Objective: There are few quantitative studies on art therapy for the treatment of depression. The objective of this study was to evaluate if art therapy is beneficial as an adjuvant treatment for depression in the elderly. Methods: A randomized, controlled, single-blind study was carried out in a sample of elderly women with major depressive disorder (MDD) stable on pharmacotherapy. The experimental group (EG) was assigned to 20 weekly art therapy sessions (90 min/session). The control group (CG) was not subjected to any adjuvant intervention. Patients were evaluated at baseline and after 20 weeks, using the Geriatric Depression Scale (GDS), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and cognitive measures. Results: Logistic regression analysis adjusted for age revealed that women in EG (n=31) had significant improvement in GDS (p = 0.007), BDI (p = 0.025), and BAI (p = 0.032) scores as compared with controls (n=25). No difference was found in the cognitive measures. Conclusion: Art therapy as an adjunctive treatment for MDD in the elderly can improve depressive and anxiety symptoms. Clinical trial registration: RBR-2YXY7Z

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.

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.

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.

OBJECTIVE: To determine the accuracy of the Mini-Mental State Examination combined with the Verbal Fluency Test and Clock Drawing Test for the identification of patients with mild cognitive impairment and Alzheimer's disease (AD). METHOD: These tests were used to evaluate cognitive function in 247 older adults. Subjects were divided into three groups according to their cognitive state: mild cognitive impairment (n=83), AD (n=81), cognitively unimpaired controls (n=83), based on clinical and neuropsychological data. The diagnostic accuracy of each test for discriminating between these diagnostic groups (mild cognitive impairment or AD vs. controls) was examined with the aid of Receiver Operating Characteristic (ROC) curves. Additionally, we evaluated the benefit of the combination of tests on diagnostic accuracy. RESULTS: Although they were accurate enough for the identification of Alzheimer's disease, neither test alone proved adequate for the correct separation of patients with mild cognitive impairment from healthy subjects. Combining these tests did not improve diagnostic accuracy, as compared to the Mini-Mental State Examination alone, in the identification of patients with mild cognitive impairment or Alzheimer's disease. CONCLUSIONS: The present data do not warrant the combined use of the Mini-Mental State Examination, the Verbal Fluency Test and the Clock Drawing Test as a sufficient diagnostic schedule in screening for mild cognitive impairment. The present data do not support the notion that the combination of test scores is better that the use of Mini-Mental State Examination scores alone in the screening for Alzheimer's disease.

O delirium corresponde a uma das primeiras doenças mentais descritas na literatura médica, há mais de 2.500 anos. Nas classificações psiquiátricas, permaneceu como categoria nosológica independente até o final do século XIX, quando foi redefinida com base nos seus aspectos fenomenológicos e etiológicos, precipitando a reclassificação das insanidades funcionais em psicoses. os estados confusionais passaram a se referir a uma síndrome mais ampla que incluía o delirium, enfatizando a desorganização dos processos cognitivos e do pensamento, e tendo no turvamento da consciência e na desorientação temporoespacial a condição de base. Com o objetivo de descrever a evolução histórica do conceito de delirium, foram realizados levantamentos da literatura médica através do sistema Medline, além da pesquisa em publicações literárias específicas sobre os temas história da medicina e história da psiquiatria. Partiu-se de algumas observações dogmáticas praticadas na Antigüidade e Idade Média, para atingir as definições e práticas atuais, oferecendo uma análise crítica dos critérios diagnósticos vigentes (DSM-III, DSM-IIIR, DSM-IV e CID-10). Não obstante a evolução conceitual, o delirium continua sendo mal compreendido, do ponto de vista fisiopatológico e são poucas as opções terapêuticas. o diagnóstico de delirium é ato eminentemente clínico: baseia-se na observação cautelosa das manifestações psíquicas e comportamentais dos pacientes acometidos, além da análise dos fatores predisponentes e precipitantes. É freqüente o seu subdiagnóstico em contextos clínicos e cirúrgicos. o diagnóstico do delirium é estabelecido em apenas 30% a 50% dos pacientes, sendo a omissão diagnóstica menos freqüente em serviços que contam com a interconsulta psiquiátrica. o delirium é uma das complicações mais comuns entre pacientes idosos hospitalizados e está associado a maior morbimortalidade. Isso sustenta a importância do seu pronto reconhecimento e manejo.

Delirium remained a stable psychiatric category until the early 19th century when it underwent etiological and phenomenological redefinition, precipitating the transformation of the functional insanities into psychoses. Confusion, introduced by French workers during the second half of the century, referred to a syndrome wider than (but including) delirium. It emphasized chaotic thinking and cognitive failure. The notion of clouding of consciousness (and temporo-spatial disorientation) established a common denominator for the two concepts, while Chaslin and Bonhoeffer redefined confusion and delirium as the stereotyped manifestations of acute brain failure.

Delirium é uma síndrome neurocomportamental decorrente da quebra transitória da homeostase cerebral. Deve-se, invariavelmente, a perturbações sistêmicas ou do sistema nervoso central. No contexto médico geral, a ocorrência de delirium está associada à maior incidência de complicações clínico-cirúrgicas, maior tempo de permanência hospitalar e pior recuperação funcional. O envelhecimento e o comprometimento cognitivo são fatores de risco conhecidos para o delirium. Em pacientes idosos, a ocorrência aumenta o reconhecimento de quadros demenciais preexistentes. Em contrapartida, indivíduos idosos não-demenciados que desenvolvem um episódio de delirium durante uma dada internação hospitalar têm incidência aumentada de demência na evolução em longo prazo. Estudos prospectivos e controlados demonstraram uma associação significativa entre o diagnóstico prévio de delirium e o ulterior desenvolvimento de síndromes demenciais. Essa associação parece ser ainda maior em indivíduos muito idosos. O presente estudo de revisão aborda criticamente a natureza da associação entre delirium e demência. Hipotetiza-se que a sua ocorrência em indivíduos idosos cognitivamente preservados é fator preditivo de deterioração cognitiva, e de risco aumentado para o desenvolvimento de demência, no seguimento de longo termo. As bases neurobiológicas da associação entre delirium e demência são discutidas à luz da hipótese colinérgica da doença de Alzheimer, uma vez que o comprometimento da neurotransmissão colinérgica é denominador comum a essas duas perturbações neuropsíquicas.

Delirium is a neurobehavioral syndrome caused by the transient disruption of cerebral homeostasis, which is invariably subsequent to systemic or central nervous system insults. In general medical settings, the occurrence of delirium is also associated with a higher incidence of post-operative complications, longer hospital stays, and poor functional recovery. Ageing and cognitive decline are known risk factors for the occurrence of delirium. In elderly patients, delirium has been shown to be associated with pre-existing dementia. Conversely, non-demented elderly subjects who develop a new delirium episode display an increased incidence of dementia in the long-term outcome. Prospective case-control studies have demonstrated a significant association between the previous diagnosis of delirium and the development of dementia. The association between delirium and dementia may be even higher among the eldest elderly. After reviewing the relevant literature on the association between delirium and dementia, we hypothesize that the occurrence of delirium in non-demented elderly individuals is predictive of a worse cognitive outcome, and increased risk of dementia, in the long-term follow-up. We further discuss the biological nature of this association in the light of the cholinergic deficit observed in the pathophysiology of both delirium and Alzheimer's disease.

Estudos epidemiológicos têm mostrado alta prevalência de transtorno psiquiátrico em pessoas com insônia. Realizamos estudo transversal em amostra de estudantes de medicina, com o objetivo de avaliar a associação entre insônia e positividade na triagem para transtorno psiquiátrico; 302 estudantes foram incluídos (184 homens e 118 mulheres; média da idade = 20.47±1,89 anos). A associação foi testada através da análise de regressão logística. A prevalência de teste positivo na triagem para transtorno psiquiátrico foi 22,19%; e de insônia, 28,15%. Dificuldade para iniciar o sono (OR=3,45), dificuldade para manter o sono (OR=7,61), dormir tarde (OR=1,99) e levantar cedo (OR=1,91) foram as variáveis associadas à possibilidade de transtorno psiquiátrico. Quando consideradas em conjunto, as variáveis "dificuldade em iniciar o sono", "dificuldade em manter o sono", "dormir após 23 h" e "acordar antes das 6 h" apresentaram razão de chance de 5,96 para positividade na triagem para transtorno psiquiátrico. Além disso, dificuldade em manter o sono (OR=2,24) foi associada ao sexo feminino; e dormir tarde (OR=0,43), ao sexo masculino. Esses resultados enfatizam a importância de determinar em que caso a dificuldade com o sono pode ter repercussões clínicas severas ou afetar o desempenho.

Epidemiological research points to the high prevalence of psychiatric disorders among insomniacs. We carried out a cross-sectional study with medical students with the aim of evaluating the association between insomnia and suspicion of psychiatric disorder; 302 medical students were included (184 males and 118 females; mean age = 20.47±1.89 years). The main association was tested by logistic regression analysis. The overall prevalence of positivity in a screening test for psychiatric disorder was 22.19%; and of insomnia, 28.15%. Difficulty initiating sleep (OR=3.45), difficulty maintaining sleep (OR=7.61), falling asleep later (OR=1.99) and waking up earlier (OR=1.91) were associated with suspicion of psychiatric disorder. As a group, the variables difficulty initiating sleep, difficulty maintaining sleep, falling asleep after 11 pm, and waking up before 6 am presented an odds ratio of 5.96 for positivity in the screening for psychiatric disorder. Furthermore, difficulty maintaining sleep (OR=2.24) was associated with "being female," and falling asleep later (OR=0.43) was associated with "being male". These results underscore the importance of determining in what cases difficulty sleeping may have severe clinical repercussions or affect performance.