Locomoção, distúrbios neuropsiquiátricos e alterações do sono de pacientes com demência e seus cuidadores / Locomotion, neuropsychiatric disturbs and sleep disorder in patients with dementia and their caregivers

INTRODUÇÃO: Os distúrbios neurodegenerativos representam condições clínicas graves, por provocar declínio neuropsíquico. OBJETIVO: Analisar a prevalência dos distúrbios neuropsiquiátricos em pacientes com demência, em relação à sua locomoção (independentes vs. dependentes), e no que se refere ao desgaste emocional e à qualidade do sono dos cuidadores. MATERIAIS E MÉTODOS: Participaram do estudo 34 sujeitos, assim divididos: dez pacientes independentes para locomoção e sete dependentes (cadeirantes); dez cuidadores dos pacientes independentes e sete cuidadores de pacientes dependentes. Os sujeitos foram avaliados no Ambulatório de Neuropsiquiatria da Universidade Estadual de Campinas. Para avaliar as funções cognitivas, utilizou-se o CAMCOOG; para quantificar frequência, intensidade e desgaste do cuidador, aplicou-se o Inventário Neuropsiquiátrico; e para mensurar as alterações do sono dos cuidadores, foi utilizado o Miniquestionário do Sono. A análise estatística foi realizada por meio dos testes U - Mann Whitney e índice de correlação de Spearman, ambos com 5% de significância. RESULTADOS: Com relação à prevalência dos distúrbios neuropsiquiátricos entre os pacientes, observou-se diferença estatisticamente significativa entre os grupos, especificamente no que se refere à irritabilidade (p < 0,05) e ao escore total dos distúrbios neuropsiquiátricos (p < 0,01). Também foram encontradas diferenças entre os grupos de cuidadores, com relação às alterações do sono (p < 0,05). CONCLUSÃO: Idosos independentes para locomoção apresentam menor prevalência dos distúrbios neuropsiquiátricos, quando comparados a idosos dependentes de cadeira de rodas. A locomoção parece não influenciar no desgaste físico e emocional do cuidador, mas constitui uma variável relevante na qualidade do sono dos cuidadores de idosos com diagnóstico de demência vascular e mista.

INTRODUCTION: The neurodegenerative disorders represent serious clinical conditions, causing neuropsychiatric decline. OBJECTIVE: To evaluate the prevalence of neuropsychiatric disorders in subjects with dementia, with respect to their locomotion (independent versus dependent ones) and to the caregivers' distress and sleep quality. MATERIALS AND METHODS: Thirty-four subjects participated in this study: ten independent locomotion patients and seven dependent ones (using wheelchair); ten carers of the independent locomotion patients and seven related to those that use wheelchairs. The subjects were recruited in the Clinic of Neurosciences and Mental Health of the Elderly of the State University of Campinas. The CAMCOG was used to evaluate patients' cognitive function; in order to quantify the frequency, intensity, emotional and physical distress of caregivers, the Neuropsychiatric Inventory was applied. Changes in the sleep were evaluated by means of Mini-Sleep Questionnaire. For comparisons of scores between the instruments, the Mann Whitney U and the Spearman coefficients index were applied, with a significant level of 5%. RESULTS: There were differences among irritability disorders (p < 0.05) as well as the total score of frequency and intensity of neuropsychiatric disorders (p < 0.01). Still, there were differences between the caregivers groups, in respect to sleep disorders (p < 0.05). CONCLUSION: Independent locomotion patients presented a lower prevalence of neuropsychiatric disorders, compared to the dependent ones. Findings suggest that motion does not influence the level of physical and emotional exhaustion of the caregiver. Nevertheless, it can be considered a relevant variable for sleep quality.

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 percent. 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.