Objective:To evaluate an early home-supported discharge service for stroke patients.Design:We carried out a prospective, randomised, open-label, blinded-endpoint trial (allocation ratio of 1:1) with patients assigned to either an early home-supported discharge service or usual care.Setting:The study was undertaken in Aveiro, Portugal, between April 2009 and April 2013.Subjects:We included stroke patients aged 25–85 years admitted to the stroke unit with an initial Functional Independence Measure of up to 100, who gave informed consent.Interventions:Patients in the early home-supported discharge group began their rehabilitation intervention in the stroke unit and the early home-supported discharge team worked with them at home for a maximum of one month. Patients in the control group received usual services.Main measures:The primary outcome measure was the Functional Independence Measure at six months after stroke.Results:We randomised 190 patients of whom 34 were lost to follow-up. There were no significant differences (p > 0.5) in the average scores of Functional Independence Measure between the early home-supported discharge (69 ±22; mean ±SD) and the control groups (71 ±17) measured at baseline; and between the early home-supported discharge (107 ±20) and the control groups (107 ±25) measured at six months. The number of individuals with a low Functional Independence Measure score (<60) in the early home-supported discharge group compared with the control group was higher at admission (34/95 vs. 26/95) and lower at follow-up (2/74 vs. 5/78).Conclusions:It was feasible to implement early home-supported discharge procedures in a Southern European setting, but we have not shown convincing differences in disability at six months.

The aim of this study was to investigate the accuracy of the Portuguese version of Addenbrooke's Cognitive Examination-Revised (ACE-R) in detecting and differentiating early stage subcortical vascular dementia (SVD) from early stage Alzheimer's disease (AD). Ninety-two subjects (18 SVD patients, 36 AD patients, and 38 healthy controls) were assessed using the ACE-R. Between-group's differences were evaluated using the Quade's rank analysis of covariance. The diagnostic accuracy and discriminatory ability of the ACE-R were examined via receiver operating characteristic (ROC) analysis. The ACE-R was able to successfully discriminate between patients and healthy subjects. The mean ACE-R total scores differed between SVD and AD patients; there were also significant differences in attention and orientation and in memory measures between the groups. An optimal cut-off of 72/73 was found for the detection of AD (sensitivity: 97%; specificity: 92%) and SVD (sensitivity: 100%; specificity: 92%).

The purpose of this study is to analyze the utility of the Portuguese version of the Wechsler Memory Scale-3rd edition (WMS-III) with demented elderly people, namely its capacity to detect and discriminate between subcortical vascular dementia (SVD) and Alzheimer's disease (AD). We assessed early demented patients (SVD = 16; AD = 36) aged 65 or older who were compared to a control group (n = 40). Both clinical groups were adequately matched in terms of disease severity, overall cognitive functioning, depressive symptomatology, and pre-morbid intelligence. Between-group's differences were evaluated using the Quade's rank analysis of covariance. We also computed indexes and subtests optimal cut-off scores, and the corresponding sensitivity, specificity, and positive and negative predictive values, which were able to successfully discriminate between patients and healthy subjects. The SVD patients had a better overall memory performance than AD patients on the majority of the indexes and the delayed condition subtests of the WMS-III. The AD patients only showed a better performance on digit span subtest. Several measures discriminated patients from healthy subjects. This study suggests some recommendations for the diagnostic accuracy of the Portuguese version of WMS-III in dementia and about differential diagnosis between SVD and AD.

ResumoEnquadramento: A esclerose múltipla (EM) é uma doença crónica que interfere na qualidade de vida (QV) das pessoas com EM e dos cuidadores. Objetivos: Avaliar a perceção da QV das pessoas com EM e dos cuidadores. Avaliar a perceção da QV das pessoas com EM e dos cuidadores segundo o sexo. Comparar a QV das pessoas com EM com a dos cuidadores. Metodologia: Aplicou-se um questionário sobre perfil sociodemográfico e QV (WHOQOL-Bref ) nos 2 grupos, e perfil clínico nas pessoas com EM. Resultados: As pessoas com EM e os cuidadores percecionam melhor QV no domínio das Relações sociais e pior no Físico. As mulheres com EM têm melhor QV, enquanto que nos cuidadores são os homens. A QV das pessoas com EM é diferente da dos cuidadores, sendo estatisticamente significativa nos domínios QV geral-saúde (p=0,039), Físico (p=0,001) e Ambiente (p=0,012). Conclusão: Os resultados sugerem que as pessoas com EM têm pior QV que os cuidadores. É fundamental o planeamento de uma intervenção de enfermagem dirigida por forma a melhorar a QV de ambos. Palavras Conclusion:The results suggest that people with MS have worse QoL than caregivers. A nursing intervention should be planned to improve the QoL of both patients and caregivers.

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