individuals with increased risk of conversion to dementia. Treatment is targeted to the underlying condition, whenever identifiable. Cognitive rehabilitation may prove useful in the management of specific deficits, such as attention and memory.O termo comprometimento cognitivo leve (CCL) designa um quadro clínico em que ocorre declínio em um ou mais domínios cognitivos, o que pode levar a um relativo prejuízo da capacidade de realização de atividades mais complexas (por exemplo, atividades no campo profissional), sem que o indivíduo preencha critérios diagnósticos para demência. O CCL pode ter diversas etiologias, incluindo doenças clínicas mal controladas, polimedicação, depressão, etc; no entanto, em muitos casos corresponde a um estágio ainda incipiente de alguma forma de demência, como a doença de Alzheimer ou demência vascular. Indivíduos com CCL podem apresentar melhora do quadro, estabilização, ou progressão para demência, de acordo com a causa subjacente. O diagnóstico de CCL é baseado em critérios clínicos, e os exames subsidiários tem por objetivo identificar causas tratáveis e tentar identificar os indivíduos com maior risco de conversão para demência. O tratamento é orientado para a doença subjacente ao quadro, quando esta pode ser identificada. Reabilitação cognitiva pode apresentar resultados favoráveis no tratamento de déficits específicos, como os de atenção e memória

Alterações do estado mental e da psicomotricidade em usuários

The use of drugs has been related to serious psychopathological disorders. The aim of this study consisted of evaluating mental and psychomotor disturbances in chronic cocaine addicts. Subjects were chemical dependent, male and female, from 13 to 49 years old (average 26.6 years), attending on psychiatry service. The methods consisted of detailed clinical history, Brief Psychiatric Rating Scale, Hamilton Rating Scale for Depression, and Hospital Anxiety and Depression Scale. There was significant correlation (pO uso crônico de drogas tem sido associado a distúrbios psicopatológicos graves. O objetivo deste estudo consistiu em avaliar alterações mentais e da psicomotricidade em usuários crônicos de cocaína. Foram estudados 50 sujeitos dependentes químicos, de ambos os sexos, com idade entre 13 e 49 anos (média: 26,6 anos), encaminhados para atendimento psiquiátrico. Os métodos utilizados consistiram em anamnese detalhada, Escala Psiquiátrica Breve, Escala de Depressão de Hamilton e Escala Hospitalar de Ansiedade e Depressão. Houve correlação significativa (

Physical activity attenuates neuropsychiatric disturbances and caregiver burden in patients with dementia

INTRODUCTION: A significant benefit from physical activity has recently been described in some patients who suffer from neurodegenerative diseases. OBJECTIVE: To assess the effects of physical activity on neuropsychiatric disturbances in demented patients and on the mental burden of their caregivers. METHODS: Assisted by a public geriatric psychiatry clinical unit, we studied 59 patients with dementia. Patients were divided into three groups according to their diagnosis and level of physical activity. Data were assessed through a semi-structured interview. Patients were evaluated with the Neuropsychiatric Inventory, the Mini-Sleep Questionnaire and the Baecke Questionnaire. The data were statistically analyzed using the Mann-Whitney U test and linear regression, with the level of significance set at 5%. RESULTS: Patients with Alzheimer's or vascular dementia who engaged in physical activity had fewer neuropsychiatric symptoms than those who did not. When compared to the control group, the caregivers of patients with vascular dementia who engaged in physical activity had a reduced burden. CONCLUSION: The regular practice of physical activity seems to contribute to a reduction in neuropsychiatric symptoms in dementia patients and to attenuate the burden of the caregivers of those patients

Efecto del ejercicio físico en la amplitud del movimiento articular de las extremidades inferiores de individuos con la enfermedad de Parkinson

The aim of this study was to investigate the effect of eight months of a multimodal program of physical exercise on articular range of motion of the lower limb of patients with Parkinson disease (PD), considering gender and disease stage. Seventeen individuals with PD participated in this study. Participants were assessed before of multimodal program of the physical exercise and after four and eight months of physical exercise. In these periods were evaluated the clinical aspects and articular range of motion of the lower limb. For statistical analysis, patients were distributed according to gender and disease stage. A MANOVA considering exercise, gender and stage of disease, with repeated measures for the first factor, was performed. The clinical results showed regression of disease progression, indicating cognitive decline for women. The articular range of motion improved after four and eight months of physical exercise, especially for the hip and ankle, independent of gender and stage of PD. It was concluded that the multimodal exercise program of the eight months was effective in improving articular range of motion in patients with PD. The benefits of exercise for this physical capacity were independent of gender and severity of PD.El objetivo de este estudio fue verificar el efecto de ocho meses de un programa multimodal de ejercicio físico en la amplitud de movimiento articular de la extremidad inferior de pacientes con enfermedad de Parkinson (EP), considerando género y la etapa de la enfermedad. El estudio incluyó a 17 sujetos con EP idiopática. Los participantes fueron evaluados antes del período de ejecución del programa multimodal de ejercicio físico y tras cuatro y ocho meses de ejercicio físico. Se evaluaron aspectos clínicos y la amplitud de movimiento de las articulaciones de las extremidades inferiores. Para el análisis estadístico, los pacientes fueron agrupados de acuerdo con el género y etapa de la enfermedad, mediante la realización de un MANOVA con factor para ejercicio físico, género y estadio de la enfermedad, con medidas repetidas para el primer factor. Los resultados clínicos mostraron regresión de la progresión de la EP, y el deterioro cognitivo en las mujeres. La amplitud de movimiento articular mejoró tras cuatro y ocho meses de ejercicio físico, especialmente para la cadera y el tobillo, independientemente de su género y etapa de la enfermedad de Parkinson. Se concluyó que el programa multimodal de ejercicio físico de los ocho meses fue eficaz en mejorar la amplitud de movimiento articular en pacientes con EP, y los beneficios independiente del género y la gravedad de la EP.O objetivo deste estudo foi verificar o efeito de oito meses de um programa multimodal de exercício físico na amplitude de movimento articular do membro inferior de pacientes com doença de Parkinson (DP), considerando gênero e estágio da doença. Participaram deste estudo 17 indivíduos com DP idiopática. Os participantes foram avaliados antes do período da execução do programa multimodal de exercício físico e após quatro e oito meses de exercício físico. Foram avaliados aspectos clínicos e a amplitude de movimento das articulações do membro inferior. Para análise estatística, os pacientes foram agrupados de acordo com gênero e estágio da doença, sendo realizada uma MANOVA com fator para exercício físico, gênero e estágio da doença, com medidas repetidas para o primeiro fator. Os resultados clínicos indicaram regressão da progressão da DP, com declínio cognitivo para as mulheres. A amplitude de movimento articular melhorou após quatro e oito meses de exercício físico, principalmente para o quadril e tornozelo, independente de gênero e estágio da doença de Parkinson. Conclui-se que o programa multimodal de exercício físico de oito meses foi eficiente em melhorar a amplitude de movimento articular de pacientes com DP, sendo os benefícios independentes do gênero e da severidade da DP

Attenuation of neuropsychiatric symptoms and caregiver burden in Alzheimer's disease by motor intervention: a controlled trial

OBJECTIVE: To analyze the effects of motor intervention on the neuropsychiatric symptoms of Alzheimer's disease and on the caregivers' burden. DESIGN: This is a controlled trial evaluating the effects of a motor intervention program on the neuropsychiatric symptoms. SETTING: The intervention was performed on community patients from two university centers specializing in physical exercise for the elderly. SUBJECTS: Patients with Alzheimer's disease were divided into two groups: sixteen received the motor intervention and sixteen controls (five controls were excluded because of clinical intercurrences). INTERVENTIONS: Aerobic exercises (flexibility, strength, and agility) and functional balance exercises were conducted over six months for 60 minutes three times per week. MAIN MEASURES: Psychopathological features of patients were evaluated with the Neuropsychiatric Inventory and Cornell Scale for Depression in Dementia. Caregivers were evaluated using the Neuropsychiatric Inventory-Distress and Burden Interview. A two-way analysis of variance (ANOVA) was applied to observe interactions (pre- vs. post-intervention; participants vs. controls). RESULTS: Patients from the intervention presented a significant reduction in neuropsychiatric conditions when compared to controls (Neuropsychiatric Inventory: F: 11.12; p = 0.01; Cornell Depression scale: F: 11.97; p = 0.01). The burden and stress of caregivers responsible for patients who participated in the intervention significantly decreased when compared to caregivers responsible for controls (Neuropsychiatric Inventory-Distress: F: 9.37; p = 0.01; Burden Interview: F: 11.28; p = 0.01). CONCLUSIONS: Aerobic exercise was associated with a reduction in the neuropsychiatric symptoms and contributed to attenuate the caregivers' burden. However, the researchers were not blinded to the patient's intervention status, which constitutes an important limitation of this study

Depressão no Idoso: Diagnóstico, Tratamento e Benefícios da Atividade Física

A depressão constitui enfermidade mental freqüente no idoso, comprometendo intensamente sua qualidade de vida, sendo considerada fator de risco para processos demenciais. É uma condição que coloca em risco a vida, sobretudo daqueles que têm alguma doença crônico-degenerativa ou incapacitante, pois há uma influência recíproca na evolução clínica do paciente. As estratégias de tratamento mais utilizadas são psicoterapia, intervenção medicamentosa e exercício físico. A atividade física, quando regular e bem planejada, contribui para a minimização do sofrimento psíquico do idoso deprimido, além de oferecer oportunidade de envolvimento psicossocial, elevação da auto-estima, implementação das funções cognitivas, com saída do quadro depressivo e menores taxas de recaída. Uma das vantagens do exercício físico é o efeito positivo também na prevenção e tratamento de outros agravos comuns nas pessoas idosas. Propõe-se que as administrações municipais organizem programas de atividade física, além da inclusão exercícios físicos nas programações dos Grupos de Terceira Idad

Correlation between cognitive functions, balance and risk of fall in elderly with Alzheimer’s dementia

The Alzheimer’s dementia (AD) represents a clinical condition inherent to many chronic and neurodegenerative diseases that are usually related to a decline in the cognitive and physical functions. The objective of this research was to verify the correlation between cognitive functions, balance and risk of fall in elderly with AD when submitted to a systemized physical activity program. The sample consisted of 16 elderly divided in two groups: the Intervention Group (IG) n=9 77.7±7.5 years and the Control Group (CG) n=7 84.4 ± 6.1 years. Both groups were submitted to the tests: Mini Exam of the Mental State (MEEM); Berg’s Balance Functional Scale (EEFB); Timed Up and Go test (TUG) and the Agility and Dynamic Balance from AAHPERD (AGILEQ). The IG was submitted to a systemized physical activity program during six months, three times a week in non consecutive days, the CG did not participate of the physical activity program, both groups had its pharmacological assistance maintained. The Spearman correlation was used to verify possible correlations between the analyzed variables, with a level of significance of 5%. The analysis pointed to a high correlation (r=0.85) between the cognitive functions and the balance at the CG, shown by the MEEM and the AGILEQ tests. Even with no he statistically significant evidences, we could notice that there was a moderate correlation between MEEM and TUG to the CG. The analysis of the IG did not show us a significant correlation between the analyzed variables. The physical activity program seems contribute with reduction of decline cognitive function and balance of elderly with AD, so may be an important non pharmacology approach of maintenance elderly with this disease front the progression of dementia

Multidisciplinary rehabilitation program: effects of a multimodal intervention for patients with Alzheimer’s disease and cognitive impairment without dementia

Background Non-pharmalogical interventions represent an important complement to standard pharmalogical treatment in dementia. Objective This study aims to evaluate the effects of a multidisciplinary rehabilitation program on cognitive ability, quality of life and depression symptoms in patients with Alzheimer’s disease (AD) and cognitive impairment without dementia (CIND). Methods Ninety-seven older adults were recruited to the present study. Of these, 70 patients had mild AD and were allocated into experimental (n = 54) or control (n = 16) groups. Two additional active comparison groups were constituted with patients with moderate AD (n = 13) or with CIND (n = 14) who also received the intervention. The multidisciplinary rehabilitation program lasted for 12 weeks and was composed by sessions of memory training, recreational activities, verbal expression and writing, physical therapy and physical training, delivered in two weekly 6-hour sessions. Results As compared to controls, mild AD patients who received the intervention had improvements in cognition (p = 0.021) and quality of life (p = 0.003), along with a reduction in depressive symptoms (p < 0.001). As compared to baseline, CIND patients displayed at the end of the intervention improvements in cognition (p = 0.005) and depressive symptoms (p = 0.011). No such benefits were found among patients with moderate AD.Discussion: This multidisciplinary rehabilitation program was beneficial for patients with mild AD and CIND. However, patients with moderate dementia did not benefit from the intervention