Evaluation of social inclusion in Brazilian adult women with epilepsy: Perception of stigma and quality of life.

Epilepsy is a chronic disease characterized by recurrent epileptic seizures that can affect the perception of stigma and compromise the quality of life of those living with it. In addition, sociodemographic factors such as employment and maintaining a job, education, and the autonomy to drive vehicles are often impaired. OBJECTIVE: To assess the social inclusion of adult women with epilepsy in relation to the perception of stigma and quality of life, and the clinical aspects of the disease. METHODOLOGY: Data from 70 adult Brazilian women with epilepsy regarding aspects related to their social inclusion were verified. Such data were linked to clinical aspects and scores from the questionnaires: Quality of Life in Epilepsy Inventory 31 (QOLIE-31) and the Epilepsy Stigma Scale (ESS), with a significance level of p < 0.05. RESULTS: Average age of 45.5 years, 40 (57.1 %) women were divorced/single/widowed, 31 (44.3 %) women had less than 10 years of formal education, 32 (45.7 %) women had no income, and 57 (81.4 %) did not have a driver's license. The age at the time of the first seizure was 18 years, the seizures were focal in 46 (65.7 %) cases, and 26 (37.1 %) cases were seizure-free in the last year. A high number of women reported that the diagnosis of epilepsy negatively influenced aspects of autonomy such as the possession of a driver's license and going out alone. Longer duration of epilepsy was associated with lower education, not having children, and lower scores on the QOLIE-31. Higher scores on the QOLIE-31 were correlated with lower frequency of seizures and with the age at the time of the first seizure. Values in the dimension - energy and fatigue of the QOLIE-31 were significantly lower in the group with less independence compared to the other two groups with more independence, in latent class analyses (ANOVA, adjusted for age 42.1 ± 35.6 vs 57.2 ± 28.4 vs 73.9 ± 23.8, p = 0.0295). DISCUSSION: Clinical aspects of epilepsy and having a partner, autonomy, and independence such as driving vehicles are factors that contribute to social inclusion and to the perception of a better quality of life for adult women with epilepsy. CONCLUSION: It was observed that having a partner, autonomy, and independence such as driving vehicles are factors that contribute to social inclusion and to the perception of a better quality of life for adult women with epilepsy.

Physical activity in adults with epilepsy: clinical aspects and relationship with cognition and quality of life.

There are several factors associated with lower participation in regular physical activity (PA) in adult patients with epilepsy (PWEs). Objective: To assess the relationship between the regular practice of PA with clinical and cognitive variables and quality of life (QoL) in PWEs. Methods: Habitual Physical Activity Questionnaire (HPAQ) was related to clinical variables, scores on the Mini-Mental State Examination (MMSE), on the Brief Cognitive Battery-Edu (BCB-Edu), on the Satisfaction Scale for Physical Activity (SSPA), and on the Quality of Life in Epilepsy Inventory (QOLIE)-31 in 60 PWEs, with a significance level of p<0.05. Results: The PWEs had a mean age of 42.4±13.6 years, 50% of whom were female. Longer length of epilepsy correlated with lower PA in leisure time (Pearson correlation [r]= -0.276; p-value [p]=0.036). The occupational physical activity scores of the HPAQ correlated positively with perception (r=0.300; p=0.021), memory (r=0.381; p=0.003), semantic verbal fluency test (SVF) (r=0.427; p=0.001), and with the total score in the MMSE (r=0.327; p=0.012). The total HPAQ score correlated with the SVF (r=0.336; p=0.009) and with the MMSE (r=0.254; p=0.049). There was no correlation among the QOLIE-31, the HPAQ, and the SSPA. Conclusions: Longer duration of epilepsy was associated with the lower practice of PA. Physical activity was associated with better performance in aspects of cognition. There was no relationship between QoL and practice and satisfaction with PA, suggesting different psychosocial aspects involved.

Existem vários fatores associados à menor participação em atividade física regular (AF) em pacientes adultos com epilepsia (PCE). Objetivo: Avaliar em PCEs a relação entre a prática regular de AF com as variáveis clínicas e cognitivas e com a qualidade de vida (QV). Métodos: Foi relacionado o Habitual Physical Activity Questionnaire (HPAQ) com as variáveis clínicas, escores no Mini-Mental State Examination (MMSE), no Brief Cognitive Battery-Edu (BCB-Edu), Satisfaction Scale for Physical Activity (SSPA) e no Quality of Life in Epilepsy Inventory (QOLIE­31) de 60 PCE, com nível de significância p<0,05. Resultados: Idade média 42,4±13,6 anos, 50% do sexo feminino. O maior tempo de epilepsia correlacionou-se com a menor prática de AF no lazer (Correlação de Person, r= -0,276; p=0,036). Escores da AF ocupacional do HPAQ correlacionaram-se positivamente com a percepção (r=0,300; p=0,021) e a memória (r=0,381; p=0,003) no teste de fluência verbal (SVF); (r=0,427; p=0,001) e com o escore total no MMSE (r=0,327; p=0,012). O escore total do HPAQ correlacionou-se com o SVF (r=0,336; p=0,009) e com o MMSE (r=0,254; p=0,049). Não houve correlação entre o QOLIE­31 com o HPAQ e a SSPA. Conclusão: A maior duração da epilepsia associou-se com a menor prática de AF. A AF associou-se com o melhor desempenho em aspectos da cognição. Não houve relação entre QV com a prática e a satisfação e a AF, sugerindo diferentes aspectos psicossociais envolvidos.

Physical activity in adults with epilepsy: clinical aspects and relationship with cognition and quality of life / Atividade física em pessoas adultas com epilepsia: aspectos clínicos e as relações com a cognição e a qualidade de vida

ABSTRACT There are several factors associated with lower participation in regular physical activity (PA) in adult patients with epilepsy (PWEs). Objective: To assess the relationship between the regular practice of PA with clinical and cognitive variables and quality of life (QoL) in PWEs. Methods: Habitual Physical Activity Questionnaire (HPAQ) was related to clinical variables, scores on the Mini-Mental State Examination (MMSE), on the Brief Cognitive Battery-Edu (BCB-Edu), on the Satisfaction Scale for Physical Activity (SSPA), and on the Quality of Life in Epilepsy Inventory (QOLIE)-31 in 60 PWEs, with a significance level of p<0.05. Results: The PWEs had a mean age of 42.4±13.6 years, 50% of whom were female. Longer length of epilepsy correlated with lower PA in leisure time (Pearson correlation [r]= -0.276; p-value [p]=0.036). The occupational physical activity scores of the HPAQ correlated positively with perception (r=0.300; p=0.021), memory (r=0.381; p=0.003), semantic verbal fluency test (SVF) (r=0.427; p=0.001), and with the total score in the MMSE (r=0.327; p=0.012). The total HPAQ score correlated with the SVF (r=0.336; p=0.009) and with the MMSE (r=0.254; p=0.049). There was no correlation among the QOLIE-31, the HPAQ, and the SSPA. Conclusions: Longer duration of epilepsy was associated with the lower practice of PA. Physical activity was associated with better performance in aspects of cognition. There was no relationship between QoL and practice and satisfaction with PA, suggesting different psychosocial aspects involved.

RESUMO Existem vários fatores associados à menor participação em atividade física regular (AF) em pacientes adultos com epilepsia (PCE). Objetivo: Avaliar em PCEs a relação entre a prática regular de AF com as variáveis clínicas e cognitivas e com a qualidade de vida (QV). Métodos: Foi relacionado o Habitual Physical Activity Questionnaire (HPAQ) com as variáveis clínicas, escores no Mini-Mental State Examination (MMSE), no Brief Cognitive Battery-Edu (BCB-Edu), Satisfaction Scale for Physical Activity (SSPA) e no Quality of Life in Epilepsy Inventory (QOLIE-31) de 60 PCE, com nível de significância p<0,05. Resultados: Idade média 42,4±13,6 anos, 50% do sexo feminino. O maior tempo de epilepsia correlacionou-se com a menor prática de AF no lazer (Correlação de Person, r= -0,276; p=0,036). Escores da AF ocupacional do HPAQ correlacionaram-se positivamente com a percepção (r=0,300; p=0,021) e a memória (r=0,381; p=0,003) no teste de fluência verbal (SVF); (r=0,427; p=0,001) e com o escore total no MMSE (r=0,327; p=0,012). O escore total do HPAQ correlacionou-se com o SVF (r=0,336; p=0,009) e com o MMSE (r=0,254; p=0,049). Não houve correlação entre o QOLIE-31 com o HPAQ e a SSPA. Conclusão: A maior duração da epilepsia associou-se com a menor prática de AF. A AF associou-se com o melhor desempenho em aspectos da cognição. Não houve relação entre QV com a prática e a satisfação e a AF, sugerindo diferentes aspectos psicossociais envolvidos.

I would be better off dead: investigating suicidal ideation in people with epilepsy.

BACKGROUND: It is known that the risk of suicidal behavior in adult people with epilepsy (PWEs) is high. However, the associated clinical and psychosocial factors are still being discussed. OBJECTIVE: To assess the risk of suicide in PWEs and relate it to resilience and quality of life (QoL) as well as with clinical variables. METHODS: The item "I'd be better off dead" of the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) was related to the resilience scale, clinical aspects, the presence of depression, and the Quality of Life in Epilepsy Inventory (QOLIE-31) scores of PWEs, with a p < 0.05. RESULTS: A total of 271 PWEs were assessed, 50.6% were female, with a mean age of 46.6 (± 15.8) years, and a mean age at 1st seizure of 24.1 (± 18.5) years. Risk for suicide occurred in 50 (19.3%) cases. In multiple logistic regression, the factors that explain the risk of suicide were female sex, depression, and lower scores on the QOLIE-31 and on the resilience scale. In the classification and regression trees, the order of importance of the variables was depression > resilience > age > QoL > age at 1st seizure. CONCLUSION: The risk of suicide was high, and it was associated with demographic aspects, clinical variables, QoL, and resilience. A higher risk of suicide was associated with lower resilience regardless of the presence or absence of depression. In the presence of depression, a higher risk of suicide was associated with the early onset of epilepsy. In the absence of depression, the risk of suicide was associated with low QoL in young adults.

ANTECEDENTES: É sabido que o risco de comportamento suicida é elevado em pessoas adultas com epilepsia (PCEs); entretanto, ainda são discutidos quais são os fatores clínicos e psicossociais associados. OBJETIVO: Avaliar o risco de suicídio em PCEs e relacioná-lo com a resiliência e a qualidade de vida (QV) e com as variáveis clínicas. MéTODOS: Foi relacionado o item ­ "Eu preferiria estar morto" do inventário de depressão em transtornos neurológicos para a epilepsia (IDTN-E) com a escala de resiliência, os aspectos clínicos, a presença de depressão e com o inventário de qualidade de vida na epilepsia (QOLIE-31) de PCEs, com p < 0.05. RESULTADOS: Foram avaliados 271 PCEs, 50.6% dos quais eram do sexo feminino. A idade média foi de 46.6 (± 15.8) anos, e idade na 1ª crise 24.1 (± 18.5) anos. O risco de suicídio ocorreu em 50 (19.3%) casos. Na regressão logística múltipla, os fatores que explicaram o maior risco de suicídio foram o sexo feminino, a depressão, e os menores escores no QOLIE­31 e na escala de resiliência. Na árvore de classificação e regressão, a ordem de importância das variáveis foi depressão > resiliência > idade > QV > idade na 1ª crise. CONCLUSãO: O risco de suicídio foi elevado e associou-se com aspectos demográficos, variáveis clínicas, a QV e a resiliência. O maior risco de suicídio associou-se à menor resiliência, independente da presença de depressão. Na presença de depressão, o maior risco de suicídio associou-se ao início precoce da epilepsia. Na ausência de depressão, o risco de suicídio associou-se à baixa QV em adultos jovens.

I would be better off dead: investigating suicidal ideation in people with epilepsy / Eu preferiria estar morto: avaliando a ideação suicida em pessoas com epilepsia

Abstract Background It is known that the risk of suicidal behavior in adult people with epilepsy (PWEs) is high. However, the associated clinical and psychosocial factors are still being discussed. Objective To assess the risk of suicide in PWEs and relate it to resilience and quality of life (QoL) as well as with clinical variables. Methods The item "I'd be better off dead" of the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) was related to the resilience scale, clinical aspects, the presence of depression, and the Quality of Life in Epilepsy Inventory (QOLIE-31) scores of PWEs, with a p < 0.05. Results A total of 271 PWEs were assessed, 50.6% were female, with a mean age of 46.6 (± 15.8) years, and a mean age at 1st seizure of 24.1 (± 18.5) years. Risk for suicide occurred in 50 (19.3%) cases. In multiple logistic regression, the factors that explain the risk of suicide were female sex, depression, and lower scores on the QOLIE-31 and on the resilience scale. In the classification and regression trees, the order of importance of the variables was depression > resilience > age > QoL > age at 1st seizure. Conclusion The risk of suicide was high, and it was associated with demographic aspects, clinical variables, QoL, and resilience. A higher risk of suicide was associated with lower resilience regardless of the presence or absence of depression. In the presence of depression, a higher risk of suicide was associated with the early onset of epilepsy. In the absence of depression, the risk of suicide was associated with low QoL in young adults.

Resumo Antecedentes É sabido que o risco de comportamento suicida é elevado em pessoas adultas com epilepsia (PCEs); entretanto, ainda são discutidos quais são os fatores clínicos e psicossociais associados. Objetivo Avaliar o risco de suicídio em PCEs e relacioná-lo com a resiliência e a qualidade de vida (QV) e com as variáveis clínicas. Métodos Foi relacionado o item - "Eu preferiria estar morto" do inventário de depressão em transtornos neurológicos para a epilepsia (IDTN-E) com a escala de resiliência, os aspectos clínicos, a presença de depressão e com o inventário de qualidade de vida na epilepsia (QOLIE-31) de PCEs, com p < 0.05. Resultados Foram avaliados 271 PCEs, 50.6% dos quais eram do sexo feminino. A idade média foi de 46.6 (± 15.8) anos, e idade na 1ª crise 24.1 (± 18.5) anos. O risco de suicídio ocorreu em 50 (19.3%) casos. Na regressão logística múltipla, os fatores que explicaram o maior risco de suicídio foram o sexo feminino, a depressão, e os menores escores no QOLIE-31 e na escala de resiliência. Na árvore de classificação e regressão, a ordem de importância das variáveis foi depressão > resiliência > idade > QV > idade na 1ª crise. Conclusão O risco de suicídio foi elevado e associou-se com aspectos demográficos, variáveis clínicas, a QV e a resiliência. O maior risco de suicídio associou-se à menor resiliência, independente da presença de depressão. Na presença de depressão, o maior risco de suicídio associou-se ao início precoce da epilepsia. Na ausência de depressão, o risco de suicídio associou-se à baixa QV em adultos jovens.

Memory complaints, clinical aspects, and self-esteem in adult people with epilepsy.

Memory complaints are common in adult people with epilepsy (PWEs). However, the associated clinical aspects are not yet fully understood. OBJECTIVE: This study aims to relate the occurrence of memory complaints in PWEs with clinical aspects and self-esteem. METHODS: To relate the data obtained from the Memory Complaint Questionnaire (MAC-Q) with clinical aspects, 71 PWEs were assessed using the Rosenberg Self-Esteem Scale (SES), the Mini Mental State Examination (MMSE), and the Brief Cognitive Battery-Edu. These data were compared with 55 individuals in a control group (CG). RESULTS: Memory complaints (MAC-Q≥25) were significantly higher in PWEs, when compared with individuals in the CG [35 (49.3%) vs. 15 (27.2%); Student's t-test; p=0.012]. Objective cognitive performance was lower in PWEs. Memory complaints were associated with a lower educational level, the presence of depression, SES, MMSE, incidental memory, and the clock-drawing test scores in PWEs. CONCLUSIONS: Memory complaints were more frequent in PWEs than in individuals in the CG, and there was a relationship with cognitive deficit, educational level, depression, and low self-esteem.

Queixas de memória são frequentes em pessoas adultas com epilepsia (PCEs). Entretanto, os aspectos clínicos associados ainda não são totalmente compreendidos. OBJETIVO: Relacionar a ocorrência de queixas de memória em PCEs com aspectos clínicos e a autoestima. MÉTODOS: Relacionar os dados do Memory Complaint Questionnaire (MAC-Q) com aspectos clínicos, a Roserberg Self-esteem Scale (SES), o MEEM e a BCB-Edu de 71 PCEs. Os dados foram comparados aos de 55 indivíduos normais (GC). RESULTADOS: Queixa de memória (MAC-Q≥25) foi significativamente maior nos PCEs quando comparada a do GC [35 (49,3%) vs. 15 (27,2%); teste t de Student; p=0,012]. O desempenho cognitivo objetivo foi inferior nas PWEs. As queixas de memória foram associadas à menor escolaridade, presença de depressão e à SES, o MEEM, à memória incidental e o clock-drawing test nas PCEs. CONCLUSÕES: As queixas de memória foi mais frequente nas PCEs do que no GC, e houve relação com o déficit cognitivo, a escolaridade, a depressão e a baixa autoestima.

Memory complaints, clinical aspects, and self-esteem in adult people with epilepsy / Queixa de memória, aspectos clínicos e a autoestima em pessoas adultas com epilepsia

ABSTRACT Memory complaints are common in adult people with epilepsy (PWEs). However, the associated clinical aspects are not yet fully understood. Objective: This study aims to relate the occurrence of memory complaints in PWEs with clinical aspects and self-esteem. Methods: To relate the data obtained from the Memory Complaint Questionnaire (MAC-Q) with clinical aspects, 71 PWEs were assessed using the Rosenberg Self-Esteem Scale (SES), the Mini Mental State Examination (MMSE), and the Brief Cognitive Battery-Edu. These data were compared with 55 individuals in a control group (CG). Results: Memory complaints (MAC-Q≥25) were significantly higher in PWEs, when compared with individuals in the CG [35 (49.3%) vs. 15 (27.2%); Student's t-test; p=0.012]. Objective cognitive performance was lower in PWEs. Memory complaints were associated with a lower educational level, the presence of depression, SES, MMSE, incidental memory, and the clock-drawing test scores in PWEs. Conclusions: Memory complaints were more frequent in PWEs than in individuals in the CG, and there was a relationship with cognitive deficit, educational level, depression, and low self-esteem.

RESUMO Queixas de memória são frequentes em pessoas adultas com epilepsia (PCEs). Entretanto, os aspectos clínicos associados ainda não são totalmente compreendidos. Objetivo: Relacionar a ocorrência de queixas de memória em PCEs com aspectos clínicos e a autoestima. Métodos: Relacionar os dados do Memory Complaint Questionnaire (MAC-Q) com aspectos clínicos, a Roserberg Self-esteem Scale (SES), o MEEM e a BCB-Edu de 71 PCEs. Os dados foram comparados aos de 55 indivíduos normais (GC). Resultados: Queixa de memória (MAC-Q≥25) foi significativamente maior nos PCEs quando comparada a do GC [35 (49,3%) vs. 15 (27,2%); teste t de Student; p=0,012]. O desempenho cognitivo objetivo foi inferior nas PWEs. As queixas de memória foram associadas à menor escolaridade, presença de depressão e à SES, o MEEM, à memória incidental e o clock-drawing test nas PCEs. Conclusões: As queixas de memória foi mais frequente nas PCEs do que no GC, e houve relação com o déficit cognitivo, a escolaridade, a depressão e a baixa autoestima.

The impact of COVID-19 on patients with epilepsy / O impacto da COVID-19 em pacientes com epilepsia

ABSTRACT Background: The COVID-19 pandemic and social distancing can have adverse impacts on adult people with epilepsy (PWE). Objective: To investigate the seizure frequency, the perceived well-being, and the presence of anxiety symptoms in PWE during the COVID-19 pandemic period. Methods: Data from a questionnaire on the repercussions of COVID-19 were analyzed in relation to the clinical variables of 114 PWE, with a significance level of p<0.05. Results: There were 26 cases of COVID-19 in PWE and/or family members (22.8%). During the pandemic period, 11 PWE (9.6%) reported an increase in seizures, but unrelated to COVID-19. Also, the number of crises in PWE with previous depressive disorders increased, with differences between epilepsies. Symptoms of depression, impaired well-being, and concern for their lifestyle were significant in PWE with a previous diagnosis of depression. Impaired well-being, increased anxiety, nervousness, and tiredness, and the concern with being infected were mentioned by a high number of PWE in the pandemic. Conclusion: Seizure frequency increased during the pandemic period, a finding associated with clinical variables of epilepsy. PWE with depression had worse perceived well-being. Changes in well-being and increased anxiety and nervousness were frequent in the pandemic.

RESUMO Introdução: A pandemia por COVID-19 e o isolamento social podem ter impactos adversos em pessoas adultas com epilepsia (PCE). Objetivo: Investigar a frequência das crises, a percepção de bem-estar e a presença de sintomas de ansiedade em PCE no período da pandemia da COVID-19. Métodos: Foram relacionados os dados de um questionário de repercussões da COVID-19 com as variáveis clínicas de 114 PCE, com nível de significância p<0,05. Resultados: A COVID-19 ocorreu em 26 (22,8%) PCE e/ou familiares. Durante o período da pandemia, houve aumento das crises epilépticas em 11 (9,6%) PCE, mas sem relação com o diagnóstico de COVID-19. No período da pandemia, houve aumento do número de crises nos PCE com transtorno depressivo prévio e de modo distinto entre as epilepsias. Sintomas de depressão, comprometimento do bem-estar e preocupação com o estilo de vida ocorreram significativamente nos PCE com diagnostico anterior de depressão. O comprometimento do bem-estar, o aumento da ansiedade, do nervosismo e do cansaço, e a preocupação em contrair a doença foram referidos na maior parte do tempo em elevado número de PCE na pandemia. Conclusão: Houve aumento da ocorrência de crises epilépticas durante o período pandêmico e isso foi associado a variáveis clínicas da epilepsia. Pior percepção de bem-estar ocorreu nos PCE com depressão. Alteração do bem-estar e aumento de ansiedade e de nervosismo foram frequentes na pandemia.

The impact of COVID-19 on patients with epilepsy.

BACKGROUND: The COVID-19 pandemic and social distancing can have adverse impacts on adult people with epilepsy (PWE). OBJECTIVE: To investigate the seizure frequency, the perceived well-being, and the presence of anxiety symptoms in PWE during the COVID-19 pandemic period. METHODS: Data from a questionnaire on the repercussions of COVID-19 were analyzed in relation to the clinical variables of 114 PWE, with a significance level of p<0.05. RESULTS: There were 26 cases of COVID-19 in PWE and/or family members (22.8%). During the pandemic period, 11 PWE (9.6%) reported an increase in seizures, but unrelated to COVID-19. Also, the number of crises in PWE with previous depressive disorders increased, with differences between epilepsies. Symptoms of depression, impaired well-being, and concern for their lifestyle were significant in PWE with a previous diagnosis of depression. Impaired well-being, increased anxiety, nervousness, and tiredness, and the concern with being infected were mentioned by a high number of PWE in the pandemic. CONCLUSION: Seizure frequency increased during the pandemic period, a finding associated with clinical variables of epilepsy. PWE with depression had worse perceived well-being. Changes in well-being and increased anxiety and nervousness were frequent in the pandemic.

Family caregivers of elderly with dementia Relationship between religiosity, resilience, quality of life and burden.

There are gaps in knowledge regarding how the family caregiver deals with the burden of caring for elderly people with dementia. OBJECTIVE: To evaluate the family caregivers' perception of quality of life (QoL), burden, resilience and religiosity and relate them with cognitive aspects and occurrence of neuropsychiatric symptoms of elderly with dementia. METHODS: Data from the QoL-AD scale, caregivers' version, burden interview, resilience scale, Beck depression inventory and PDUREL of 50 family caregivers were correlated with disability assessment for dementia, neuropsychiatric inventory and clinical aspects of 50 elderly with dementia. RESULTS: Linear regression showed that resilience is related with better perceived QoL (p<0.001), severity of dementia (p=0.008), higher intrinsic religiosity (IR) (p=0.044) and lower occurrence of depressive symptoms (p=0.001). Increased burden of family caregivers was associated with a higher occurrence of neuropsychiatric symptoms, education of the elder with dementia, and worse perceived QoL (p<0.001). Lower level of organizational religiosity was associated with severity of dementia. CONCLUSION: The most resilient caregivers had higher QoL and IR, fewer depressive symptoms, and cared for elders with more severe dementia. Cognitive and sociodemographic aspects, as well as neuropsychiatric symptoms, in the elderly with dementia were associated with QoL and greater caregiver burden.

Existem lacunas no conhecimento sobre como o cuidador familiar lida com o ônus de cuidar de idosos com demência. OBJETIVO: Avaliar a percepção de qualidade de vida (QV), sobrecarga, resiliência e religiosidade dos cuidadores familiares e relacioná-los com aspectos cognitivos e ocorrência de sintomas neuropsiquiátricos em idosos com demência. MÉTODOS: Dados da escala de QV, versão dos cuidadores, entrevista de sobrecarga, escala de resiliência, inventário de depressão de Beck e PDUREL de 50 cuidadores familiares foram correlacionados com avaliação de incapacidade para demência, inventário neuropsiquiátrico e aspectos clínicos de 50 idosos com demência. RESULTADOS: A regressão linear mostrou que a resiliência está relacionada a melhor percepção da QV (p<0,001), gravidade da demência (p=0,008), maior religiosidade intrínseca (p=0,044) e menor ocorrência de sintomas depressivos (p=0,001). O aumento da sobrecarga do cuidador familiar esteve relacionado à maior ocorrência de sintomas neuropsiquiátricos, escolaridade dos idosos com demência e pior percepção da QV (p<0,001). Nível inferior de religiosidade organizacional estava relacionado à gravidade da demência. CONCLUSÃO: O cuidador mais resiliente apresenta maior QV e IR, menos sintomas depressivos e cuida de idosos com graus mais severos de demência. Aspectos cognitivos, sociodemográficos e sintomas neuropsiquiátricos em idosos com demência estão relacionados à QV e maior sobrecarga do cuidador.

Family caregivers of elderly with dementia: relationship between religiosity, resilience, quality of life and burden / Cuidador familiar de idosos com demência: relação entre religiosidade, resiliência, qualidade de vida e sobrecarga

ABSTRACT: There are gaps in knowledge regarding how the family caregiver deals with the burden of caring for elderly people with dementia. Objective: To evaluate the family caregivers' perception of quality of life (QoL), burden, resilience and religiosity and relate them with cognitive aspects and occurrence of neuropsychiatric symptoms of elderly with dementia. Methods: Data from the QoL-AD scale, caregivers' version, burden interview, resilience scale, Beck depression inventory and PDUREL of 50 family caregivers were correlated with disability assessment for dementia, neuropsychiatric inventory and clinical aspects of 50 elderly with dementia. Results: Linear regression showed that resilience is related with better perceived QoL (p<0.001), severity of dementia (p=0.008), higher intrinsic religiosity (IR) (p=0.044) and lower occurrence of depressive symptoms (p=0.001). Increased burden of family caregivers was associated with a higher occurrence of neuropsychiatric symptoms, education of the elder with dementia, and worse perceived QoL (p<0.001). Lower level of organizational religiosity was associated with severity of dementia. Conclusion: The most resilient caregivers had higher QoL and IR, fewer depressive symptoms, and cared for elders with more severe dementia. Cognitive and sociodemographic aspects, as well as neuropsychiatric symptoms, in the elderly with dementia were associated with QoL and greater caregiver burden.

RESUMO: Existem lacunas no conhecimento sobre como o cuidador familiar lida com o ônus de cuidar de idosos com demência. Objetivo: Avaliar a percepção de qualidade de vida (QV), sobrecarga, resiliência e religiosidade dos cuidadores familiares e relacioná-los com aspectos cognitivos e ocorrência de sintomas neuropsiquiátricos em idosos com demência. Métodos: Dados da escala de QV, versão dos cuidadores, entrevista de sobrecarga, escala de resiliência, inventário de depressão de Beck e PDUREL de 50 cuidadores familiares foram correlacionados com avaliação de incapacidade para demência, inventário neuropsiquiátrico e aspectos clínicos de 50 idosos com demência. Resultados: A regressão linear mostrou que a resiliência está relacionada a melhor percepção da QV (p<0,001), gravidade da demência (p=0,008), maior religiosidade intrínseca (p=0,044) e menor ocorrência de sintomas depressivos (p=0,001). O aumento da sobrecarga do cuidador familiar esteve relacionado à maior ocorrência de sintomas neuropsiquiátricos, escolaridade dos idosos com demência e pior percepção da QV (p<0,001). Nível inferior de religiosidade organizacional estava relacionado à gravidade da demência. Conclusão: O cuidador mais resiliente apresenta maior QV e IR, menos sintomas depressivos e cuida de idosos com graus mais severos de demência. Aspectos cognitivos, sociodemográficos e sintomas neuropsiquiátricos em idosos com demência estão relacionados à QV e maior sobrecarga do cuidador.

Alzheimer's disease: nutritional status and cognitive aspects associated with disease severity / Enfermedad de Alzheimer: estado nutricional y sus relaciones con los aspectos cognitivos y la gravedad de la enfermedad

Introduction: Alzheimer's pathology is a neurodegenerative disease characterized by cognitive impairment and functional disability that causes progressive restrictions in daily activities. The present study associates nutritional status with cognitive and clinical aspects of the elderly with mild, moderate and severe Alzheimer's disease (AD). Methods: data from the Mini Nutritional Assessment (MNA), bioelectrical impedance (BIA), anthropometric measurements, and physical activity indicators were associated with clinical and cognitive aspects of 43 elderly patients with AD. The data were compared to a paired control group (NC) (n = 51) at a significance level of p < 0.05. Results: elderly patients with AD presented lower cognitive performance, higher risk of malnutrition (p = 0.001), lower weight (t-test, p = 0.017) and body mass index (BMI) (p = 0.006), and higher sedentarity (Chi-square, p = 0.040) when compared with the NC. The elderly with AD presented significant reduction in lean body mass (LM) and increased fat mass (FM). As dementia progresses, significant impairment of nutritional indicators is observed. Elderly patients with severe AD present lower weight, BMI, MNA scores and increased body fat mass index and fat mass when compared with those with mild/moderate AD. A correlation was observed between better cognitive performance and weight, BMI, calf circumference and triceps skinfold thickness. Conclusion: elderly patients with AD present high sedentarity, risk of malnutrition, lower weight, BMI and LM, and increased FM. There was progressive impairment of nutritional status and cognition as the disease progressed. There is an association between the nutritional variables and cognitive aspects

Introducción: la enfermedad de Alzheimer (EA) es una enfermedad neurodegenerativa caracterizada por incapacidad funcional, generalmente progresiva y con restricciones en la vida diaria. El objetivo de este estudio es valorar la asociación entre el estado nutricional y los aspectos cognitivos y clínicos en las personas mayores con EA leve, moderada y grave. Métodos: se relacionaron los datos del Mini Nutritional Assessment (MNA), la impedancia bioeléctrica (BIA), las medidas antropométricas y los indicadores de actividad física con los aspectos clínicos y cognitivos de 43 personas mayores con EA. Los datos se compararon a los de un grupo control (GC) pareado de 51 individuos, con un nivel de significación p < 0,05. Resultados: las personas mayores con EA tuvieron peores resultados en la evaluación cognitiva, un mayor riesgo de desnutrición (Mann-Whitney test; p = 0,001), menor peso (t test; p = 0,017) y menor índice de masa corporal (IMC) (p = 0,006), aunque un mayor sedentarismo (c2; p = 0,040), en comparación al GC. Las personas mayores con EA presentan, de manera significativa, menores medidas de masa magra (MM) y mayores medidas de masa grasa (MG). Según evoluciona la demencia los indicadores nutricionales empeoran. Las personas mayores con EA grave presentan menor peso, IMC y puntuación del MNA, pero mayores índices de masa grasa y masa magra cuando se comparan con los de EA leve y moderado. Hubo una correlación significativa entre un mejor desempeño cognitivo con el peso, IMC y medidas de la circunferencia de la pantorrilla c y el grosor del pliegue tricipital. Conclusión: las personas mayores con EA son más sedentarias, presentan mayor riesgo de desnutrición, menor peso, IMC y MM, y un aumento de la MG según va empeorando la enfermedad. Hay relación entre las variables nutricionales y los aspectos cognitivos

Epilepsy and quality of life: socio-demographic and clinical aspects, and psychiatric co-morbidity.

Objective To study socio-demographic and clinical aspects, as well as psychiatric co-morbidity that influence the quality of life of adult epileptic patients. Methods One hundred and thirty-two individuals diagnosed with epilepsy were evaluated from neurological/clinical and psychiatric points of view and by the Quality of Life in Epilepsy Inventory (QOLIE-31). Predictive factors for the QOLIE-31 scores were studied. Results The regression analyses indicated the existence of psychiatric co-morbidity (total score, seizure worry, emotional well-being, energy/fatigue, social function and cognitive function) and a greater seizure frequency (total score, cognitive function and energy/fatigue) as predictive factors for lower scores in the total QOLIE-31 score and in various dimensions. Abnormalities in the neurological exam and poly-therapy with anti-epileptic drugs were negative factors limited to one of the dimensions cognitive function and social function, respectively. Conclusion The presence of psychiatric co-morbidity and a greater seizure frequency were the main factors influencing the quality of life in epileptic patients as evaluated by QOLIE-31.

Epilepsy and quality of life: socio-demographic and clinical aspects, and psychiatric co-morbidity / Epilepsia e qualidade de vida: aspectos sociodemográficos, clínicos e comorbidade psiquiátrica

To study socio-demographic and clinical aspects, as well as psychiatric co-morbidity that influence the quality of life of adult epileptic patients.

Estudar os aspectos sociodemográficos, clínicos e comorbidades psiquiátricas que influenciam a qualidade de vida de pacientes adultos com epilepsia.

Epilepsia e espiritualidade/religiosidade / Epilepsy and spirituality/religiosity

As implicações da espiritualidade/religiosidade na saúde vêm sendo estudadas e documentadas cientificamente. A relação entre epilepsia e espiritualidade/religiosidade está presente na história da humanidade e também tem sido alvo de investigação em décadas recentes. Este estudo utilizou as bases de dados e Lilacs e MedLine, a partir da busca com os descritores spirituality AND epilepsy, e com religious AND epilepsy, nos idiomas inglês, espanhol e português, em artigos publicados no período de 1997 a 2009. São apresentados nesta revisão, de forma sistemática, os achados dos estudos, distribuídos em cinco tópicos: 1) aspectos históricos da relação entre epilepsia e espiritualidade/religiosidade; 2) experiência religiosa ictal e pós-ictal na epilepsia de lobo temporal; 3) hiper-religiosidade e epilepsia do lobo temporal; 4) experiência religiosa, crise epiléptica e bases neurais; 5) qualidade de vida e espiritualidade/religiosidade. Historicamente a epilepsia tem sido ligada a preconceitos relacionados a interpretações religiosas acerca da gênese das crises epilépticas. Experiências religiosas ou hiper-religiosidade têm sido descritas em cerca da 10% dos pacientes com epilepsia do lobo temporal. A base neural dessas experiências religiosas não está bem definida, mas estruturas dos lobos temporais parecem ter uma participação importante. Esta revisão mostra, na avaliação de pessoas com epilepsia, a importância de uma perspectiva integrada, de cunho biopsicossocial, na qual aspectos religiosos podem ser relevantes

The implications of spirituality and religiosity on health have been scientifically studied and documented. The relationship between epilepsy and spirituality and religiosity is present in the history of mankind and has been investigated in the past few decades. This study searched the Lilacs and Medline databases for articles published from 1997 to 2009 in English, Spanish and Portuguese using the terms ?spirituality AND epilepsy? and ?religiosity AND epilepsy?. The findings of the studies were divided into five topics and presented systematically in this review: 1) historical aspects of the relationship between epilepsy and spirituality/ religiosity; 2) ictal and postictal religious experience in temporal lobe epilepsy; 3) hyper-religiosity and temporal lobe epilepsy; 4) religious experience, epileptic seizures and neural bases; and 5) quality of life and spirituality and religiosity. Historically, epilepsy has been associated with prejudice against the religious interpretations of the genesis of epileptic seizures. Religious experiences or hyper-religiosity have been described in roughly 10% of the patients with temporal lobe epilepsy. The neural base of these religious experiences is not well defined, but temporal lobe structures seem to play an important role. This review shows the importance of considering biological, psychological and social aspects when assessing individuals with epilepsy, since religious aspects can be relevant

Epilepsia e depressão: aspectos sociodemográficos e clínicos associados / Sociodemographic and clinical factors associated with depression in epilepsy

Objetivo Avaliar, em pacientes adultos com epilepsia focal, a ocorrência de depressão e sua relação com variáveis sociodemográficas e clínicas. Métodos Foram estudados 87 pacientes adultos (idade média de 44,2 anos) com diagnóstico de epilepsia focal sintomática ou provavelmente sintomática, acompanhados no ambulatório de neurologia clínica do Hospital e Maternidade Celso Pierro da Pontifícia Universidade Católica de Campinas. Foram realizados anamnese, exame clínico-neurológico e aplicação da Escala de Depressão de Hamilton. Foi estudada a relação dos aspectos sociodemográficos e clínicos com a ocorrência de depressão. Foram utilizados testes estatísticos, com nível de significância p<0,05. Resultados Cinquenta e três pacientes apresentaram depressão conforme a Escala de Depressão de Hamilton (leve em 42, moderada em 8, e grave em 3 casos). Foi observada maior ocorrência de depressão entre as mulheres e em pacientes com epilepsia do lobo temporal com esclerose hipocampal (análise de regressão p<0,05). Não foram observadas relações estatisticamente significativas entre as outras variáveis clínicas e a ocorrência de depressão. Conclusão A depressão é frequente em pacientes com epilepsia e pode ser um fator de impacto, na qualidade de vida, por vezes mais importante do que a frequência das crises. O presente estudo sugere a existência de fatores sociodemográficos e biológicos associados à depressão. O conhecimento adequado desses fatores pode ter importância nas estratégias de diagnóstico e de atenção ao portador de epilepsia.

Objective This study aimed to evaluate the occurrence of depression and its relationships with sociodemographic and clinical factors in adult patients with focal epilepsy. Methods A total of 87 adult patients (age = 44.2 standard deviation=14.8 years) were assessed using medical history, neurological evaluation and Hamilton depression scale. They had symptomatic or probably symptomatic focal epilepsy. The relationships between depression in the Hamilton depression scale and sociodemographic and clinical aspects were studied. Statistical tests were done with the significance level set at p<0.05. Results Fifty-three patients had depression in the Hamilton depression scale (mild in 42 cases, moderate in 8, and severe in 3 cases). Depression was more prevalent in women and in temporal lobe epilepsy patients with hippocampus sclerosis (regression analysis, p<0.05). There were no significant statistical relationships among the other clinical variables and the presence of depression. Conclusion Depression is common among patients with focal epilepsy and may impact quality of life more than the frequency of seizures. The present study suggests the existence of sociodemographic and biological factors associated with depression. Good knowledge of these factors can be important for the diagnostic and care strategies provided to epilepsy patients.

Potencial evocado somato-sensitivo: considerações gerais sobre componente cortical com amplitude elevada / Somatosensory evoked potential: general considerations on high amplitude cortical component

Os componentes corticais do potencial evocado somato-sensitivo apresentam uma grande variabilidade interindividual tendo em vista as mudanças fisiológicas e patológicas que ocorrem no desenvolvimento e no envelhecimento. Dawson em 1946 descreveu o componente cortical com amplitude elevada em pacientes com epilepsia mioclônica progressiva. Outros estudos mostraram que a associação do componente cortical com amplitude elevada estaria associada à ocorrência de mioclonia cortical, não estando presente nas mioclonias subcorticais e segmentares. Em estudos do PES nas epilepsias parciais benignas da infância foi observado que os componentes corticais precoces apresentam latências e amplitudes normais, enquanto os de média e longa latências podem apresentar amplitudes elevadas com morfologia e latência normais. A origem do componente cortical com amplitude elevada não está esclarecida. Tem sido proposto que a amplitude elevada reflita um aumento da excitabilidade de áreas corticais, em especial, das áreas do córtex sensorial primário, em razão de uma desordem primária cortical dos interneurônios inibitórios, ou em decorrência de uma falência das influências inibitórias de estruturas subcorticais.