OBJECTIVE:To evaluate the effects of a multidisciplinary rehabilitation program on cognition, quality of life, and neuropsychiatric 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.

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

Aging is associated with cognitive decline, yet this does not prevent older adults from finding ways to compensate for age-related deficits. Earlier studies have shown that cognitively unimpaired older adults can benefit from training programs. The efficacy of cognitive interventions among older adults without dementia but with cognitive decline (mild cognitive impairment, MCI) has not yet been widely tested.ObjectivesTo evaluate the impact of 8-session cognitive training on the cognitive and functional performance of older adults with MCI.Methods16 older adults diagnosed with MCI received cognitive training (18 participated as controls). All participants were assessed pre and post intervention using the Short Cognitive Test (SKT), Direct Assessment of Functional Scale Revised (DAFS-R), Geriatric Depression Scale (GDS), and Clock Drawing Test (CDT).ResultsA significant improvement was observed in the study group between pre and post-test in attention (SKT), time orientation, shopping skills and dealing with finances (DAFS-R) along with reduced depressive symptoms (GDS).ConclusionThese results indicate the importance of non-pharmacological interventions for older adults with MCI to help compensate for cognitive decline.

We have evaluated the genetic diversity of HIV-1 strains infecting injecting drug users (IDUs) in Lisbon, Portugal. Heteroduplex mobility assay and/or phylogenetic analysis revealed that env (C2V3C3 or gp41) subtype B is present in 63.7% of the 135 viral samples studied, followed by subtypes G (23.7%), A (6.7%), F (5.2%), and D (0.7%). Similar analysis of gag (p24/p7) performed on 91 of the specimens demonstrated that 49.5% of the infections were caused by subtype G viruses; other gag subtypes identified were B (39.5%), F (3.3%), A and D (1.1.% each), and the recombinant circulating form CRF02_AG (5.5%). Discordant env/gag subtypes were detected in 34.1% of the strains and may reflect the presence of dual infections and/or recombinant viruses. The presumptive B/G recombinant form was highly predominant (21 of 31). The genetic pattern of HIV-1 subtype B and G strains is suggestive of multiple introductions and recombination episodes and of a longstanding presence of both subtypes in the country. C2V3C3 amino acid sequences from IDU-derived subtype G viruses presented highly significant signatures, which distinguish the variants from this transmission group. The unusually high prevalence of subtype G sequences (34.1%), independent of the geographic origin of the infected individuals, makes this IDU HIV-1 epidemic unique. INJECTING DRUG USERS (IDUs) form one of the major risk groups for HIV-1 infection in Portugal. In the period of 1997-2001, 62% of the reported AIDS cases were related to this transmission class 1 but, following the general trends in most Western European countries, the incidence of HIV-1 infection among Portuguese IDUs has started to decrease.Phylogenetic analyses of HIV-1 isolates distributed worldwide showed, overall, 23 distinct HIV-1 subtypes (A-D, F-H, J, and K) and circulating recombinant forms (CRF01-14) within group M (HIV Sequence Database, http://hiv-web.lanl.gov/). These HIV-1 subtypes are geographically distributed nonrandomly, with subtype B being predominant in Europe and North America. We have reported multiple env HIV-1 subtypes circulating in Portugal, with a high prevalence of non-B subtypes, both in African and Portuguese individuals. 2 The aim of the present study was to investigate the genetic diversity of incident HIV-1 strains among IDUs living in Lisbon. From May 1999 through December 2000, after obtaining informed consent, blood samples were collected from 81 HIV-1 seropositive individuals attending three different drug addiction recovery centers and enrolled in a methadone therapy program. Seventy additional seropositive IDUs had been part of a previous broader surveillance study.2 Among these 151 IDUs, the mean age was 31 years, ranging from 18 to 49 years; the great majority (88.1%) were of Portuguese nationality, and 29.1% were women. Proviral DNA from uncultured peripheral blood mononuclear cells was extracted and we proceeded to the analysis of the env C2V3C3 (nucleotides 6982-7246, based on HXB2) or the gp41 (nucleotides 7878-8282 of HXB2) regions by het-

Background: Non-pharmalogical interventions represent an important complement to standard pharmalogical treatment in dementia. Objective: This study aims to evaluate the effects of a multidisciplinary rehabilitation program on cognitive ability, quality of life and depression symptoms in patients with Alzheimer's disease (AD) and cognitive impairment without dementia (CIND). Methods: Ninety-seven older adults were recruited to the present study. Of these, 70 patients had mild AD and were allocated into experimental (n = 54) or control (n = 16) groups. Two additional active comparison groups were constituted with patients with moderate AD (n = 13) or with CIND (n = 14) who also received the intervention. The multidisciplinary rehabilitation program lasted for 12 weeks and was composed by sessions of memory training, recreational activities, verbal expression and writing, physical therapy and physical training, delivered in two weekly 6-hour sessions. Results: As compared to controls, mild AD patients who received the intervention had improvements in cognition (p = 0.021) and quality of life (p = 0.003), along with a reduction in depressive symptoms (p < 0.001). As compared to baseline, CIND patients displayed at the end of the intervention improvements in cognition (p = 0.005) and depressive symptoms (p = 0.011). No such benefits were found among patients with moderate AD. Discussion: This multidisciplinary rehabilitation program was beneficial for patients with mild AD and CIND. However, patients with moderate dementia did not benefit from the intervention.