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Alzheimer's Disease (AD) is an illness that degenerates an individual's cognitive functions, leaving them unable to take care of themselves. Even without a definitive cure, AD should be treated with remedies and cognitive enhancement. This article presents an application that assists in the cognitive reinforcement of AD patients through games, supports the medical follow-up of patients, and facilitates the daily exchange of information between the caregiver and the doctor.

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Objective: Understand how seniors live with Alzheimer’s and their perceptions about the actions of the health strategy of the family (FHS). Methods: Exploratory and descriptive study, conducted with ten seniors who agreed to give information. Two forms were used for the evaluation, the index of Katz and the Mini Mental State Examination. Approved by the Research Ethics Committee of the grape with the opinion nº 608,721. Results: The elderly were mostly female, married and illiterate. Had cognitive impairment and some were independent in practice of daily life activities. There are weaknesses in the adaptation of households, but they notice the efforts of their relatives in the space adjustment. The elderly demonstrated satisfaction regarding the attention on ESF. Conclusion: Infer the importance of improving the condition of life, independence and autonomy of the elderly.

Objetivo: Compreender como vivem os idosos com Alzheimer e as suas percepções sobre as ações da Estratégia Saúde da Família (ESF). Métodos: Estudo exploratório-descritivo realizado com dez idosos que concordaram em dar informações. Utilizou-se dois formulários para a avaliação, o Índice de Katz e Mini Exame do Estado Mental. Aprovado pelo Comitê de Ética em Pesquisa da UVA com o parecer nº 608.721. Resultados: Os idosos eram, em sua maioria, do sexo feminino, casados e analfabetos. Apresentavam comprometimento cognitivo e alguns eram independentes na prática das atividades da vida diária. Existem fragilidades na adaptação dos domicílios, porém percebem-se esforços dos familiares no ajuste do espaço. Os idosos demonstraram relativa satisfação quanto à atenção dispensada na ESF. Conclusão: Infere-se a importância de um cuidado que potencialize a melhoria da condição de vida, independência e autonomia do idoso.

Objetivo: Comprender cómo viven los ancianos Alzheimer y sus percepciones sobre las acciones de la Estrategia de Salud de la Familia (ESF). Métodos: Estudio exploratorio descriptivo, realizado con diez ancianos que accedió a dar información. Utiliza dos formas para la evaluación, el Índice de Katz y el Mini Examen del Estado Mental. Aprobado en Comité de Ética con la opinión n° 608.721. Resultados: Los ancianos eran en su mayoría mujeres, casadas y analfabetos. Tenían deterioro cognitivo y eran independientes en la práctica de actividades diarias. Existen deficiencias en la adaptación de los hogares, pero se da cuenta de los esfuerzos de los familiares en el ajuste de espacio. Los ancianos demostraron satisfacción con respecto a la atención en ESF. Conclusión: Inferir la importancia de un cuidado es a influencia para mejorar las condiciones de vida, la independencia y autonomía de las personas mayores.

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PURPOSE: Localization-based technologies promise to keep older adults with dementia safe and support them and their caregivers during getting lost events. This paper summarizes mainly technological contributions to support the target group in these events. Moreover, important aspects of the getting lost phenomenon such as its concept and ethical issues are also briefly addressed. METHODS: Papers were selected from scientific databases and gray literature. Since the topic is still in its infancy, other terms were used to find contributions associated with getting lost e.g. wandering. RESULTS: Trends of applying localization systems were identified as personal locators, perimeter systems and assistance systems. The first system barely considered the older adult's opinion, while assistance systems may involve context awareness to improve the support for both the elderly and the caregiver. Since few studies report multidisciplinary work with a special focus on getting lost, there is not a strong evidence of the real efficiency of localization systems or guidelines to design systems for the target group. CONCLUSIONS: Further research about getting lost is required to obtain insights for developing customizable systems. Moreover, considering conditions of the older adult might increase the impact of developments that combine localization technologies and artificial intelligence techniques. Implications for Rehabilitation Whilst there is no cure for dementia such as Alzheimer's, it is feasible to take advantage of technological developments to somewhat diminish its negative impact. For instance, location-based systems may provide information to early diagnose the Alzheimer's disease by assessing navigational impairments of older adults. Assessing the latest supportive technologies and methodologies may provide insights to adopt strategies to properly manage getting lost events. More user-centered designs will provide appropriate assistance to older adults. Namely, customizable systems could assist older adults in their daily walks with the aim to increase their self-confidence, independence and autonomy.

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To identify and characterize the scientific literature on the effects of exercise on Alzheimer's disease, research was conducted in the following databases: MEDLINE, CINAHL, Web of Science, and Scopus. These MeSH terms--"exercise", "motor activity", "physical fitness", "Alzheimer disease", and its synonyms in English--were used in the initial search to locate studies published between 2003 and 2013. After reading the 12 final articles in their entirety, two additional articles, found by a manual search, were included. Of these, 13 had beneficial results of exercise in Alzheimer's disease. Given the results discussed here, the exercise may be important for the improvement of functionality and performance of daily life activities, neuropsychiatric disturbances, cardiovascular and cardiorespiratory fitness, functional capacity components (flexibility, agility, balance, strength), and improvements in some cognitive components such as sustained attention, visual memory, and frontal cognitive function in patients with AD.

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Unawareness of deficit has been shown to affect the outcome of targeted cognitive intervention programmes applied to patients with Alzheimer' disease (AD), but the effects on multimodal therapeutic approaches have not yet been explored. This research investigated the efficacy of the Multi-Intervention Programme (MIP) approach on improving cognitive, functional, affective, and behavioural symptoms in people with mild AD. In addition, we examined whether the presence of unawareness influences the MIP outcomes. Sixty-one mild stage AD patients were randomly assigned to either an experimental group which carried out an MIP individually (48 sessions, 16 weeks duration), combining diverse cognitive tasks, training in daily life and recreational activities, or a waiting list group which did not receive any treatment for the same time period. The efficacy of MIP (vs. waiting list) was tested using various standardised neuropsychological, functional, and behavioural outcome measures. Planned analyses were carried out to determine the effect of unawareness versus awareness on such outcomes. The results showed that patients overall benefited from the MIP in terms of both cognitive and non-cognitive symptoms. AD patients with awareness of deficits showed positive effects on all outcome measures in comparison with the waiting list group, while AD patients with unawareness showed improvements in non-cognitive symptoms only. In conclusion, the presence of unawareness reduces the cognitive and functional effects of MIP in patients with mild AD.

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A Constituição Federal Brasileira defende que o cuidado com o idoso é uma responsabilidade compartilhada entre o Estado, a família e a sociedade. As Políticas públicas voltadas à pessoa idosa vêm corroborar com esse entendimento e apontam o domicílio como um espaço privilegiado para o cuidado do idoso. Isto determina a participação do familiar como cuidador, porém destaca-se a ausência de estratégias de assistência voltadas às necessidades do cuidador familiar que se sente desamparado e desassistido na sua responsabilidade do cuidado com o idoso no domicilio. Nos últimos anos, apesar da busca incessante pela saúde e qualidade de vida, observa-se uma crescente incidência de idosos com doenças demenciais que levam à incapacidade funcional, dentre elas destaca-se a doença de Alzheimer. Essa doença compromete de forma grave e irreversível a cognição, memória e independência do idoso, tornando-o dependente de terceiros para executar atividades básicas da vida diária, por toda sua vida. O presente estudo tem como objetivo conhecer a percepção e os sentimentos dos cuidadores familiares de idosos com Alzheimer sobre o papel de cuidador. Trata-se de um estudo com abordagem qualitativa, realizado com cuidadores familiares de idosos com Alzheimer, vinculados ao grupo de cuidadores do Centro Especializado de Atenção em Saúde do Idoso, localizado em Natal/RN. Por meio de entrevista semiestruturada a pesquisa buscou investigar a percepção dos cuidadores familiares sobre o papel de cuidador, os sentimentos e as mudanças ocorridas na vida do cuidador ao assumir esse papel. Os dados foram organizados em categorias e unidades de análise semântica e analisados pela técnica de análise de conteúdo temática, segundo Bardin. Os relatos originaram três categorias: a percepção do papel do cuidador; sentimentos relacionados ao cuidado e consequências do papel de cuidador. Na percepção dos cuidadores de idosos a exigência proveniente da dedicação ao cuidado gera perdas na vida pessoal e profissional do familiar que assume essa responsabilidade. A falta de suporte, familiar e social, acentua a sobrecarga do cuidado ao idoso dependente. As Políticas públicas de saúde do idoso reconhecem a importância e as necessidades dos familiares cuidadores, porém não disponibilizam apoio e suporte suficiente para atender as necessidades e auxiliá-los em suas limitações. Os resultados da pesquisa demonstraram a urgência na tomada de medidas de assistência aos cuidadores de idosos com Alzheimer, reconhecendo-as como uma ação de promoção da qualidade de vida e saúde do idoso e proteção da saúde do cuidador. (AU)

The Brazilian Constitution maintains that care for elderly people is a responsibility shared by the state, the family and the society. The politics for the elderly corroborate this understanding and treats home as a privileged place for elderly care taking. This determines the participation of the familiar as a caregiver, but highlights the lack of strategic assistance for the needs of the relative caregiver who feels helplessly and unattended in their responsibility for elderly homecare. In recent years , despite the recently pursuit for health and life quality, there is an increasing incidence of elderly patients with dementia diseases that lead to disability, the most common among then is the Alzheimer's disease. This disease affects seriously and irreversibly cognition, memory and independence of the elderly, making it dependent on others to perform basic activities of daily life, for all his life. The present study aims to evaluate the perceptions and feelings of family caregivers of elders with Alzheimer on the role of caregiver. This is a qualitative study conducted with family caregivers of seniors with Alzheimer's, caregivers linked to the group of the Specialized Care Center of the Elderly's Health, located in Natal / RN. Through semi-structured interview research sought to investigate the perceptions of family caregivers on the role of caregiver, the feelings and the changes in the caregiver's life since they assumed this role. The data were organized into categories and units of semantic analysis and analyzed using thematic content analysis by Bardin. The reports originated three categories: the perception of the role of caregiver, feelings related to the caregving and consequences of the caregiver role. Perceptions of caregivers of elderly from the requirement of dedication to the care generates losses in personal and professional life for the familiar who assumes this responsibility. The lack of family and social support, aggravates the burden of care for the dependent elderly. Public health politics for the elderly recognize the importance and needs of family caregivers, but not enough to provide support and meet the needs and assist them in supporting their limitations. The research results show the urgent need to take measures to assist the caregivers of seniors with Alzheimer, recognizing them as an action of promotion quality of life and health of the elderly and protection the health of the caregiver. (AU)

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AIM: The objective of the present study was to investigate the effect of a multimodal exercise intervention on frontal cognitive functions and kinematic gait parameters in patients with Alzheimer's disease. METHODS: A sample of elderly patients with Alzheimer's disease (n=27) were assigned to a training group (n=14; aged 78.0±7.3 years) and a control group (n=13; aged 77.1±7.4 years). Multimodal exercise intervention includes motor activities and cognitive tasks simultaneously. The participants attended a 1-h session three times a week for 16 weeks, and the control participants maintained their regular daily activities during the same period. The frontal cognitive functions were evaluated using the Frontal Assessment Battery, the Clock Drawing Test and the Symbol Search Subtest. The kinematic parameters of gait-cadence, stride length and stride speed were analyzed under two conditions: (i) free gait (single task); and (ii) gait with frontal cognitive task (walking and counting down from 20--dual task). RESULTS AND DISCUSSION: The patients in the intervention group significantly increased the scores in frontal cognitive variables, Frontal Assessment Battery (P<0.001) and Symbol Search Subtest (P<0.001) after the 16-week period. The control group decreased the scores in the Clock Drawing Test (P=0.001) and increased the number of counting errors during the dual task (P=0.008) after the same period. CONCLUSION: The multimodal exercise intervention improved the frontal cognitive functions in patients with Alzheimer's disease.

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OBJECTIVE: To analyze the influence of a six-month exercise program on neuropsychiatric disorders and on the performance of instrumental activities in elderly patients with Alzheimer's disease (AD). METHODS: The study included 20 patients with AD in the mild to moderate stages of the Clinical Dementia Rating (CDR) divided into two groups: the experimental group, composed of 10 women who participated in the six-month exercise program, and the control group, composed of the 10 remaining AD patients who did not take part in an exercise program during the same period. All participants were evaluated using the Mini-Mental State Exam for global cognitive function, the Neuropsychiatric Inventory Questionnaire for neuropsychiatric disorders, and the Pfeffer Functional Activities Questionnaire for the degree of functional impairment. RESULTS: The control group showed functional and neuropsychiatric deterioration in the comparisons between pre- and post-intervention times and between groups. CONCLUSION: The experimental group showed a propensity for less deterioration in neuropsychiatric disorders and performance of instrumental activities compared to the sedentary group.

OBJETIVO: Analisar os efeitos de seis meses de intervenção de um programa de atividade física sobre os distúrbios neuropsiquiátricos e o desempenho nas atividades instrumentais da vida diária de idosos com Doença de Alzheimer (DA). MÉTODOS: Foram recrutados 20 pacientes nos estágios entre leve e moderado da DA. Segundo o escore clínico de demência (CDR), foram distribuídos em dois grupos: o grupo treinamento (GT), composto por dez mulheres que participaram de um program de exercícios físicos por um período de seis meses, e o grupo controle (GC), composto por dez outras participantes que não realizaram nenhum tipo de intervenção motora estruturada durante o mesmo período. Todas as participantes foram avaliadas por meio do Miniexame do Estado Mental, para obtenção da caracterização cognitiva; Inventário Neuropsiquiátrico, para identificação dos distúrbios neuropsiquiátricos mais prevalentes e Questionário de Atividades Instrumentais de Pfeffer, para verificação do grau de comprometimento funcional. RESULTADOS: Os participantes do GC mostraram uma deterioração tanto no desempenho das atividades instrumentais quanto na intensificação dos distúrbios neuropsiquiátricos, quando comparados os momentos pré e pós-intervenção. CONCLUSÃO: O GT demonstrou uma atenuação da intensificação dos distúrbios neuropsiquiátricos e do desempenho funcional em relação ao grupo sedentário.

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OBJECTIVE: To analyze the influence of a six-month exercise program on neuropsychiatric disorders and on the performance of instrumental activities in elderly patients with Alzheimer's disease (AD). METHODS: The study included 20 patients with AD in the mild to moderate stages of the Clinical Dementia Rating (CDR) divided into two groups: the experimental group, composed of 10 women who participated in the six-month exercise program, and the control group, composed of the 10 remaining AD patients who did not take part in an exercise program during the same period. All participants were evaluated using the Mini-Mental State Exam for global cognitive function, the Neuropsychiatric Inventory Questionnaire for neuropsychiatric disorders, and the Pfeffer Functional Activities Questionnaire for the degree of functional impairment. RESULTS: The control group showed functional and neuropsychiatric deterioration in the comparisons between pre- and post-intervention times and between groups. CONCLUSION: The experimental group showed a propensity for less deterioration in neuropsychiatric disorders and performance of instrumental activities compared to the sedentary group.

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BACKGROUND: Immediately after patients with Alzheimer's disease (AD) receive a single anodal transcranial direct current stimulation (tDCS) session their memory performance improves. Whether multiple tDCS sessions improve memory performance in the longer term remains unclear. OBJECTIVE: In this study we aimed to assess memory changes after five consecutive sessions of anodal tDCS applied over the temporal cortex in patients with AD. METHODS: A total of 15 patients were enrolled in two centers. Cognitive functions were evaluated before and after therapeutic tDCS. tDCS was delivered bilaterally through two scalp anodal electrodes placed over the temporal regions and a reference electrode over the right deltoid muscle. The stimulating current was set at 2 mA intensity and was delivered for 30 minutes per day for 5 consecutive days. RESULTS: After patients received tDCS, their performance in a visual recognition memory test significantly improved. We found a main effect of tDCS on memory performance, i.e., anodal stimulation improved it by 8.99% from baseline, whereas sham stimulation decreased it by 2.62%. tDCS failed to influence differentially general cognitive performance measures or a visual attention measure. CONCLUSIONS: Our findings show that after patients with AD receive anodal tDCS over the temporal cerebral cortex in five consecutive daily sessions their visual recognition memory improves and the improvement persists for at least 4 weeks after therapy. These encouraging results provide additional support for continuing to investigate anodal tDCS as an adjuvant treatment for patients with AD.

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