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.

The difference between self-reported QoL and family caregivers' ratings of QoL in people with mild dementia indicated that cognitive impairment was not the primary factor that accounted for the differences in the QoL assessments. Our findings suggested that non-cognitive factors, such as awareness of disease and depressive symptoms, played an important role in the differences between the self-reported AD QoL ratings and the caregivers' AD QoL ratings. A major implication is that discrete measures such as cognition or level of function are likely to miss important factors that influence QoL.

Despite the growing understanding of the conceptual complexity of awareness, there currently exists no instrument for assessing different domains of awareness in dementia. In the current study, the psychometric properties of a multidimensional awareness scale, the Assessment Scale of Psychosocial Impact of the Diagnosis of Dementia (ASPIDD), are explored in a sample of 201 people with dementia and their family caregivers. Cronbach's alpha was high (α = 0.87), indicating excellent internal consistency. The mean of corrected item-total correlation coefficients was moderate. ASPIDD presented a four-factor solution with a well-defined structure: awareness of activities of daily living, cognitive functioning and health condition, emotional state, and social functioning and relationships. Functional disability was positively correlated with total ASPIDD, unawareness of activities of daily living, cognitive functioning, and with emotional state. Caregiver burden was correlated with total ASPIDD scores and unawareness of cognitive functioning. The results suggest that ASPIDD is indeed a multidimensional scale, providing a reliable measure of awareness of disease in dementia. Further studies should explore the risk factors associated with different dimensions of awareness in dementia.

Caregivers' gender, patients who attended Day Care Center and neuropsychiatric symptoms were differentiating factors in the burden of Brazilian and Spanish caregivers.

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.

Resilience is the capacity for successful adaptation when faced with the stress of adversity. We aimed to investigate the relationship between caregivers’ resilience and the sociodemographic and clinical factors of people with dementia. Cross-sectional assessment of 58 people with dementia and their caregiver dyads showed that most caregivers were female adult children. The caregivers reported moderate to higher levels of resilience, lower levels of anxiety and depressive symptoms and moderate levels of burden. Resilience was not related to the caregiver’s gender (p = 0.883), nor clinical (p = 0.807) or emotional problems (p = 0.420). The regression showed that resilience was related to the caregiver’s quality of life (p < 0.01) and inversely associated with their depressive symptoms (p < 0.01). There was no relationship between caregivers’ resilience and the sociodemographic and clinical characteristics of people with dementia. We can assume that resilience is an individual characteristic. Support groups should also focus on the factors that may increase resilience among caregivers.