Effects of a multidisciplinar cognitive rehabilitation program for patients with mild Alzheimer's disease

OBJECTIVE: To evaluate the effects of a multidisciplinary rehabilitation program on cognition, quality of life, and neuropsychiatry symptoms in patients with mild Alzheimer's disease. METHOD: The present study was a single-blind, controlled study that was conducted at a university-based day-hospital memory facility. The study included 25 Alzheimer's patients and their caregivers and involved a 12-week stimulation and psychoeducational program. The comparison group consisted of 16 Alzheimer's patients in waiting lists for future intervention. INTERVENTION: Group sessions were provided by a multiprofessional team and included memory training, computer-assisted cognitive stimulation, expressive activities (painting, verbal expression, writing), physiotherapy, and physical training. Treatment was administered twice a week during 6.5-h gatherings. MEASUREMENTS: The assessment battery comprised the following tests: Mini-Mental State Examination, Short Cognitive Test, Quality of Life in Alzheimer's disease, Neuropsychiatric Inventory, and Geriatric Depression Scale. Test scores were evaluated at baseline and the end of the study by raters who were blinded to the group assignments. RESULTS: Measurements of global cognitive function and performance on attention tasks indicated that patients in the experimental group remained stable, whereas controls displayed mild but significant worsening. The intervention was associated with reduced depression symptoms for patients and caregivers and decreased neuropsychiatric symptoms in Alzheimer's subjects. The treatment was also beneficial for the patients' quality of life. CONCLUSION: This multimodal rehabilitation program was associated with cognitive stability and significant improvements in the quality of life for Alzheimer's patients. We also observed a significant decrease in depressive symptoms and caregiver burden. These results support the notion that structured nonpharmacological interventions can yield adjunct and clinically relevant benefits in dementia treatment.

Papel da proteína Tau na fisiopatologia da demência frontotemporal / The role of TAU protein in the pathophysiology of frontotemporal dementia

CONTEXTO: Sob a denominação demência frontotemporal (DFT) enquadram-se importantes síndromes demenciais de natureza degenerativa progressiva que acometem os lobos frontais e temporais em ambos os hemisférios. As DFTs podem ser agrupadas, segundo seus aspectos clínicos dominantes, em variante frontal, afasia progressiva não fluente e demência semântica. A proteína Tau tem papel importante na patogenia desses transtornos, e anormalidades conformacionais estão presentes em até 50 por cento dos casos de DFT esporádica. Do ponto de vista neuropatológico, as DFTs podem ser classificadas em Tau negativas e Tau positivas, estas últimas também classificadas entre as tauopatias. OBJETIVO: Neste trabalho será revisto o papel da proteína Tau na patogenia das DFTs. MÉTODOS: Busca simples no Scielo e na Pubmed por meio das palavras-chave: "tauopatias", "demência frontotemporal" e "proteína Tau". Foram revisados os artigos publicados a partir de 2000, e artigos anteriores de maior relevância, identificados a partir das referências estudadas. RESULTADOS: Dentre os trabalhos incluídos nesta análise, 12 abordam as tauopatias, sendo dez originais e sete de revisão. Foram identificados 20 artigos sobre DFT, sendo 16 artigos originais e quatro de revisão. CONCLUSÃO: A proteína Tau tem papel fundamental na patogenia das DFTs e outras doenças neurodegenerativas. O conhecimento desses mecanismos fisiopatológicos é o passo inicial para o desenvolvimento de estratégias terapêuticas.

BACKGROUND: Frontotemporal dementia (FTD) represents an important group of neurodegenerative diseases, affecting temporal and frontal lobes of both hemispheres. FTD can be divided into three clinical subsyndromes: frontal variant, non-fluent progressive aphasia, and semantic dementia. Abnormalities of the metabolism of Tau protein are present in the physiopathology of FTD, and is found in approximately 50 percent of sporadic cases, supporting the classification of the FTDs into Tau-negative and Tau-positive subtypes, the latter also called "Tauopathies". OBJECTIVE: To review the role of Tau in the pathophysiology of FTD. METHODS: Review of the literature on FTD published in the Pubmed and Scielo databases since the year 2000, using the keywords: Tau, Tauopathies, frontotemporal dementia. Relevant references previously published, as indicated in the reference list of selected articles, were also included. RESULTS: Through electronic search we identified 12 articles addressing Tauopathies (ten containing original data and seven reviews), and 20 articles (16 with original data and four reviews) on FTDs. CONCLUSIONS: There is consistent evidence in the literature to support the notion that Tau protein plays a crucial role in the pathogenesis of FTDs and other neurodegenerative dementias, and the knowledge on these mechanisms is necessary for the development of more specific therapies.