Introduction: Although caregivers of people with dementia may face difficulties, some positive feelings of caregiving may be associated with resilience. Objective: This study systematically reviewed the definitions, methodological approaches and determinant models associated with resilience among caregivers of people with dementia. Methods: Search for articles published between 2003 and 2014 in ISI, PubMed/MEDLINE, SciELO and Lilacs using the search terms resilience, caregivers and dementia. Results and conclusions: Resilience has been defined as positive adaptation to face adversity, flexibility, psychological well-being, strength, healthy life, burden, social network and satisfaction with social support. No consensus was found about the definition of resilience associated with dementia. We classified the determinant variables into biological, psychological and social models. Higher levels of resilience were associated with lower depression rates and greater physical health. Other biological factors associated with higher levels of resilience were older age, African-American ethnicity and female sex. Lower burden, stress, neuroticism and perceived control were the main psychological factors associated with resilience. Social support was a moderating factor of resilience, and different types of support seemed to relieve the physical and mental overload caused by stress.

Facial recognition is one of the most important aspects of social cognition. In this study, we investigate the patterns of change and the factors involved in the ability to recognize emotion in mild Alzheimer’s disease (AD). Through a longitudinal design, we assessed 30 people with AD. We used an experimental task that includes matching expressions with picture stimuli, labelling emotions and emotionally recognizing a stimulus situation. We observed a significant difference in the situational recognition task (p ≤ 0.05) between baseline and the second evaluation. The linear regression showed that cognition is a predictor of emotion recognition impairment (p ≤ 0.05). The ability to perceive emotions from facial expressions was impaired, particularly when the emotions presented were relatively subtle. Cognition is recruited to comprehend emotional situations in cases of mild dementia.

Awareness of disease can be compromised to some degree in a proportion of people with dementia, with evident differences across domains. We designed this study to determine the factors associated with the impairment of awareness over a period of time. Using a longitudinal design, 69 people with mild Alzheimer's disease and their family caregivers completed the Assessment Scale of Psychosocial Impact of the Diagnosis of Dementia, the Quality of Life in Alzheimer's Disease Scale, the Mini-Mental State Examination, the Clinical Dementia Rating Scale, the Cornell Scale for Depression in Dementia, the Pfeffer Functional Activities Questionnaire, the Neuropsychiatric Inventory, and the Zarit Burden Interview. Univariate and logistic regression analyses were conducted to examine the contribution of the various factors. The level of awareness of disease was significantly lower (p ≤ 0.001) between baseline and at follow up. At follow up, there was no change in the level of awareness of disease in 61.8%, whereas 25.4% worsened. However, the level of awareness improved in 12.3%. Logistic regression demonstrated that functional deficits (OR = 1.12, 95% CI: (1.03-1.22), p ≤ 0.01), and caregivers' quality of life (OR = 0.83, 95% CI: (0.70-0.98), p ≤ 0.05) were a significant predictor of impaired awareness of disease. The results confirmed that awareness and cognition are relatively independent, and showed that in people with mild dementia, unawareness is mainly manifested by poor recognition of changes in the activities of daily living, and decrease in quality of life.

Objective: To investigate quality of life (QoL) of caregivers of mild and moderate dementia and the aspects related to QoL. Method: Crosssectional assessment of dyads of people with dementia (PwD) and family caregivers (n=88). Results: Burden (p,0.05) and depressive symptoms (p,0.001) were related to caregivers' QoL in both stages of dementia. In mild dementia, caregivers' depressive symptoms (p,0.001) and PwD neuropsychiatric symptoms (p,0.001) were related to burden. PwD aberrant motor activity (p,0.001) and anxiety (p,0.001), and caregiver-reported QoL domains of friends (p,0.001) and mood (p,0.05) were related to depressive symptoms. In moderate dementia, selfreported QoL (p,0.01) and anxiety (p,0.01), and PwD anxiety (p,0.01) were related to burden. Caregivers' anxiety (p,0.001) and self-reported QoL (p,0.001) were related to depressive symptoms. Conclusion: Burden and depressive symptoms were related to QoL of caregivers of mild and moderate dementia. However, they are driven by different factors according to dementia severity.Keywords: caregivers, quality of life, depression, dementia. RESUMOObjetivo: Investigar qualidade de vida (QdV) de cuidadores na demência leve e moderada e aspectos relacionados. Método: Avaliação transversal de pessoas com demência e cuidadores familiares (n=88). Resultados: Sobrecarga (p,0,05) e sintomas depressivos (p,0,001) estavam relacionados à QdV dos cuidadores nos dois estágios da demência. Na demência leve, sintomas depressivos dos cuidadores (p,0,001) e sintomas neuropsiquiátricos dos pacientes (p,0,001) estavam relacionados à sobrecarga. Atividade motora aberrante (p,0,001) e ansiedade do paciente, bem como domínios amigos (p,0,001) e humor (p,0,05) da QdV do cuidador estavam relacionados aos sintomas depressivos. Na demência moderada, QdV (p,0,01) e ansiedade (p,0,01) do cuidador, e ansiedade do paciente (p,0,01) estavam relacionadas à sobrecarga. Ansiedade (p,0,001) e QdV dos cuidadores (p,0,001) estavam relacionadas aos sintomas depressivos. Conclusão: Sobrecarga e sintomas depressivos estavam relacionados à QdV de cuidadores de pessoas com demência leve e moderada. Entretanto, estes aspectos estão relacionados a diferentes fatores por severidade da demência.Palavras-chave: cuidadores, qualidade de vida, depressão, demência.

Objectives: To determine changes over time in self and caregiver ratings of quality of life (QoL) in people with dementia (PwD) and to identify factors associated with changes in QoL ratings. Methods: In this longitudinal study, 69 people with mild Alzheimer's disease and their caregivers were assessed at baseline and after 1 year. We examined the association of QoL ratings with the following variables at the two time points: awareness of disease, cognitive status, mood, functionality, neuropsychiatric symptoms, and caregiver burden. Multivariate regression analyses were conducted to examine the contribution of co-factors. Results: At baseline, PwD self-ratings of QoL were associated with caregiver ratings of PwD QoL (p = 0.001). Caregiver ratings were associated with PwD mood (p = 0.001) and self-rated QoL (p = 0.001). After 1 year, caregiver ratings of PwD QoL changed significantly (p = 0.049, d = -0.27), whereas PwD selfratings did not (p = 0.89, d = 0.09). PwD awareness of disease changed significantly (p = 0.001) at 1 year, having declined in 25.4% and improved in 12.3% of participants. PwD QoL self-ratings were associated with caregiver ratings (p = 0.001). Caregiver ratings of PwD QoL after 1 year were associated with PwD mood (p = 0.029), self-reported QoL (p = 0.001), and awareness of disease (p = 0.033). Conclusions:The association between self and caregiver ratings of PwD QoL was maintained over 1 year. The primary factors accounting for the change in caregiver ratings were PwD mood and awareness of disease. QoL and cognitive impairment seem to be relatively independent in mild dementia.