RESUMO
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.
Assuntos
Idoso , Feminino , Humanos , Masculino , Doença de Alzheimer/reabilitação , Cuidadores/psicologia , Transtornos Cognitivos/reabilitação , Equipe de Assistência ao Paciente , Qualidade de Vida/psicologia , Doença de Alzheimer/complicações , Doença de Alzheimer/psicologia , Terapia Combinada , Transtornos Cognitivos/etiologia , Transtornos Cognitivos/psicologia , Método Simples-Cego , Resultado do TratamentoRESUMO
Abstract: Quality of life is seldom explored in evaluations of therapeutic interventions in Alzheimer's disease. Objective: To verify whether participation in a cognitive and functional rehabilitation program improves quality of life (QOL) among Alzheimer's disease (AD) patients. Methods: 19 AD patients participated in this study, 12 of whom attended 24 multi-professional intervention sessions - the experimental group - whereas the remaining 7 comprised the control group. The following tools were used to assess changes: a) Mini-Mental State Examination (MMSE); b) Geriatric Depression Scale (GDS); c) Quality of Life in AD evaluation scale (QOL-AD); d) Open question on QOL. Results: Participation had no positive impact on quantitative clinical variables (MMSE, GDS, QOL-AD). The answers to the open question, examined using the Collective Subject Discourse (CSD) method, suggested that QOL improved after the intervention. Conclusion: Combining pharmacological treatment with psychosocial intervention may prove to be an effective strategy to enhance the QOL of AD patients.
Resumo: Qualidade de vida não é frequentemente explorada na avaliação dos resultados de intervenções terapêuticas em DA. Objetivo: Verificar se a participação em um programa de reabilitação cognitiva e funcional melhora a qualidade de vida (QV) de pacientes com doença de Alzheimer. Metodos: 19 pacientes com DA participaram deste estudo, 12 participaram de 24 sessões de intervenção multiprofissional - grupo experimental - enquanto os 7 restantes compuseram o grupo controle. Os seguintes instrumentos foram utilizados para avaliar mudanças: a) Mini-Exame do Estado Mental (MEEM); b) Escala de Depressão Geriátrica (EDG); c) Escala de Avaliação de Qualidade de Vida na Doença de Alzheimer (QdV-DA); d) questão aberta sobre QV. Resultados: A participação não mostrou efeitos positivos em variáveis clínicas quantitativas (MEEM, EDG, QdV-DA). Os relatos na questão aberta, analisados através da metodologia do discurso do sujeito coletivo (DSC), sugeriram que a QV melhora após a intervenção. Conclusão: Aliar o tratamento medicamentoso às intervenções psicossociais pode ser uma boa estratégia para a melhora da QV dos portadores de DA.
Assuntos
Humanos , Qualidade de Vida , Reabilitação , Doença de AlzheimerRESUMO
OBJECTIVE: To describe the neuropsychological profile of mild cognitive impairment subtypes (amnestic, non-amnestic and multiple-domain) of a clinical sample. We further address the diagnostic properties of the Mini-Mental State Examination and the Cambridge Cognitive Examination for the identification of the different mild cognitive impairment subtypes in clinical practice. METHOD: Cross-sectional clinical and neuropsychological evaluation of 249 elderly patients attending a memory clinic at a university hospital in Sao Paulo, Brazil. RESULTS: The performance of patients with mild cognitive impairment was heterogeneous across the different subtests of the neuropsychological battery, with a trend towards an overall worse performance for amnestic (particularly multiple domain) mild cognitive impairment as compared to non-amnestic subtypes. Screening tests for dementia (Mini-Mental State Examination and Cambridge Cognitive Examination) adequately discriminated cases of mild Alzheimer's disease from controls, but they were not accurate to discriminate patients with mild cognitive impairment (all subtypes) from control subjects. CONCLUSIONS: The discrimination of mild cognitive impairment subtypes was possible only with the aid of a comprehensive neuropsychological assessment. It is necessary to develop new strategies for mild cognitive impairment screening in clinical practice.
OBJETIVO: Descrever o perfil neuropsicológico dos subtipos de comprometimento cognitivo leve, amnéstico, não-amnéstico e múltiplos domínios, de uma amostra clínica. Além disto, avaliou-se as propriedades diagnósticas do Mini-exame do Estado Mental e do Cambridge Cognitive Examination na identificação dos diferentes subtipos de comprometimento cognitivo leve na prática clínica. MÉTODO: Avaliação clínica e neuropsicológica transversal de 249 idosos em uma clínica de memória de um hospital universitário em São Paulo, Brasil. RESULTADOS: Testes de rastreio para demência (Mini-exame do Estado Mental e Cambridge Cognitive Examination) identificam corretamente casos de doença de Alzheimer leve, mas não apresentam boa acurácia para diferenciar os diversos subtipos de comprometimento cognitivo leve. A performance dos sujeitos portadores de comprometimento cognitivo leve foi heterogênea nos diferentes testes da bateria neuropsicológica, com uma tendência a uma pior performance global nos pacientes com o subtipo amnéstico (especialmente os com envolvimento de múltiplos domínios cognitivos) em relação ao comprometimento cognitivo leve não-amnéstico. CONCLUSÕES: A discriminação dos diferentes subtipos de comprometimento cognitivo leve foi possível somente a partir de uma avaliação neuropsicológica detalhada. Desta maneira, é necessário o desenvolvimento de novas estratégias de rastreio para esta condição na prática clínica.